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The etiology and pathogenesis of median rhomboid glossitis have been subjects of controversial discussions for a long time. In recent years, the possible role of Candida albicans has been stressed. The findings in 18 patients with median rhomboid glossitis only support partly the hypothesis of Candida albicans being an important etiologic factor.
To investigate the possible rôle of Candida in median rhomboid glossitis, the presence of Candida was looked for both in the foramen cecum area and the lateral borders of 100 human cadaver tongues. Almost equal %s were found in both locations. Although extrapolation of findings from postmortem material to normal subjects is somewhat hazardous, the results seem to question the importance of Candida in the etiology of median rhomboid glossitis.
Herpes simplex virus (HSV) type 1 (HSV-1) infection of the tongue commonly accompanies acute primary herpetic gingivostomatitis. However, recurrent infection of the tongue is exceptional and is restricted to immunocompromised individuals. A 57-year-old man with corticosteroid-dependent chronic obstructive pulmonary disease and sciatica presented with a chronic median glossitis due to HSV-1. The main clinical and histological feature was massive necrosis of the entire mucosa. Immunohistochemistry demonstrated a considerable amount of HSV gB, gC and gD envelope glycoproteins dispersed in the chorion. In contrast, HSV-1 DNA was detected only in a limited number of epithelial cells using in situ hybridization. The extent of necrosis and the pattern of viral DNA and envelope protein distribution represent unique features of median herpetic glossitis, which are not found in more common types of HSV infection.
We treated five patients with Hunter's glossitis following total gastrectomy. The major complaints of the patients were taste disorder and abnormal glossal sensation. In all five cases, the patient's tongue was red and smooth, and laboratory testing showed the presence of macrocytic anemia and decreased serum concentration of vitamin B12 (cyanocobalamin). Gustometry was carried out in four cases and the results documented the presence of taste disorder. All five patients were treated by administration of vitamin B12, which led to improvements in the appearance of the tongue, the patients' subjective complaints and the results of taste testing. When patients present with a red, smooth tongue, Hunter's glossitis (which can easily be improved by administration of vitamin B12) should be considered in the differential diagnosis.
BACKGROUND: Asthma, eczema and hay fever are the classical manifestations of atopic disease. Geographic tongue (benign migratory glossitis) has also been reported to be a manifestation. Anecdotally, atopic people frequently report irritation of the tongue by heat and certain foods, which may be more common than realized. OBJECTIVES: To determine whether atopic people have an increased likelihood of a sensitive tongue manifest as inflamed fungiform papillae and a history of irritation by certain foods. PATIENTS/METHODS: A descriptive classification of inflammation of the fungiform papillae on the tongue was developed using a 9-point analogue scale where 1 was considered normal and 9 was considered to be severely inflamed. An opportunistic sample of participants were classified as atopic or not on the basis of a personal history of asthma, eczema or hay fever. An examination of the tongue was performed using the classification and then a questionnaire was administered on whether they burnt their tongue easily with hot food and whether they were irritated by certain foods. RESULTS: There were 200 participants aged 20 years and over of whom 104 (52%) were classified as atopic on the basis of the personal history. There was a significant positive association between increasingly inflamed fungiform papillae and the likelihood of being atopic. There was also a positive association between increasing inflammation of the fungiform papillae and a history of both burning the tongue easily and irritation of the tongue by food. There was an increased likelihood of a history of irritation of the tongue with certain foods amongst atopic participants and they were also more likely to burn their tongue with hot food than those who were nonatopic. CONCLUSION: Atopic people are more likely than the normal community to have inflammation of the fungiform papillae of their tongue which correlates with a history of a sensitive tongue manifest as irritation by heat and certain foods. These data suggest that atopic disease may occur in the mouth as a common inflammatory change on the tongue-fungiform papillary glossitis.
A 50-year-old man was admitted to our clinic with a complaint of lingual enlargement. Detection of non-caseous epithelioid granuloma on histopathological examination led to a diagnosis of a granulomatous glossitis. Extensive investigation for the presence of associated disorders yielded negative results. Metranidazole and clofazimine were totally ineffective and tetracycline led to a minimal improvement. No associated disorder was detected at a 4-year follow-up examination. The position of granulomatous glossitis within the spectrum of orofacial granulomatous conditions is discussed.
Although it is recognized that glossitis is a classical sign of pernicious anemia, occurring in the evolution of this disease, it is unfrequent for this sign to reveal this affection. We report two cases where diagnosis was evacuated on the presence of glossitis and macrocytosis despite absence of anemia. Confirmation was done by low serum cobalamin level, gastritis atrophy and presence of intrinsic factor antibody. We emphasize that increased clinical suspicion may lead to early diagnosis even if anemia is lacking.
Glossitis, known clinically as "redtongue," was studied in tissues from 34 military working dogs (MWD) in the Republic of Vietnam. This condition was manifested grossly by loss of lingual papillae on the dorsal margins of the rostral third of the tongue. Microscopically, the principal lesions consisted of loss of filiform papillae, hemorrhage and edema in the lamina propria, acanthosis, and cellular infiltration. The cause of glossitis remains unknown at this time.
BACKGROUND: The aim of this study was to examine the relationship of geographic tongue to psoriasis. METHODS: We report a comparative study on two groups of patients: the first (20 patients) with cutaneous psoriasis and lesions of the oral mucosa similar to geographic tongue; the second (20 patients), with benign migratory glossitis only. Biopsy samples of the lingual mucosa were taken from both groups. RESULTS: The histologic examination of oral biopsies from the first groups showed typical features of psoriasis. The second group showed the same features of psoriasis in 80% of patients. CONCLUSIONS: The clinical and histopathologic findings support the hypothesis that migrant glossitis can be considered an expression of oral psoriasis.
The case is reported of a patient with incomplete peripheral facial palsy. In addition to hyperacousia and gustation disturbance, he presented with signs of glossitis limited to the region supplied by the chorda tympani. Clinical and laboratory investigations excluded the possibility of a viral infection. Possible connections between this combination of symptoms (apparently "idiopathic" facial palsy and regional glossitis) and the Melkersson-Rosenthal syndrome are discussed.
The case of a 59-year-old man with granulomatous glossitis is presented. The patient complained of increasing swelling of his tongue for years and a recent onset of perioral edema. Because of sarcoid-like granulomas found in a first lingual biopsy specimen, the disease was initially misdiagnosed as a localized form of sarcoidosis. A second biopsy specimen from the tongue revealed lymphonodular-plasmocytic granuloma-like infiltrates, which, in connection with the labial swelling, led to the diagnosis of Schuermann's glossitis granulomatosa as a peculiar manifestation of Melkersson-Rosenthal syndrome. The surface of the tongue showed deep furrows characteristic of lingua plicata. However, no history or signs of facial or trigeminal nerve paralysis were present; thus the patient did not show the complete triad of symptoms typical of Melkersson-Rosenthal syndrome. After treatment with clofazimine the perioral and lingual swelling disappeared within two weeks. Recurrences have been suppressed with a reduced maintenance dosage of this agent.
We studied the relationship between laboratory markers of iron status and atrophic glossitis diagnosed clinically and documented with photographs. Nine subjects with glossitis underwent determination of CBC, ferritin, iron, and iron binding capacity. Five of the subjects had laboratory evidence suggesting iron deficiency.
In a colony of sledge dogs, an increased incidence of ulcerative glossitis was diagnosed. Several facts indicate that the lesions were directly caused by UV light. The presence of signs coincided with the use of the dogs of the glacier. The lesions were localized on the first part of the tongue. The histologic changes were consistent with a phototoxic reaction and other causes of glossitis were ruled out.
Routine soft-tissue examination of a 44-year-old Negro woman who consulted her dentist for a new maxillary partial denture revealed a depressed white lesion in the area of median rhomboid glossitis. Biopsy diagnosis of the area was well-differentiated squamous-cell carcinoma. The relation of this lesion to median rhomboid glossitis is questioned in view of previous reports.
After 10 days of minocycline therapy, stomatitis, glossitis and esophagitis were seen in a 62-year-old male patient, who had previously tolerated minocycline for > 20 years without complications. This typical side effect of minocycline was initially misinterpreted in the differential diagnosis and was only diagnosed, when the patient was reexposed to a new 7-day minocycline therapy. Healing was achieved by termination of the minocycline therapy and the initiation of antimycotic treatment.
The observations on seventy patients with migratory glossitis and follow-up experiences over a period of 10 years are recorded. Women represented 65.7 per cent of the total, and most cases occurred in patients over 40 years of age. In 20 per cent of the patients other anomalies of the tongue were associated, and in 20 per cent subjective complaints were associated with psychic stress. Histologic investigations showed an inflammatory reaction of the epithelium and of the underlying connective tissue. The patient must be reassured of the benign nature of the tongue lesion. At follow-up examination, the lesions were present but no malignant change was observed.
A case of benign migratory glossitis atypically confined to only one side of the tongue is presented. The diagnosis was confirmed by repeated histopathologic evaluation. Electron microscopic studies revealed a striking intimacy between sensory nerve processes and the basal lamina of the lingual epithelium.
Benign migratory glossitis, or geographic tongue, is usually an asymptomatic inflammatory disorder of unknown etiology that affects the epithelium of the tongue. Local loss of filiform papillae leads to ulcer-like lesions that rapidly change the color and size. Histopathologic findings parallel the clinical appearance, and may have a psoriasiform pattern. The disorder is characterized by exacerbations and remissions. In most cases, patients do not require treatment other than reassurance about the benign nature of the disorder.