bubble_chart Overview

Tongue diseases include: geographical tongue, fissured tongue, hairy tongue, and median rhomboid glossitis.

bubble_chart Etiology

Geographical tongue: The cause of the disease is unknown, possibly related to chronic gastrointestinal disorders, anemia, intestinal parasites, vitamin B deficiency, mental disorders, focal infections, etc. Some patients have a significant family history.

Fissured tongue: The cause of the disease is unknown, possibly related to congenital developmental abnormalities of the tongue. Additionally, vitamin deficiencies and geographical conditions have also been noted. In recent years, it has been suggested that this condition may be an early manifestation of psoriasis. Some patients have a significant family history, leading to the belief that it may be related to genetics.

Hairy tongue: Often caused by changes in the oral environment, such as poor oral hygiene, long-term use of antibiotics, application of mouthwashes, excessive smoking, etc., which affect the function of proteases, leading to delayed shedding of keratinized epithelial cells on filiform papillae.

Median rhomboid glossitis: Previously thought to be formed during the development of the tongue, where certain factors prevented the tuberculum impar from being fully covered by the lateral lingual swellings, resulting in an exposed rhomboid area anterior to the foramen cecum. Later, it was found that this area has a high detection rate of Candida albicans, and its histopathological features closely resemble chronic hyperplastic candidiasis. Therefore, it is now believed that this condition is caused by Candida albicans infection.

bubble_chart Pathological Changes

Geographic tongue: Microscopically, the erythematous areas show obvious atrophy of filiform papillae, thinning of the epithelium, and flattening of epithelial rete ridges. The marginal zones exhibit epithelial thickening, intracellular edema, and occasional microabscess formation in the superficial epithelium. The submucosal layer of the affected area shows dilated and congested blood vessels, with infiltration of lymphocytes and plasma cells.

Fissured tongue: Characterized by significant thinning of the epithelium at the base of the fissures, absence of the keratinized layer, columnar epithelial rete ridges, and orderly arrangement of basal cells. The lamina propria shows increased capillaries, dilated and congested blood vessels, and predominant infiltration of neutrophils. The fissures may extend to the submucosal tissue or muscle layer, with visible lymphocyte and plasma cell infiltration and capillary dilation during inflammation.

Hairy tongue: The keratinocytes of filiform papillae are markedly elongated, and the epithelial rete ridges are also significantly elongated. The lamina propria shows infiltration of lymphocytes and plasma cells.

Median rhomboid glossitis: Presents with epithelial atrophy, disappearance of lingual papillae, and mild inflammatory cell infiltration in the lamina propria.

bubble_chart Diagnosis

Geographical tongue

is more common in children, with generally mild subjective symptoms and no significant impact on health.

Smooth, erythematous patches with irregular shapes (round, oval, or arc-shaped) appear on the dorsum of the tongue, where the filiform and fungiform papillae have shed, slightly depressed and surrounded by a slightly raised yellowish-white border. The lesions exhibit alternating red and white areas, resembling a map, hence the name "geographical tongue" (or "geographic tongue"). The lesion patterns can expand centrifugally overnight and may merge with each other. Due to their variable morphology and shifting locations, it is also called "migratory glossitis." During the expansion process, the central area gradually returns to normal. Most patients experience no significant subjective symptoms, except for a few who may report a burning sensation or irritative pain. Tongue movement and taste remain normal. Similar lesions can also appear on the lips, cheeks, floor of the mouth, and gingival mucosa, referred to as "geographic stomatitis."

Fissured tongue

Fissured tongue (furrowed tongue, fissured tongue) is primarily characterized by grooves of varying depth and length on the dorsum of the tongue. Studies show that these grooves may deepen with age and often intersect in a crisscross pattern. It frequently coexists with geographical tongue.

The most common presentation is grooves of varying depth and length on the dorsum of the tongue, with diverse shapes and sizes. Clinically, based on the groove patterns, it can be classified into two types: "leaf-vein tongue" and "cerebriform tongue." The former features a prominent, deep longitudinal groove dividing the tongue dorsum into "halves," accompanied by transverse grooves resembling leaf veins. The latter exhibits grooves resembling the convolutions of the cerebral cortex. Despite these grooves, the papillae on the tongue surface remain intact, the mucosa appears normal in color, the tongue is soft, mobile, and taste is unaffected. In rare cases, deeper grooves may trap food debris and bacteria, leading to inflammation and mild irritative pain (grade I), accompanied by tongue swelling and scalloped edges. Shallow grooves are only visible when the tongue is extended or when the papillae are gently separated with forceps. The groove bases and sidewalls lack papillae.

Hairy tongue

Hairy tongue occurs when the keratinized epithelium of the filiform papillae on the dorsum of the tongue is delayed in shedding, resulting in elongated, hair-like projections, hence the name.

The mid-to-posterior portion of the tongue dorsum shows elongated filiform papillae resembling villi. When gently probed, the papillae may bend to one side. Patients may experience diminished taste or, if the elongation is severe, nausea or discomfort due to stimulation of the soft palate. Fetid mouth odor may also occur, but tongue movement remains normal. The elongated filiform papillae may become stained black by food or bacterial byproducts, resulting in "black hairy tongue."

Median rhomboid glossitis

Median rhomboid glossitis is a depapillated area on the midline of the tongue dorsum, anterior to the foramen cecum, shaped like a water caltrop base peel, hence the name. Its incidence is approximately 0.2%–0.3%, more common in males and adults.

Anterior to the sulcus terminalis on the tongue dorsum, there is a water caltrop base peel-shaped, round, or oval depapillated area. It appears slightly red, smooth, and clearly demarcated from surrounding tissue. Some patients may develop nodules within this area, which feel slightly firm but have a soft base. Most patients experience no functional impairment.

bubble_chart Treatment Measures

Geographic tongue: There is no specific treatment for this condition. The cause should be identified as much as possible, and symptomatic treatment should be administered. If there is irritating pain, local ultraviolet irradiation or B-complex vitamin supplementation can be considered.

Fissured tongue: No treatment is needed if there are no subjective symptoms. Maintaining oral hygiene is crucial, and rinsing with water after meals to remove food debris and bacteria from the fissures is recommended. In cases of inflammation, a 3% hydrogen peroxide or 0.2% chlorhexidine solution can be used for cleaning, along with oral B-complex vitamins. If necessary, local ultraviolet irradiation with an oral UV lamp may be applied. For deep fissures causing frequent pain, surgical excision and suturing may be considered.

Hairy tongue: Improve oral hygiene, discontinue or replace locally applied medications, quit smoking, and apply nystatin solution or 5% salicylic acid solution topically.

Median rhomboid glossitis: Generally, no treatment is required if asymptomatic. For local discomfort, topical application of nystatin solution may be used. If neoplasia is suspected, a thorough examination of local changes and proper explanation should be provided, with a biopsy performed if necessary.

bubble_chart Differentiation

Geographic tongue: The dorsum of the tongue shows areas of filiform papillae detachment, surrounded by raised yellowish-white margins, which are highly migratory. There are usually no subjective symptoms, and the diagnosis is not difficult.

Fissured tongue: The signs of this condition are obvious, and diagnosis is easy. If fissured tongue is accompanied by facial nerve palsy and granulomatous cheilitis, it is diagnosed as Melkersson-Rosenthal syndrome.