eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa
Fissured Tongue
Updated: Dec 11, 2008
Introduction
Background
Fissured tongue is a condition frequently seen in the general population that is characterized by grooves that vary in depth and are noted along the dorsal and lateral aspects of the tongue. Although a definitive etiology is unknown, a polygenic mode of inheritance is suspected because the condition is seen clustering in families who are affected. Patients are usually asymptomatic, and the condition is initially noted on routine intraoral examination as an incidental finding. Fissured tongue is also seen in Melkersson-Rosenthal syndrome and Down syndrome and in frequent association with benign migratory glossitis (geographic tongue).
Melkersson-Rosenthal syndrome is a rare condition consisting of a triad of persistent or recurring lip or facial swelling, intermittent seventh (facial) nerve paralysis (Bell palsy), and a fissured tongue. The etiology of this condition is also unknown. The orofacial swelling usually manifests as pronounced lip enlargement. It may or may not affect both lips, and it may be tender or erythematous. Histologic examination of this tissue exhibits characteristic noncaseating granulomatous inflammation. Therapy for these lesions is often intralesional steroid injections.1 The facial paralysis is indistinguishable from Bell palsy, and it may be an inconsistent and intermittent finding with spontaneous resolution. The presence of fissured tongue in association with these other features is diagnostic of the condition.
Pathophysiology
This condition affects only the tongue and is a finding in Melkersson-Rosenthal syndrome, which consists of a triad of fissured tongue, granulomatous cheilitis, and cranial nerve VII paralysis (Bell palsy).2,3
Frequency
United States
Overall, the prevalence within the United States has been reported to range from 2-5% of the population.
International
The prevalence worldwide varies by geographic location and has been reported to be as high as 21%.4
Mortality/Morbidity
Fissured tongue is a totally benign condition and is considered by most to be a variant of normal tongue architecture. When seen in association with Melkersson-Rosenthal syndrome, the morbidity is due not to the fissured tongue but is secondary to the granulomatous inflammation of the lips/facial soft tissues and facial paralysis.
Race
No predilection for any particular race is apparent.
Sex
Some reports have shown a slight male predilection.
Age
Although fissured tongue may be diagnosed initially during childhood, it is diagnosed more frequently in adulthood. The prominence of the condition appears to increase with increasing age.
Clinical
History
The lesions are usually asymptomatic unless debris is entrapped within the fissure or when it occurs in association with geographic tongue (a common finding).
Physical
Upon clinical examination, fissured tongue affects the dorsum and often extends to the lateral borders of the tongue. The depth of the fissures varies but has been noted to be up to 6 mm in diameter. When particularly prominent, the fissures or grooves may be interconnected, separating the tongue dorsum into what may appear to be several lobules.
Causes
Although a specific etiology has not been elicited, a polygenic or autosomal dominant mode of inheritance is suspected because this condition is seen with increased frequency in families with an affected proband.5
More on Fissured Tongue |
 Overview: Fissured Tongue |
| Differential Diagnoses & Workup: Fissured Tongue |
| Treatment & Medication: Fissured Tongue |
| Follow-up: Fissured Tongue |
| References |
| Next Page » |
References
Stein SL, Mancini AJ. Melkersson-Rosenthal syndrome in childhood: successful management with combination steroid and minocycline therapy. J Am Acad Dermatol. Nov 1999;41(5 Pt 1):746-8. [Medline].
Alioglu Z, Caylan R, Adanir M, Ozmenoglu M. Melkersson-Rosenthal syndrome: report of three cases. Neurol Sci. Feb 2000;21(1):57-60. [Medline].
Gerressen M, Ghassemi A, Stockbrink G, Riediger D, Zadeh MD. Melkersson-Rosenthal syndrome: case report of a 30-year misdiagnosis. J Oral Maxillofac Surg. Jul 2005;63(7):1035-9. [Medline].
Kovac-Kovacic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med. Aug 2000;29(7):331-5. [Medline].
Eidelman E, Chosack A, Cohen T. Scrotal tongue and geographic tongue: polygenic and associated traits. Oral Surg Oral Med Oral Pathol. Nov 1976;42(5):591-6. [Medline].
Rogers RS. Melkersson-Rosenthal syndrome and orofacial granulomatosis. Dermatol Clin. Apr 1996;14(2):371-9. [Medline].
Kullaa-Mikkonen A, Sorvari T. Lingua fissurata. A clinical, stereomicroscopic and histopathological study. Int J Oral Maxillofac Surg. Oct 1986;15(5):525-33. [Medline].
Nakane T, Hatakeyama K, Nakamura K, Aihara M, Nakazawa S. Melkersson-Rosenthal syndrome with isolated immunoglobulin E hypogammaglobulinaemia. J Int Med Res. Nov-Dec 2007;35(6):922-5. [Medline].
Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. Jul 2006;12(4):381-6. [Medline].
Tan O, Atik B, Calka O. Plastic surgical solutions for melkersson-rosenthal syndrome: facial liposuction and cheiloplasty procedures. Ann Plast Surg. Mar 2006;56(3):268-73. [Medline].
Yarom N, Cantony U, Gorsky M. Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Dermatology. 2004;209(2):88-94. [Medline].
Further Reading
Keywords
fissured tongue, scrotal tongue, lingua plicata, Melkersson-Rosenthal syndrome, Down syndrome, benign migratory glossitis, geographic tongue
