The Tongue

Thyroid Factor

The Natural Thyroid Diet

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Frenulum Linguae

Fig. 4.21 "Tongue tie." This is due to a short frenulum linguae, and apart from the defect of being unable to protrude the tongue, the patient is almost always symptom-free. Speech defects can rarely be attributed to tongue tie necessitating division of the frenu-lum.

Fig. 4.21 "Tongue tie." This is due to a short frenulum linguae, and apart from the defect of being unable to protrude the tongue, the patient is almost always symptom-free. Speech defects can rarely be attributed to tongue tie necessitating division of the frenu-lum.

Black Hairy Tongue

Fig. 4.23 Black hairy tongue. Patients not infrequently regard the appearance of their tongue as an index of their general health, and are concerned upon seeing a brown-black staining. This may be fungal (Aspergillusniger) and related to prolonged antibiotic therapy, but is frequently a chance finding with no other pathology than hypertrophy of the filiform papillae. Tobacco may be a cause. Scraping and cleaning the tongue temporarily improves the appearance, but is unnecessary since this condition is harmless.

Fig. 4.22 Geographic tongue (benign migratory glossitis). There are smooth areas with no filiform papillae. These areas vary in site on the tongue, and the appearance may concern the patient. It is, however, a condition of no significance requiring no treatment other than reassurance.

Fig. 4.23 Black hairy tongue. Patients not infrequently regard the appearance of their tongue as an index of their general health, and are concerned upon seeing a brown-black staining. This may be fungal (Aspergillusniger) and related to prolonged antibiotic therapy, but is frequently a chance finding with no other pathology than hypertrophy of the filiform papillae. Tobacco may be a cause. Scraping and cleaning the tongue temporarily improves the appearance, but is unnecessary since this condition is harmless.

Hemangioma The Tongue Treatment
Fig. 4.24 Hemangiomas of the tongue. These may be chance findings and are usually innocuous. If large and giving rise to bleeding, laser surgery is the most effective present treatment.
Lingual Hemangioma
Fig. 4.25a, b Papilloma of the tongue. Benign lesions of the tongue are common, and are either sessile or pedunculated (b). Simple excision under local anesthetic with biopsy is required.
Surgical Removal Oral Ranula

Fig. 4.26 The ranula is a mucocele occurring in the floor of the mouth (a). A blue color and the profunda vein stretched across the surface are characteristic. This ranula may extend into the tissues of the floor of the mouth and neck (plunging ranula). Total surgical removal is difficult because of the thin wall, and marsupialisa-tion, as with the lip lesion (Fig. 4.1), is adequate treatment. Recurrence is not uncommon.

The ranula may also present more in the floor of the mouth than on the under-surface of the tongue, and the diagnosis may not be so obvious. b A less well-defined ranula occupying the floor of the mouth.

Fig. 4.26 The ranula is a mucocele occurring in the floor of the mouth (a). A blue color and the profunda vein stretched across the surface are characteristic. This ranula may extend into the tissues of the floor of the mouth and neck (plunging ranula). Total surgical removal is difficult because of the thin wall, and marsupialisa-tion, as with the lip lesion (Fig. 4.1), is adequate treatment. Recurrence is not uncommon.

The ranula may also present more in the floor of the mouth than on the under-surface of the tongue, and the diagnosis may not be so obvious. b A less well-defined ranula occupying the floor of the mouth.

Fig. 4.27 Lingual thyroid. Developmental anomalies in the thyroid gland may result in thyroid tissue remaining at the foramen caecum or in the thyroglossal tract. The symptom-free swelling at the base of this tongue is thyroid tissue, and was shown on a radioactive idodine scan to be active. No thyroid gland was palpable in the neck, and there was no iodine uptake other than at the base of the tongue. This lingual thyroid, therefore, was this patient's only active thyroid tissue.

Tongue Ulcers

Fig. 4.28 Tongue ulceration. The site and type of tongue ulcers give the provisional diagnosis: A marginal ulcer with a raised edge is probably a carcinoma; an ulcer on the dorsum with a punched-out margin may be a gumma. Tuberculosis may be the cause of a tender ulcer on the tip of the tongue in an area where tuberculosis is prevalent. However, these clinical findings are only guides. Biopsy of this ulcer on the dorsum showed it to be a solitary aphthous ulcer (Fig. 4.18).

Fig. 4.28 Tongue ulceration. The site and type of tongue ulcers give the provisional diagnosis: A marginal ulcer with a raised edge is probably a carcinoma; an ulcer on the dorsum with a punched-out margin may be a gumma. Tuberculosis may be the cause of a tender ulcer on the tip of the tongue in an area where tuberculosis is prevalent. However, these clinical findings are only guides. Biopsy of this ulcer on the dorsum showed it to be a solitary aphthous ulcer (Fig. 4.18).

Fig. 4.29 An aphthous tongue ulcer of the tongue may be deceptive. A buccal mucosal aphthous ulcer is flat, but on the tongue some swelling due to trauma may make a biopsy necessary in order to be certain of the diagnosis.

Fig. 4.30 A Chancre.

Tongue ulceration from primary syphilis.

Tongue Lesion
Fig. 4.31 Laser excision of a tongue lesion. This shows the minimal reaction at the excision margin, and the non-bleeding base of the excision.

Fig. 4.32 Median rhomboid glossitis.

This rare anomaly results from failure of the lateral halves of the tongue to fuse posteriorly, leaving the tuberculum impar in the mid-line. A smooth, red, usually symptom-free area persists.

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Responses

  • Antje Klug
    Can a ranula affect hearing?
    3 years ago
  • venla
    Is hearing loss related to tongue tied?
    12 months ago

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