Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Macroglossia Workup

  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Mar 25, 2015
 

Laboratory Studies

Macroglossia involves numerous etiologic factors, but a carefully considered patient history can indicate the exact cause and thus determine the need for lab tests.[1] For example, if macroglossia is caused by primary or secondary amyloidosis, microscopic examination and special staining will reveal the presence of hyaline.

Next

Imaging Studies

Imaging studies in macroglossia include the following:

  • Computed tomography (CT) scanning and magnetic resonance imaging (MRI): Helpful if macroglossia is interfering with the airway, especially in severe obstructive sleep apnea
  • Ultrasonography: May be applicable as a primary diagnostic modality to determine the size of a tongue lesion [5]
  • Panorex and cephalometric radiographs: Are very helpful in identifying dental or skeletal deformities associated with macroglossia
  • Barium swallow study: May be helpful in ruling out upper gastrointestinal airway interference
Previous
Next

Diagnostic Procedures

Diagnostic procedures must be performed according to the suspected etiology of macroglossia. Any physician who has taken a tongue biopsy knows that significant bleeding can occur. Certainly this potential is even greater with vascular or even inflammatory lesions.

Much of the time, especially for base-of-tongue lesions, biopsy can be performed safely only in the operating room, after scouring of the airway. Performing the biopsy can be perilous because intubation may not be easily completed in patients with obstructing tongue lesions; a controlled environment and the ability to perform tracheotomy are necessary for manipulation of the base of the tongue.

Biopsies of small lesions in the anterior tongue can usually be safely performed in the clinic, but these small lesions are often not responsible for the global enlargement demonstrated in macroglossia.

Fine-needle aspiration (FNA) may not be adequate for diagnosis of difficult-to-reach lesions in the posterior tongue. For example, an FNA alone cannot be used to diagnose lymphomas or other malignancies. Clinical judgment should be used to determine whether FNA can obtain an appropriate amount of tissue for assessment given this significant differential diagnosis.

Previous
Next

Histologic Findings

Given the vast differential diagnosis in macroglossia, listing all of the possible histologic findings would be imprudent. However, in Down syndrome and Beckwith-Wiedemann syndrome — although the diagnoses are made via clinical findings — tongue muscles show hypertrophy and hyperplasia.

Previous
Next

Staging

There is no specific staging for macroglossia. Clinical and CT-scan examination will determine the size and location of the tongue in the oral cavity.

Previous
 
 
Contributor Information and Disclosures
Author

Talib Najjar, DMD, MDS, PhD Professor of Oral and Maxillofacial Surgery and Pathology, Rutgers School of Dental Medicine

Talib Najjar, DMD, MDS, PhD is a member of the following medical societies: American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Todd Schneiderman, MD Private Practice, Bridgewater, NJ

Todd Schneiderman, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Rhinologic Society

Disclosure: Nothing to disclose.

Acknowledgements

Disclosure: Nothing to disclose.

References
  1. Prada CE, Zarate YA, Hopkin RJ. Genetic causes of macroglossia: diagnostic approach. Pediatrics. 2012 Feb. 129(2):e431-7. [Medline].

  2. V U, Sivasankari T, Jeelani S, et al. Lymphangioma of the tongue - a case report and review of literature. J Clin Diagn Res. 2014 Sep. 8(9):ZD12-4. [Medline]. [Full Text].

  3. Dudhia SB, Dudhia BB. Undetected hypothyroidism: a rare dental diagnosis. J Oral Maxillofac Pathol. 2014 May. 18(2):315-9. [Medline]. [Full Text].

  4. Batra M, Valecha UK. Anesthetic management of tongue reduction in a case of Beckwith-Wiedemann syndrome. J Anaesthesiol Clin Pharmacol. 2014 Oct. 30(4):562-4. [Medline]. [Full Text].

  5. Kagan KO, Berg C, Dufke A, et al. Novel fetal and maternal sonographic findings in confirmed cases of Beckwith-Wiedemann syndrome. Prenat Diagn. 2015 Jan 6. [Medline].

  6. Follmar A, Dentino K, Abramowicz S, et al. Prevalence of sleep-disordered breathing in patients with Beckwith-Wiedemann syndrome. J Craniofac Surg. 2014 Sep. 25(5):1814-7. [Medline].

  7. Heggie AA, Vujcich NJ, Portnof JE, Morgan AT. Tongue reduction for macroglossia in Beckwith Wiedemann syndrome: review and application of new technique. Int J Oral Maxillofac Surg. 2013 Feb. 42(2):185-91. [Medline].

  8. Balaji SM. Reduction glossectomy for large tongues. Ann Maxillofac Surg. 2013 Jul. 3(2):167-172. [Medline]. [Full Text].

  9. Byrne PJ, Bernstein PE. The use of medicinal leeches to treat macroglossia secondary to blunt trauma. Otolaryngol Head Neck Surg. 2001 Dec. 125(6):649-50. [Medline].

  10. Cable BB, Mair EA. Radiofrequency ablation of lymphangiomatous macroglossia. Laryngoscope. 2001 Oct. 111(10):1859-61. [Medline].

  11. Costa SA, Brinhole MC, da Silva RA, Dos Santos DH, Tanabe MN. Surgical treatment of congenital true macroglossia. Case Rep Dent. 2013. 2013:489194. [Medline]. [Full Text].

  12. Elinav E, Rabinowitz Y, Lorberbaum M. Episodic macroglossia as the sole manifestation of angiotensin-converting enzyme inhibitor-induced angioedema. Ann Otol Rhinol Laryngol. 2004 Mar. 113(3 Pt 1):223-4. [Medline].

  13. Farronato G, Salvadori S, Giannini L, Maspero C. Congenital macroglossia: surgical and orthodontic management. Prog Orthod. 2012 May. 13(1):92-8. [Medline].

  14. Gadban H, Gilbey P, Talmon Y. Acute edema of the tongue: a life-threatening condition. Ann Otol Rhinol Laryngol. 2003 Jul. 112(7):651-3. [Medline].

  15. Gasparini G, Saltarel A, Carboni A. Surgical management of macroglossia: discussion of 7 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Nov. 94(5):566-71. [Medline].

  16. Harada K, Enomoto S. A new method of tongue reduction for macroglossia. J Oral Maxillofac Surg. 1995 Jan. 53(1):91-2. [Medline].

  17. Iwuchukwu I, Ardelt A, Cueva W, et al. Macroglossia associated with brainstem injury. Neurocrit Care. 2014 Feb. 20(1):106-10. [Medline].

  18. Jian XC. Surgical management of lymphangiomatous or lymphangiohemangiomatous macroglossia. J Oral Maxillofac Surg. 2005 Jan. 63(1):15-9. [Medline].

  19. Kacker A, Honrado C, Martin D, Ward R. Tongue reduction in Beckwith-Weidemann syndrome. Int J Pediatr Otorhinolaryngol. 2000 Jun 9. 53(1):1-7. [Medline].

  20. Limbrock GJ, Fischer-Brandies H, Avalle C. Castillo-Morales' orofacial therapy: treatment of 67 children with Down syndrome. Dev Med Child Neurol. 1991 Apr. 33(4):296-303. [Medline].

  21. Matsumoto K, Morita KI, Jinno S, Omura K. Sensory changes after tongue reduction for macroglossia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Aug 15. [Medline].

  22. Maturo SC, Mair EA. Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction. Ann Otol Rhinol Laryngol. 2006 Aug. 115(8):624-30. [Medline].

  23. Mixter RC, Ewanowski SJ, Carson LV. Central tongue reduction for macroglossia. Plast Reconstr Surg. 1993 May. 91(6):1159-62. [Medline].

  24. Morgan WE. Macroglossia. 1992. Available at: http://www.bcm.tmc.edu/oto/. [Full Text].

  25. Morgan WE, Friedman EM, Duncan NO, Sulek M. Surgical management of macroglossia in children. Arch Otolaryngol Head Neck Surg. 1996 Mar. 122(3):326-9. [Medline].

  26. Moura CG, Moura TG, Duraes AR, Souza SP. Exuberant macroglossia in a patient with primary systemic amyloidosis. Clin Exp Rheumatol. 2005 May-Jun. 23(3):428. [Medline].

  27. Pau M, Reinbacher KE, Feichtinger M, Kärcher H. Surgical treatment of macroglossia caused by systemic primary amyloidosis. Int J Oral Maxillofac Surg. 2012 Jun 21. [Medline].

  28. Ring ME. The treatment of macroglossia before the 20th century. Am J Otolaryngol. 1999 Jan-Feb. 20(1):28-36. [Medline].

  29. Rizer FM, Schechter GL, Richardson MA. Macroglossia: etiologic considerations and management techniques. Int J Pediatr Otorhinolaryngol. 1985 Mar. 8(3):225-36. [Medline].

  30. Severtson M, Petruzzelli GJ. Macroglossia. Otolaryngol Head Neck Surg. 1996 Mar. 114(3):501-2. [Medline].

  31. Siddiqui A, Pensler JM. The efficacy of tongue resection in treatment of symptomatic macroglossia in the child. Ann Plast Surg. 1990 Jul. 25(1):14-7. [Medline].

  32. Tei E, Yamataka A, Komuro Y. Huge lymphangioma of the tongue: a case report. Asian J Surg. 2003 Oct. 26(4):228-30. [Medline].

  33. Tomlinson JK, Morse SA, Bernard SP, Greensmith AL, Meara JG. Long-term outcomes of surgical tongue reduction in Beckwith-Wiedemann syndrome. Plast Reconstr Surg. 2007 Mar. 119(3):992-1002. [Medline].

  34. Ueyama Y, Mano T, Nishiyama A, Tsukamoto G, Shintani S, Matsumura T. Effects of surgical reduction of the tongue. Br J Oral Maxillofac Surg. 1999 Dec. 37(6):490-5. [Medline].

  35. Van Lierde K, Galiwango G, Hodges A, et al. Impact of tongue reduction on overall speech intelligibility, articulation and oromyofunctional behavior in 4 children with Beckwith-Wiedemann syndrome. Folia Phoniatr Logop. 2012. 64(2):55-63. [Medline].

  36. Vermeersch G, Menovsky T, De Ridder D, et al. Life-threatening macroglossia after posterior fossa surgery: a surgical positioning problem?. B-ENT. 2014. 10(4):309-13. [Medline].

  37. Vogel JE, Mulliken JB, Kaban LB. Macroglossia: a review of the condition and a new classification. Plast Reconstr Surg. 1986 Dec. 78(6):715-23. [Medline].

  38. Wang J, Goodger NM, Pogrel MA. The role of tongue reduction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Mar. 95(3):269-73. [Medline].

  39. Weiss LS, White JA. Macroglossia: a review. J La State Med Soc. 1990 Aug. 142(8):13-6. [Medline].

  40. Wolford LM, Cottrell DA. Diagnosis of macroglossia and indications for reduction glossectomy. Am J Orthod Dentofacial Orthop. 1996 Aug. 110(2):170-7. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.