Lumps and swellings inthe tongue

INTRODUCTION
Tongue swelling is usually because of an isolated lump typically acquired and caused by trauma, infection or a neoplasm (Box 14.1, Figs 14.114.3). Biopsy and other investigations are usually indicated. Ectopic thyroid tissue in the tongue is rare, and usually presents as a persistent single symptomless nodule in the posterior midline dorsum of tongue lingual thyroid. It is important not to remove this without establishing there is adequate thyroid tissue present in the neck. Diffuse swelling is usually acquired and caused by trauma, infection or allergy (angioedema). Sudden swelling of the
BOX14.1 Main causes of enlarged tongue
Allergy Trauma n Infection n Angioma n Neoplasm
n n

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Fig.14.2 Fibrous lump on the tongue

Fig.14.3 Tongue cancer, presenting as a persistent lump that has ulcerated

Fig.14.1 Lingual lump caused by abnormal healing after trauma

tongue can arise due to an allergic reaction or an adverse drug effect. Rare acquired causes are of slow onset over weeks or months and include amyloidosis (then often with purpura; Ch. 57) and other deposits (Box 14.2), or parasites such as cysticercosis. Diffuse swelling of the tongue (macroglossia) may occasionally have congenital causes including: lymphangioma (see Ch. 57); haemangioma (see Ch. 57); neurofibromatosis (see Ch. 57); Down syndrome; cretinism; Hurler syndrome (a mucopolysaccharidosis) and multiple endocrine adeno115 matosis (Ch. 57).

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SECTION 2

COMMON COMPLAINTS

BOX 14.2
n n n n n n n n n n n n n n n n n n

More advanced list of causes of tongue swelling/lumps

n n n n n

Acromegaly Allergic reaction (see also Drugs: Ch. 54) Amyloidosis Angioedema Beckwith syndrome Congenital micrognathia Deep mycosis Down syndrome Fibrous lump Foreign body Granular cell tumour Granulomatous conditions (Crohn disease, OFG, Sarcoidosis) Median rhomboid glossitis Haemangioma Hypothyroidism Infection Leishmaniasis Leukaemia

n n n n n n n n n n

Lymphangioma Lingual thyroid Mucopolysaccharidosis Multiple endocrine neoplasia syndrome Neoplasms (carcinoma, lymphoma, Kaposi sarcoma, salivary gland neoplasms, metastases others) Oedema Papilloma Pellagra Pernicious anaemia Pyogenic granuloma SimpsonGolabiBehmel syndrome (Ch. 56) Syphilis Trauma Tuberculosis TUGSE (traumatic ulcerative granuloma with stromal eosinophilia)

The tongue may get somewhat wider in edentulous persons who do not wear dentures (false macroglossia):
n

In true macroglossia, the tongue is indented by teeth, or too large to be contained in the mouth.

Severe macroglossia can cause cosmetic and functional difficulties including in speaking, eating, swallowing and sleeping. Surgery may be indicated.

FURTHER READING
Abdel-Aziz, M., Ibrahim, N., Ahmed, A., et al., 2011. Lingual tonsils hypertrophy; a cause of obstructive sleep apnea in children after adenotonsillectomy: Operative problems and management. Int. J. Pediatr. Otorhinolaryngol. 75 (9), 11271131. Bezerra, M.F., Costa, F.W., Pereira, K.M., et al., 2010. Chondrolipoma of the posterior tongue. J. Craniofac. Surg. 21 (6), 19821984. Breik, O., Hay, K.D., 2008. Migrating foreign body in the tongue. N. Z. Dent. J. 104 (2), 6264. Cohen, M., Wang, M.B., 2009. Schwannoma of the tongue: two case reports and review of the literature. Eur. Arch. Otorhinolaryngol. 266 (11), 18231829. Eley, K.A., Afzal, T., Shah, K.A., Watt-Smith, S.R., 2010. Alveolar soft-part sarcoma of the tongue: report of a case and review of the literature. Int. J. Oral. Maxillofac. Surg. 39 (8), 824826. Furugen, M., Nakamura, H., Tamaki, Y., et al., 2009. Tuberculosis of the tongue initially suspected of tongue cancer: a case report including the search for recent 16 cases in Japan. Kekkaku 84 (8), 605610. Groh, O.R., Southwold, A., Verbeek, P.C., 2010. A foreign body in the tongue. Ned. Tijdschr. Tandheelkd. 117 (9), 433434. Gupta, R., Gupta, K., Gupta, R., 2009. Polymorphous low-grade adenocarcinoma of the tongue: a case report. J. Med. Case Reports 3, 9313. Kapferer, I., Berger, K., Stuerz, K., Beier, U.S., 2010. Self-reported complications with lip and tongue piercing. Quintessence Int. 41 (9), 731737. Karaca, C.T., Habesoglu, T.E., Naiboglu, B., et al., 2010. Schwannoma of the tongue in a child. Am. J. Otolaryngol. 31 (1), 4648. Kumar Choudhury, B., Kaimal Saikia, U., Sarma, D., et al., 2011. Dual ectopic thyroid with normally located thyroid: a case report. J. Thyroid Res. 2011, 159703. Leszczyska, M., Borucki, L., Popko, M., 2008. Head and neck amyloidosis. Otolaryngol. Pol. 62 (5), 643648. Merz, H., Marnitz, S., Erbersdobler, A., Goektas, O., 2010. Schmincke's Tumor, Carcinoma of the Base of the Tongue c T1-2, cN2c M0 - A Case Report. Case Rep. Oncol. 3 (1), 7782. Mukozawa, M., Kono, T., Fujiwara, S., Takakura, K., 2011. Late onset tongue edema after palatoplasty. Acta Anaesthesiol. Taiwan 49 (1), 2931. Ottomeyer, C., Sick, C., Hennerici, M.G., Szabo, K., 2009. Orolingual angioedema under systemic thrombolysis with rt-PA: an underestimated side effect. Nervenarzt 80 (4), 459463. Prlesi, L., Plakogiannis, R., 2010. Angioedema after nonsteroidal antiinflammatory drug initiation in a patient stable on an angiotensin-converting-enzyme inhibitor. Am. J. Health Syst. Pharm. 67 (16), 13511353. Snchez Barrueco, A., Melchor Daz, M.A., Jimnez Huerta, I., et al., 2012. Recurrent lingual abscess. Acta Otorrinolaringol. Esp. 63 (4), 318320. Sarwar, A.F., Ahmad, S.A., Khan, M.H., et al., 2010. Swelling of vallate papillae of the tongue following arsenic exposure. Bangladesh Med. Res. Counc. Bull. 36 (1), 13. Scully, C., 2002. Oral medicine for the general practitioner: part three: lumps and swellings. Independent Dent. 7 (10), 2532. Scully, C., Felix, D.H., 2005. Oral medicine update for the dental practitioner. 8. Lumps and swellings. Br. Dent. J. 199, 763770. Scully, C., Porter, S., 2000. ABC of Oral Health. 6. Swellings, and red: white, and pigmented lesions. BMJ 321, 225228. Scully, C., Porter, S.R., 2000. Orofacial disease: update for the dental clinical team. 11. Cervical lymphadenopathy. Dent. Update. 27, 4447. Sood, A., Kumar, R., 2008. The ectopic thyroid gland and the role of nuclear medicine techniques in its diagnosis and management. Hell. J. Nucl. Med. 11 (3), 168171. Urs, A.B., Shetty, D., Praveen Reddy, B., Sikka, S., 2011. Diverse clinical nature of cavernous lymphangioma: report of two cases. Minerva Stomatol. 60 (3), 149153. Watanabe, T., Fujiwara, T., Toyama, M., et al. , 2011. Case of sublingual hematoma following difficult laryngoscopy in a patient on anticoagulant therapy. Masui 60 (1), 100103.

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