Folded tongue

A folded tongue (lingua plicata) is considered a benign condition in which the back of the tongue is covered with deep grooves (grooves, cracks). This language is also often called scrotal. According to ICD-10, the code is K14.5.

Causes folded tongue

Despite the presence of a code in the section of diseases of the language of the ICD, many experts consider folding a fairly common type of surface of the tongue or an age sign that does not require treatment. [1]

In many cases, the causes of this anomaly of the structure of the tongue in early childhood are unknown, however, sometimes the folded tongue in children can be associated with an underlying syndrome or condition, for example, with  acromegaly  or trisomy 21 -  Down syndrome .

In most cases, folds and  cracks in the child's tongue  are congenital and are abnormal.

In addition, a tongue with grooves is observed with an increase in its size (macroglossia) and in almost half of patients with desquamative  glossitis .

At a young age, a folded tongue appears with Rosenthal syndrome -  Melkerson-Rosenthal syndrome , which is a rare skin and nervous disease of unknown etiology, which is manifested by swelling of the face, especially one or both lips (granulomatous cheilitis), weakness (paralysis) of the facial muscles and cracks in the tongue... There may be one, two, or all three symptoms; folded tongue (often from birth) occurs in a third of patients. 

Risk factors

Among the risk factors, experts call heredity and the presence of the underlying syndrome; smoking; hyposalivation, as well as removable dentures in the elderly; Crohn's disease and sarcoidosis; chronic granulomatous diseases; endocrine, enzymatic and hormonal pathologies.

Additional factors that increase the risk of developing a scrotal tongue are: prolonged dehydration (for example, with metabolic syndrome), chronic adrenal overload, chemotherapy for malignant neoplasms. [2]

Pathogenesis

Although the folding of the tongue is one of the most common anomalies, its pathogenesis in many cases has not yet been clarified. Autosomal dominant inheritance of this condition with incomplete phenotypic gene variability is assumed. But the hypothesis of genetic origin is questioned by many researchers, since the prevalence of scrotal language is different in different age groups.

A tongue with folds is observed in patients with Sjogren's syndrome, in which there is an autoimmune infiltration of the salivary and lacrimal glands with lymphocytes (which leads to impaired saliva secretion and dry mouth - xerostomia).

In orofacial granulomatosis (which often accompanies Crohn's disease or sarcoidosis), the folding of the tongue develops due to an increase in the volume of soft tissues of the mouth and lips, caused by the formation of granulomas in the mucous membrane of the tongue - clusters of granular leukocytes (modified macrophages or epithelioid cells).

Epidemiology

The frequency of detection of folded tongue among the population is estimated at 10-20%. In children under four years of age, cracks in the tongue appear only in exceptional cases, and in children under ten years of age, its prevalence ranges from 0.6-2%. In Down syndrome, tongue folding occurs in children in more than 80% of cases.

This language condition is common among the elderly and is estimated to have a prevalence of up to 30% in the general older population.

The incidence of Melkerson-Rosenthal syndrome does not exceed 0.08% in the general population; the disease develops more often in young people (between 20-30 years), and orofacial granulomatosis is accompanied by facial paralysis and folded tongue in 8-25% of cases.[3]

Such pathology of the oral cavity and maxillofacial region as orofacial granulomatosis is rare (usually manifests itself in adolescence or adolescence), but the incidence is increasing. [4]

Symptoms

The first signs of a folded tongue are the appearance of a groove (crack) in the middle of its dorsal surface. The deeper this groove, the more transverse grooves depart from it, which can be connected to each other. Because of this, it seems that the tongue consists of separate lobules.

So the symptoms of the scrotal tongue are obvious, and this is the presence of deep grooves or cracks on its dorsal and lateral surfaces. The condition affects two anterior thirds of the surface of the tongue, and its appearance does not change in the root zone. Some patients may complain of mild burning or soreness while eating or after eating.

Since the syndrome implies a combination of symptoms of a certain painful condition, doctors do not define folded tongue syndrome.

Folded  geographic tongue  with desquamative glossitis is distinguished by the presence of hyperemic areas of various shapes on its dorsal surface with raised edges and the absence of papillae.[5]

Diagnostics folded tongue

Diagnosis is usually based on a clinical assessment of the protruding tongue.

When examining patients regarding possible concomitant conditions, appropriate tests are prescribed and, if necessary, instrumental diagnostics are carried out.

Differential diagnosis

Differential diagnosis of the folded tongue includes interstitial glossitis in tertiary syphilis, as well as allergic reactions and chronic inflammatory and infectious diseases characterized by granulomatous infiltration.

Treatment folded tongue

The folded tongue does not need any treatment, but brushing the tongue daily can help remove trapped food particles that can become a source of irritation.

Treatment is carried out in the presence of desquamative glossitis and geographic language.

What medications can be used, in more detail in the material -  Treatment of glossitis

Herbal treatment is also carried out with desquamative glossitis: in the form of rinsing the mouth with decoctions of oak bark, sage and St. John's wort, plantain leaves, calendula flowers or chamomile.

Complications and consequences

Failure to observe oral hygiene may lead to infection of folds in the tongue with the development of inflammation - glossitis. And due to the accumulation of food particles in the cracks, halitosis (bad breath) is often noted.[6]

Prevention

Specific prophylaxis of folded tongue has not been developed. But avoiding complications helps to quit smoking, alcohol and products that irritate the mucous membrane of the tongue.

Forecast

With proper oral hygiene, people with a folded tongue have a good prognosis.