The Internet Journal of Nutrition and Wellness ISSN: 1937-8297

Fissured Tongue: A ase !e"ort and !e#ie$

of %iterature
Manu Rathee MDS Prosthodontics Assistant Professor, Department of Prosthodontics,
Government Dental College, Pt. B.D Sharma Universit of !ealth Sciences Rohta" #ndia
Anita !ooda MDS Prosthodontics Associate Professor and !ead, $ral Anatom, Government
Dental College, Pt. B.D Sharma Universit of !ealth Sciences Rohta" #ndia
Arun %umar Post&Graduate student, Pedodontics and Preventive Dentistr, Government Dental
College, Pt. B.D Sharma Universit of !ealth Sciences Rohta" #ndia
itation: M. Rathee, A. !ooda, A. %umar' (issured )ongue' A Case Report and Revie* of
+iterature. The Internet Journal of Nutrition and Wellness. ,-.- /olume .- 0um1er .. D$#'
.-.223-4ce
&e'$ords: Dorsal surface, (issured tongue, Geographic tongue, #nflammation
A(stra)t
(issured tongue is a 1enign condition characteri5ed 1 numerous shallo* to deep grooves or
furro*s on the dorsal surface of the tongue. Aging, malnutrition and local factors such as
infection and ma contri1ute to its development and smptoms. (issured tongue ma have a
familial occurrence and can 1e associated *ith certain underling sndromes. A case of a 2-
ears female *ith fissured tongue along *ith a revie* of literature is 1eing presented.
Introdu)tion
Patients *ith fissured tongue ma present *ith multiple grooves, or furro*s on the dorsal surface
tongue ranging from , to 6 mm in depth. )he condition is usuall asmptomatic unless de1ris is
entrapped *ithin fissure. Patients ma also present *ith complains of 1urning and soreness in
tongue. )he mucosa of the dorsal surface of the tongue has filiform papillae, the hairs of *hich
ma shelter the superficial epithelial cells from the mechanical stress.
.
)his mechanical
protection of tongue mucosa is lo*ered in fissured tongue in the a1sence of hairs, "eratin and
"eratohaline granules and ma contri1ute to inflammation.
,
A case of fissured tongue is 1eing
reported, etiologic factors and management of this entit are discussed.
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ase !e"ort
A 2- ear old female from the rural area *ith poor socioeconomic 1ac"ground presented in the
dental outpatient department *ith one month histor of mild pain and 1urning sensation on the
tongue *hich aggravated on inta"e of citrus and spic foods. She also complained of discomfort
during che*ing and malodor. Medical and famil histor *ere non&contri1utor.
General clinical e7amination demonstrated the patient *as normal e7cept for mild anemia.
87tra&oral e7amination revealed normal facial morpholog, no s"in lesions *ere seen. #ntra&oral
e7amination revealed poor oral hgiene, halitosis and deepl grooved lesions on the dorsal
surface of the tongue *ith entrapped food de1ris. (lushing *as done on the tongue surface *ith
diluted povodine&iodine solution *hich revealed numerous prominent fissures covering the entire
dorsal surface and dividing the tongue papillae into multiple separate lo1ules. 9(ig .: 0o other
tongue lesion or associated sndrome *as o1served.
(ig .' Sho*ing fissured tongue
Routine 1lood investigation revealed mild anemia. 0utrition education and diet modification *as
advised. )he patient *as put on oral iron therap. Patient *as advised to maintain the lingual
hgiene 1 .- times stro"ing the tongue *ith soft tooth 1rush after meals and 1edtime
supplemented *ith mouth*ash 9-.,; solution *4v of Chlorhe7idine gluconate: prescri1ed to
s*ish and spit *ith .- ml t*ice dail for one minute and to strictl adhere to the oral hgiene
instructions. Patient had smptomatic improvement *ith the treatment.
*is)ussion
(issured tongue is a common variant of the tongue that has numerous grooves or fissures on the
dorsum of the tongue
<
. )he prevalence rate varies in different geological regions' it=s reported to
1e -.6; in South Africa, ,>.>; in Bra5il
?
, 2.>.; in southern #ndia
2
. #t occurs *orld*ide *ith no
predilection for an particular race. Benevides
6
supported a difference in prevalence 1et*een the
se7es, and reported a higher fre@uenc among males. Motalle1neAad also reported a higher
prevalence in males in an epidemiological stud in #ranian patients
>
*hile Bensc5
3
reported
higher fre@uenc in *omen.
)he etiolog is un"no*n 1ut hereditar plas a significant role. )he condition ma 1e
congenital, present at 1irth, or ma 1ecome apparent during childhood or later in life. AAra
e7amined clinical and genetic characteristics of histologicall defined fissured tongue in a
familial stud and reported that fissured tongue *ith smooth&surfaced papillae *as transmitted as
a dominant characteristic *ith incomplete penetrance and *as preceded 1 geographic tongue.
)he severit of fissured tongue changed *ith increasing age. )ongue fissuring *ith normal
appearing filiform papillae *as not familial and *as not associated *ith geographic tongue.
(issuring *ith normal&appearing structure should 1e considered as variation of normal anatom,
*hereas fissured tongue and geographical tongue are clinical and etiological disease entit.
B

Aging and local environmental factors ma also contri1ute to its development. (issured tongue
ma present as an independent manifestation or associated *ith certain underling sndromes or
familial conditions.
.-,..
Conditions associated *ith fissured tongue include Mel"ersson&Rosenthal
sndrome, Do*n sndrome, acromegal, SAorgen=s sndrome, oro&facial granulomatosis,
psoriasis and geographic tongue.
.,

)he Mel"ersson&Rosenthal sndrome consists of recurrent s*elling of the lip or face,
intermittent facial pals and fissured tongue. +ength intervals ma occur 1et*een various
manifestations.
.<

(issured tongue is the most common oral finding in psoriasis. But the severit of fissured tongue
does not seem to increase *ith increasing severit of psoriasis.
.?

SAorgenCs sndrome is an autoimmune e7ocrinopath characteri5ed 1 lmphocte infiltration of
salivar and lacrimal glands that leads to progressive 7erostomia and 7erophtalmia. $ne&third of
patients suffer of sstemic manifestations including arthritis, fever, fatigue and mucosal drness
*hereas those *ith maAor salivar involvement sho* an increased ris" to develop lo*&grade
non&!odg"in lmphomas
.2
. )he tongue in SAorgenCs sndrome often 1ecomes fissured as a result
of decreased salivar secretion.
Geographic tongue 91enign migrator glossitis: is an entit of un"no*n cause and presents
cliniDcall *ith loss of the filiform papillae on the dorsal and lateral surfaces of the tongue
sometimes accompanied 1 an advancing *hite 1order *ith or *ithout erthema. )here might
also 1e fissures on the tongue. #f smpDtomatic, patients e7perience 1urning and stinging after
ingestion of spic and acidic foods.
.6
Geographical tongue occurs in a1out .; of general
population, and 2-; in association *ith fissured tongue.
.>

(issured tongue is diagnosed clinicall on the 1asis of fissures. Based on the position of the
fissures, fissured tongue can 1e classified as median and lateral tpes.
.3
Considera1le variation is
seen in the presentation of grooves or furro*s ranging from fissures that are located mostl on
the dorso&lateral area of the tongue. )he second pattern is a large central fissure *ith smaller
fissures 1ranching out*ards at right angles. #n the most severe cases, numerous fissures cover the
entire dorsal surface dividing the tongue papillae into multiple separate EicelandsF or lo1ules as
in our case. )he condition is usuall asmptomatic. Some patients ma complain of mild pain.
.B

)he condition is *orsened 1 entrapment of food particles *ithin the fissures and in patients
*ith poor oral hgiene and nutrition.
Clinical presentation is characteristicall diagnostic and 1iops is rarel done. #nflammation has
1een descri1ed to 1e the most stri"ing histological finding in the various forms of fissured tongue
1ut not in tongue *ith normal appearing filiform papillae. !istological e7amination sho*s an
increase in the thic"ness of lamina propria, hperplasia of rete&pegs, neutrophillic micro&a1scess
in the upper epithelial laers and mi7ed inflammator infiltrate in lamina propria. An
erthematous tongue resem1les the inflammator condition "no*n as traumatic ulcerative
granuloma *ith stromal eosinophilia 9)UGS8:, mainl found in the tongue manifesting as an
ulcer *ith elevated margin. )rauma plas an important role in its development.
,-
+ac" of
traumatic event and the clinical presentation in our case, renders )UGS8 an unli"el
consideration. Mer"elsson&Rosenthal sndrome *as not considered as the patient did not e7hi1it
the other cardinal signs namel, chelitis granulomatosis and Bell=s pals.
,.
0ormal facial
morpholog of the patient ruled out acromegal and Do*n sndrome. (issured tongue as a result
of decreased salivar secretion in SAorgan sndrome *as also ruled out on the 1asis of clinical
signs and smptoms seen in this autoimmune condition that involves salivar glands.
(issured tongue is a 1enign condition and no specific treatment is indicated 1ut in patients *ith
severe conditions the first goal of management should 1e discover of the irritating cause. +ocal
measures to resolve the clinical manifestations can 1e attempted. )he patient should 1e
encouraged to maintain the oral hgiene and 1alanced diet.
on)lusion
(issured tongue is fre@uentl misdiagnosed and over&treated. $ral hgiene and nutrition need to
1e emphasi5ed to prevent the smptoms caused 1 local irritating factors.
!eferen)es
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