Pain and paresthesia in the tongue (glossalgia)

Complaints about pain and paresthesia in the tongue (itching, numbness, sadness, raspiranie, burning, etc.) are often found among patients with neurological and somatic profile. Neurological examination rarely reveals evidence of sensitive (and motor) disorders. It is useful to pay attention to the unilateral or bilateral nature of paresthesia and the illness of the gastrointestinal tract.

I. One-sided (damage to the lingual nerve):

1. Iatrogenic damage;
2. Limited neoplastic or inflammatory process of the posterior lateral region of the oral cavity;

II. Two-sided:

1. Psychogenic pain;
2. Carcinoma of the upper larynx and related conditions;
3. Pernicious anemia.

[1], [2], [3], [4], [5]

I. Unilateral pain in the tongue (damage to the lingual nerve)

Sensory disorders in one half of the tongue are an indicator of lesion of the lingual nerve, which is one of the largest branches of the mandibular nerve, the third branch of the trigeminal nerve. The lingual nerve innervates the anterior two-thirds of the tongue, but it is always necessary to check the sensitivity on the posterior third of the tongue innervated by the glossopharyngeal nerve.

Pain usually does not have features of trigeminal neuralgia, but has a longer and less intense character. As a rule, movement or sensory stimulation are not triggers. Often the pain is burning. Some patients experience a decrease in taste sensations. Sensations on the other half of the tongue and on the oral mucosa are preserved.

It is important to establish that sensitive disorders are limited only by language and do not spread to the area innervated by the lower alveolar nerve. This area includes the teeth of the lower jaw and the mucosa of the lower parts of the oral cavity. In this case, the lesion site should be sought laterally in the oral cavity, next to the angle of the lower jaw.

Iatrogenic lesions

The most common cause of iatrogenic damage are cases of removal of the second and, especially, the third molar. Sometimes the nerve is damaged due to osteotomy or similar surgical procedures, or an incision of the sublingual abscess.

Limited neoplastic or inflammatory process of the posterior lateral region of the oral cavity

The inflammatory process can damage the nerve due to compression or toxic damage, the nerve can also be damaged by the tumor.

II. Two-sided pain in the tongue

Psychogenic pain

In the case of bilateral numbness or burning pain in the tongue without compromising taste, the most commonly diagnosed is psychogenic pain. To explain the anatomical cause of this pain, it is difficult to imagine a pathological process with a symmetrical localization in the oral cavity, closely associated with the angle of the lower jaw, and when such a pathological process does happen, in the clinical picture the loss of taste sensations is leading. Patients with psychogenic disorders often do not have mood reduction. On the contrary, they can demonstrate emotional activity and deny emotional problems. Characteristic is the reduction or complete disappearance of symptoms during meals.

A tendency to anxiety-hypochondriacal disorders is often revealed against the background of this or that dysfunction of the organs of the gastrointestinal tract.

The suspected diagnosis is confirmed by the relief of symptoms due to the use of antidepressants, neuroleptics and treatment with the help of psychotherapy.

Carcinoma of the upper larynx and related conditions

However, do not rely heavily on this effect of the drugs, since even sensitive symptoms of organic origin can be reduced under their influence. Thus, it is advisable to fully examine such patients with visualization of the upper larynx, the base of the skull, since in some patients it is possible to develop symptoms of the defeat of the mandibular branch of the trigeminal nerve that were not detected in the previous examination.

Pernicious anemia

In rare cases, a burning pain in the tongue can be a leading symptom of pernicious anemia. The fact that this condition becomes more or less rare can be associated with widespread parenteral administration of drugs containing more than a daily vitamin B12 requirement. These drugs are mistakenly prescribed for pain of various origins. And thus, involuntary treatment of the underlying vitamin B12 deficiency occurs.

The diagnosis is based on carrying out serological tests, including determining the level of vitamin B12 in the blood serum, determining the absorption of vitamin in the gastrointestinal tract and studying under the microscope of the bone marrow. Often changes and the appearance of the language ("scalded language", "lacquered language").