What is a fissured tongue

Fissured tongue is also known as ‘scrotal tongue’ or ‘lingua plicata’. Fissured tongue is a benign condition characterized by one or more shallow or deep grooves or furrows (fissures) on the top surface of the tongue ¹. These fissures can be shallow or deep, single or multiple. Often there is a prominent fissure in the center of the tongue. The depth of the fissures varies but has been noted to be up to 6 mm in diameter. When particularly prominent, the fissures or grooves may be interconnected, separating the tongue dorsum into what may appear to be several lobules. Typically most fissures are found on the middle one-third of the tongue. Fissured tongue occurs in about 2-5% in the U.S. population. The prevalence of fissured tongue worldwide varies by geographic location and has been reported to be as high as 30.5% ².  As people age, fissured tongue is found more commonly and the severity also increases. Men are affected slightly more commonly than women.

The cause of fissured tongue is not known. Some authorities believe that fissured tongue is just a variation of normal. Fissured tongue and geographic tongue (benign migratory glossitis) can occur together and some believe that these two conditions are related. However, it has been also considered that fissured tongue and geographic tongue are associated with psoriasis ³. Fissured tongue occurred with more frequency in late psoriasis, supporting that it can be a permanent consequence of geographic tongue. Geographic tongue was more common in early-onset psoriasis and it is associated with psoriasis severity ⁴.

Fissured tongue is a harmless condition usually with no associated symptoms. No treatment is necessary except to encourage good oral hygiene including brushing the top surface of the tongue to remove any food debris from the fissures. Cleansing of the tongue helps prevent irritation and possible bad breath that may occur from food getting trapped in the grooves. In addition to regular toothbrushes, numerous specific devices to clean the tongue are available at most major pharmacies. Dentists can assist patients by making recommendations concerning devices for tongue cleansing.

Figure 1. Fissured tongue

Footnote: Clinical aspects of fissured tongue (black arrow) and geographic tongue (blue arrow)

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Who can get fissured tongue?

Anyone can potentially develop fissured tongue, particularly later in life. Although the cause is unknown, fissured tongue is not a contagious disease and people cannot pass it to anyone else.

How long does fissured tongue take to heal?

Fissured tongue is a totally benign condition and is considered by most to be a variant of normal tongue architecture and not specific therapy is required ⁶. Unless trapping of food and bacteria leads to inflammation of the fissures ⁷. Gentle brushing of tongue if symptomatic inflammation occurs.

Does fissured tongue go away?

Fissured tongue is a totally benign condition and is considered by most to be a variant of normal tongue architecture and not specific therapy is required ⁶. Unless trapping of food and bacteria leads to inflammation of the fissures ⁷. Gentle brushing of tongue if symptomatic inflammation occurs.

Fissured tongue causes

The cause of fissured tongue is not clearly defined but a polygenic mode of inheritance is suspected because it may occur with certain underlying syndromes or may be an inherited condition ⁸. Fissured tongue is sometimes seen in orofacial granulomatosis, Melkersson-Rosenthal syndrome ⁹, Down syndrome, acromegaly, psoriasis, and Sjogren syndrome ¹⁰. Fissured tongue is frequently associated with geographic tongue and psoriasis, especially pustular psoriasis. Fissured tongue and geographic tongue have been reported in association with chronic granulomatous disease ¹¹.

Melkersson-Rosenthal syndrome is a rare condition consisting of a triad of persistent or recurring lip or facial swelling, intermittent seventh (facial) nerve paralysis (Bell palsy), and a fissured tongue ¹². The cause of Melkersson-Rosenthal syndrome is also unknown. The orofacial swelling usually manifests as pronounced lip enlargement. It may or may not affect both lips, and it may be tender or erythematous. Histologic examination of this tissue exhibits characteristic noncaseating granulomatous inflammation. Therapy for Melkersson-Rosenthal syndrome lesions is often intralesional steroid injections ¹³. The facial paralysis is indistinguishable from Bell palsy, and it may be an inconsistent and intermittent finding with spontaneous resolution. The presence of fissured tongue in association with these other features is diagnostic of the condition.

Although fissured tongue may be evident at birth or early childhood, the signs and symptoms of the condition tend to become more frequent and severe in adulthood. The prominence of the condition appears to increase with increasing age.

 

 

 

 

What are the signs and symptoms of fissured tongue?

Fissured tongue affects the top surface of the tongue and often extends out to the edges of the tongue. The size and depth of the fissures vary and when particularly large and deep the fissures or grooves may be interconnected, separating the top surface of the tongue into what may look like several lobules.

Fissured tongue is not usually painful unless debris such as food gets trapped within the grooves or when it occurs in association with geographic tongue.

How is the diagnosis of fissured tongue made?

Fissured tongue is usually observed as an incidental finding on a routine dental examination and the diagnosis made by the characteristic clinical appearance of the tongue. A biopsy is usually not indicated for diagnosis of fissured tongue because of its characteristic diagnostic clinical appearance. Patients should also be assessed for possible associated conditions.

Fissured tongue treatment

Fissured tongue is a benign condition that does not require any specific treatment. Patients should be encouraged to brush the top surface of their tongue to remove any debris that may cause irritation or infection when lodged between the grooves.

References

1. Fissured tongue https://www.dermnetnz.org/topics/fissured-tongue/
2. Yarom N, Cantony U, Gorsky M. Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Dermatology. 2004. 209(2):88-94.
3. Picciani B. L. S., Silva-Junior G. O., Michalski-Santos B., et al. Prevalence of oral manifestations in 203 patients with psoriasis. Journal of the European Academy of Dermatology and Venereology. 2011;25(12):1481–1483. doi: 10.1111/j.1468-3083.2010.03936.x
4. Picciani BL, Souza TT, Santos Vde C, et al. Geographic tongue and fissured tongue in 348 patients with psoriasis: correlation with disease severity. ScientificWorldJournal. 2015;2015:564326. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320844/
5. Picciani BL, Souza TT, Santos Vde C, et al. Geographic tongue and fissured tongue in 348 patients with psoriasis: correlation with disease severity. ScientificWorldJournal. 2015;2015:564326. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320844
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8. Eidelman E, Chosack A, Cohen T. Scrotal tongue and geographic tongue: polygenic and associated traits. Oral Surg Oral Med Oral Pathol. 1976 Nov. 42(5):591-6.
9. Kaminagakura E, Jorge J Jr. Melkersson Rosenthal syndrome: a histopathologic mystery and dermatologic challenge. J Cutan Pathol. 2009 Oct 15.
10. Daneshpazhooh M, Moslehi H, Akhyani M, Etesami M. Tongue lesions in psoriasis: a controlled study. BMC Dermatol. 2004;4(1):16.
11. Dar-Odeh NS, Hayajneh WA, Abu-Hammad OA, et al. Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature. BMC Res Notes. 2010 Feb 17. 3(1):37.
12. Gerressen M, Ghassemi A, Stockbrink G, Riediger D, Zadeh MD. Melkersson-Rosenthal syndrome: case report of a 30-year misdiagnosis. J Oral Maxillofac Surg. 2005 Jul. 63(7):1035-9.
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