Fissured Tongue Research Articles

Lightweight YOLOv8 for tongue teeth marks and fissures detection based on C2f_DCNv3

This paper propose a significantly enhanced YOLOv8 model specifically designed for detecting tongue fissures and teeth marks in Traditional Chinese Medicine (TCM) diagnostic images. By integrating the C2f_DCNv3 module, which incorporates Deformable Convolutions (DCN), replace the original C2f module, enabling the model to exhibit exceptional adaptability to intricate and irregular features, such as fine fissures and teeth marks. Furthermore, the introduction of the Squeeze-and-Excitation (SE) attention mechanism optimizes feature weighting, allowing the model to focus more accurately on key regions of the image, even in the presence of complex backgrounds. The proposed model demonstrates a significant performance improvement, achieving an average precision (mAP) of 92.77%, which marks a substantial enhancement over the original YOLOv8. Additionally, the model reduces computational cost by approximately one-third in terms of FLOPS, maintaining high accuracy while greatly decreasing the number of parameters, thus offering a more robust and resource-efficient solution. For tongue crack detection, the mAP increases to 91.34%, with notable improvements in F1 score, precision, and recall. Teeth mark detection also sees a significant boost, achieving an mAP of 94.21%. These advancements underscore the model’s outstanding performance in TCM tongue image analysis, providing a more accurate, efficient, and reliable tool for clinical diagnostic applications.

Oral manifestations of COVID-19 in children: a narrative literature review

COVID-19 triggers an acute inflammatory response in organs, tissues, tongue mucosa, and salivary glands. Some symptoms such as lesions on the tongue and oral mucosa, oral pseudomembranous candidiasis, pharyngitis, taste alteration, gingivitis, canker sores, and even multisystem inflammatory syndrome have been reported in children with COVID-19. Early diagnosis of oral manifestations improves patients' prognosis and quality of life. A narrative literature review was conducted based on studies published in PubMed and LiLacs from January 2020 to April 2024, related to oral manifestations in COVID-19 in children. Of the 68 articles found, 7 were selected after analysis. The main manifestations presented were: abscesses, mucositis, ulcerative lesions, gingivitis, pseudomembranous candidiasis, mucosal lesions, lip and tongue fissures, hemorrhagic crust, inflammation of salivary glands, lip swelling, and reactive infectious mucocutaneous eruption. The selected articles showed that these oral manifestations of COVID-19 can affect children in various age groups, serving as indicators of the disease and signs of worsening infection.

Granulomatous cheilitis: a rare case report

Granulomatous cheilitis is a rare granulomatous disorder characterized by a recurrent firm swelling of one or both lips. This is called the cheilitis granulomatosa of Miescher (CGM) when it occurs in isolation. It is called Melkersson-Rosenthal syndrome (MRS) if the classical triad of recurrent or persistent orofacial edema, plicated or fissured tongue (lingua plicata), and relapsing peripheral facial nerve paralysis is present. A 40-year-old female patient came to the Dermatology Department with persistent painless swelling of both lips and perioral area for the last one year. On histopathological examination there was a nodular tuberculoid granulomatous inflammation in patchy pattern present throughout the submucosa. The granuloma consists of lymphocytes, histiocytes and occasional plasma cells. AFB stain and PAS stain were negative. Diagnosis of granulomatous cheilitis was made and patient was put on tab clofazimine and intralesional corticosteroids. The case is being reported due to its rarity and the role of dermatopathologist to make a diagnosis.

Pathophysiology of oral lesions subsequent to SARS-CoV-2 vaccination: A systematic review.

Amidst worldwide reports of adverse oral lesions subsequent to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, the current systematic review planned to determine the prevalence of adverse oral events in adult individuals (≥18 years) after SARS-CoV-2 vaccination, emphasizing upon the type and dose of vaccine, time of onset, and underlying pathophysiology. The registered protocol (PROSPERO CRD42023421307), conforming with PRISMA guidelines, included an all-inclusive literature search through online databases, consisting of Scopus, PubMed/MEDLINE, Web of Science, Lilacs, Livivo, and PROSPERO, completed on 2 May 2023, followed by assessment of risk of bias by Joana Briggs Institute Evaluation Checklist. Due to the paucity of literature, case reports and case series were included. Self-reported lesions were excluded. Qualitative synthesis employing Microsoft Excel software 2019 revealed low prevalence (43 subjects) from 26 case reports and two case series. There were multiple erosive oral ulcers on gingiva, palate, burning pain in the mouth, xerostomia, tongue fissuring and glossitis, palatal petechiae, diffuse erythematous lesions and loss of smell (16.2%), primary herpetic gingivostomatitis (21%), oral lichen planus (16.2%), Stevens-Johnson syndrome (6.9%), Bell's palsy in four cases where two cases were Guillain-Barré syndrome (9.3%), erythema multiforme (11.6%), pemphigus (4.6%), idiopathic thrombocytopenic purpura (6.9%), unilateral hypoglossal nerve palsy (4.6%), and trigeminal neuralgia (2.3%). Maximum cases (22 subjects) presented oral lesions after Pfizer (BNT162b2) SARS-CoV-2 vaccine. No association was found between the vaccine type and dose with oral side effects. Dentists must be aware of the oral adverse effects after coronavirus disease 2019 vaccination to better understand the pathogenesis and the risk factors associated with such reactions.

Clinical features of atypical presentations of mucocutaneous herpes simplex virus infection observed in immunosuppressed individuals. Part I: herpetic geometric glossitis.

Herpetic geometric glossitis is a unique morphologic variant of HSV (herpes simplex virus) type 1 infection on the dorsum of the tongue that presents as an extremely painful linear central lingual fissure with a branched pattern. in the center of the tongue; there is a branched pattern of fissures that extend bilaterally from the central linear fissure. Herpetic geometric glossitis has been reported in 11 patients; 8 of these individuals were immunocompromised. Medical conditions and immunosuppressive medication treatment (7 patients) or only medical disorders (3 patients) or neither (1 patient) were present. HSV type 1 infection was diagnosed by viral culture in (7 patients), Tzanck preparation (2 patients) or clinically (2 patients). Mucocutaneous HSV infection at non-lingual locations--including the lips, labial mucosa, face and chest--were observed in 5 patients. All patients' symptoms and lesions responded to treatment with oral antiviral therapy: acyclovir (9 patients), famciclovir (1 patient) or valacyclovir (1 patient). The lingual pain and dorsal tongue fissures completely resolved completely within two to 14 days. In summary, herpetic geometric glossitis is a unique HSV type 1 infection, usually in immunocompromised patients, that occurs on the dorsal tongue and responds completely after treatment with orally administered antiviral therapy.

Tongue Anomalies Occurrence in Patients from Collage of Dentistry/University of Baghdad 2018-2019

To evaluate the occurrence of the most common tongue developmental anomalies in patients attending the teaching hospital of the University Of Baghdad\ College Of Dentistry and determine their distribution between males and females (2018-2019).Examination of 700 patients was done clinically by the use of probe and dental mirror. The patients age that was included was from (30-39) years old. The developmental anomalies were more in females (66%) than males and were widely distributed at age of 39years (20%), while the lowest percentage was recorded at the age of 30 (2.6%). The most widely distributed anomalies of the tongue was the fissure tongue 40%. The anomalies that were found to be most prevalent were fissure tongue and followed by geographic tongue and some of them were associated with each other and they found to be increasing with age. They were more in females than in males.

Melkersson-Rosenthal syndrome - a diagnostic-therapeutic challenge in oral medicine

Melkersson-Rosenthal syndrome (MRS) is a rare disease and is characterised by the classic triad of cheilitis granulomatosa, lingua plicata and peripheral facia- lis paresis. These symptoms rarely manifest themselves all at the same time, often only one of these clinical signs appears. In the literature, the umbrella term orofacial granulomatosis (OFG) is also used, which covers the occurrence of granulomas in the maxillofacial region without associated systemic diseases.

Benign Migratory Glossitis Prevalence and Its Association with Other Tongue Lesions and Systemic Conditions: A Cross-Sectional Study in a Population of Tripoli, Libya

Background: Benign migratory glossitis (BMG) is an inflammatory disorder, usually asymptomatic, of unknown aetiology, which regularly happens at the dorsum of the tongue and may sometimes involve its lateral borders. BMG prevalence among adults ranges from 0.28% to 2.4%. It appears to become more females in the middle age group. Aim: This study aimed to determine the prevalence of BMG and evaluate the possible correlation between the occurrence of BMG with age, gender, burning symptoms and some systemic conditions. Materials and Methods: The present cross-sectional study was conducted at the Dar Alfardous dental facility, Tripoli – Libya. A random sample of 577 patients attended the dental clinics over nine months. The patients were examined for the presence of BMG over one year. Statistical analysis: A chi-square test was done to assess the correlation of BMG with age, gender, burning sensation and some systemic conditions. Result: The prevalence of BMG among Tripoli city, Libya's population was as high as (10%). Fissured tongue (FT) (35.7%) revealed a high association with BMG followed by the hairy tongue (HT) (3.5%). Prevalence of BMG was found to be significantly higher in the < 20 (3-19) years old (13%) (P = 0.004). Conclusion: BMG among this study sample of the population showed a higher prevalence rate. BMG was more frequently observed in children and young adults and most prevalent in females. Based on our results, there was a significant association between BMG and FT.

Macroheilitis as a manifestation of Melkersson – Rosenthal syndrome

Melkersson – Rosenthal syndrome (SMR) is a disease manifested by a triad of symptoms: swelling of the lips and/or face, paralysis of the facial nerve, scrotal tongue. In clinical practice, the monosymptomatic variant of SMR is more common. The disease can develop at any age, but most cases occur at 25–40 years with a 2-fold predominance of women among patients. In children, SMR is more often observed at the age of 7 to 12 years, and the smallest child is described at the age of 22 months. The causes of the Melkersson – Rosenthal syndrome have not been definitively clarified. There are many hypotheses about the pathogenesis of SMR, the main of which are allergic, angioedema, infectious and genetic, immunological dysfunction. There are various historically established terms: Mischer’s granulomatous cheilitis, orofacial granulomatosis, SMR, which are regularly used as synonyms in the available literature. To date, SMR remains a diagnosis of exclusion, which is accompanied by the establishment of controversial diagnoses in practical healthcare. In most cases, the treatment of SMR is ineffective. Mainly systemic glucocorticosteroids, antibiotics, antihistamines, immunosuppressive drugs are used, upon discontinuation of which the disease often recurs. In this publication, we present two clinical cases of SMR. The interest of the first case lies in the presence of the entire group of clinical symptoms and the achievement of a positive treatment result. The second case is characterized by the achievement of long-term remission as a result of combination therapy with betamethasone, azithromycin and ketotifen. An overview of successful treatment options is also presented.

Treatment of Orofacial Granulomatosis—9-Month Follow-up: A Case Report

Orofacial granulomatosis is a condition that manifests clinically as painless labial enlargement, perioral and mucosal edema, oral ulcers, and gingivitis. It is characterized by non-necrotizing granulomatous inflammation of the oral and maxillofacial region. When the swelling only affects the lips, the pathology is called Miescher's granulomatous cheilitis; however, when it also causes facial paresis and lingua plicata, it is known as Melkersson-Rosenthal syndrome. We report a case that was successfully treated with a combination of a local (intralesional) steroid, a systemic antibiotic, and a systemic steroid. After 6 months of therapy, we observed improvement in gingival hyperplasia and buccal mucosa and lip edema.

Lingua Plicata Associated with Increased Level of Proinflammatory Cytokines in Gingival Cervical Fluid: Possible New Sign in Ulcerative Colitis

Abstract Ulcerative colitis (UC) is a complex disease in which the interaction of genetic, environmental, and microbial factors drives chronic intestinal inflammation. Gastrointestinal symptoms are predominant including pathological manifestations in the oral cavity, as well as extra-intestinal complications. Lingua plicata (LP) is a condition characterized by an increased number of fissures and grooves at the central and lateral aspects of the dorsal surface of the tongue. LP is usually asymptomatic and discovered incidentally, but the accumulation of food in the fissures and grooves can lead to focal glossitis and halitosis. In this study, we analyzed the level of proinflammatory cytokines in gingival crevicular fluid (GCF) and demonstrated that proinflammatory cytokines IFN-γ, IL-12, and IL-1β were significantly increased in the group of UC patients when compared with healthy controls. Obtained results have shown that 35% of UC patients have lingua plicata. The GCF levels of IFN-γ and IL-12 were higher in UC patients with LP compared with UC patients without lingua plicata. In conclusion, increased GCF values of IFN-γ and IL-12, in UC patients with LP may be considered as a sign of the disease progression and, consequently, of a poor prognosis for patients.

Soluble LPS receptor CD14 is increased in saliva of patients with geographic tongue

Objectives The soluble bacterial pattern recognition receptor, sCD14 augments inflammatory responses in oral cavity. The aim of the study was to investigate whether patients with geographic tongue (GT) with and without fissured tongue (FT) have impaired inflammatory regulation, manifesting as increased levels of sCD14 in the saliva. Material and Methods An enzyme-linked immunosorbent assay was used to measure the amount of sCD14 in whole and parotid saliva of patients diagnosed with GT (GT whole, n = 21; GT parotid, n = 23) and control subjects (GT whole, n = 25; GT parotid, n = 18). The levels of sCD14 were also evaluated according to our previous clinical assessment of GT based on the number of lesions detected on the tongue, as ‘mild’ (a single lesion), ‘moderate’ (2–5 lesions), or ‘severe’ (≥6 lesions). Diagnosis of FT was established when multiple grooves or fissures were observed on the dorsal and lateral surfaces of the tongue. Results GT patients had significantly higher sCD14 levels in whole (p<.05) and parotid saliva (p<.001), compared with controls. GT patients with FT had significantly increased sCD14 levels only in parotid saliva. A gradual increase in sCD14 levels in parotid and unstimulated saliva was seen in GT patients with multiple tongue lesions compared with single lesions. Conclusions GT patients had increased sCD14 in both parotid and unstimulated saliva. sCD14 seems to increase local inflammatory responses, which suggests its involvement in the pathophysiology of GT.

The risk factors associated with geographic tongue in a southwestern Chinese population

The goal of this study was to look into age, genetics,sex, oral mucosa diseases, and systemic diseases as potential risk factors for the geographic tongue (GT) in a Chinese population. This retrospective cross-sectional study used the demographic and medical data of 3400 patients between March 2021 and August 2021 from the Department of Oral Medicine at West China Hospital of Stomatology. Binary logistic regression was conducted to analyze the association of GT and age, fissured tongue (FT), burning mouth syndrome (BMS), oral lichen planus (OLP), gastrointestinal disorders, and hematologic disorders and to acquire the adjusted odds ratio (AOR). GT occurred in 3.6% of patients, with 15 out of 123 (12.2%) patients with GT having a family history. Binary logistic regression found age <30 years (AOR: 4.4; [95% CI: 2.8-6.9]), FT (28.8 [17.1-48.4]), BMS (0.3 [0.1-0.6]), OLP (0.2 [0.0-0.5]), and gastrointestinal disorders (4.3 [2.7-6.7]) were significantly associated with GT, and GT was unrelated to recurrent aphthous ulcer (RAU) or systemic diseases such as cardiovascular diseases. In the Chinese population, GT was more prevalent in patients with <30 years of age, FT, and gastrointestinal disorders, and it was less prevalent in BMS and OLP.

Exploring the pivotal variables of tongue diagnosis between patients with acute ischemic stroke and health participants

Background and aimStroke is a major cause of disability worldwide, and ischemic stroke is the most common type of stroke. The prevention and treatment of ischemic stroke remain a challenge worldwide. Traditional Chinese medicine (TCM) is often sought to provide an alternative therapy for the prevention and rehabilitation intervention of ischemic stroke in Taiwan. Therefore, this study explored the pivotal variables of tongue diagnosis among acute ischemic stroke and healthy participants in middle and older age. Experimental procedureThis was a cross-sectional and case-controlled study. Data were collected from 99 patients with acute ischemic stroke and 286 healthy participants who received tongue diagnoses at Changhua Christian Hospital (CCH) from September 1, 2014, to December 31, 2016. Tongue features were extracted using the automatic tongue diagnosis system. Nine tongue features, including tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissures, ecchymoses, teeth marks, and red spots were analyzed. Results and conclusionObjective image analysis techniques were used to identify significant differences in the many tongue features between patients with acute ischemic stroke and individuals without stroke. According to the logistic regression analysis, pale tongue color (OR:5.501, p = 0.001), bluish tongue color (OR:4.249, p = 0.014), ecchymoses (OR:1.058, p < 0.001), and tongue deviation angle (OR:1.218, p < 0.001) were associated with significantly increased odds ratios for acute ischemic stroke. The research revealed that tongue feature abnormalities were significantly related to the occurrence of ischemic stroke.

Aponeurosis linguae-Myocutaneous or myotendinous junctions of skeletal muscle fibres in the human tongue?

The morphology of the more superficial tissue of the human tongue was investigated and discussed with the clinical appearance of fissures. Three regions could be distinguished according to the presence and shape of the aponeurosis linguae: the central region showed a thick aponeurotic plate with myotendinous muscle fibre insertions. The lateral region showed still an aponeurosis linguae but of reduced thickness and without muscle insertions. The edge‐wise and lower region showed no aponeurosis linguae but a fatty subcutis and myocutaneous muscle fibre insertions lacking specific molecules of myotendinous junctions. This system of partially developed exoskeleton seems to underlie but not to be involved in tongue fissures, which are more superficial within the epidermis and dermis.

A Case of Unrelenting Facial Swelling

Melkersson-Rosenthal syndrome (MRS) is an uncommon disorder with presenting symptoms that typically involve the face and orofacial structures. It is a difficult diagnosis to make, as it may present with a protracted course of seemingly unrelated dermatological, ocular, and neurological findings. This case report reviews the presentation, workup, and diagnosis of a 75-year-old woman who presented with orofacial swelling, facial palsy, and tongue fissuring that had intermittently recurred over 10 years without a unifying diagnosis. Extensive medical history, photography, laboratory workup, and radiographic imaging were performed to identify the diagnosis of MRS in this patient. Our case highlights the challenge and importance of critically evaluating and consolidating a patient’s history of their present illness, physical examination, and ancillary testing to successfully establish a unifying diagnosis, especially when the diagnosis is relatively rare and diverse in its range of affected populations and symptomatology.

A Perspective on Tongue Diagnosis in Patients with Breast Cancer.

Introduction Breast cancer (BC) is the most common cancer in women and patients with BC often undergo complex treatment. In Taiwan, nearly 80% of patients with BC seek traditional Chinese medicine (TCM) during adjuvant chemotherapy to relieve discomfort and side effects. This study investigated tongue features and pattern differentiation through noninvasive TCM tongue diagnosis in patients with BC. Materials and Methods This cross-sectional, case-controlled, retrospective observational study collected patient data through a chart review. The tongue features were extracted using the automatic tongue diagnosis system (ATDS). Nine tongue features, including tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissures, ecchymoses, teeth marks, and red dots, were analyzed. Results and Discussion. Objective image analysis techniques were used to identify significant differences in the many tongue features between BC patients and non-BC individuals. A significantly larger proportion of patients with BC had a small tongue (p < 0.001), pale tongue (p < 0.001), thick fur (p < 0.001), yellow fur (p < 0.001), wet saliva (p < 0.001), thick tongue fur (p < 0.001), fissures (p=0.040), and ecchymoses in the heart-lung area (p=0.013). According to logistic regression, small tongue shape, pale tongue color, yellow fur color, wet saliva, and the amounts of fissures were associated with a significantly increased odds ratio for BC. Conclusions This study showed significant differences in tongue features, such as small tongue shape, pale tongue color, thick fur, yellow fur color, wet saliva, fissure, and ecchymoses in the heart-lung area in patients with BC. These tongue features would imply yin deficiency, deficiencies of blood, stagnation of heat, and phlegm/blood stasis in TCM theory. There is a need to investigate effective and safe treatment to enhance the role of TCM in integrated medical care for patients with BC.

Oral Mucosa Status and Saliva Parameters of Multimorbid Adult Patients Diagnosed with End-Stage Chronic Kidney Disease.

There has been an increasing number of patients diagnosed with chronic diseases. Many of those diseases determine changes in patients’ social and even professional life. The aim of the present work was to analyze saliva and oral mucosa parameters in adult patients diagnosed with chronic diseases. A total of 228 patients took part in the research. A total of 180 patients were hemodialyzed in Diaverum dialysis stations, and there were 48 patients from the Conservative Dentistry with Endodontics Clinic of the Academic Centre of Dentistry of Silesian Medical University in Bytom and patients from the dentistry division of the Arnika Clinic in Zabrze not diagnosed with any such diseases. Selected saliva parameters (secretion, pH and buffer capacity) and mucosa status were examined. In order to obtain information regarding xerostomia, patients were given a questionnaire. Patients assigned to the control group rarely used water to make swallowing easier or used candies to lessen the feeling of oral cavity dryness. They also rarely suffered from eye dryness. The feeling of dryness also did not influence their social life. The amount of produced saliva was higher in the control group. There was a significantly lower percentage of patients with a low buffer capacity of saliva. There were no differences in terms of saliva pH values between the two groups of patients. A significantly lower number of patients were diagnosed with ecchymosis, candidiasis, scrotal tongue and mechanical damages. Patients diagnosed with chronic diseases need to be provided with long-term care.

Surgical Debulking of Persistent Orofacial Swelling in a Patient with Melkersson–Rosenthal Syndrome

Summary:Melkersson–Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous granulomatous disorder that is likely underdiagnosed due to its variability on presentation. Few patients present with the characteristic triad of orofacial swelling, recurrent facial palsy, and lingua plicata; in fact, most patients present with only one or two of the symptoms. Additionally, patients are evaluated by a variety of specialists, including ophthalmologists, otolaryngologists, dermatologists, and plastic surgeons, depending on their particular symptom. There is no consensus standard of care for MRS due to a limited understanding of the disease. We describe a case of a patient with a 5-year history of persistent orofacial edema in the setting of Melkersson–Rosenthal syndrome refractory to medical management, who was treated with surgical debulking of the upper lip. We encourage increased clinical suspicion for Melkersson–Rosenthal syndrome when evaluating persistent orofacial edema in the plastic surgery clinic and highlight the importance of obtaining a full patient history. Surgical debulking can correct for aesthetic deformity while sparing oral function.

Geographic with Scrotal tongue in a 9 year old child

Geographic with Scrotal tongue in a 9 year old child