Open Access
Issue
Med Buccale Chir Buccale
Volume 23, Number 2, Juin 2017
Page(s) 111 - 114
Section Note technique / Technical note
DOI https://doi.org/10.1051/mbcb/2016058
Published online 19 September 2017

© The authors, 2017

Licence Creative Commons
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Macroglossia is defined as a condition in which the tongue protrudes because its volume is too high compared to the oral cavity (Fig. 1). Depending on the underlying cause, macroglossia can be divided into pseudomacroglossia and true macroglossia. Surgical procedure by reduction glossoplasty (by decreasing the length and width of the tongue) aims to improve lingual morphology and subsequent improvement in tongue function.

thumbnail Fig. 1

Clinical aspect of true macroglossia: the tongue is in protrusion because of the fact that its volume is too large compared to the oral cavity.

Technical note

The procedure was conducted under general anesthesia with nasotracheal intubation, the patient was placed in a dorsal position with the head resting on a headrest. The tongue was then maintained outside the oral cavity by three sutures, maintaining its symmetry, so that the incision traces could be drawn. Excision was performed according to Morgan transfixing technique. The initial full-thickness incision was made in the middle and back of the tongue following an elliptical trace approximately 4 mm from the taste buds up to the ventral aspect (Fig. 2). This incision was completed by side incisions forming a “keyhole” on the dorsal aspect and a “W” on the ventral aspect (Fig. 3). The purpose of this “W”-type incision is to maintain the lingual frenulum, which will be sacrificed with a racket aspect after the partial glossectomy if a “V”-shaped incision (as described by Morgan) is used (Fig. 4). Closure was finally made end to end in three planes after hemostasis was assured (Fig. 5). Postoperative care was simple. The slight edema of the floor of the mouth (without respiratory signs) and mild hypoesthesia of the tip of the tongue resolved over time. The resumption of sensorimotor and gustatory functions was back to normal 10 days after surgery, with preservation of lingual symmetry and good oral capacity. Postoperative medical treatment consisted of analgesia (paracetamol 60 mg/kg/day for 5 days and then as required), intravenous prophylactic antibiotics for 24 h and then orally for 7 days total (amoxicillin + clavulanic acid 50 mg/kg/day), local antisepsis by mouthwash and dietary advice (cold meals for 48 h, then soft food).

Patients are subsequently referred to occlusal and phonatory rehabilitation so as to recreate physiological conditions that prevent the recurrence of functional or morphological disorders.

thumbnail Fig. 2

Dorsal incision of the tongue. It starts with a 4-mm central, elliptical incision of the taste buds and is complemented by two lateral incisions, forming a “keyhole”.

thumbnail Fig. 3

“W”-shaped incision of the ventral side of the tongue, enabling the preservation of the lingual frenulum.

thumbnail Fig. 4

The excision is transfixing, racket-shaped.

thumbnail Fig. 5

Images after multilayer closure. The tongue reduction has been achieved in both length and width.

Discussion

Macroglossia is a general term used to describe a protruding tongue beyond the teeth during the natural resting phase [1]. This can compromise the integrity of the upper airways because of obstruction and often results in obstructive sleep apnea [1,2]. We refer to pseudomacroglossia or relative macroglossia when the lingual protrusion is because of specific anatomical conditions [3]. This is the case with constituent endoalveoli, where the dental/lingual axis reduces the volume available for the tongue. A similar lingual protrusion is found in cases of a low mandible (Down and Pierre–Robin syndromes).

True macroglossia is characterized by hypertrophy with hyperplasia of glottic muscles or abnormal tissue hypertrophy. It could be due to congenital or acquired causes. Congenital factors include muscular hypertrophy, glandular hyperplasia, neonatal diabetes as well as certain genetic diseases, such as trisomy 21 and Beckwith–Wiedemann syndrome. Acromegaly, myxedema, hyperthyroidism, amyloidosis, and tongue tumors are acquired etiologies [4,5].

Reduction glossoplasty surgery is indicated in cases of growth disorders of the dental arch, with a tendency to class-III skeletal patterns and pro-alveoli, phonation problems, swallowing problems, occurrence of recurrent mouth infections due to poor oral hygiene, or salivary incontinence.

Several reduction techniques have been described (Fig. 6) [5,6]. We use the Morgan technique [7], which has been modified by performing a “W”-shaped ventral incision of the tongue instead of a “V”-shaped incision to preserve the lingual frenulum. Its preservation ensures better symmetry of the tongue, allows better limitation of lingual movements, and thus avoids recurrence because of lingual misalignment. This technique also allows more relevant reduction either in length or in width while preserving the neurovascular bundle, thus preserving gustatory, sensory, and motor functions. Nevertheless, postoperative care of reduction glossoplasty is often complicated by tongue and mouth floor edema, delaying the resumption of normal functions [8].

Rehabilitation consisted essentially of the following [9]:

  • correction of the tongue position at rest;

  • rehabilitation of swallowing with two objectives: (1) breaking the “glossolabial” reflex and (2) achieving efficient back and forth movement of the tongue;

  • reading exercises; speech therapy aims to standardize lingual support during the pronunciation of different phonemes: the palatal “L, N, D, T”, sibilant “S”, the postalveolar sibilant “CH, J”;

  • rehabilitation of tongue strength by alternating between a strong contraction of the tongue by tapering the tip “rat tongue” and a sprawl “cat tongue”.

This technique was performed in three patients of ages 5, 8, and 11 years. We have not found age limit in the literature to perform this surgical technique. At the time of drafting this report, the patients have been followed up for an average of 2 years, with no relapses or complications.

thumbnail Fig. 6

Diagrams of different reduction glossoplasty techniques.

Conclusion

Macroglossia is a rare pathology, the source of functional and morphologic complications. Surgical reduction is the treatment of choice. Our technique is simple and minimal, ensuring good functional and morphological results over the long term.

Conflicts of interest

The authors declare that they have no conflicts of interest in relation to this article.

References

  1. Balaji SM. Reduction glossectomy for large tongues. Ann Maxillofac Surg 2013;3:167–172. [CrossRef] (In the text)
  2. Jaja Z, Boulaich M, El Ayoubi A, El Ayoubi F, Kettani S, Essakalli S, et al. Syndrome de Beckwith-Wiedemann : évolution favorable des troubles fonctionnels après glossectomie. Med Buccale Chir Buccale 2011;17:55–57. [CrossRef] [EDP Sciences] (In the text)
  3. Raposo A, Preisler G, Salinas F, Muñoz C. Glosoplastía con Técnica de Harada en un Paciente con Síndrome de Down. Int J Odontostomat 2011;5(3):245–248. [CrossRef] (In the text)
  4. Maladière E, Vacher C. Examen clinique en stomatologie. EMC (Elsevier Masson SAS, Paris), Stomatologie 2008;22-010-A-10; Médecine buccale 2008;28-230-P-10. (In the text)
  5. Gasparini G, et al. Surgical management of macroglossia: discussion of 7 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:566–571. [CrossRef] [PubMed] (In the text)
  6. Davalbhaktaand A, Lamberty BGH. Technique for uniform reduction of macroglossia. Br J Plast Surg 2000;53:294–297. [CrossRef] [PubMed] (In the text)
  7. Morgan WE, Friedman EM, Duncan NO, Sulek M. Surgical management of macroglossia in children. Arch Otolaryngol Head Neck Surg 1996;122:326–329. [CrossRef] (In the text)
  8. Dutot MC, Soupre V, Vazquez MP, Picard A, Kadlub N. Syndrome de Wiedemann-Beckwith glossectomie de réduction par Ultracision® : une approche novatrice. Rev Stomatol Chir Maxillofac Chir Orale 2015;116(2):82–85. (In the text)
  9. Breton I, Nicolas P, Torres JH. Temps buccal de la déglutition salivaire : physiologie et principes de Rééducation. EMC (Elsevier Masson SAS, Paris), Stomatologie/Odontologie 2000;22-008-A-20; Médecine buccale, 2008;28-165-M-10. (In the text)

All Figures

thumbnail Fig. 1

Clinical aspect of true macroglossia: the tongue is in protrusion because of the fact that its volume is too large compared to the oral cavity.

In the text
thumbnail Fig. 2

Dorsal incision of the tongue. It starts with a 4-mm central, elliptical incision of the taste buds and is complemented by two lateral incisions, forming a “keyhole”.

In the text
thumbnail Fig. 3

“W”-shaped incision of the ventral side of the tongue, enabling the preservation of the lingual frenulum.

In the text
thumbnail Fig. 4

The excision is transfixing, racket-shaped.

In the text
thumbnail Fig. 5

Images after multilayer closure. The tongue reduction has been achieved in both length and width.

In the text
thumbnail Fig. 6

Diagrams of different reduction glossoplasty techniques.

In the text

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