Otolaryngologist (ENT Surgeon) or Oral and Maxillofacial Surgeon
An otolaryngologist (ENT surgeon) or oral and maxillofacial surgeon is the appropriate specialist to perform tongue biopsies and treat tongue diseases. 1
Primary Specialists for Tongue Pathology
Otolaryngologist (ENT)
- Performs comprehensive examination of the oral cavity and pharynx, including manual palpation of the tongue base and bimanual palpation of the floor of mouth 1
- Conducts fiberoptic examination to visualize difficult-to-access areas of the tongue, particularly the base of tongue 1
- Evaluates and biopsies suspicious tongue lesions, especially when malignancy is suspected 1
- Manages tongue cancers (squamous cell carcinoma) through surgical resection, often combined with neck dissection 1
Oral and Maxillofacial Surgeon
- Performs biopsies of oral lesions including tongue pathology 2, 3
- Treats benign and malignant tongue conditions requiring surgical intervention 2
- Israeli studies demonstrate that dentists and oral surgery specialists perform better than general medical specialists in diagnosing early-stage oral cancer 3
When to Refer
Immediate Referral Indications
- Any tongue abnormality lasting more than 2 weeks should be reevaluated and considered for biopsy 1
- Suspected malignancy based on visual inspection or palpation 1
- Non-healing ulcers on the tongue 3, 4
- Tongue masses or growths requiring tissue diagnosis 2
- High-risk patients with tobacco and alcohol use presenting with tongue lesions 1
Additional Specialists (Secondary Role)
- Pediatric otolaryngologist for congenital malformations of the oral cavity in children 1
- Oral medicine specialists for diagnostic evaluation of unclear tongue lesions 2, 3
- Dermatologists may see tongue lesions but should refer to oral surgery or ENT specialists for definitive diagnosis and biopsy 3
Clinical Pitfall
A critical error is delaying biopsy by treating presumptively (e.g., treating as aphthous ulcer or candidiasis without tissue diagnosis when lesions persist beyond 2 weeks) 3. One case report documented a patient treated by a dermatologist for presumed aphthous ulcer and candidiasis over several months before squamous cell carcinoma was finally diagnosed by an oral surgeon, resulting in extensive resection 3.
Examination Approach
The specialist will perform:
- Visual inspection of all tongue surfaces (dorsum, lateral borders, ventral surface, base) 1
- Manual palpation of the tongue base and tonsil fossae to assess for masses 1
- Bimanual palpation of the floor of mouth 1
- Fiberoptic laryngoscopy when indicated for posterior tongue and oropharyngeal evaluation 1
- Regional lymph node palpation 1