GEOGRAPHIC TONGUE: CASE REPORT AND LITERATURE REVIEW

GEOGRAPHIC TONGUE: CASE REPORT AND LITERATURE REVIEW

1MAHREEN SHAHZAD, BDS, MSc (Oral Medicine) 2ANAM SATTAR, BDS

3SYED MOHAMMAD FARAN ALI, BDS, MSc (Oral Pathology)

ABSTRACT

Geographic tongue (Benign migratory glossitis, erythema migrans) is an asymptomatic inflammatory 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

CASE REPORT

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 neutrophils. 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 understood.? 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.

Correspondence: Dr Mahreen Shahzad, 1Assistant Professor and Head Oral Diagnosis & Medicine Department, Sir Syed Dental Hospital, Karachi, Pakistan. DHA, Phase-7, Near KPT Interchange, Korangi Road, Karachi. Residential Address: House No. 41, 1st Street, Khayaban-e-Rahat, Phase-6, DHA, Karachi. E-mail: mahreen_dimz@, Contact: 35383241-35383978, Ext- 820 2 Demostrator, Oral Diagnosis & Medicine Department 3 Assistant Professor, Oral Pathology Department

Received for Publication: Revision Received: Revision Accepted:

July 10, 2014 August 8, 2014 August 9, 2014

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 porcelain 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 & 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 available. 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 popula-

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Geographic Tongue

Fig 1: Geographic Tongue in 13 years old male

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. 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 prednisolone 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

Fig 2: Irregular erthyematous patches bounded by slightly elevated keratotic bands on dorsal surface tongue

tion.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 sensation to minimal itching to a severe burning sensation, which may occasionally interfere with eating or sleeping. Moreover, some patients implicate smoking and seasoned or spicy foods as aggravating factors.8 The etiology of geographic tongue is not well understood,

REFERENCES

1 Karuza Maria Alves Pereira1, Cassiano Francisco,Weege Nonaka2, Pedro Paulo de Andrade Santos3, Ana Myriam Costa de Medeiros4, H?bel Cavalcanti Galv?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. Geographic 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 & 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 AprJun; 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. Gavrilovic,A Yevgeniy Balagula,B Alyx C. Rosen,B Vijay Ramaswamy,C Maura N. Dickler,D Ira J. Dunkel,C Mario E. Lacoutureb, Characteristics Of Oral Mucosal Events Related To Bevacizumab Treatment, The Oncologist 2012;17:274?278 Www.

9 Zargari O. The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients. Clin Exp Dermatol 2006;2: 19295.

10 DarOdeh NS, Hayajneh WA, AbuHammad OA, Hammad HM,AlWahadneh 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, Takahiro Tamabuchi 4, Takashi Masu4,Setsuya Aiba2, Geographic tongue treated with topical tacrolimus, J Dermatol Case Rep 2010; 4: 57-59.

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