MacroglossiaBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6975.329 (Published 04 February 1995) Cite this as: BMJ 1995;310:329
Classify the pathology as normal or abnormal
- A G Renehan,
- M E Morton
- Medical student University of Manchester, Manchester M13 9PL
- Consultant in oral and maxillofacial surgery Blackburn Royal Infirmary, Blackburn BB2 3LR
EDITOR,—We agree with P Murthy and M R Laing that the term macroglossia should be restricted to chronic enlargement of the tongue as the differentiation from acute swelling has implications for both the aetiology and management.1 Having made this distinction early in the paper, the authors later give rise to confusion by listing angio-oedema, Ludwig's angina, and angioneurotic oedema as causes. These conditions are of rapid onset and do not cause true macroglossia. We have reported on a series of patients with acute swelling of the tongue and found corticosteroids useful.2 They are unlikely, however, to be of benefit in long standing cases.
In our experience, it is helpful to classify the pathology of macroglossia as normal or abnormal. Biopsy is therefore indicated, particularly if reduction glossectomy is contemplated. The diseased tongue—for instance, in lymphangioma or in amyloidosis—is a hugely vascular structure, and blood loss may be considerable and even life threatening. Possible preoperative precautions include tracheotomy, ligation of the external carotid artery and embolisation of selective branches of the external carotid artery tree. Surgery by laser is a theoretical alternative, but experience is limited.