Pathology · patient case question
What is the diagnosis and management for Patient B?
Patient case: Three tongues and a salivary gland
Patient: Three separate patients
Chief Complaint: A: reduced salivation on one side after surgery in the floor of the mouth. B: “My tongue has cracks in it — is something wrong?” C: “The red patches on my tongue keep moving around.”
Background: A, 55-year-old male: recent excision of a floor-of-mouth lesion. B, 46-year-old female: asymptomatic, noticed the appearance for years. C, 33-year-old male: mild sensitivity to acidic and spicy food; history of psoriasis.
Findings: B: deep grooves radiating across the dorsum of the tongue, no induration, no ulceration. C: well-demarcated red depapillated patches with raised white serpiginous borders, in different locations from those photographed at a visit three weeks ago.
Show answer and explanation
Correct answer: D. Fissured tongue — reassurance and instruction to brush the dorsum
- A. Oral hairy leukoplakia is a corrugated white patch on the LATERAL border of the tongue that does not rub off, driven by Epstein-Barr virus in an immunosuppressed patient. It is a surface plaque, not a fissure pattern.
- B. Atrophic glossitis is a smooth, red, DEPAPILLATED tongue caused by iron, folate or vitamin B12 deficiency — a LOSS of papillae, the opposite finding to deep grooves in a normally papillated dorsum.
- C. Median rhomboid glossitis is a well-demarcated DEPAPILLATED rhomboid patch in the MIDLINE of the posterior dorsum, associated with candidal infection. It is a smooth area, not a set of grooves.
- D. CORRECT. FISSURED TONGUE — also called scrotal or plicated tongue — is a benign developmental variant affecting roughly 5% of the population, with prevalence rising with age. It requires NO treatment. The only useful advice is to BRUSH THE DORSUM of the tongue, because food debris and micro-organisms accumulate in the grooves and can cause halitosis or a localised inflammation. Its associations are worth knowing: GEOGRAPHIC TONGUE, DOWN SYNDROME, and MELKERSSON-ROSENTHAL syndrome — the triad of fissured tongue, recurrent facial paralysis and orofacial oedema.
Note: The reassurance itself is the treatment, and it should be explicit: this is a normal anatomical variant, it is not a sign of infection, deficiency or cancer, and it will not change. Patients frequently arrive having found alarming material online, so naming it plainly matters.