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Fissured Tongue

  • Author: Robert D Kelsch, DMD; Chief Editor: William D James, MD  more...
 
Updated: Jun 24, 2016
 

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.[1] Fissured tongue is also seen in Melkersson-Rosenthal syndrome[2] and Down syndrome and in frequent association with benign migratory glossitis (geographic tongue). Fissured tongue and geographic tongue have been reported in association with chronic granulomatous disease.[3]

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.[4] 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.

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Pathophysiology

Fissured tongue 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).[5, 6]

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Epidemiology

Frequency

United States

Overall, the prevalence of fissured tongue within the United States has been reported to range from 2-5% of the population.

International

The prevalence of fissured tongue worldwide varies by geographic location and has been reported to be as high as 30.5%.[7, 8]

Race

No predilection for any particular race is apparent in fissured tongue.

Sex

Some reports have shown a slight male predilection for fissured tongue.

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.

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Prognosis

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.

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Patient Education

Inform patients that fissured tongue is a frequent finding and no specific therapy is required, aside from that necessary to treat the manifestations of Melkersson-Rosenthal syndrome, if present.

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Contributor Information and Disclosures
Author

Robert D Kelsch, DMD Attending, Department of Dental Medicine, Division of Oral Pathology, Northwell Health System, Long Island Jewish Medical Center

Robert D Kelsch, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jean Paul Ortonne, MD Chair, Department of Dermatology, Professor, Hospital L'Archet, Nice University, France

Jean Paul Ortonne, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Madani FM, Kuperstein AS. Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management. Med Clin North Am. 2014 Nov. 98 (6):1281-98. [Medline].

  2. Kaminagakura E, Jorge J Jr. Melkersson Rosenthal syndrome: a histopathologic mystery and dermatologic challenge. J Cutan Pathol. 2009 Oct 15. [Medline].

  3. Dar-Odeh NS, Hayajneh WA, Abu-Hammad OA, et al. Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature. BMC Res Notes. 2010 Feb 17. 3(1):37. [Medline]. [Full Text].

  4. Stein SL, Mancini AJ. Melkersson-Rosenthal syndrome in childhood: successful management with combination steroid and minocycline therapy. J Am Acad Dermatol. 1999 Nov. 41(5 Pt 1):746-8. [Medline].

  5. Alioglu Z, Caylan R, Adanir M, Ozmenoglu M. Melkersson-Rosenthal syndrome: report of three cases. Neurol Sci. 2000 Feb. 21(1):57-60. [Medline].

  6. Gerressen M, Ghassemi A, Stockbrink G, Riediger D, Zadeh MD. Melkersson-Rosenthal syndrome: case report of a 30-year misdiagnosis. J Oral Maxillofac Surg. 2005 Jul. 63(7):1035-9. [Medline].

  7. Kovac-Kovacic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med. 2000 Aug. 29(7):331-5. [Medline].

  8. 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].

  9. Eidelman E, Chosack A, Cohen T. Scrotal tongue and geographic tongue: polygenic and associated traits. Oral Surg Oral Med Oral Pathol. 1976 Nov. 42(5):591-6. [Medline].

  10. Rogers RS. Melkersson-Rosenthal syndrome and orofacial granulomatosis. Dermatol Clin. 1996 Apr. 14(2):371-9. [Medline].

  11. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010 Mar 1. 81(5):627-34. [Medline].

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