Case 5/Picture 7 (13.09.2013.) Could you identify the picture?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
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:
- Beckwith-Wiedemann syndrome
- Cardiofaciocutaneous syndrome
- Chromosomal disorders – triploid syndrome, trisomy 4p, 17p11.2 deletion, 4p deletion/11p duplication
- Congenital hypothyroidism
- Diabetes, transient neonatal diabete
- Down syndrome
- Glycogen storage disease type 2
- Klippel-Trenaunay-Weber syndrome
- Lingual thyroid
- Lysosomal storage disorders (e.g. Mucopolysaccharidoses, Pompe disease)
- Multiple endocrine neoplasia type 2B
- Primary amyloidosis
- Ras pathway disorders (e.g. Neuroﬁbromatosis type 1, Cardiofaciocutaneous syndrome)
- Simpson-Golabi-Behmel syndrome
- Tumors (e.g. carcinoma)
- Dyspnea – difficult, noisy breathing, obstructive sleep apnea or airway obstruction
- Dysphagia – difficulty swallowing and eating
- Dysphonia – disrupted speech, possibly manifest as lisping
- Sialorrhea – drooling
- Angular cheilitis – sores at the corners of the mouth
- Crenated tongue – indentations on the lateral borders of the tongue caused by pressure from teeth (“pie crust tongue”)
- Open bite – a type of malocclusion of the teeth
- Mandibular prognathism – enlarged mandible
- Mouth breathing
- Dry tongue, ulceration, infection, necrosis
- Orthodontic abnornamlities – including diastema and tooth spacing
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.
- Speech problems
- Ulcerated tongue tip
- Necrotic tongue tip
- Jaw development abnormalities
- Dental abnormalities (see Dental symptoms)
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