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Diagnosis of macroglossia and indications for reduction glossectomy
Larry M. Wolford DDS and David A. Cottrell DMD
Dallas, Texas, and Boston, Mass

Available online 5 November 2005.

Abstract
Macroglossia can create dentomusculoskeletal deformities, instability of orthodontic and orthognathic surgical procedures, and masticatory, speech, and airway problems. The cause of macroglossiamust be clearly defined, and true macroglossia separated from pseudomacroglossia (displacement of the tongue created by anatomic factors other than tongue size alone). This article discusses the signs and symptoms of macroglossia, including the clinical and radiographic features, treatment techniques, as well as previously reported results. Cases are shown to illustrate the applicability of thistechnique. (Am J Orthod Dentofac Orthop 1996;110:170-7.)
Article Outline
Etiologic factors of macroglossia
Signs and symptoms of macroglossia
Experimental studies of the tongue
Sequencing in combination with orthognathic surgery
Reported results
Case reports
Case 1
Case 2
Case 3
Conclusions
References
An enlarged tongue (macroglossia) can cause dentomusculoskeletal deformities,instability of orthodontic and orthognathic surgical treatment, and create masticatory, speech, and airway management problems. Understanding the signs and symptoms of macroglossia will help identify those patients who could benefit from a reduction glossectomy (reduction of tongue size) to improve function, esthetics, and treatment stability. This article discusses the etiologic factors, diagnosticcriteria, experimental studies, preferred technique for performing reduction glossectomy, and reported results.
Etiologic factors of macroglossia
Pseudomacroglossia is a condition where the tongue may be normal in size, but appears large relative to its anatomic interrelationships. This can be created by (1) habitual posturing of the tongue, (2) hypertrophied tonsils and adenoid tissue displacing thetongue forward, (3) low palatal vault decreasing the oral cavity volume, (4) transverse, vertical, or anteroposterior deficiency of the maxillary or mandibular arches that decreases the oral cavity volume, (5) severe mandibular deficiency, and (6) cysts or tumors that displace the tongue. Pseudomacroglossia must be distinguished from true macroglossia because the methods of management may bedifferent. For instance, if the problem is secondary to enlarged tonsils displacing the tongue forward, then the indicated treatment may be tonsillectomy, thereby increasing the oropharyngeal volume to accommodate the tongue. If the mandible is severely deficient, creating a relative macroglossia, then orthognathic surgery to advance the mandible would also increase the oral cavity volume. If a cystor tumor is the etiologic factor, removal of the lesion would be indicated.
There are many congenital and acquired causes of true macroglossia. Examples of congenital enlargement of the tongue include: (1) muscular hypertrophy, (2) glandular hyperplasia, (3) hemangioma, and (4) lymphangioma.1 Macroglossia also occurs commonly in conditions such as Downs Syndrome and Beckwith-Wiedemann syndrome.2and 3
Acquired factors may include acromegaly, myxedema, amyloidosis, tertiary syphilis, cyst or tumor involving the tongue, and neurologic injury.1 and 4 With the acquired deformities, the underlying cause should be addressed primarily, and any residual macroglossia treated secondarily.
By far, the most common cause of macroglossia is muscular hypertrophy and will be the primary focus of thisarticle.
Signs and symptoms of macroglossia
To determine whether a reduction glossectomy is necessary, it will be important to identify the signs and symptoms of macroglossia. There are several clinical and cephalometric features (Tables I and II) that may help the clinician identify the presence or absence of macroglossia.
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