Best Examination Tips: Medcase, Interesting Medical Cases and Pictures

  • Sunday, July 7th, 2013

Case 5/Picture 7 (13.09.2013.) Could you identify the picture?

Macroglosia, 09.07.2013., Dr Jemila Abdullah; Maxillofacial Advancements; mouth open for 25 yrs

Answer

Reference: Maxillofacial Advancements, Facebook

This is a picture of macroglossia.

* Macroglossia is a disorder in which the tongue is larger than normal.

* Macroglossia is usually caused by an increase in the amount of tongue-tissue, rather than by a growth/tumour. http://www.nlm.nih.gov/medlineplus/ency/article/002250.htm

* Macroglossia is associated with cosmetic and functional difficulties including in speaking, eating, swallowing and sleeping. *Macroglossia is uncommon, and usually occurs in children.

*There are several causes. *The treatment depends on the cause. http://en.wikipedia.org/wiki/Macroglossia

*Definitions i>  “a tongue that protrudes beyond the teeth during (the) resting posture” ii>  “if there is an impression of a tooth on the lingual border when the patients slightly open their mouths”. Prada, CE; Zarate, YA; Hopkin, RJ (2012 Feb). “Genetic causes of macroglossia: diagnostic approach.”.Pediatrics 129 (2): e431–7. Other suggestions – there is no objective definition Vogel, JE; Mulliken, JB; Kaban, LB (1986 Dec). “Macroglossia: a review of the condition and a new classification.”. Plastic and reconstructive surgery 78 (6): 715–23.

* Types Vogel classification

• True macroglossia: when histologic abnormalities correlate with the clinical findings of macroglossia; e.g. tumours, vascular malformations, muscular enlargement etc

 Relative macroglossia: when histology does not provide a pathologic explanation for the enlargement; macroglossia, e.g. Down syndrome

 Pseudomacryglossia: when the size of the tongue is normal but it appears large relative to the adjacent anatomical structures, e.g. edentulous persons.

Topouzelis, N; Iliopoulos, C; Kolokitha, OE (2011 Apr). “Macroglossia.”. International dental journal 61 (2): 63–9. http://pediatrics.aappublications.org/content/129/2/e431.full.pdf

Myer classification

 Generalised

 Localised

Prada, CE; Zarate, YA; Hopkin, RJ (2012 Feb). “Genetic causes of macroglossia: diagnostic approach.”.Pediatrics 129 (2): e431–7.

* Causes A.  Congenital (present at birth), genetic or hereditary B. Acquired

• Most common causes of true macroglossia – vascular malformations and muscular hypertrophy (Lingual lymphatic malformations is the most common vascular malformations. Enlargement due to lymphangioma gives the tongue a pebbly appearance with multiple superficial dilated lymphatic channels.)

Other causes include:

http://pediatrics.aappublications.org/content/129/2/e431.full.pdf http://www.nlm.nih.gov/medlineplus/ency/article/002250.htm http://en.wikipedia.org/wiki/Macroglossia

* Features

Perkins, JA (2009 Dec). “Overview of macroglossia and its treatment.”. Current Opinion in Otolaryngology & Head and Neck Surgery 17 (6): 460–5.

Bouquot, Brad W. Neville , Douglas D. Damm, Carl M. Allen, Jerry E. (2002). Oral & maxillofacial pathology (2. ed. ed.). Philadelphia: W.B. Saunders. pp. 9–10.

* Complications

http://www.rightdiagnosis.com/m/macroglossia/complic.htm

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