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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.


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

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.


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.



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.

Contributor Information and Disclosures

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.


Disclosure: Nothing to disclose.

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