Glossitis

GLOSSITIS, glossitis (from Greek glossa-tongue), inflammation of the tongue. G. as an independent disease occurs rarely, more often it is observed as a disease accompanying other general or local (in the oral cavity) diseases. G. can be odontogenic [e.g. when the superficial or deep tissues of the tongue are infected with microbes, which are so abundant in the oral cavity (cavities)] or hematogenous (e.g. in infectious diseases). Rarely does G. begin spontaneously. Usually there is a traumatic (even if barely noticeable) injury-a scratch, a bite to the edge of the tongue, a crack on its dorsum, a burn from hot food or a chemical substance, a sting from insects (bees, wasps). In G., besides the main signs of inflammation, there is a reflex sign specific to the oral cavity-salivation. G., causing pain and swelling of the tongue itself and the surrounding cellular tissue, creates difficulties in chewing, swallowing, and breathing, which can reach life-threatening proportions for the patient. Glossitis can be acute or chronic. Acute G. in turn is divided into superficial, when the epithelial and subepithelial layers are affected, and deep, when the intermuscular cellular tissue and muscular tissue are affected by inflammation. All these forms are primary or secondary. Of the acute primary superficial G., it is necessary to point out a) acute papular G. and b) papillitis of the tongue. In the first disease, small and painful elevations with a red border and a whitish purulent center appear on the mucous membrane of the tongue, resembling aphthae; sometimes the gums become inflamed at the same time; after a few days from simple rinses with boric acid and light smearing with silver nitrate, everything passes. In the second disease-persistent inflammation of the papillae of the tongue, located mainly along its edges. The patient complains of itching and pain; the papillae are red and swollen. It is difficult to determine the cause of this inflammation. Treatment-as in the first form of G.; sometimes it is necessary to perform galvanocautery or superficial excision of the affected areas. [Glossitis in thrush (Soor), aphthae and yagtsur (see).] In streptococcal angina, as well as in erysipelas, the mucous membrane of the mouth and in particular the tongue can become inflamed at the same time, giving characteristic redness and swelling, with the formation of blisters or aphthiform rash. In a mild degree, the same sometimes occurs in influenza, measles, smallpox. Also notable for its rapid appearance is papillitis of the tongue in scarlet fever (scarlatinal raspberry tongue). In typhoid and relapsing fever, significant catarrhal coatings of the tongue are observed; the condition can lead to the formation of ulcers. In typhus, due to prolonged unconscious state, decreased salivation and increased breathing through the mouth, the tongue is sometimes covered with a dry coating, cracks and small ulcers may appear, and finally, necrosis of the tongue (a fatal complication) was often observed. G. are also observed in blood diseases, mainly in Werlhoff's disease, chlorosis and pernicious anemia. In the first of these diseases, sometimes there is severe swelling and bluing of the front part of the tongue, its tissue is imbued with blood, and bleeding ulcers form on the surface. In chlorosis, excoriations and painful cracks on the tip or edges of the tongue are often observed. In malignant anemia (see Anemia), an initial G. with a burning sensation on the tongue and later atrophy of the mucous membrane of the tongue with disappearance of the papillae (so-called Hunterian glossitis) is characteristic. A special description is deserved by deep G. and as its prototype-phlegmonous G. This form is generally rare; etiologically, phlegmon of the tongue occurs as a result of the introduction of staphylococcal or streptococcal bacteria into the body of the organ, often together with other bacteria of the oral cavity, with superficial damage to the mucous membrane or with the impaction of a foreign body (fish bone, fruit seed, etc.). The process develops rapidly due to the abundance of lymphatic vessels and is accompanied by high temperature. The front part of the tongue or its deep muscular plates swell greatly. Microscopically, hyperemia, edema and leukocytic infiltration are observed; clinically-pain, difficulty swallowing, salivation and swelling. The swollen tongue, on the edges of which deep indentations from the teeth are outlined, is first densely infiltrated, then softens. By palpation through the mouth, fluctuation is detected or, in deep posterior forms, edema of the floor of the mouth, swelling and softening of the skin in the chin area, closer to the hyoid bone, is noted. As a result of difficulty swallowing and excessive salivation, particles of food or infected saliva often fall into the larynx and trachea, as a result of which pneumonia easily develops. Phlegmon of the deep layers of the tongue, left to itself, further spreads to the cellular tissue of the neck, threatening the danger of developing laryngeal edema. Only after opening the inflammatory focus and emptying the pus outward or into the oral cavity does the reverse development of phlegmon of the tongue begin. The prognosis can be different; sometimes the outcome can be fatal. The treatment of acute G. in mild, superficial cases consists in prescribing weak antiseptic mouth rinses [hydrogen peroxide solutions, potassium chloride (2%), boric acid], 'softening' rinses of decoctions of sage, althea root; sometimes it is useful to prescribe smearing with astringent substances (10% Tannin-glycerin; T-rae Ratanhiae, T-rae Gallarum aa), but the main thing is to give rest to the organ: do not talk, do not take solid, spicy or hot food; in very acute cases, pieces of ice are prescribed to melt in the oral cavity. As for the surgical treatment of phlegmonous G., even in the first stage of acute, hard and painful edema, incisions can be made on the tongue with dissociation of the muscular tissue. When a focus of purulent softening has already formed, it is opened-by an incision through the mouth if the focus is in the front part of the tongue, and from the chin side, along the midline, above the hyoid bone, if the focus is located deep in the tissues of the tongue towards its root. In this case, after a superficial incision of the skin with a knife, it is necessary to use the blunt method of operating to penetrate deep between the geniohyoid muscles and through the mylohyoid muscle to avoid injuring any more or less large vessel. Occasionally, a small fragment of a foreign body is found in the pus that has been discharged. Further treatment is carried out with tamponade or drainage.

P. Herzen. Glossitis sclerosa s. indurativa. Sclerotic or indurative glossitis, a chronic syphilitic sclerotic infiltration of the tongue as a frequent manifestation of late syphilis, more common in men, especially smokers. Depending on the depth of the sclerotic process, two clinical forms are distinguished. 1. G. sclerosa corticalis s. superficialis, in which the sclerotic infiltrate affects only the mucous membrane. The areas of the tongue's dorsum impregnated with and stretched by the infiltrate, ranging in size from a lentil to a two-kopek coin, are level, smooth, as if devoid of papillae, velvety, cherry-red, and feel plate-like hardened, which is especially noticeable when healthy and affected areas are pinched between the fingers. Lying either level with the general surface of the tongue or slightly elevated above it, they cause no painful sensations but make the tongue only slightly movable. Without treatment, due to progressive sclerosis, the affected areas become pale, flatten, and may transform into scar-like milky-white spots, and the epithelial covering of the mucous membrane, thinning and losing its elasticity, becomes easily injured, at times covered with cracks, erosions, and abrasions, which are painful when the tongue moves (especially when chewing). 2. If the sclerotic process affects not only the mucous membrane but also the muscles of the tongue (G. sclerosa profunda s. diffusa), the affected part appears bulky, bears tooth marks along its edges, and on its dorsum is covered with a series of grooves and convolutions of various sizes and shapes. Due to the asynchronous development of sclerotic foci, the diseased surface is also mottled and unevenly bumpy, as convex cherry-red convolutions are interspersed with flatter and sunken areas of red, pale pink, and milky-white colors. The mottling is further intensified because individual sclerotic disks may show leukoplakic changes. This results in limited tongue mobility, difficulty in chewing and phonation, drooling, especially at night, etc. Painful erosions and cracks are common, especially in the bottom of the grooves. The outcome is atrophic cirrhosis with transformation of the affected areas into sunken, woody-hard areas intersected on the surface by whimsically interlacing grooves ('strung tongue'). A possible complication is cancer ('spinocellular epithelioma' of French authors) with a poor prognosis, occurring either on a leukoplakic disk or on one of the erosions or cracks. The appearance of papillomatous formations on a leukoplakic disk or a dense nodule under an erosion serves as the first sign of neoplasm. G. gummatous occurs in two clinical varieties: 1) superficial gummatous glossitis, or rather, tubercular syphilid affecting only the mucous membrane of the tongue - small, from a millet seed to a pea-sized, semispherical or flattened tubercles, usually arranged in groups or an arch on the dorsum or edges of the tongue, initially dense, later centrally softening and giving crater-like ulcers that grow rapidly at the periphery and have the typical appearance of ulcerotubercular syphilid; 2) deep gummatous glossitis, true gummas of the tongue muscles, which reach the size from a pea to a forest nut, rarely larger, are either solitary or grouped in 2-4, have the form of rounded or oval nodules on any part of the tongue's dorsum, developing slowly (2-3 months) according to the type of syphilitic gummas and giving deep, sharply defined, geometrically regular ulcers with vertical, sharply infiltrated edges and necrotic diphtheroid yellow-gray bottoms. The ulcers heal, forming slightly depressed scars. The general condition is not affected. The glands are normal. Subjective symptoms are relatively weakly expressed compared to the objective appearance. G. sclero-gummatous - a common combination of the above types. - Differential diagnosis - with hard chancre, ulcerative glossitis from a carious tooth, tuberculous ulcer, scrofulotuberculous gumma, eroded disk of leukoplakia, epithelioma of vegetative or ulcerative type. - Treatment: general - triple iodide-arsenobenzol-bismuth (or mercury) therapy; local: for ulcers - application of a 1:300 aqueous-glycerine solution of arsenobenzol, rinsing with 1-4% solution of iodine alkali; in the presence of leukoplakic disks - application of 20-50% aqueous solution of balsam of Peru. Glossitis migrans (lingua geographica, glossitis exfoliativa marginata, s. desquamativa aberrans, synonyms: erythema migrans linguae, derm.exfol. linguae, exfoliatio areata linguae, annulus migrans, pityriasis linguae), separated from the unclear group of psoriasis or pityriasis of the tongue by older authors. Clinical picture: on the dorsum of the tongue one or several flattened red spots, as if devoid of the horny covering, round or oval, of various sizes, surrounded by an elevated narrow ridge of milky-white or yellowish color, forming either a complete or incomplete ring. The disks are sometimes located in isolation, sometimes partially merge or change their size and contours, moving from place to place. There are no subjective sensations. The course is chronic - months and years, more common in women, especially in children. The cause is unknown. It often coincides with a furrowed tongue and is passed from generation to generation. Desquamative agents (sulfur, resorcin, etc.) are of little reliability. More reliable is the effect of ultraviolet or X-rays.