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GEOGRAPHIC TONGUE: CASE REPORT AND LITERATURE REVIEW.

Byline: MAHREEN SHAHZAD ANAM SATTAR and SYED MOHAMMAD FARAN ALI

Abstract

Geographic tongue (Benign migratory glossitis erythema migrans) is an asymptomatic inflam- matory disorder of tongue of unknown etiology. This disease is characterized by erythematous areas showing raised greyish or white circinate lines or bands with irregular pattern on the dorsal surface of the tongue and depapillation. The objective in presenting the case report and literature review is to discuss the clinical presentation associated causative factors and management strategies of geographic tongue.

Key Word: Geographic tongue.

INTRODUCTION

Geographic tongue (Benign migratory glossitis) may be characterized by erythematous patches with whitish margins across the surface of the tongue with periods of exacerbation and remission that confer the typical migratory aspect of this entity. The central erythematous patch represents atrophy of the filiform papillae. The white border is composed of regenerating filiform papillae and a mixture of keratin and neutro- phils. The fungiform papillae remain shiny dark red eminences. It is a benign condition commonly occurring on the tip lateral borders and dorsum of the tongue; lesions sometimes extend to the ventral portion as well.

The etiology of geographic tongue is not well under- stood. The diagnosis is based on history and clinical presentation characteristics of the lesion particularly the migratory pattern on the dorsal surface of tongue. Geographic tongue is an inflammatory disease usually asymptomatic in nature but in some cases burning sensation has been reported. Similar lesions may also be seen in atrophic candidiasis local trauma drug induced reactions chemical burn psoriasis atrophic lichen panus and erthyema migrans.

The purpose of this study was to determine the clinical presentation of geographic tongue associated etiological factors and treatment modalities.

CASE REPORT

A 13 year old male came to OPD with the complaint of pain in lower left side particularly in first molar. Pain was severe and continuous in nature radiated towards head and was aggravated on eating food and relieved by medicine. During intra oral examination lower left first molar was found carious. Working diagnosis was reversible pulpitis and a periapical radiograph was taken. He was advised to have RCT followed by porce- lain crown. Besides on doing further oral examination it was diagnosed that he has geographic tongue and patient was not aware from it. His medical history was unremarkable. Detailed history related to tongue that condition is mostly asymptomatic but rarely mild burning sensation occurs on tongue on eating spicy food and drinking acidic beverages. On examination of tongue groups of smooth reddish-pink atrophic or depapillated patches on the dorsum or lateral borders of the tongue were noted.

These patches frequently have a slightly elevated thin yellow border (Fig 1 and 2). Just to differentiate it from other similar oral lesion such as psoriasis Reiter syndrome glossitis lichen planus and lupus erythematosus his scalp hair palms nails soles and eye were examined but no abnormalities were found. This patient was prescribed benzydamine hydrocholride mouth wash for symptomatic relief. On second visit there was improvement in his symptoms and on observing the oral lesion in patient his parents and siblings were called for detailed oral examination but no such lesion were found among them.

DISCUSSION

A plenty of geographic tongue literature is avail- able. One case is discussed here. The prevalence of the appearance of geographic tongue is important and it varies from region to region and studies conducted in those regions. According to the study of Goswami the prevalence of geographic tongue ranged from 1.0-2.5% in the study population.5 Darwazeh reported the prevalence which was 4.8% in Jordanian population.6 Investigations proved that there was no specific racial predilection or gender difference observed in their studies. Contrary to this the study conducted by Brian revealed that geographic tongue was highly expressed in white and black population as compared to Mexican Americans. In United States of America geographic tongue prevalence range is from 1-14%.7

The most commonly affected site is the tongue; however other oral mucosal soft tissue sites may be affected. The majority of affected patients are asymptomatic. However discomfort ranging from foreign body sensa- tion to minimal itching to a severe burning sensation which may occasionally interfere with eating or sleep- ing. Moreover some patients implicate smoking and seasoned or spicy foods as aggravating factors.8 The etiology of geographic tongue is not well understood but various factors contribute in the pathogenesis of this disease. Some researchers still consider it as an anomaly of tongue and others mark it as hereditary in origin.4 Geographic tongue has been reported with increased frequency in patients with psoriasis9 and in patients with fissured tongue. Geographic tongue and fissured tongue have been reported in association with chronic granulomatous disease .10

Previous studies have shown the involvement of geographic tongue with various systemic and psychological factors such as anemia emotional stress Reiter's syndrome allergies diabetes and hormonal disturbances. The histopathological findings are parakeratosis and psoriasiform hyperplasia with neutrophilic infiltration into the epithelium. The diagnosis of BMG usually is based on the history and clinical presentation. When the lesion is asymptomatic no medical intervention is required. Topical prednis- olone can be used for the treatment of symptomatic lesion. A topical or systemic antifungal medication can be tried if secondary candidiasis is suspected. Nevertheless successful treatment with cyclosporine and with topical and systemic antihistamines has been reported. Patients are encouraged to brush the dorsum of the tongue to eliminate debris that may serve as an irritant if the condition is symptomatic.5

REFERENCES

1 Karuza Maria Alves Pereira1 Cassiano FranciscoWeege Non- aka2 Pedro Paulo de Andrade Santos3 Ana Myriam Costa de Medeiros4 HACopyrightbel Cavalcanti GalvAPound o5 Unusual coexistence of oral lymphoepithelial cyst andbenign migratory glossitis BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY 75 (2) MARCH/APRIL 2009

2 Jainkittivong A Langlais RP. Geographic Tongue: Clinical Characteristics of 188 Cases. J Contemp Dent Pract 2005 February;(6)1:123-35.

3 Honarmand M Farhad ML Shirzaiy M Sehhatpour M. Geo- graphic Tongue and Associated Risk Factors among Iranian Dental Patients. Iran J Public Health. 2013; 42(2): 215-19.

4 Daud Mirza Navid Rashid Qureshi Kashif Naqvi Benign Migratory Glossitis An Unusual Enigmatic Lesion Pakistan Oral and Dental Journal Vol 33 No. 3 (December 2013)

5 Goswami M Verma A Verma M. Benign migratory glossitis with fissured tongue. J Indian Soc Pedod Prev Dent. 2012 Apr- Jun; 30(2): 173-75

6 Darwazeh AM Almelaih AA. Tongue lesions in a Jordanian population. Prevalence symptoms subject's knowledge and treatment provided. Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16(6): e745-49.

7 Brian VR Derby R Bunt WC. Common tongue conditions in primary care. Am Fam Physician. 2010 mar 1;81(5):627-34.

8 Igor T. GavrilovicA Yevgeniy BalagulaB Alyx C. RosenB Vijay RamaswamyC Maura N. DicklerD Ira J. DunkelC Mario E. Lacoutureb Characteristics Of Oral Mucosal Events Related To Bevacizumab Treatment The Oncologist 2012;17:274278 Www.Theoncologist.Com

9 Zargari O. The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients. Clin Exp Dermatol 2006;2: 192-95.

10 Dar-Odeh NS Hayajneh WA Abu-Hammad OA Hammad HMAl-Wahadneh AM Bulos NK et al. Orofacial findings in chronic granulomatous disease: Report of twelve patients and review of the literature. BMC Res Notes 2010;3:37.

11 Masaya Ishibashi 1 Genichi Tojo2 Masahiko Watanabe3 Taka- hiro Tamabuchi 4 Takashi Masu4Setsuya Aiba2 Geographic tongue treated with topical tacrolimus J Dermatol Case Rep 2010; 4: 57-59.
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Publication:Pakistan Oral and Dental Journal
Article Type:Clinical report
Date:Sep 30, 2014
Words:1229
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