Multiple Clinical Findings on The Tongue: Variants of Normal or Pathologic Condition? (A Case Report)

Various normal and pathologic findings might occasionally be found on the tongue and might confuse some patients and clinician due to its atypical presentation. This case report aimed to present a case report of multiple oral findings related to variants of normal and pathological findings on the tongue: geographic tongue, fissured tongue, and central papillary atrophy. A 53-year-old male patient came to Universitas Indonesia Dental Hospital for a dental check-up. Objective examination in the tongue showed depapilated areas surrounded by keratinized lining in the ventral and lateral left and right area of the tongue, multiple fissures in all over the dorsum of the tongue, and an ovoid redness area in the middle of 2/3 posterior dorsum part of the tongue. All those findings were asymptomatic. Those clinical findings were diagnosed as geographic tongue, fissured tongue, and central papillary atrophy. This case presents unique multiple variants of normal and pathological findings in the tongue. It is important to an oral health professional to have knowledge and ability to determine normal anatomy, variants of normal and pathological lesions. Patients should be informed and educated about oral mucosa normal variations and related clinical findings so they would not develop unnecessary anxiety. Keywords: central papillary atrophy, fissured tongue, geographic tongue, normal variations

Application of U-Net with Global Convolution Network Module in Computer-Aided Tongue Diagnosis

The rapid development of intelligent manufacturing provides strong support for the intelligent medical service ecosystem. Researchers are committed to building Wise Information Technology of 120 (WIT 120) for residents and medical personnel with the concept of simple smart medical care and through core technologies such as Internet of Things, Big Data Analytics, Artificial Intelligence, and microservice framework, to improve patient safety, medical quality, clinical efficiency, and operational benefits. Among them, how to use computers and deep learning technology to assist in the diagnosis of tongue images and realize intelligent tongue diagnosis has become a major trend. Tongue crack is an important feature of tongue states. Not only does change of tongue crack states reflect objectively and accurately changed circumstances of some typical diseases and TCM syndrome but also semantic segmentation of fissured tongue can combine the other features of tongue states to further improve tongue diagnosis systems’ identification accuracy. Although computer tongue diagnosis technology has made great progress, there are few studies on the fissured tongue, and most of them focus on the analysis of tongue coating and body. In this paper, we do systematic and in-depth researches and propose an improved U-Net network for image semantic segmentation of fissured tongue. By introducing the Global Convolution Network module into the encoder part of U-Net, it solves the problem that the encoder part is relatively simple and cannot extract relatively abstract high-level semantic features. Finally, the method is verified by experiments. The improved U-Net network has a better segmentation effect and higher segmentation accuracy for fissured tongue image dataset. It can be used to design a computer-aided tongue diagnosis system.

Migratory Glossitis Associated with Cleft Tongue: Case Report

Benign migratory glossitis, also known as geographic tongue, is characterized by the tongue inflammation and is associated with pain and difficulty eating due to the lingual papillae atrophy. It may appear in association with the fissured tongue. This paper reports the case of a 47-year-old male patient who sought dental care with the main complaint of burning, discomfort, increased sensitivity and a burning sensation on the tongue. He was diagnosed with migratory glossitis associated with a fissured tongue. The patient treatment was performed with an ointment based on triamcinolone acetonide (Omcilon- A Orabase®), which showed improvement in the clinical signs after seven days. The therapy used in this patient was effective in restoring the tongue papillae and improving signs and symptoms. Keywords: Glossitis, Benign Migratory. Tongue, Fissured. Oral Medicine ResumoA glossite migratória benigna, também conhecida como língua geográfica, caracteriza-se por inflamação da língua e está associada a dor e dificuldade na alimentação devido a atrofia das papilas linguais. Pode aparecer em associação à língua fissurada. Este trabalho relata o caso de um paciente do sexo masculino com idade de 47 anos que buscou atendimento odontológico com queixa principal de ardência, desconforto, sensibilidade aumentada e sensação de queimação na língua. Foi diagnosticado com glossite migratória associada a língua fissurada. O tratamento do paciente foi realizado com pomada à base de triancinolona acetonida (Omcilon- A Orabase®) demonstrou melhora no quadro clinico após sete dias. A terapêutica usada neste paciente foi eficaz no restabelecimento das papilas da língua e melhora dos sinais e sintomas. Palavras-chave: Glossite Migratória Benigna. Língua Fissurada. Medicina Bucal.

Kelainan variasi normal lidah yang dipicu makanan pedas dan panas pada pasien dengan kondisi anemiaAbnormalities in normal tongue variation triggered by hot and spicy food in anaemic patients

Pendahuluan: Lidah dalam filosofi medis dipercaya sebagai barometer kesehatan rongga mulut maupun tubuh secara keseluruhan. Permukaan mukosa lidah kadang memperlihatkan gambaran yang berbeda dari kondisi normal sehingga disebut variasi normal. Geographic tongue dan fissured tongue merupakan suatu variasi normal yang asimptomatik namun dapat menjadi simptomatik ketika dipengaruhi suatu kebiasaan baru yang bersifat mengiritasi seperti setiap hari mengkonsumsi makanan yang memiliki rasa pedas yang ekstrim. Tujuan laporan kasus ini memaparkan tentang kelainan pada variasi normal lidah yang dipicu oleh kebiasaan baru konsumsi makanan tersebut pada seorang pasien remaja. Pasien juga kemudian diketahui dalam kondisi anemia. Laporan kasus: Seorang wanita berusia 18 tahun berobat ke Poliklinik Ilmu Penyakit Mulut RSUP.Dr Hasan Sadikin dengan diagnosis geographic tongue disertai fissured tongue. Pasien mengeluhkan sakit pada lidah dan terasa mati rasa serta nyeri seperti tertusuk-tusuk, terutama jika terkena makanan pedas, sejak satu tahun yang lalu. Terdapat riwayat mengonsumsi makanan yang pedas dan panas hampir setiap hari. Hasil pemeriksaan penunjang hematologi menunjukkan pasien dalam kondisi anemia. Penatalaksanan yang dilakukan meliputi instruksi menjaga kesehatan rongga mulut, pemberian preparat Fe, B12, dan asam folat, serta obat kumur. Pasien menunjukkan perbaikan dalam pengobatan selama 3 minggu. Simpulan: Kondisi variasi normal pada lidah yang semula asimtomatik dapat menjadi simtomatik akibat iritasi makanan panas dan pedas, pada pasien dengan kondisi anemia.Kata kunci: Geographic tongue, fissured tongue, variasi normal lidah, makanan pedas dan panas, anemia. ABSTRACTIntroduction: In medical philosophy, the tongue is believed to be a barometer of the oral cavity’s health and the body as a whole. The mucosal tongue surface often shows a different feature from normal conditions, thus called normal variation. Geographic tongue and fissured tongue are normal variations that are asymptomatic but can become symptomatic when influenced by new irritating habits such as daily food consumption with an extremely spicy taste. This case report was aimed to describe abnormalities in normal tongue variation triggered by the new habit of consuming such foods in a teenage patient. The patient was also found to be anaemic. Case report: An 18-year-old woman went to the Oral Medicine Polyclinics of Dr Hasan Sadikin Hospital with a geographic tongue diagnosis accompanied by the fissured tongue. The patient complained of a sore tongue and felt numbness and soreness like being prickly, especially when exposed to spicy food, since one year prior. There was a history of spicy and hot foods consumption almost every day. The results of the haematology examination showed that the patient was in an anaemic condition. The treatment included instructions for maintaining oral health, administration of Fe, B12, folic acid preparations, and mouthwash usage. The patient showed improvement after treatment for three weeks. Conclusion: The condition of normal tongue variation, which initially asymptomatic, can become symptomatic due to irritation of hot and spicy food in anaemic patients.Keywords: Geographic tongue, fissured tongue, normal tongue variations, hot and spicy food, anaemia.

Clinical Profile of Melkersson-Rosenthal Syndrome/Orofacial Granulomatosis: A Review of 51 Patients

Background Melkersson–Rosenthal syndrome (MRS) is a rare disease characterized by the triad of granulomatous cheilitis, fissured tongue, and facial paralysis. Publications concerning large series are rare in the literature. Objectives To describe the clinical and histopathological characteristics of patients with complete and oligosymptomatic forms of MRS. Methods A retrospective records review was performed for the diagnoses of Melkersson-Rosenthal syndrome, granulomatous cheilitis, and orofacial granulomatosis at oral Diseases Clinic of the Department of Dermatology, University of São Paulo, Brazil (2003, 2017). Results A total of 51 patients were included, mean age at presentation 35.69 years. Four patients were younger than 18 years. The complete triad of was observed in 10 patients. The rare findings of granulomatous blepharitis, gingivitis and palatitis are presented. Comorbidities included Crohn’s disease (5 patients), migraine headaches (1 patient) and convulsions (2 patients). Granulomatous inflammatory infiltrate was detected in 31 biopsies. Medical therapies included included oral and intralesional steroids, thalidomide, dapsone, azathioprine, tetracycline, methotrexate, and surgery, with variable responses. Conclusions Our report meant to draw attention to the clinical spectrum of this rare disorder, mainly to oligosymptomatic forms and rarer presentations.

Melkersson–Rosenthal syndrome misdiagnosed as recurrent Bell’s palsy: a case report and review of literature

Background Melkersson–Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder of unknown cause, clinically characterized by a triad of recurrent facial palsy, orofacial swelling, and fissured tongue. It is frequently seen in females in their second and third decades of life. MRS is diagnosed based on clinical features and it is rarely possible to observe all the classical triad symptoms at the same time. The disorder may cause recurring peripheral facial palsy that is wrongly diagnosed as recurrent Bell’s palsy Case presentation A 25-year-old female patient was presented to the neurology clinic of Tikur Anbessa Specialized Hospital in Addis Ababa complaining of recurrent left-side peripheral facial weakness, facial swelling and fissured tongue of 5 days duration. Her past medical history was positive for similar symptoms, for which she was diagnosed with Bell’s palsy and received oral corticosteroid treatment. On examination left side lower facial swelling with flat naso-labial fold and fissured tongue were identified. After excluding other mimickers, she was diagnosed with Melkersson–Rosenthal syndrome and completely recovered with high dose of corticosteroid treatment. Conclusion Melkersson–Rosenthal syndrome may present with the classic triads of symptoms, but mostly it shows an incomplete clinical pattern. Therefore, when clinicians including allergists encountered patients with facial swelling and facial palsy, they should have to consider MRS in their differential diagnosis and specifically assess for recurrent facial palsy and fissured tongue. Unlike true angioedema, the facial swelling in MRS often develops gradually and it might cause permanent swelling with cosmetic disfigurement from multiple relapses, which can be prevented by early detection and timely initiation of treatment.