Scrotal (Creased) Tongue: Causes and Treatment

When grooves develop in the tongue, the condition is called scrotal tongue. It makes the tongue look wrinkled. Scrotal tongue has other names, too. It also is called furrowed tongue, lingua fissurata, lingua plicata, lingua scrotalis, plicated tongue or grooved tongue.

Fissured tongue affects the top surface of the tongue and often extends out to the edges of the tongue. The size and depth of the cracks differ and when particularly large and deep the fissures or grooves may be adjoined, separating the top surface of the tongue into what may appear like a number of lobules.

The tongue can have many grooves or a single groove down the middle with others branching off from it. Scrotal tongue impacts 2% to 5% of the population of the United States? according to Medscape. Rates in other countries vary. Nevertheless, one study reported that the condition is discovered in up to 21% of individuals worldwide.

Synonyms: folded glossitis, scrotal, slit-shaped, wrinkled, furrowed, split, and lobulated tongue.

Prevalence of a creased tongue

Folded tongue is more common in men. Among children and adults, the abnormality is equally common. Mild tongue and cheek folding can appear in older people due to a decrease in the elasticity of the mucous membrane, but this condition is not related to a creased tongue .

Causes of a creased tongue

The exact cause is not yet known. There is a hypothesis that the folded tongue develops because of an excess of somatotropin, a growth hormone that is produced by the anterior lobe of the pituitary gland. If levels of the hormone are elevated, the tongue can enlarge and swell, resulting in changes in its topography.

The abnormality is genetically transmitted and occurs in 70% of close relatives.

Folded tongue in other diseases

A true folded tongue is a congenital condition. But folded tongue is also found in diseases such as:

Down’s disease;

Interstitial glossitis in tertiary syphilis;
Hereditary keratoses – Siemens syndrome and symmetrical interdigital keratoses;
Rossolimo-Melkersson-Rosenthal syndrome;

acromegaly;
Congenital mental disorders, such as dysmorphia;
Diseases of the endocrine and central nervous system, including pituitary gland lesions and diabetes mellitus;

Anhydrotic ectodermal dysplasia, a developmental abnormality resulting from genetic damage to the outer germ layer.

Folded tongue is combined with desquamative glossitis, or geographic tongue, in 30-40% of cases. In this abnormality, certain areas of the tongue lack thread-like papillae, which makes its surface look like a geographic map.

If you notice any similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!

Symptoms of a creased tongue

There are many folds on the surface of the tongue, which patients often mistake for cracks. But if you look closely, you can see that the folds do not violate the integrity of the mucosa, but are deep grooves. The folds can be mild or pronounced – the depth of the grooves can be up to 0.2 in and more. The folds can be multiple and single, located longitudinally or haphazardly. The tongue is soft and large with pronounced papillae.

If there is a deep longitudinal groove that runs along the midline of the tongue and smoothed transverse ones, such a tongue is called “slit-shaped”.

The folds can be so deep that you sometimes get the impression of a “lobed” tongue, that is, it seems to be divided into lobes.

The tongue creases are usually not uncomfortable. However, poor oral hygiene and an infection from fungus or bacteria may result in pain, inflammation, burning, and bad breath. This is usually the situation patients go to the dentist for. Sometimes they are concerned about the unusual structure of the tongue and its appearance. In very rare cases, if the tongue is severely enlarged, it will not fit in the mouth. The person cannot close his or her teeth, making it difficult to chew and speak.

Symptoms of a folded tongue in other diseases

The signs are the same: an unusual appearance of the tongue and discomfort if an infection has joined. But most often, there are no complaints at all – patients are more concerned about the symptoms of the underlying disease.

Pathogenesis of a creased tongue

The tongue is a muscular organ, which consists of transverse striated muscles and is covered with multi-layered squamous epithelium. Between the muscle bundles is connective tissue, which contains blood vessels, nerves, salivary glands and fat cells.

The body, tip and root of the tongue are distinguished by the relief and structure of the mucous membrane, on which there are many outgrowths, or papillae.

The cause of tongue folds is not fully understood. It is known that they appear due to an increase in its musculature. This occurs both in the development of congenital folds and in the case of acquired pathology. Often this enlargement leads to macroglossia – an abnormally large tongue. An enlarged tongue is accompanied by swollen mucosa and enlarged papillae. For this reason, the surface of the tongue acquires a folded relief.

With age, the folded tongue increases even more, the grooves become more prominent and deeper.

Men may be slightly more likely to have fissured tongue than women, and older adults with dry mouth tend to have more severe symptoms.
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Classification and stages of development of a creased tongue

ICD-10 (International Classification of Diseases) disease code: K14.5.

Folded tongue refers to developmental abnormalities. The folds can be shallow or deep, solitary or multiple.

There is no generally accepted classification of folded tongue. In 2015, researchers from India proposed their own version of the typology. They classified the folded tongue according to three characteristics: the pattern of cracks, their number, and the presence of associated symptoms.

According to the pattern of cracks, they distinguished:

central longitudinal type with a vertical crack in the center of the tongue;
central transverse type with horizontal cracks in the center of the tongue;
Lateral longitudinal type with vertical cracks or fissures on the sides of the tongue going toward the center

branched type with horizontal cracks departing from the vertical sulcus;
diffuse type with horizontal and vertical cracks covering the entire tongue.

Complications of a creased tongue

With poor oral and tongue care, food debris, pathogenic microflora and dental plaque accumulate in the folds. This can lead to candida glossitis and a catarrhal inflammation that is red and swollen. The patient complains of dryness, burning, and pain in the tongue. There may also be bad breath and pain when eating hot, cold, spicy foods and drinks.

Folded tongue is often joined by desquamative glossitis, which is an inflammatory-dystrophic condition that manifests as redness, most often on the back and sides of the tongue.

Diagnosis of a creased tongue

If a patient has found furrows on the tongue, he should visit a dentist – this will help prevent the development of complications. You should also make an appointment with a general practitioner to rule out serious chronic diseases.

Gathering the anamnesis

The diagnosis is established by the patient’s complaints and the external condition of the tongue [5]. Most often, patients are concerned about its unaesthetic appearance and pain, if an infection has joined.

When collecting the anamnesis, the doctor may ask whether the pain and discomfort are related to food intake and its temperature.

Examination

Conducted with dental instruments: a mirror and a periodontal probe. The probe has digital and color-coded markings that allow you to assess the topography of the tongue and the depth of the folds. The procedure is safe and painless: the end of the working surface of the probe is rounded, so the tongue is not traumatized.

During the examination, the doctor evaluates:

The shape and size of the tongue, its folding, and the color of the mucosa;

Moisture, mobility and elasticity of the tongue;
the condition of the papillae, their number, size, color and location;
nature of plaque, its color and localization;

The presence of pathological elements on the tongue, such as spots or ulcers;
the consistency of the tongue;
presence of pain, its location, and possible cause – whether it is due to the folds or some other disease of the tongue.

Bacterioscopy

If symptoms are severe, a bacterioscopic examination of a swab taken from the surface of the tongue, particularly from the folds, is indicated. This will help to identify the cause of the complications and choose an effective treatment tactic.

Differential diagnosis

Folded tongue should be distinguished from glossitis, which occurs in tertiary syphilis. In syphilis, the connective tissue grows and the tongue becomes lobular, dense, and almost immobile. This distinguishes it from a congenital folded tongue, which is soft and mobile.

Treatment of a creased/folded tongue

A creased tongue can be either a separate disease or part of a pathological process in the body.

If the folded tongue is the result of a disease of any organ or system, the main disease should be treated first.

If there are no complaints or complications, then no special treatment is needed for congenital puckered tongue. The bumps that have arisen on the mucosa can no longer be removed.

Antifungal agents

If a candidiasis infection has occurred, the oral cavity is treated with antifungal agents (e.g. 1% Clotrimazole ointment) and the tongue is cauterized with aniline dyes.

The doctor prescribes antifungal drugs after examination and only if the pathological activity of Candida fungi has been confirmed by laboratory testing. Self-treatment is unacceptable: symptoms can worsen because of it.

Oral hygiene

If the disease is complicated by infection, it is important to carefully observe oral hygiene:

Brush your teeth twice a day;
Clean your tongue daily with a special brush or scraper;
Use interdental floss.

After examination, the doctor may recommend rinsing the mouth with antiseptic solutions. It can be used only if the results of scraping for fungal or bacterial infection are positive.

In other cases, rinsing with solutions with soda and salt, decoctions of chamomile and calendula flowers, oak bark, sage herb, St. John’s wort and their combinations are indicated. They will help reduce inflammation and prevent food debris and bacterial colonies from getting stuck deep in the sulcus.

Rinse your mouth three times a day for 1-2 weeks.

Surgical treatment for a creased tongue

If the tongue is 2-3 times the normal size, surgical treatment may be necessary. During surgery, the doctor corrects the shape and volume of the tongue: excising its tissues, suturing the folds and vaporizing them with a laser.

The operation is performed by an oral surgeon, the patient is under general anesthesia. After the operation the patient is usually kept under 24-hour observation in the intensive care unit. With a favorable course the patient is transferred to a general ward 24 hours later.

Prognosis and Prevention

Folded tongue rarely leads to complications or causes any disease. But the prognosis may be unfavorable if the pathology developed on the background of syphilis.

To prevent complications, you should:

carefully observe oral hygiene;
Timely treatment of teeth and chronic lesions of infection;

Avoid smoking and alcohol consumption;
Eat a balanced diet;
Eat freshly cooked and heat-treated food;

exclude from your diet spicy, sour, salty, smoked, and very hot foods that may additionally irritate the mucous membrane of the tongue;
Stop eating solid foods;
do not drink coffee and carbonated drinks;

Do not eat raw sunflower seeds, as their husks can damage the tongue and clog the furrows between the folds.