Fissured Tongue: A Case Report and Review of Literature

M Rathee, A Hooda, A Kumar

Keywords

dorsal surface, fissured tongue, geographic tongue, inflammation

Citation

M Rathee, A Hooda, A Kumar. Fissured Tongue: A Case Report and Review of Literature. The Internet Journal of Nutrition and Wellness. 2 ! "olume # Num$er #.
Abstract

%issured tongue is a $enign condition characteri&ed $' numerous shallo( to deep groo)es or furro(s on the dorsal surface of the tongue. Aging, malnutrition and local factors such as infection and ma' contri$ute to its de)elopment and s'mptoms. %issured tongue ma' ha)e a familial occurrence and can $e associated (ith certain underl'ing s'ndromes. A case of a * 'ears female (ith fissured tongue along (ith a re)ie( of literature is $eing presented.

Introduction
+atients (ith fissured tongue ma' present (ith multiple groo)es, or furro(s on the dorsal surface tongue ranging from 2 to , mm in depth. The condition is usuall' as'mptomatic unless de$ris is entrapped (ithin fissure. +atients ma' also present (ith complains of $urning and soreness in tongue. The mucosa of the dorsal surface of the tongue has filiform papillae, the hairs of (hich ma' shelter the superficial epithelial cells from the mechanical stress.# This mechanical protection of tongue mucosa is lo(ered in fissured tongue in the a$sence of hairs, -eratin and -eratoh'aline granules and ma' contri$ute to inflammation.2 A case of fissured tongue is $eing reported, etiologic factors and management of this entit' are discussed.

Case Report
A * 'ear old female from the rural area (ith poor socioeconomic $ac-ground presented in the dental outpatient department (ith one month histor' of mild pain and $urning sensation on the tongue (hich aggra)ated on inta-e of citrus and spic' foods. .he also complained of discomfort during che(ing and malodor. Medical and famil' histor' (ere non/contri$utor'. 0eneral clinical e1amination demonstrated the patient (as normal e1cept for mild anemia. 21tra/oral e1amination re)ealed normal facial morpholog', no s-in lesions (ere seen. Intra/oral e1amination re)ealed poor oral h'giene, halitosis and deepl' groo)ed lesions on the dorsal

surface of the tongue (ith entrapped food de$ris. %lushing (as done on the tongue surface (ith diluted po)odine/iodine solution (hich re)ealed numerous prominent fissures co)ering the entire dorsal surface and di)iding the tongue papillae into multiple separate lo$ules. 3%ig #4 No other tongue lesion or associated s'ndrome (as o$ser)ed.
Figure 1

%ig #5 .ho(ing fissured tongue Routine $lood in)estigation re)ealed mild anemia. Nutrition education and diet modification (as ad)ised. The patient (as put on oral iron therap'. +atient (as ad)ised to maintain the lingual h'giene $' # times stro-ing the tongue (ith soft tooth $rush after meals and $edtime supplemented (ith mouth(ash 3 .26 solution (7) of 8hlorhe1idine gluconate4 prescri$ed to s(ish and spit (ith # ml t(ice dail' for one minute and to strictl' adhere to the oral h'giene instructions. +atient had s'mptomatic impro)ement (ith the treatment.

Discussion
%issured tongue is a common )ariant of the tongue that has numerous groo)es or fissures on the dorsum of the tongue9. The pre)alence rate )aries in different geological regions5 it:s reported to $e .,6 in .outh Africa, 2;.;6 in <ra&il=, *.;#6 in southern India*. It occurs (orld(ide (ith no predilection for an' particular race. <ene)ides, supported a difference in pre)alence $et(een the se1es, and reported a higher fre>uenc' among males. Motalle$ne?ad also reported a higher pre)alence in males in an epidemiological stud' in Iranian patients; (hile <ensc&'@ reported higher fre>uenc' in (omen. The etiolog' is un-no(n $ut hereditar' pla's a significant role. The condition ma' $e congenital, present at $irth, or ma' $ecome apparent during childhood or later in life. A?ra e1amined clinical and genetic characteristics of histologicall' defined fissured tongue in a familial stud' and reported that fissured tongue (ith smooth/surfaced papillae (as transmitted as a dominant characteristic (ith incomplete penetrance and (as preceded $' geographic tongue. The se)erit' of fissured tongue changed (ith increasing age. Tongue fissuring (ith normal appearing filiform papillae (as not familial and (as not associated (ith geographic tongue. %issuring (ith normal/appearing structure should $e considered as )ariation of normal anatom', (hereas fissured tongue and geographical tongue are clinical and etiological disease entit'.! Aging and local en)ironmental factors ma' also contri$ute to its de)elopment. %issured tongue ma' present as an independent manifestation or associated (ith certain underl'ing s'ndromes or familial conditions.# ,## 8onditions associated (ith fissured tongue include Mel-ersson/Rosenthal s'ndrome, Ao(n s'ndrome, acromegal', .?orgen:s s'ndrome, oro/facial granulomatosis, psoriasis and geographic tongue.#2 The Mel-ersson/Rosenthal s'ndrome consists of recurrent s(elling of the lip or face, intermittent facial pals' and fissured tongue. Bength' inter)als ma' occur $et(een )arious manifestations.#9

%issured tongue is the most common oral finding in psoriasis. <ut the se)erit' of fissured tongue does not seem to increase (ith increasing se)erit' of psoriasis.#= .?orgenCs s'ndrome is an autoimmune e1ocrinopath' characteri&ed $' l'mphoc'te infiltration of sali)ar' and lacrimal glands that leads to progressi)e 1erostomia and 1erophtalmia. Dne/third of patients suffer of s'stemic manifestations including arthritis, fe)er, fatigue and mucosal dr'ness (hereas those (ith ma?or sali)ar' in)ol)ement sho( an increased ris- to de)elop lo(/grade non/Hodg-in l'mphomas#*. The tongue in .?orgenCs s'ndrome often $ecomes fissured as a result of decreased sali)ar' secretion. 0eographic tongue 3$enign migrator' glossitis4 is an entit' of un-no(n cause and presents cliniEcall' (ith loss of the filiform papillae on the dorsal and lateral surfaces of the tongue sometimes accompanied $' an ad)ancing (hite $order (ith or (ithout er'thema. There might also $e fissures on the tongue. If s'mpEtomatic, patients e1perience $urning and stinging after ingestion of spic' and acidic foods.#, 0eographical tongue occurs in a$out #6 of general population, and * 6 in association (ith fissured tongue.#; %issured tongue is diagnosed clinicall' on the $asis of fissures. <ased on the position of the fissures, fissured tongue can $e classified as median and lateral t'pes.#@ 8onsidera$le )ariation is seen in the presentation of groo)es or furro(s ranging from fissures that are located mostl' on the dorso/lateral area of the tongue. The second pattern is a large central fissure (ith smaller fissures $ranching out(ards at right angles. In the most se)ere cases, numerous fissures co)er the entire dorsal surface di)iding the tongue papillae into multiple separate FicelandsG or lo$ules as in our case. The condition is usuall' as'mptomatic. .ome patients ma' complain of mild pain.#! The condition is (orsened $' entrapment of food particles (ithin the fissures and in patients (ith poor oral h'giene and nutrition. 8linical presentation is characteristicall' diagnostic and $iops' is rarel' done. Inflammation has $een descri$ed to $e the most stri-ing histological finding in the )arious forms of fissured tongue $ut not in tongue (ith normal appearing filiform papillae. Histological e1amination sho(s an increase in the thic-ness of lamina propria, h'perplasia of rete/pegs, neutrophillic micro/a$scess in the upper epithelial la'ers and mi1ed inflammator' infiltrate in lamina propria. An er'thematous tongue resem$les the inflammator' condition -no(n as traumatic ulcerati)e granuloma (ith stromal eosinophilia 3TH0.24, mainl' found in the tongue manifesting as an ulcer (ith ele)ated margin. Trauma pla's an important role in its de)elopment.2 Bac- of traumatic e)ent and the clinical presentation in our case, renders TH0.2 an unli-el' consideration. Mer-elsson/Rosenthal s'ndrome (as not considered as the patient did not e1hi$it the other cardinal signs namel', chelitis granulomatosis and <ell:s pals'. 2# Normal facial morpholog' of the patient ruled out acromegal' and Ao(n s'ndrome. %issured tongue as a result of decreased sali)ar' secretion in .?organ s'ndrome (as also ruled out on the $asis of clinical signs and s'mptoms seen in this autoimmune condition that in)ol)es sali)ar' glands. %issured tongue is a $enign condition and no specific treatment is indicated $ut in patients (ith se)ere conditions the first goal of management should $e disco)er' of the irritating cause. Bocal measures to resol)e the clinical manifestations can $e attempted. The patient should $e encouraged to maintain the oral h'giene and $alanced diet.

Conclusion
%issured tongue is fre>uentl' misdiagnosed and o)er/treated. Dral h'giene and nutrition need to $e emphasi&ed to pre)ent the s'mptoms caused $' local irritating factors. References #. Kullaa/Mi--onen A, Teno)uo J, .or)ari T. 8hanges in composition of (hole sali)a in patients (ith fissured tongue. .cand J Aent Res #!@*I !95 *22/@. 2. Ne)elle <W, Aamm AA, Allen 8M, <ou>uot J2. Dral and Ma1illofacial +atholog', 2 =I 2nd edition .aunders Ne( Aelhi India. p. #2/9. 9. Jarom N, 8anton' H, 0ors-' M. +re)alence of fissured tongue, geographic tongue and median rhom$oid glossitis among Israeli adults of different ethnic origins. Aermatol 2 =I 2 !5 @@/!=. =. Rio$oo/8respso MR, +lanells/del +o&o +, Rio$oo/0racia R. 2pidemiolog' of the most common oral mucosal diseases in children. Med Dral +atol 8ir <ucal 2 *I # 5 9;,/@;. *. Mathe( AB, +ai KM, .holapur-ar AA, "engal M. The pre)alence of oral mucosal lesions in patients )isiting a dental school in .outhern India. Indian J Aent Res 2 @I #!5 !!/# 9. ,. <ene)ides dos .antos +J, %erreira 8, %erreira de Aguilar M8, "ieria do 8armo MA. 8ross/ sectional stud' of oral mucosal conditions among a central Ama&onian Indian communit'. <ra&il J Dral +athol Med 2 =I 995 ;/#2. ;. Motalle$ne?ad M, <a$aee N, .a-hdari ., Ta)asoli M. An epidemiologic stud' of tongue lesions in #! # iranian dental outpatients. J 8ontemp Aent +ract 2 @I #5 ;9/@ . @. <anoc&' J, RigK D, Al$recht M. +re)alence stud' of tongue lesions in a Hungarian population. 8ommunit' Aent Dral 2pidemiol #!!9I 2#5 22=/,. !. Kullaa/Mi--onen A. A familial stud' of fissured tongue. .cand J Aent Res #!@@I !,5 9,,/;*. # . Rogers R. 9rd, <ruce AJ. The tongue in clinical diagnosis. J 2ur Acad Aermatol "enerol 2 =I #@5 2*=/!. ##. Largari D. The pre)alence and significance of fissured tongue and geographical tongue in psoriatic patients. 8lin 21p Aermatol 2 ,I 9#5 #!2/*. #2. Jain-itti)ong A, Banglais R+. 0eographic tongue5 8linical characteristics of #@@ cases. J 8ontemp Aent +ract 2 *I #*5 #29/9*. #9. Wadlington W<, Rile' HA Jr, Bo($een B. The Mel-ersson/Rosenthal s'ndrome. +ediatrics #!@=I ;95* 2/,. #=. Richardson BJ, Kratoch)il %J, Lieper M<. Hnusual palatal presentation of oral psoriasis. J 8an Aent Assoc 2 I ,,5 @ /2. #*. Tucci M, Muatraro 8, .il)estris %. .?orgen:s s'ndrome5 An autoimmune disorder (ith otolar'ngological in)ol)ement. Acta Dtorhinolar'ngol Ital 2 *I 2*5 #9!/==. #,. Adams .+. 0eographic tongue. 8an %an +h'sician 2 2I =@5,!;/; 2. #;. Assima-opoulos A, +atri-a-os 0, %oti-a 8, 2lisaf M. <enign migrator' glossitis or geographic tongue5 an enigmatic oral lesion. Am J Med 2 2I ##95 ;*#/**. #@. A$o'ans ", 0haemmaghami A. The incidence of fissured tongue among =, ! Iranian dental outpatients. Dral .urg #!;9I 9,5 9=/@. #!. Jontell M, Haraldso.N T, +ersson B/D, Dhman ./8. An oral and ps'chosociai e1amiiiadon of patients (ith presumed oral gal)anism. .(ed Aent J #!@*I !I #;*/@*. 2 . Hirsh$erg A, Amariglio N, A-rish ., Jahalom R, Rosen$aum H, D-on 2, et al. Traumatic

ulcerati)e granuloma (ith stromal eosinophilia5 A reacti)e lesion of oral mucosa. Am J 8lin +athol 2 ,I #2,5 *22/!. 2#. Hoe1ter AB. Mel-ersson Rosenthal s'ndrome. N J .tate Aent J 2 ;I ;95 9 /2. NfullOcitationP Aut or Infor!ation "anu Rat ee# "D$ %rost odontics Assistant +rofessor, Aepartment of +rosthodontics, 0o)ernment Aental 8ollege, +t. <.A .harma Hni)ersit' of Health .ciences Anita &ooda# "D$ %rost odontics Associate +rofessor and Head, Dral Anatom', 0o)ernment Aental 8ollege, +t. <.A .harma Hni)ersit' of Health .ciences Arun Ku!ar +ost/0raduate student, +edodontics and +re)enti)e Aentistr', 0o)ernment Aental 8ollege, +t. <.A .harma Hni)ersit' of Health .ciences $ are T is Article Your free access to ISPUB is funded b t!e fo""owing advertise#ents:
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