Folded tongue

Folded tongue (lingua plicata) is considered a benign condition in which the back of the tongue is covered with deep grooves (grooves, cracks). Such a tongue 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 ICD section on tongue diseases, many experts consider the folds to be a fairly common type of tongue surface or an age-related symptom that does not require treatment. [ 1 ]

In many cases, the cause of this tongue anomaly in early childhood is unknown, but sometimes a fissured tongue in children may be associated with an underlying syndrome or condition, such as acromegaly or trisomy 21 – Down syndrome.

In most cases, folds and cracks on the tongue of a child are congenital and are an anomaly.

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

In young adults, a fissured tongue appears in Rosenthal syndrome - Melkersson-Rosenthal syndrome, which is a rare skin and nerve disease of unknown etiology, which is characterized 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; a fissured tongue (often from birth) is observed in one third of patients.

Risk factors

Among the risk factors, experts name 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 scrotal tongue include: prolonged dehydration (for example, with metabolic syndrome), chronic adrenal overload, and chemotherapy for malignant neoplasms. [ 2 ]

Pathogenesis

Although tongue folding 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 variability of the gene is assumed. However, the hypothesis of genetic origin is questioned by many researchers, since the prevalence of scrotal tongue varies in different age groups.

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

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

Epidemiology

The incidence of folded tongue in 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 is observed in children in more than 80% of cases.

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

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

Orofacial granulomatosis, a pathology of the oral cavity and maxillofacial region, is rare (usually manifests itself in adolescence or youth), but the incidence rate 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 that can connect with each other extend from it. Because of this, it seems that the tongue consists of separate lobes.

So the symptoms of scrotal tongue are obvious, and they are the presence of deep grooves or cracks on its dorsal and lateral surfaces. The condition affects the anterior two-thirds of the tongue surface, and in the root zone, its appearance does not change. Some patients may complain of a slight burning sensation or pain during or after eating.

Since the syndrome implies a set of symptoms of a certain disease state, doctors do not define the syndrome of folded tongue.

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

Diagnostics folded tongue

Diagnosis is usually made based on clinical assessment by examining the protruding tongue.

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

Differential diagnosis

Differential diagnosis of 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

Fissured tongue does not require any treatment, but daily tongue cleaning 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 tongue.

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

Herbal treatment is also used for 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

If oral hygiene is not observed, the folds of the tongue may become infected, leading to inflammation – glossitis. And due to the accumulation of food particles in the cracks, halitosis (bad breath) is often observed. [ 6 ]

Prevention

Specific prevention of folded tongue has not been developed. However, avoiding complications can be achieved by giving up smoking, alcohol, and products that irritate the mucous membrane of the tongue.

Forecast

With proper oral hygiene, the prognosis for people with a fissured tongue is good.