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INTRODUCTION

Tongue swelling is usually because of an isolated lump typi-cally acquired and caused by trauma, infection or a neoplasm (Box 14.1, Figs 14.1–14.3). Biopsy and other investigations are usually indicated. Ectopic thyroid tissue in the tongue is rare, and usually presents as a persistent single symptomless nodule in the posterior midline dorsum of tongue lingual thy-roid. It is important not to remove this without establishing there is adequate thyroid tissue present in the neck.

Diffuse swelling is usually acquired and caused by trauma, infection or allergy (angioedema). Sudden swelling of the

tongue can arise due to an allergic reaction or an adverse drug effect. Rare acquired causes are of slow onset over weeks or months and include amyloidosis (then often with purpura; Ch. 57) and other deposits (Box 14.2), or parasites such as cysticercosis.

Diffuse swelling of the tongue (macroglossia) may occa-sionally have congenital causes including: lymphangioma (see Ch. 57); haemangioma (see Ch. 57); neurofibromatosis (see Ch. 57); Down syndrome; cretinism; Hurler syndrome (a mucopolysaccharidosis) and multiple endocrine adeno-matosis (Ch. 57).

14Lumps and swellings in the tongue

BOX 14.1 Main causes of enlarged tongue

n Allergyn Trauman Infectionn Angioman Neoplasm

Fig. 14.1 Lingual lump caused by abnormal healing after trauma

Fig. 14.2 Fibrous lump on the tongue

Fig. 14.3 Tongue cancer, presenting as a persistent lump that has ulcerated

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14 SECTION 2 COMMON COMPLAINTS

The tongue may get somewhat wider in edentulous persons who do not wear dentures (false macroglossia): n In true macroglossia, the tongue is indented by teeth, or too

large to be contained in the mouth.

n Severe macroglossia can cause cosmetic and functional difficulties including in speaking, eating, swallowing and sleeping. Surgery may be indicated.

BOX 14.2 More advanced list of causes of tongue swelling/lumps

n Acromegaly n Allergic reaction (see also Drugs: Ch. 54 ) n Amyloidosis n Angioedema n Beckwith syndrome n Congenital micrognathia n Deep mycosis n Down syndrome n Fibrous lump n Foreign body n Granular cell tumour n Granulomatous conditions (Crohn disease, OFG, Sarcoidosis) n Median rhomboid glossitis n Haemangioma n Hypothyroidism n Infection n Leishmaniasis n Leukaemia

n Lymphangioma n Lingual thyroid n Mucopolysaccharidosis n Multiple endocrine neoplasia syndrome n Neoplasms (carcinoma, lymphoma, Kaposi sarcoma, salivary

gland neoplasms, metastases others) n Oedema n Papilloma n Pellagra n Pernicious anaemia n Pyogenic granuloma n Simpson–Golabi–Behmel syndrome (Ch. 56) n Syphilis n Trauma n Tuberculosis n TUGSE (traumatic ulcerative granuloma with stromal

eosinophilia)

FURTHER READING

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