Fissured tongue: A sign of tongue edema?

Tongue feature dataset construction and real-time detection

BACKGROUND

Tongue diagnosis in traditional Chinese medicine (TCM) provides clinically important, objective evidence from direct observation of specific features that assist with diagnosis. However, the current interpretation of tongue features requires a significant amount of manpower and time. TCM physicians may have different interpretations of features displayed by the same tongue. An automated interpretation system that interprets tongue features would expedite the interpretation process and yield more consistent results.

MATERIALS AND METHODS

This study applied deep learning visualization to tongue diagnosis. After collecting tongue images and corresponding interpretation reports by TCM physicians in a single teaching hospital, various tongue features such as fissures, tooth marks, and different types of coatings were annotated manually with rectangles. These annotated data and images were used to train a deep learning object detection model. Upon completion of training, the position of each tongue feature was dynamically marked.

RESULTS

A large high-quality manually annotated tongue feature dataset was constructed and analyzed. A detection model was trained with average precision (AP) 47.67%, 58.94%, 71.25% and 59.78% for fissures, tooth marks, thick and yellow coatings, respectively. At over 40 frames per second on a NVIDIA GeForce GTX 1060, the model was capable of detecting tongue features from any viewpoint in real time.

CONCLUSIONS/SIGNIFICANCE

This study constructed a tongue feature dataset and trained a deep learning object detection model to locate tongue features in real time. The model provided interpretability and intuitiveness that are often lacking in general neural network models and implies good feasibility for clinical application.

Clinical Neurology in Practice: The Tongue (part 2)

BACKGROUND

The tongue is an essential organ for the development of certain crucial functions such as swallowing and speech. The examination of the tongue can be very useful in neurology, as the various types of lingual alterations can lead to certain specific diagnoses, the tongue being a kind of 'mirror' of some neurological function.

REVIEW SUMMARY

To discuss the elements of clinical examination of the tongue in relation to neurological disorders. After reviewing the different superficial lesions of the tongue, we deal with various movement disorders of the tongue (fasciculations/myokimia, orolingual tremor, choreic movements of the tongue, dystonia of the tongue, lingual myoclonus, and psychogenic movements), disorders of taste and lingual sensitivity and lingual pain.

CONCLUSIONS

Examination of the tongue should not be limited to studying its motility and trophicity. It is equally important to check the sensory function and understand how to interpret abnormal movements involving the tongue. This study also aimed to demonstrate the importance of nonmotor tongue function in neurological practice.

The Prevalence and Significance of Fissured Tongue in Kabul City Among Dental Patients

Background

The tongue is known as the mirror of oral and general health. Some diseases may show signs in the tongue. Fissured is approximately an asymptomatic condition characterized by grooves and fissures of varying depth on the dorsal surface of the tongue. Epidemiologically, its prevalence is varied based on different factors, but most of them report 10-20%.

Methods

In the department of oral medicine at Ali-Abad University Hospital of Kabul University of Medical Sciences, a cross-sectional study was conducted among 400 patients. This fissured tongue is first diagnosed based on clinical appearance (fissures) on each side of tongue. Meanwhile, the whole medical and dental histories were taken for the rest of the leading factors.

Results

Out of 400 patients (124 males and 276 females) seen and checked, which 142 cases were fissured tongue [45 (31.7%) males and 97 (68.3%) females]. The fissures were found to be least in the >10 - 19-year age group, 23 (16.3%) and it was most prevalent in the 20 -39 age group, 73 (51.8%), followed by 40 -59, 35 (24.8%) and 60< age group, 10 (7.1%). The most prevalent type of pattern of fissures was found to be superficial, multiple and not connected fissures, 46.32% (33.3% males, 32.3% females), followed by superficial, multiple and connected fissures, 25.5% (26.7% males, 25% females), and whereas 6.4% of patients with (single and deep type of fissure) was the lowest prevalent type of fissured tongue. In our study, more than half of patients asymptomatic (51.6% females and 71.1% males), 17.9% complained from tongue dryness, 14.3% soreness, 6.4% halitosis, 1.4% tongue swelling and 2.1% had all the signs.

Conclusion

The prevalence of fissured tongue was 35.5%. A significant difference between genders was reported with female predominance in all cases observed. The most prevalent age groups were 20-29 and 30-39 in both gender groups. Superficial, multiple, and not connected fissures 46.32% were the most common type of fissure.

Prevalence of Oral Normal Variance in Healthy Elderly Patients: A Descriptive Study on Oral Pseudo Lesions

Introduction The aging process in the elderly can change the condition of the oral cavity, regarding both clinical appearance and function. The oral mucosa becomes more susceptible to mechanical damage and irritant agents. Any changes in the oral mucosa, including normal variance, should be examined. This is especially true for the elderly, to improve oral health and prevent any abnormalities.

Objective To describe the prevalence of oral normal variance in healthy elderly patients.

Methods An observational descriptive study with a cross-sectional design with total sampling conducted from March to April 2020.

Results Among the 117 elderly patients who participated in this study, 58 were described as healthy without any comorbidities. From those subjects, there were 117 cases of normal variance in the oral mucosa. The three most prevalent issues were fissured tongue (93.1%), coated tongue (58.62%), and crenated tongue (27.59%).

Conclusion Fissured tongue is a normal variance of the oral mucosa that is commonly found in healthy elderly patients.

Aponeurosis linguae-Myocutaneous or myotendinous junctions of skeletal muscle fibres in the human tongue?

The morphology of the more superficial tissue of the human tongue was investigated and discussed with the clinical appearance of fissures. Three regions could be distinguished according to the presence and shape of the aponeurosis linguae: the central region showed a thick aponeurotic plate with myotendinous muscle fibre insertions. The lateral region showed still an aponeurosis linguae but of reduced thickness and without muscle insertions. The edge-wise and lower region showed no aponeurosis linguae but a fatty subcutis and myocutaneous muscle fibre insertions lacking specific molecules of myotendinous junctions. This system of partially developed exoskeleton seems to underlie but not to be involved in tongue fissures, which are more superficial within the epidermis and dermis.

Cerebriform Tongue

Cerebriform tongue (CT) is diagnosed to be a benign clinical condition that is characterized by grooves on the dorsal surface of the tongue and referred with other terminologies such as the scrotal tongue, grooved tongue, lingua fissurata, and lingua plicata which can be chronic trauma, vitamin deficiencies, and probably not a developmental malformation. The incidence of this condition was predominant among males and found to be higher with increasing age. It is very rarely observed in children. It is usually painless and sometimes food debris accumulation can irritate. CT has been reported with the association of various systemic factors and syndromes. A case of a 62-year-old male with CT is presented along with the review of the literature.

Oral and Dental Status of Lebanese and Syrian Refugees Living in Proximity to Deir Kanoun Ras El Ain Dump in Lebanon

Aims:

In this study, we aimed at investigating the oral and dental health conditions of Lebanese and Syrian refugees living in proximity to Deir Kanoun Ras El Ain dump whereby its leachates influx into a canal used for irrigation and drinking purposes.

Materials and Methods:

This observational study involved oral and dental examinations of 589 Lebanese and Syrian Refugees participants living in the three villages: Deir Kanoun Ras El Ain, Klayleh, and Smaiyeh. Differences in oral and dental examination results were analyzed between different villages, sexes, nationalities, and age groups. Correlation tests were conducted between dental fluorosis, staining, papilla swelling, and several sociodemographic factors.

Results:

Dental fluorosis, staining, and papilla swelling were the most prominent problems among total participants. The highest percentages of individuals with the studied diseases were shown to be in Klayleh village, among females, and individuals aged between 21 and 40 years. Significant associations were observed between dental fluorosis and nationality; between dental staining and gender, nationality, age, and smoking; as well as between papilla swelling and age, smoking, and diabetes.

Conclusions:

Our study investigated and highlighted the prevalence of several oral and dental diseases among Lebanese and Syrian inhabitants that are related to environmental, social, and economic determinants and not just by individual behaviors. It also showed gaps of oral and dental health knowledge that recommend implementing health systems that focus on preventing oral diseases.

Salivary levels of interleukin-8 and growth factors are modulated in patients with geographic tongue

OBJECTIVES

The aim of the study was to determine the levels of salivary epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) as well as interleukin-8 (IL-8) in patients with geographic tongue (GT), as compared to control subjects.

METHODOLOGY

An enzyme-linked immunosorbent assay was used to measure the levels of IL-8, EGF and VEGF in whole saliva samples collected from 34 patients with GT and 38 control subjects. The patients and controls were grouped and matched according to age, gender and the presence of systemic diseases, which are factors that may influence the levels of salivary biomarkers.

RESULTS

All patients with GT displayed significantly higher levels of IL-8 than the controls (P < 0.001). The young female patients also showed reduced levels of EGF (P < 0.05) and VEGF (P < 0.05), as compared to the young male patients where no such differences were observed. Interestingly, high levels of IL-8 (P < 0.001) and VEGF (P < 0.05) were detected in the patients with GT who also suffered from hypertension.

CONCLUSION

We consider IL-8 an inflammatory mediator, which contributes to the acute inflammatory response found in GT. EGF and VEGF also seem to be involved in the pathophysiology of GT.

Diagnosis of Lingual Atrophic Conditions: Associations with Local and Systemic Factors. A Descriptive Review

Atrophic glossitis is a condition characterised by absence of filiform or fungiform papillae on the dorsal surface of the tongue. Consequently, the ordinary texture and appearance of the dorsal tongue, determined by papillary protrusion, turns into a soft and smooth aspect.

Throughout the years, many factors, both local and systemic, have been associated with atrophic glossitis as the tongue is currently considered to be a mirror of general health. Moreover, various tongue conditions were wrongly diagnosed as atrophic glossitis. Oral involvement can conceal underlying systemic conditions and, in this perspective, the role of clinicians is fundamental.

Early recognition of oral signs and symptoms, through a careful examination of oral anatomical structures, plays a crucial role in providing patients with a better prognosis.

Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant

Melkersson-Rosenthal syndrome is a rare neuro-mucocutaneous disease with a chronic intermittent course, characterized by a classic triad of orofacial swelling, fissured tongue (lingua plicata) and facial paralysis. The authors describe the case of an oligosymptomatic variant (lip and tongue involvement) with childhood onset, whose diagnosis was only established at the age of 19 years. The syndrome's pathophysiology is unclear and the treatment is challenging; corticosteroid therapy is the mainstay of treatment and is associated with clinical and histological improvement.