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The tongue may be affected by most oral soft tissue lesions, but certain lesions are peculiar to the tongue. These lesions may be the result of developmental anomalies, systemic disorders, local irritations, or neoplastic changes. Because of the tendency for oral cancer to occur in the tongue, a thorough examination must be made to ensure early discovery of these lesions.


Median rhomboid glossitis appears as a smooth, flat, depressed or elevated nodular area on the dorsum of the tongue just anterior to the circumvallate papillae. It is usually an oval- or diamond-shaped area and stands out because the area has no filiform papilla. Median rhomboid glossitis is believed to be caused by a Candida infection, often with secondary hyperplasia. Treatment may include the use of an antifungal drug and surgical removal of the hyperplastic tissue.

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Figure 2-9. Median rhomboid glossitis.


a.  Cleft or Bifid Tongue. This condition is characterized by the failure of the two halves of the tongue to unite. It rarely occurs. The cleft tongue is usually normal in size, but its function is greatly impaired. Treatment is surgical, if indicated.

b.  Ankyloglossia (Figure 2-10). In this condition, the tongue is restricted in its movements by a strand of mucosa (lingual frenum) that attaches the anterior third of the tongue to the floor of the mouth and the lingual gingival mucosa. Persons with this condition are commonly called "tongue-tied." Treatment is surgical.

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Figure 2-10. Ankyloglossia.

c. Geographic Tongue (Figures 2-11 and 2-12). Geographic tongue, or benign migratory glossitis, is characterized by alternating red areas with a yellowish-white border. This appearance is due to alternating areas of hypertrophy and atrophy of the filiform papillae. In the areas of atrophy, the fungiform papillae appear as irregular, reddish areas surrounded by horny growth (keratosis). In the areas of hypertrophy, filiform papillae appear as whitish areas. The patterns developed are variable with changes in shape and position from time to time. The cause of this lesion is unknown. Developmental defects may also be present, which are responsible, due to debris collection, for a secondary burning sensation. Treatment consists of proper cleansing of the tongue.

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Figure 2-11. Geographic tongue, dorsal view.

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Figure 2-12. Geographic tongue, lateral view.

d.  Fissured Tongue (Figure 2-13). In fissured (or scrotal) tongue, the surface of the tongue appears furrowed with a deep median fissure and numerous shorter fissures radiating out on either side or may be seen with independent furrows. This condition is usually painless. However, with food accumulation, pain may result. Proper cleansing of the tongue is essential.

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Figure 2-13. Fissured tongue.

e.  Macroglossia. A congenital macroglossia is generally caused by an overdevelopment of the muscular portion of the tongue. Surgical correction is the treatment indicated for severe cases. Macroglossia may develop after removal of teeth. This develops as a hypertrophy (increase in cell size) when the teeth no longer contain the tongue within the previously established boundaries.

f. Aglossia. In this condition, a portion or all of the tongue is absent. Rarely is all the tongue absent.


Hairy tongue (or black hairy tongue) occurs on the dorsum of the tongue. The filiform papillae are hypertrophied and may be colored by substances in the diet. Treatment consists of good oral hygiene and brushing the tongue.


Systemic disorders may cause a smoothness of the tongue because of atrophy of papillae on the dorsal surface. Associated color change may denote the possible underlying cause. A bright, "beefy-red" tongue is associated with pernicious anemia, pellagra, or nicotinic acid (niacin) deficiency. Deficiencies of vitamin B and niacin may cause a magenta-colored atrophic tongue. Due to the papillae atrophy, these patients generally complain of a burning sensation as a symptom of this disorder. Patients with burning, smooth tongues should be evaluated for vitamin B12 deficiency or other systemic causative factors.

David L. Heiserman, Editor

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Revised: June 06, 2015