1.

Fordyce’s Granules
2. Leukoedema
3. Microglossia
4. Macroglossia
5. Ankyloglossia
6. Lingual Thyroid
7. Hairy Tongue
8. Fissured Tongue
DEFINITION:
A Fordyce granule is a developmental anomaly characterized
by heterotrophic collection of sebaceous glands at various sites
in the oral cavity which is covered with intact mucosa.

Yellow papules on the vermilion of the upper lip

 PATHOGENESIS:
The occurrence of sebaceous glands in the mouth may result
from the inclusion in the oral cavity of ectoderm having some of
the potentialities in the course of the development of the
maxillary and mandibular processes during embryonic life.

CLINICAL FEATURES:
 Appearance : appears as a multiple yellow or yellowish –
white papular lesions.
 Common site : on the buccal mucosa and lateral portion of
the vermilion of the upper lip.
Occasionally – retromolar area and anterior tonsillar pillar.
 Age : adults > children
Sex : Male> Female
 Non ulcerated smooth surface with sharply delineated.

 Consistency : slightly cheesy consistency.

 Increases rapidly in number at puberty as a result of hormonal

factor.
HISTOPATHOLOGIAL FEATURES :
 Consists of submucosal
clusters of sebaceous acini
which are communicating with
the oral epithelium through a
central duct.
 Aciner tubules – polygonal
sebaceous cells with centrally
located nuclei and abundant
foamy cytoplasm.
 Fordyce’s granules are Multiple sebaceous glands below
similar to normal sebaceous the surface epithelium
glands in the skin except for
the absence of hair follicles.
TREATMENT:
 No treatment
 If it causes disfigurement – surgical removal can be done.
DEFINITION:
It is a common oral mucosal condition which clinically
resembles early leukoplakia.

ETIOLOGY:
 Use of tobacco
 Racial
 Poor oral hygiene

White, wrinkled appearance of the buccal mucosa

CLINICAL FEATURES:
 Age : 15-35 years.
 Sex : Male>Female -2:1
 Most common site – buccal mucosa and lip
 Bilateral lesions
 Appearance :
diffuse, grayish-white, milky, opalescent appearance of the
mucosa.
Mucosa retains the normal softness and flexibility with folded
surface appearance resulting in wrinkles or whitish streaks.
 It can be easily diagnosed clinically because the white
appearance greatly diminishes when the cheek is everted and
stretched and re-establishes itself almost immediately.
diffuse white appearance of
the buccal mucosa

Whiteness disappears when

the cheek is stretched
HISTOPATHOLOGICAL FEATURES:
 Frequently parakeratinized epithelium
 Increased in thickness of epithelium ;
Broad, elongated rete pegs and
Intracellular edema of spinous layer.
 Large vacuolated Cells at the surface are flattened and may
retain pyknotic nuclei that contain glycogen.

Parakeratosis and
intracellular edema of the
spinous layer
 DIFFERENTIAL DIAGNOSIS:

Leukoplakia Hereditary benign

Cheek biting lesion White sponge nevus
intraepithelial dyskeratosis

MANAGEMENT:
 No treatment
 DEFINITION:
AGLOSSIA: It is the complete absence of the tongue at birth.
MICROGLOSSIA : it is the presence of abnormally small
rudimentary tongue.

CAUSES
 Usually occurs in syndromes such as
(1) Hypoglossiahypodactylia syndrome
(2) Pierre robin syndrome.
 Also associated with cleft lip,
cleft palate,
intraoral bands,
situs inversus.
 CLINICAL FEATURES:
 Difficulty in eating and speaking
 high arched palate and a narrow constricted mandible
 frequently associated with hypoplasia of the mandible and
lower incisors may be missing.
 May be an airway obstruction, due to negative pressure
generated by deglutition and inspiration.

Abnormally small tongue

associated with constricted
mandibular arch.
MANAGEMENT :
Depends on the nature and severity of the condition
 Surgery and orthodontics – may improve oral function
 Non surgical techniques such as positioning, naso-gastric
intubation and temporary endotracheal intubation-to prevent
airway obstruction.
DEFINITION:
It is an uncommon condition characterized by enlargement of
the tongue.

CLASSIFICATION

Congenital Acquired Relative macroglossia Apperent macroglossia

Hypertrophic Inflammatory Neoplastic

 ETIOLOGY
Muscular
hypertrophy
Neoplastic
Inflammatory
Congenital Traumatic Metabolic

hemangioma tuberculosis dental irritation myxodema

lymphangioma actinomycosis hematoma amyloidosis

syphilitic gumma post operative acromegaly

lingual thyroid edema

Ranula
 CLINICAL FEATURES:
 Commonly occurs in children
 Symptoms: noisy breathing, drooling, difficulty in
eating, swallowing difficulties, lisping speech, airway
obstruction.
 Signs - crenation or scalloping of the lateral borders of
the tongue
- malocclusion : open bite
- mandibular prognathism.
 If the tongue constantly protrudes from the mouth, it
may ulcerate and become secondarily infected or
necrosis.
 Syndromes associated – beckwith’s hypoglycemic
syndrome
- fetal visceromegaly
- postnatal somatic
gigantism
Large tongue in a patient with Down syndrome
MANAGEMENT :
 Depends on the cause and severity of the condition
- in symptomatic patients : reduction glossectomy.
- if speech is affected : speech therapy
- for dental arch deformity: orthodontic treatment
DEFINITION:
It is a developmental anomaly of the tongue characterized by a
short, thick lingual frenum, resulting in limitation of the tongue
movement.

TYPES:
1. complete : fusion of tongue and the floor of mouth
2. partial : short lingual frenum.
CLINICAL FEATURES :
Symptoms :
 limitation of the tongue movement
 recurrent tongue biting, poor sucking and inability to food
chewing.
 Speech abnormalities like lisping and inability to pronounce
certain sounds and words viz t, d, n, i, as, ta, te, time etc.
 In extreme cases : nursing and feeding problems can occur.

Abnormal attachment of the

lingual frenum, limiting
tongue mobility
Signs :
 ‘V’ shaped notch at the tip of the tongue
 short or anteriorly placed lingual frenum
 midline mandibular diestema
 Inability to clean the teeth

Syndromes associated :
 Ankyloglossum superious syndrome
 Rainbow’ syndrome
 Fraser’s syndrome
 Orofacial digital syndrome

MANAGEMENT :
Frenectomy
DEFINITION :
The lingual thyroid is an anomalous condition in which follicles of
thyroid tissue are found between the foramen caecum and
epiglottis or in the substance of the tongue, possibly arising from
a thyroid anlage that failed to migrate to its predestinated
position.

ETIOLOGY :
 Failure of the primitive thyroid anlage to descend.
CLINICAL FEATURES :
 Age : birth to 6th decade
 Sex : Female > Male
- Occurs during puberty, adolescence,
pregnancy or menopause.
 Appearance : appears as a small asymptomatic remnants of
thyroid tissue on the posterior dorsal tongue.
 Common clinical symptoms - dysphagia
- dysphonia
- dyspnea
- haemorrhage with pain or
feeling of tightness
 Nodular mass of the posterior dorsal
midline of the tongue

HISTOLOGICAL FEATURES :
 resemble either normal or an embryonal type of thyroid
tissue.
 characteristically has an incomplete or poorly defined
capsules.
DIAGNOSIS :
 thyroid scan using iodine isotopes or technetium 99m.
 computed tomography scan.
 magnetic resonance imaging.

MANAGEMENT :
 thyroxin – to reduce the size of the swelling.
 if it causing difficulty to patient – excision or ablation with
radioiodine – 131.
DEFINITION :
Hairy tongue is characterized by marked accumulation of
keratin on the filiform papillae of the dorsal tongue, resulting in a
hairlike appearance.

ETIOLOGY :
 heavy smoking
 oral use of certain drugs – sodium perborate
- sodium peroxide
- antibiotics
1. penicillin
2. auremycin
  poor oral hygiene.
 general debilitation.
 extensive x-ray radiation therapy.
 over growth of fungal organisms like candida albicans
and systemic disturbances i.e. anaemia, gastric upset.
 use of oxidizing mouthwashes or antacids.
 delayed shadding of the horny layer of the filiform
papillae

CLINICAL FEATURE :
 lesion involves the dorsum, particularly the midline of the
middle and posterior 1/3 . sparing the lateral and anterior borders.
 Elongated papillae are usually yellowish-white to brown or
black depending upon the growth of pigment producing bacteria or
staining from tobacco and food.
 Asymptomatic condition, occasionally gagging sensation or
bad taste in the mouth.
 Hypertrophy of filiform papillae, the papillae may reach a
length of 2cm..

Marked elongation and

Elongated, black-staining filiform
brown staining of the
papillae on the posterior dorsal
filiform papillae, resulting
tongue
in a hairlike appearance
HISTOPATHOLOGICAL FEATURES :

 Marked elongation
and hyperkeratosis of
the filiform papillae.

 External colonization
of the papillae by
basophilic microbial
colonies.

Elongation and marked

hyperkeratosis of the filiform
papillae, with bacterial
accumulation on the surface
TREATMENT :

 Predisposing factors such as tobacco, antibiotics or

mouthwashes should be eliminated.
 Excellent oral hygiene should be encouraged.
 Desquamation of the hyperkeratotic papillae-by periodic
scraping or brushing with a toothbrush or tongue scraper twice
daily for 2 min.
 Application of topical keratolytic agents such as podophyllin
or other lactobacillus acidophilus cultures.
DEFINITION :
Fissured tongue is relatively common condition characterized by
presence of numerous grooves, or fissures on the dorsal tongue
surface.

TYPES :
1. foliaceus
2. cerebriform
3. plicated
ETIOLOGY :
 Genetically determined
 Mentally retarded and psychotic individuals
 Extrinsic factors like chronic trauma or vitamin
deficiency.

CLINICAL FEATURES :
 Multiple grooves or furrows on the surface of the tongue
ranging from 2-6 mm in depth, often radiating out from the
central groove along the midline of the tongue.
 Usually, asymptomatic.
Occasionally mild burning or soreness due to irritation.
- Prevalence and severity increases with age.
- Associated with Melkersson Rosenthal syndrome
Extensive fissuring involving the entire
dorsal tongue surface Moderate fissuring of the
dorsal tongue
HISTOPATHOLOGICAL FEATURES :

 Hyperplasia of the rete pags.

 Loss of the keratin “hairs” on the surface of the filiform
papillae.
 Polymorphonuclear leucocytes seen migrating into the
epithelium, often forming microabscesses in the upper
epithelial cells.
 A mixed inflammatory cells present in the lamina propria.

TREATMENT :

 Clean the debris with brush to tongue.