Macroglossia

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Last modified 22/04/2025

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246 Macroglossia

Instruction

Examine this patient’s mouth.

Salient features

History

• Ask whether there is any difficulty in breathing or swallowing

• Look for an underlying cause such as hypothyroidism or acromegaly.

Examination

• Protrusion of the resting tongue beyond the teeth or alveolar ridge. The impressions of the teeth may be obvious along the edges of the tongue on either side (Fig. 246.1).

image

Fig. 246.1 Macroglossia in AL amyloidosis.

(With permission from Firestein et al. 2008.)

Diagnosis

This patient has macroglossia (lesion), the cause of which is not obvious by clinical examination (aetiology); it is complicated by heavy breathing (functional status).

Questions

What do you understand by the term macroglossia?

It is a resting tongue that protrudes beyond the teeth or alveolar ridge. It is usually used to indicate long-term painless enlargement rather than the rapid growth of acute parenchymatous glossitis.

What are the types of macroglossia?

• True macroglossia: definitive histopathological findings:

• Primary: characterized by hypertrophy or hyperplasia of tongue muscles
• Secondary: the result of infiltration of normal tissue with anomalous elements.

• Pseudomacroglossia: relative enlargement secondary to a small mandible with no histological abnormalities.

Advanced-level questions

What are the causes of true macroglossia?

• In children:

• Hypothyroidism
• Lymphangioma
• Haemangioma
• Idiopathic hyperplasia
• Metabolic disorders
• Beckwith–Wiedmann syndrome.

• Secondary macroglossia:

• Amyloidosis
• Acromegaly
• Angioedema
• Lymphoma
• Chronic infections: TB, syphilis
• Space-occupying lesions: cystic hygroma, cysts in lingual thyroglossal ducts, rhabdomyosarcoma.

What are the causes of pseudomacroglossia?

• Down syndrome

• Pierre Robin syndrome

• Cerebral palsy.

What are the complications of macroglossia?

• Prolonged exposure can cause ulceration and necrosis of the mouth and tip of the tongue

• Noisy breathing, drooling and unsightly appearance, particularly in children

• Maxillofacial defects such as anterior open bite, prognathism

• Difficulty in swallowing and, as a consequence, poor weight gain

• Difficulty in the articulation of consonants requiring the tip of the tongue to be in contact with the alveolar ridge or roof of the mouth

• Airway obstruction, which can be life threatening.

How would you manage macroglossia?

• Medical:

• Treatment of the underlying systemic cause, e.g. thyroxine in hypothyroidism, bromocriptine in acromegaly
• Steroids: in life-threatening airway obstruction or postoperative oedema.

• Surgical:

• Reduction glossectomy for symptomatic macroglossia
• Excision for neoplastic lesions.

• Rehabilitation of physical and psychological problems:

• Secondary orthodontic care and speech therapy
• Psychological and psychiatric support.

Further reading

Murthy P, Laing MR. Macroglossia. BMJ. 1994;309:1386.

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