Fissured tongue is a condition characterized by the presence of grooves of varying depth on the surface of the tongue. These are mostly seen on the dorsal (upper) and the lateral aspects of the tongue. This condition is also called as the scrotal tongue and lingua plicata.
The condition of the fissured tongue is commonly seen in the general population and is ‘benign’ in nature. Sometimes these grooves are considered to be simple variations of the normal tongue.
The exact cause for the appearance of fissures on the tongue isn’t known. However, many oral pathologists and other specialists in the field suspect a ‘polygenic mode of inheritance’ to be the main reason.
And that’s because the condition of the fissured tongue is highly prevalent in families whose ancestors are already affected by the same condition. So, the scrotal tongue can be considered an autosomal dominant trait.
A person who has this condition is usually asymptomatic. But in some cases, the fissured tongue is seen in association with other diseases such as ‘Melkersson-Rosenthal syndrome’ and ‘Down syndrome’. These fissures on the surfaces of the tongue are also frequently seen in case of ‘geographic tongue‘.
Fissured Tongue in Melkersson-Rosenthal syndrome
Melkersson-Rosenthal syndrome is a rare condition which consists of a triad of persistent or recurring lip swelling or facial swelling, intermittent facial (seventh cranial) nerve paralysis (Bell’s palsy), and a fissured tongue.
The main reason for this syndrome is still not known. The syndrome usually manifests itself in the form of prominent lip enlargement which may or may not affect both the lips. The affected lip may be tender and may also bleed.
In this condition, noncaseating granulomatous inflammatory tissue is a common finding, histologically. This condition characterized by chronic swelling of the lip is called ‘Cheilitis granulomatosa’.
The other component of the triad of diseases seen in Melkersson-Rosenthal syndrome is Bell’s palsy or the facial nerve paralysis. This may or may not be present in all cases. And if present, the condition may resolve spontaneously.
The third component of the triad is the fissured tongue. The presence of fissures on the surfaces of the tongue in association with the two other features mentioned above is used as the basis for the clinical diagnosis of the syndrome.
Clinical Features of the Fissured Tongue
The condition of the scrotal tongue is a commonly seen phenomenon among the general public and its prevalence rate is believed to be as high as 21%. Its believed that both the males and the females are equally affected by this condition (males, slightly more).
The fissures on the tongue become more prominent as the age advances. Even though it is present since childhood, diagnosis is usually done in the adult age.
If debris gets entrapped in between the fissures in the scrotal tongue, the condition may need attention. Also in cases of fissures associated with the geographic tongue and the syndromes mentioned above, medical intervention may be required. Apart from these, the scrotal tongue condition is usually asymptomatic.
Clinically the fissures appear to be starting from the dorsal (upper) surface of the tongue and extending towards the lateral surface. The fissures appear to be of varying depths and widths. They can be up to 6mm in diameter.
If fissures are prominent they may be interconnected and may appear to be separating the tongue into several lobules.
A biopsy is rarely required for a case of the fissured tongue. If a biopsy is performed, one may find the following things histologically.
- An increase in the thickness of the lamina propria
- Loss of filiform papillae of the surface mucosa,
- Hyperplasia of the rete pegs,
- Neutrophilic microabscesses within the epithelium,
- A mixed inflammatory infiltrate, in the lamina propria.
Treatment for Scrotal Tongue
No specific treatment is required for the fissured tongue unless it is associated with other diseases and/or syndromes.