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A 25-year-old male patient came with a chief complaint of halitosis and mild occasional burning sensation on tongue since over one year duration. Past medical and dental history was non-contributory. Patient gave a history of tobacco chewing and cigarette smoking since 2-3 years. Intra-oral examination mainly revealed generalized stains on teeth, tongue appeared coated (Figure 1-A) and multiple deep grooves measuring 1-2 cm were seen on the dorsal surface of the tongue and also there were multiple small grooves on the right and left lateral borders of the tongue (Figure 1-B). A provisional diagnosis of a coated and fissured tongue was given. The patient was advised to stop his deleterious habits and was advised to add use of mouthwash and mechanic tongue cleansing in his daily oral hygiene habits. The patient was referred to department of periodontics for oral prophyaxis.

Figure 1. Fissured tongue.

Fissured tongue, also known as scrotal tongue, lingua plicata, plicated tongue or furrowed tongue is a benign condition characterized by deep grooves or fissures in the dorsum of the tongue. Although these grooves may look unsettling, the condition is usually painless [1]. Males are more commonly affected. The condition may be seen at any age, but generally affects older people more frequently. Kullaa-Mikkonen described two types of fissured tongue-fissure tongue with normal filiform papillae; and Fissure tongue syndrome, where fissures are associated with geographical tongue [2]. Fissuring of the tongue is seen in patients with pernicious anemia or Sjogren’s syndrome. It is also seen in in Melkersson-Rosenthal syndrome, Down syndrome, sometimes in Cowden’s syndrome [3]. Some authors believe it to be a mucosal manifestation of pustular psoriasis. Occasionally fissured tongue and geographic tongue have been reported in association with chronic granulomatous diseases [4]. Since the condition is otherwise entirely benign, no treatment is indicated and the patient should be reassured that it is a common variance of the normal appearance of the tongue.

References

1. Crispian S (2008) Oral and maxillofacial medicine: the basis of diagnosis and treatment. Edinburgh: Churchill Livingstone. 2^nd edition.
2. Bhat VS (2016) Fissured tongue to worry or not to worry? Otolaryngology online journal 6(3): 136.
3. Kaminagakura E, Jorge J Jr (2011) Melkersson Rosenthal syndrome: A histopathologic mystery and dermatologic challenge. J Cutan Pathol 38: 241-245. [Crossref]
4. Dar-Odeh NS, Hayajneh WA, Abu-Hammad OA, Hammad HM, Al-Wahadneh AM, et al. (2010) Orofacial findings in chronic granulomatous disease: Report of twelve patients and review of the literature. BMC Res Notes 3: 37. [Crossref]