Macroglossia

Macroglossia

Speech-Language-Hearing Issues

• Mechanical obstruction in the oral cavity can directly occlude the airway
• Usually worsened by lying supine when an enlarged tongue base is more directly acted upon by gravity to block the oropharynx and hypopharynx
• speech and swallowing may also be severely affected
• If the tongue protrudes beyond the lips and is exposed to the air, drying of the tongue with resultant glossitis and bleeding is common

• Several studies document the role of the tongue in shaping the oral cavity
• Upper incisors can be pushed horizontally, inducing forward maxillary growth
• Other morphologic changes include open bite deformities, prognathism, class III malocclusion, anterior and/or posterior crossbites, buccal tipping of posterior teeth, accentuated curve of Spee in the maxillary arch, reverse curve of Spee in the mandibular arch, increased transverse width of mandibular and/or maxillary arches
• Difficulty with mastication may lead to temporomandibular joint pain

enlarged tonge

Characteristics

SUMMARY

Macroglossia is nothing to be ashamed about. It is important to not treat people with this condition differently. It does not change one's personality, although there is a strong chance that it may change there speech. Patience is key, and as a health care professional, it is essential to make a patient with this condition feel as comfortable as possible.

Diagnostic

methods

• Must be performed according to the suspected etiology
• Adequate assessment of the patient's ability to breathe, swallow, and speak should be obtained quickly
• Family history is crucial in discerning possible congenital causes
• Take note of signs related to potential airway compromise such as stridor, turgor, drooling, and poor or muffled speech
• The most frequently ordered diagnostic tests were BWS molecular testing, chromosomes, thyroid function tests, biochemical assessments (lactate, serum amino acids, and organic acids), urine glycosaminoglycans (GAGs), and very long chain fatty acids (VLCFA)

Exact incidence of Macroglossia is

unknown because the etiologies are too numerous. It is most commonly expressed in Down syndrome.

Reference

• Macroglossia is an enlarged tongue that is often diagnosed subjectively
• Medicine has identified a triad for those with macroglossia: open bite deformity, mandibular prognathism, and malalignment
• Loss of taste and difficulty eating solid foods because of macroglossia may contribute to weight loss
• True macroglossia can be subdivided into 2 main subcategories: congenital causes [such as Down syndrome and Beckwith-Wiedemann syndrome] and acquired causes [such as diabetes and small pox]

Thrasher, R. (2014, January 10). Medscape.

Retrieved from http://emedicine.medscape.

com/article/873658-overview

Costa, SAP., Brinhole, MCP., Silva, RA., Santos,

DH., and Tanabe, MN., “Surgical Treatment of Congenital True Macroglossia,” Case Reports in Dentistry, vol. 2013, Article ID 489194, 5 pages, 2013. doi:10.1155/2013/489194

Falk, R. (2014, February 25). Retrieved from http://

www.brighamandwomens.org/Departments_

and_Services/medicine/services/cvcenter/Amyloidsis/patients.aspx

Prada, C., & Zarate, Y. (2012). Genetic causes of

macroglossia: Diagnostic approach. Pediatrics, 129(2), e431-e437. doi: 10.1542

Macroglossia occurs when 1 of the following 3 criteria is met:

• extravasation of the lingual apex or lingual border onto or outside the dentition
• the impression of one or more teeth on the lingual border visualized when the mouth is open
• following surgery for correction, a relapse of increased interdental space, open bite deformity, and/or jaw deformation with malocclusion occurs

• physical examination should always include palpation of the tongue to help diagnose discreet masses not prominent on the lingual surface
• CT scanning can provide plenty of information regarding the morphology of the tongue
• Magnetic resonance imaging (MRI) is another useful modality in assessing the potential cause of macroglossia and can provide the definitive size of the tongue
• Much of the time, especially for base of tongue lesions, biopsy can be performed safely only in the operating room

Thank You!

26 year old, female patient complained of difficulty in speech and recurrent anterior open bite. Her tongue was increased in length and width, with anterior over bite, interposition of the tongue, and loss of the tooth 31 and 41. She was diagnosed with true macroglossia requiring treatment of surgery, orthodontics, and fonoaudiology.

Surgical reduction of the tongue is an uncommon procedure, being indicated in specific cases:

the keyhole technique allows anterior and median partial resection; technically simple, minimal morbidity, and good functional result.

The 'keyhole' technique was chosen for reduction glossectomy to reduce the tongue in width and length. Tongue was pulled out of the oral cavity through 3 repairs. Partial thickness elliptical wedge incision was made in the tongue dorsum, with incisions on the dorsum and belly anterior tongue using electrocautery, which were reunited in a full-thickness flap.

• Medical therapy for macroglossia is only useful when the etiology of the disease is a clearly defined medically treatable entity
• The treatment has been largely surgical in the modern era
• goal of surgery is to reduce tongue size and thereby improve function
• Surgery, orthodontics, and phonoaudiology are the most common interventions

Case Report

Intervention Techniques