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Xu J, Roser SM, Avadhani V, Amin D, Melville JC. Management of MACROGLOSSIA: Case Series and Suggested Algorithm. J Oral Maxillofac Surg 2023; 81:107-119. [PMID: 36207006 DOI: 10.1016/j.joms.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Idiopathic macroglossia is a rare entity of true tongue enlargement without an underlying etiology. There are only a few case reports on the diagnosis and management of idiopathic macroglossia. This study's purpose was to present a series of patients with idiopathic macroglossia and suggest a treatment algorithm. METHODS This was a retrospective case series of a cohort of patients with macroglossia who were treated by the Oral and Maxillofacial Surgery service at the University of Texas Health Science Center at Houston (UTHealth)and Emory University. The patient's medical comorbidities, history of present illness, clinical presentation, radiographic findings, and disease management were studied. The outcome variables include normalization of the tongue size, dependence on parenteral nutrition, and tolerating tracheostomy decannulation. RESULTS Five patients with a mean age of 45 years were included in the study. All of the patients (n = 5, 100%) in our cohort developed macroglossia following prolonged oral intubation, with 3.5 weeks being the average length of intubation. All patients presented with difficulty feeding orally and breathing. The average tongue dimension was 12.20 x 6.25 cm. All tongue enlargements were located in the anterior 2/3 of the tongue, and all patients had displaced anterior dentition. In addition, 60% of the patients (n = 3) experienced altered tongue sensation (pain and/or decreased taste). These patients were surgically managed with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement followed by partial glossectomy (n = 5, 100%). We defined successful outcomes as 1) modifying the tongue to a functional, nonprotruding form, 2) tracheostomy decannulation and 3) PEG tube removal. Tracheostomy decannulation and PEG tube removal were achieved in 80% of the patients (n = 4). CONCLUSIONS In this patient cohort, we were unable to identify the cause of the pathology based on existing clinical data. When the etiology is unclear or irreversible, management should involve tracheostomy and surgical feeding access for the initial stabilization, followed by modified glossectomy to improve form, function, and cosmesis thereby improving the overall quality of life.
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Affiliation(s)
- Joyce Xu
- Resident, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, GA
| | - Vaidehi Avadhani
- Assistant Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine, Associate Chief Oral and Maxillofacial Surgery Service, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA
| | - James C Melville
- Associate Professor of Surgery, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston (UTHealth), School of Dentistry, Huston, TX
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Dietrich E, Grimaux X, Martin L, Samimi M. Etiological diagnosis of macroglossia: Systematic review and diagnostic algorithm. Ann Dermatol Venereol 2022; 149:228-237. [PMID: 36229262 DOI: 10.1016/j.annder.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The objective of this literature review was to list the different etiologies of macroglossia reported in the literature, to identify characteristics that might guide diagnosis, and to create a diagnostic algorithm. METHODS The bibliographic search was carried out between October 2019 and July 2020 in the PubMed research base using the keywords "macroglossia" (MESH) and/or "tongue enlargement". RESULTS Of the 1711 references identified, 615 articles were excluded, and 1096 abstracts were reviewed. We classified the different etiologies identified according to their mechanism and whether they were congenital or acquired. The etiologies are divided into the following categories: genetic malformation syndromes, non-syndromic congenital malformations, endocrinopathies, neuromuscular diseases, storage disorders, infectious, inflammatory, traumatic, and iatrogenic diseases. CONCLUSION Based on this review, we propose a diagnostic algorithm for macroglossia according to the characteristics described. The most common diagnoses among acquired causes were amyloidosis (13.7%), endocrinopathies (8.8%), myopathies (4%) and tongue tumors (6.7%). The most common congenital causes were aneuploidy, lymphatic malformations, and Beckwith-Wiedemann syndrome, which is the main cause of congenital macroglossia, even if it appears isolated.
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Affiliation(s)
- E Dietrich
- Dermatology Department, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49000 Angers, France.
| | - X Grimaux
- Dermatology Department, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49000 Angers, France
| | - L Martin
- Dermatology Department, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49000 Angers, France
| | - M Samimi
- Dermatology Department, Centre Hospitalier Universitaire de Tours, 2 boulevard Tonnellé, 37000 Tours, France
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Osoba MY, Schneider AL, Alexiev B, Matsuoka AJ. Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke. BMJ Case Rep 2021; 14:14/1/e238775. [PMID: 33431468 PMCID: PMC7802688 DOI: 10.1136/bcr-2020-238775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 50-year-old African American woman with hypertension, congestive heart failure, chronic kidney disease and prior cerebral vascular accident was transferred from an outside hospital after being found unresponsive and subsequently intubated for severe orolingual swelling. Imaging showed left thalamic haemorrhagic stroke, and the lingual swelling was clinically concerning for angio-oedema, with which a lingual biopsy was consistent. Work-up was negative for hereditary or acquired angio-oedema, and imaging was negative for structural causes. Of note, the patient had an episode of severe orolingual swelling 3 months prior to this presentation after suffering left thalamic haemorrhage which self-resolved after approximately 2 months. In both episodes lingual swelling predated receipt of tissue plasminogen activator and she had discontinued ACE inhibitor therapy since her first episode of tongue swelling. Despite medical and supportive management, tongue swelling progressed during admission and the decision was made to allow the patient's tongue swelling to self-resolve.
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Affiliation(s)
- Muyinat Y Osoba
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander L Schneider
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Borislav Alexiev
- Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akihiro J Matsuoka
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA,Hugh Knowles Center for Hearing Research, Northwestern University, Evanston, Illinois, USA
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4
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Self-Induced Traumatic Macroglossia: Case Report and Literature Review. Case Rep Otolaryngol 2019; 2019:6040354. [PMID: 31214372 PMCID: PMC6535868 DOI: 10.1155/2019/6040354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
Traumatic macroglossia is an extremely rare condition characterized by a sudden edematous swelling of the tongue due to trauma. We report a rare case of traumatic macroglossia in a 37-year-old male with known trisomy 21 and epilepsy who presented to the emergency room with a huge protruded tongue due to aggressive behavior and a history of multiple tongue tractions, leading to sudden severe tongue swelling without any respiratory distress symptoms. The examination was unremarkable; fixable nasolaryngoscopy relieved bilateral vocal cord movement, and there was no laryngeal edema. The patient was managed immediately by endotracheal intubation to secure the airway, and corticosteroids were used to diminish and stop the tongue swelling. We describe the clinical management for such patients, highlighting the different causes of traumatic macroglossia. A few cases have been reported in the literature, but this is the first case to report self-induced traumatic macroglossia in a seizure-free patient managed successfully by endotracheal intubation, corticosteroids, a bite block, and warm wet dressing.
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Ducote C, Kesterke MJ, Bhattacharjee R, Read-Fuller A, Reddy LV. Macroglossia secondary to lisinopril-induced acute angioedema. Proc (Bayl Univ Med Cent) 2019; 32:70-72. [PMID: 30956587 DOI: 10.1080/08998280.2018.1540736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022] Open
Abstract
Presented here are two cases of acute acquired macroglossia in adults caused by angioedema resulting from a reaction to angiotensin-converting enzyme inhibitors (ACEIs). Angioedema can be caused by a variety of factors, but ACEIs are the most common precipitating factor. Symptoms such as swelling of the lips, face, tongue, and throat can lead to life-threatening airway compromise. Early management of acute angioedema and macroglossia includes antihistamines, steroids, and occasionally epinephrine, yet a small percentage of patients progress toward airway obstruction and will require intubation. Edema within the lips, face, and throat usually subsides within a week, but the tongue can remain edematous for prolonged periods if biting trauma occurs. If the patient's macroglossia does not resolve in a reasonable amount of time, a partial glossectomy may be indicated.
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Affiliation(s)
- Colten Ducote
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,Department of Oral and Maxillofacial Surgery, Texas A&M University College of DentistryDallasTexas
| | - Matthew J Kesterke
- Department of Biomedical Sciences, Texas A&M University College of DentistryDallasTexas
| | - Ritesh Bhattacharjee
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of DentistryDallasTexas.,Department of Biomedical Sciences, Texas A&M University College of DentistryDallasTexas
| | - Andrew Read-Fuller
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,Department of Oral and Maxillofacial Surgery, Texas A&M University College of DentistryDallasTexas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,Department of Oral and Maxillofacial Surgery, Texas A&M University College of DentistryDallasTexas
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Dougherty JA. Atorvastatin-Associated Macroglossia in a Cardioembolic Stroke Patient. Ann Pharmacother 2018; 52:1259-1260. [DOI: 10.1177/1060028018793111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Actinomycosis Presenting as Macroglossia: Case Report and Review of Literature. Head Neck Pathol 2018; 13:327-330. [PMID: 30244331 PMCID: PMC6684727 DOI: 10.1007/s12105-018-0966-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Cervicofacial actinomycosis is a common form of Actinomyces infection. However, the latter seldom occurs in the tongue. We present a case of a 66 year-old man with macroglossia caused by actinomycosis of the tongue. Radiographic features were compatible with a chronic inflammatory disease. Biopsies revealed granulomas containing giant cells and Gram positive bacterial clusters consistent with actinomycosis. The patient was treated with a 22 week course of antibiotics. Imaging showed a notable improvement in the extent of the lesions 1 year later. The patient was asymptomatic and in good condition during his second year follow-up. Diagnosis of actinomycosis of the tongue can prove to be challenging because of the non-specific nature of its symptoms, clinical signs, and radiographic features. Isolation of Actinomyces sp. is an added diagnostic hurdle, because of its fastidious nature.
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Melville JC, Menegotto KD, Woernley TC, Maida BD, Alava I. Unusual Case of a Massive Macroglossia Secondary to Myxedema: A Case Report and Literature Review. J Oral Maxillofac Surg 2017; 76:119-127. [PMID: 28742994 DOI: 10.1016/j.joms.2017.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022]
Abstract
Macroglossia is classified as true macroglossia, which exhibits abnormal histology with clinical findings, and relative macroglossia, in which normal histology does not correlate with pathologic enlargement. This report describes an atypical case of morbidity with massive macroglossia secondary to myxedema; the macroglossia enlarged over a 3-month period before being presented to the Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston (Houston, TX). Substantial enlargement of the tongue (16 cm long × 10 cm wide) was first attributed to angioedema, which was refractory to the discontinuation of lisinopril and a C1 esterase inhibitor. A core tongue biopsy examination was performed to rule out angioedema, amyloidosis, myxedema, and idiopathic muscular hypertrophy. Interstitial tissue was positive for Alcian blue and weakly positive for colloidal iron, which are correlated with hypothyroidism and a diagnosis of myxedema. However, the macroglossia did not resolve after correcting for hypothyroidism. The patient required a wedge glossectomy for definitive treatment. She recovered unremarkably, with excellent cosmesis and preservation of lingual and hypoglossal function. There are some case reports of massive macroglossia but none with myxedema as the primary etiology.
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Affiliation(s)
- James C Melville
- Assistant Professor, Oral and Maxillofacial Surgery, Oral, Head and Neck Oncology and Microvascular Reconstructive Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX.
| | - Kelsey D Menegotto
- Resident PGY-3, Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Timothy C Woernley
- Resident PGY-3, Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Blake D Maida
- Chief Resident PGY-6, Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Ibrahim Alava
- Assistant Professor, Otolaryngology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
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10
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Ribeiro NRB, Silva LDF, Silva HFD, Reis ENRDC, Neto JQDO, Maia RN, Mello MDJR. Partial Glossectomy as an Adjunctive Method to Ortho-Surgical Treatment. J Craniofac Surg 2017; 28:e325-e327. [PMID: 28277477 DOI: 10.1097/scs.0000000000003571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The macroglossia is a rare condition, congenital or acquired, characterized by hypertrophy of the lingual muscles that can cause both aesthetic and functional changes such as mandibular prognathism and malocclusion. Diagnosis is through clinical examination. Treatment consists of excision of part of the tongue and different surgical techniques have been described in the literature. The keyhole lingual resection technique has shown satisfactory results in reducing the volume and preservation of the neurovascular bundles of the tongue. This work aims to present a clinical report of true macroglossia associated with dental-skeletal discrepancies, submitted to partial glossectomy previously to orthognathic surgery.
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Affiliation(s)
- Ney Robson Bezerra Ribeiro
- *Oral and Maxillofacial Surgery Division, Batista Memorial Hospital, Fortaleza †Araçatuba School of Dentistry, São Paulo State University-UNESP, Araçatuba ‡Ribeirão Preto School of Dentistry, São Paulo University-USP, Ribeirão Preto §Program in Oral and Maxillofacial Surgery
- Oral Surgery Division, Doc. José Frota Institute-IJF, Fortaleza, Brazil
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Núñez-Martínez PM, García-Delgado C, Morán-Barroso VF, Jasso-Gutiérrez L. [Congenital macroglossia: clinical features and therapeutic strategies in paediatric patients]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:212-216. [PMID: 29421209 DOI: 10.1016/j.bmhimx.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/25/2016] [Indexed: 11/29/2022] Open
Abstract
Congenital macroglossia is a condition that consists in an enlarged tongue that in resting position protrudes beyond the alveolar ridge. It has been classified in two categories: true macroglossia, which occurs in congenital or acquired forms, and relative macroglossia. As this alteration may be due to different causes, its incidence is not known. It is more frequently associated to Beckwith-Wiedemann syndrome, to mucopolysaccharidosis diseases and to Pompe's disease, and it has been less frequently associated to lymphangioma, hemangioma or isolated muscular hypertrophy. Macroglossia is characterized by an enlarged and thick tongue that may have fissures and ulcers, may cause language alterations, difficulties for feeding and swallowing, sialorrhea and recurrent infections of the upper airway or even its obstruction. Its clinical evaluation must include a complete clinical chart with careful physical exploration and a pedigree of that may identify the presence or absence of a hereditary associated syndrome. Macroglossia management is complex. More than twenty different surgical options to reduce the tongue size have been proposed, however, so far there is not a general agreement in this respect. The objective of this work is to review clinical and surgical aspects related to macroglossia from the point of view of non-surgical pediatricians and genetists, addressed to the different medical specialists, including the maxillofacial surgeons involved in the management of these patients.
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Affiliation(s)
| | | | | | - Luis Jasso-Gutiérrez
- Departamento de evaluación y análisis de medicamentos, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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