Tongue is the site for a variety of lesions which
range from insignificant mucosal changes to
malignancy. Lesions over the tongue arise due
to variety of causes like trauma, infection, and
neoplasm or sometimes idiopathic. The lesions on
the tongue generally are symptomatic, as tongue is
an integral part of deglutition and speech. However
some lesions do not cause any symptom, but patient
present to the doctor by self-appreciation of the
lesion. Fissured tongue is one such condition.
Fissured tongue also known as scrotal tongue
or lingua plicata is generally an incidental finding,
characterized by grooves over the dorsal aspect of
the tongue, sometimes involving the lateral aspects
(Figure 1). This is one of the commonest tongue
abnormalities. Literature shows, wide variation
in the prevalence of this condition, from as low as
0.6% in South Africa  to as high as 30.6% in Israel .
However, the study in South Africa was done in
preschool children, which cannot be applied to general population. Although a specific etiology has
not been identified for fissured tongue, a polygenic
or autosomal dominant inheritance with incomplete
penetrance is suspected, because this condition
is seen with increased frequency in families of the
affected . This could be the reason for prevalence
variability world-wide. Fissuring of the tongue is
seen in patients with pernicious anemia or Sjogren’s
Syndrome. It is also seen in Melkerson Rosenthal
syndrome, which is associated with recurrent facial
welling and lower motor facial nerve palsy . 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 .
Figure 1: Fissure tongue.
Incidence of fissured tongue progresses with age,
being more common in elderly, which is thought
to be due to salivary hypo function, Vitamin B12
deficiency. 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 .
Generally, fissured tongue is detected during
routine examination of the oral cavity, when a patient
seeks medical consultation for some other oral health
disorder. Deep fissures can result in collection of food
within the groves, causing discomfort. Association of
fissured tongue with geographical tongue can lead
to burning sensation while having spicy food, which
is due to geographical tongue (Figure 2). Sometimes,
patient may seek medical consultation, after selfexamination
of the tongue, with the worry of having
some serious disease. While examining for fissured tongue, patient is asked to push the tip of the tongue
against mandibular incisors, as the fissures may
become prominent with this maneuver.
Figure 2: Fissure tongue with geographical tongue.
Isolated fissure itself will not lead to any further
complication, but the associated diseases need to be
ruled out. No treatment is necessary for fissures and
person need to be informed about the benign nature
of the condition, and advised to keep the groves
clean with the help of brush. When the fissures are
deep, infection with Candida albicans may occur,
which is treated with topical antifungal medication .
To conclude, fissure tongue is an insignificant
condition involving the oral tongue, which can be
diagnosed easily by clinical examination. Association
of other illness need to be ruled out, before
counseling the patient about the benign nature of
the nature, and advising about maintaining good
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- Yarom N, Cantony U, Gorsky M (2004) Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Dermatology 209: 88-94.
- Eidelman E, Chosack A, Cohen T. Scrotal tongue and geographic tongue: polygenic and associated traits. Oral Surg Oral Med Oral Pathol 1976; 42: 591-596.
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- Dawson TA (1974) Tongue lesions in generalized pustular psoriasis. Br J Dermatol 91: 419-424.
- Dar-Odeh NS, Hayajneh WA, Abu-Hammad OA (2010) Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature. BMC Research Notes 3: 37.
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