Macroglossia

Management depends on the cause; many patients will need long term psychological support

Macroglossia is traditionally defined as a resting tongue that protrudes beyond the teeth or alveolar ridge. The diagnosis is usually based on this sign and comparison with an apparently normal tongue (objective measurements of size are unreliable). The term should be reserved for cases of long term painless enlargement of the tongue and is distinct from rapid growth of the tongue due to acute parenchymatous glossitis.1

The condition may be classified as true macroglossia, which is associated with definitive histopathological findings, or pseudomacroglossia, which is a relative enlargement of the tongue secondary to a small mandible and with no demonstrable histological abnormalities. True macroglossia may be primary—characterised by hypertrophy or hyperplasia of the tongue muscles—or secondary—the result of infiltration of normal tissue with anomalous elements.2

Given its varied causes, both physicians and surgeons may see macroglossia. Common causes of true macroglossia in children include hypothyroidism, lymphangioma, haemangioma, idiopathic hyperplasia, metabolic disorders, and chromosomal abnormalities including the Beckwith-Wiedemann syndrome.2 Amyloidosis is the commonest cause of macroglossia in adults, the tongue being involved in both its primary and secondary forms.3 Secondary macroglossia may also be a manifestation of both benign …