What is the management and treatment of Lingua plicata (furrowed tongue)?

Management and Treatment of Lingua Plicata (Furrowed Tongue)

Lingua plicata is a benign condition that typically requires no specific treatment unless it causes symptoms or is associated with an underlying syndrome.

Understanding Lingua Plicata

Lingua plicata, also known as fissured tongue, scrotal tongue, grooved tongue, or cerebriform tongue, is characterized by grooves or fissures on the dorsal surface of the tongue. It is generally considered a benign anatomical variant rather than a pathological condition.

Key Characteristics:

• Deep grooves or fissures on the dorsal surface of the tongue
• Usually asymptomatic
• May be congenital or develop over time
• Prevalence increases with age
• More common in males 1
• Rarely observed in children 1

Diagnostic Approach

When evaluating lingua plicata, consider:

1. Associated symptoms: Pain, burning sensation, or discomfort
2. Food debris accumulation: Can cause irritation or halitosis
3. Potential syndromic associations:
   • Melkersson-Rosenthal syndrome (MRS): Triad of orofacial swelling, facial palsy, and lingua plicata 2
   • Down syndrome
   • 22q11.2 deletion syndrome 3

Treatment Algorithm

For Asymptomatic Lingua Plicata:

• No treatment required - this is the standard approach for most cases
• Patient education and reassurance about the benign nature of the condition

For Symptomatic Lingua Plicata:

1. Hygiene Measures:

   • Regular, gentle tongue cleaning to remove debris from fissures
   • Soft toothbrush or tongue scraper to clean the dorsal surface
   • Avoid harsh mouthwashes that may cause irritation

2. For Discomfort or Inflammation:

   • Warm saline rinses (1/2 teaspoon salt in 8 oz warm water)
   • Avoid spicy, acidic, or irritating foods
   • Maintain adequate hydration

3. For Associated Fungal Infection:

   • If Candida infection is present in the fissures, topical antifungals may be prescribed
   • Similar to treatment approach for median rhomboid glossitis 4

For Lingua Plicata Associated with Syndromes:

If Associated with Melkersson-Rosenthal Syndrome:

• The tongue fissures themselves don't require treatment
• Management focuses on other manifestations:
  • For orofacial swelling:
    • Intralesional or systemic corticosteroids
    • In persistent cases, surgical interventions including facial liposuction or cheiloplasty may be considered 5, 2
  • For facial palsy:
    • Similar management to Bell's palsy
    • Various medications have been tried including NSAIDs, steroids, metronidazole, dapsone, acyclovir, methotrexate, and thalidomide, but with inconsistent responses 2

Special Considerations

Differential Diagnosis

Distinguish lingua plicata from other tongue conditions:

• Geographic tongue (benign migratory glossitis)
• Hairy tongue (lingua villosa)
• Atrophic glossitis (may indicate nutritional deficiencies)

When to Refer

Consider referral to a specialist when:

• Rapid changes in appearance or symptoms
• Ulceration or suspicious lesions within fissures
• Severe symptoms not responding to conservative measures
• Suspected association with systemic conditions

Patient Education Points

• Reassure patients about the benign nature of the condition
• Explain that fissures may trap food debris, requiring regular cleaning
• Clarify that the condition is often genetic and not contagious
• Advise that no specific treatment is needed unless symptoms develop

Conclusion

Lingua plicata is typically a benign anatomical variant that requires no specific treatment in most cases. Management should focus on good oral hygiene, especially thorough cleaning of the tongue surface to prevent food debris accumulation in the fissures. Only when the condition causes symptoms or is associated with syndromes like Melkersson-Rosenthal syndrome would additional interventions be considered.