From Big Medical Encyclopedia

GLOSSITIS (glossitis; grech, glossa language + - itis) — the morbid condition of fabrics of language of inflammatory character representing more often a symptom of the general disease of an organism, more rare proceeding independently. This term is often traditionally used in relation to all patol, to changes of language. Happens superficial and deep. The concept «superficial glossitis» reflects only localization of a catarrh of a mucous membrane of an oral cavity (see. Stomatitis ).

A mucous membrane of language as well as the mucous membrane of all oral cavity, can be involved in any patol, the process proceeding in a human body, caused by an infection (banal or specific), an injury, a new growth, etc. Language reacts to the most different patol, conditions of an organism most often a catarrh, a cut can have acute and hron, a current.

An injury keen edges of teeth or a prosthesis, thermal and chemical irritants, and also some species of microorganisms (yeast-like fungi, viruses of herpes and flu, a streptococcus, etc.) can be the local reasons of acute G.

Defeat of language fungi of the sort Candida albicans, etc. (so-called blastomikotichesky G.) corresponds to manifestations of a superficial zymonematosis on other sites of a mucous membrane of an oral cavity, genitalias and skin (see. Zymonematoses , Candidiasis ). At children's infectious diseases (measles, diphtheria) in language the acute catarrh develops; at scarlet fever the hyperemia of language differs in bigger intensity — so-called crimson language (among the first symptoms of a disease).

Inflammatory changes of language, pathognomonic for a certain infectious disease, do not arise therefore such terms as, e.g., diphtheritic are not justified. At the same time at serious infectious diseases (sypny, belly typhus, etc.) in connection with fever, the lowered salivation language becomes covered by a plaque — a so-called coated tongue. At the same time the inflammation does not arise, the plaque consists of the wrinkled threadlike nipples, a desquamated epithelium, the food remains.

Fig. 9. Leprose infiltration in the thickness of language.

Hron, G.'s current can be observed, e.g., at disturbance of acid-forming function of a stomach; at the same time on a mucous membrane of language there are sites of bright red color on which threadlike nipples are absent, and fungoid — are a little increased in sizes (glossitis superficialis Moelleri).

At specific infectious diseases (syphilis, a leprosy, tuberculosis) it is reasonable to designate defeat of language respectively nozol, a form of a disease (e.g., tuberculosis of language). The exception makes the syphilitic intersticial G. allocated as nozol, a form because of a wedge, and morfol, features (see below). The isolated defeat of language at a leprosy does not meet, it is combined, as a rule, with typical skin manifestations. Leprose granulomas at localization in language (the incorrect name «leprose glossitis»), just as syphilomas, form major defects after permission; along with separate granulomas considerable infiltrates during which formation language of the patient with a leprosy can increase to the huge sizes (tsvetn are observed. fig. 9).

Defeat of language can be observed also at diseases of blood. At a Werlhof's disease (Verlgof's disease) language is considerably increased in sizes, cyanotic color; fabrics it are as if impregnated with blood, edges exudes from surface erosions at the slightest touch. At pernicious anemia the so-called gunterovsky glossitis is characteristic (see below).

Inflammatory process can be localized in the thickness of language in the form of abscess, phlegmon, etc. (see. Language ).

Fig. 1. Normal language.
Fig. 2. Desquamative glossitis. Whitish ochazhka of the bulked-up epithelium, bright pink spots of deskvamirovanny sites.
Fig. 3. Rhomboid glossitis. On the centerline of language hilly education.
Fig. 4. Scrotal glossitis. Deep furrows are visible, the central furrow is especially characteristic.
Fig. 5. Combination of a scrotal and desquamative glossitis. Along with deep furrows of an ochazhka of the bulked-up epithelium with deskvamirovanny sites.
Fig. 6. Hairy black language. The site of the extended pigmented threadlike nipples.
Fig. 7. Gunterovsky glossitis. The underlined drawing of fungoid nipples of a tip of language against the background of the absent threadlike nipples.
Fig. 8. Intersticial glossitis. Language is reduced in volume, speckled by the involved furrows, reminds a type of a quilt.

The standard classification, all-in types patol, conditions of language, does not exist. The following nozol, forms enters the concept «glossitis» (tsvetn. fig. 1 — 8): folded (synonym scrotal G.), rhomboid median G., desquamative G. (synonym geographical language), hairy black language, gunterovsky G., intersticial G. (synonym sclerous G., indurative G.). Allocation of these forms is connected with the fact that these defeats are localized only in fabrics of language; however most of them can only conditionally be referred to G.

the Folded glossitis

the Folded glossitis represents congenital anomaly of language, can sometimes develop owing to a deep hron, an inflammation, being one of symptoms of a syndrome of Melkersson — Rosenthal (see. Melkerssona-Rosenthal syndrome ).

Patogistologiya: a focal thickening of an epithelium, small diffusion limfogistiotsitarny infiltrate in connecting fabric.

Language is a little increased in sizes and speckled by deep furrows which are well visible at extension of language. The deepest furrow passes usually across the centerline. Threadlike and fungoid nipples are usually not changed, however sometimes the surface of a back of the tongue is maleficiated at the expense of an atrophy of threadlike nipples, nek-ry increase in fungoid nipples. Quite often folded G. is combined with geographical. Between folds the remains of food, a desquamated epithelium accumulate, irritating fabrics of language, causing burning sensation and a fetor from a mouth.

The diagnosis is made on the basis by a wedge, pictures. Changes of a mucous membrane are irreversible; do not need treatment. For the purpose of reduction of subjective feelings it is recommended to grease periodically language of 15% with solution of borax in glycerin.

The rhomboid median glossitis

the Rhomboid median glossitis was described by L. Brock and Potriye (L. M of Pautrier) in 1914, having called it glossite losangique mediane. The term «rhomboid glossitis» was offered by Lane (J. E. Lane, 1924). In 1963. I. M. Vorontsov described three a wedge, versions (forms, stages): smooth, warty and papillomatous (can pass one into another).

The etiology is not clear. Most of authors considers rhomboid G. a consequence of congenital anomaly of language; however R. Degos (1954) revealed at this pathology considerable insufficiency ascorbic to - you; T. K. Somova (1965) considers that rhomboid G. represents dystrophic process because of diseases of the digestive system, in particular decrease in acid-forming function of a stomach.

Patogistologiya: at a smooth stage of G. the epithelium is slightly thickened, in warty and papillomatous — the acanthosis with submersible growth epithelial tyazhy is sharply expressed. It is quite often possible to observe an otshnurovka of epithelial islands and formation of horn pearls. Sometimes there is a slight cellular atypia. Collagenic fibers of a stroma are merged in homogeneous dense substance. Along with sharply fuchsinophil fibers meet argyrophil (destruction of collagen). Infiltrate is located perivaskulyarno or diffuzno and consists of lymphocytes, macrophages y plasmocytes.

Clinically rhomboid G., according to A.S. Olshanetsky (1961), develops at the age of 20 — 30 years more often. Characteristic sign: rhomboid G. emergence of accurately delimited site of defeat in front from valikoobrazny nipples on the centerline of language is. The center of defeat has the oblong and oval or rhomboid form, normal or cyanotic-red color.

The site of defeat is in a smooth stage flush with surrounding fabric or sinks down a little; flavoring nipples are maleficiated why the struck surface becomes as if varnished. In a warty stage outgrowths hilly, dense to the touch appear. In a papillomatous stage on a chicken skin there are growths covered in some cases with a keratosic epithelium.

The diagnosis is based on very characteristic type of language. Differential diagnosis is carried out with a blastoma of language, a geterotopichny lingual almond and a malrelated share of a thyroid gland, in doubtful cases it is specified gistol, a research.

Treatment is not required; in cases of progressing of a warty and papillomatous stage excision of the site of defeat for the prevention of a malignancy is recommended.

A desquamative glossitis

the Desquamative glossitis — a widespread disease of a mucous membrane of language. The etiology and a pathogeny are finally not found out. The researches conducted by S. M. Budylina (1959), A. I. Rybakov (1967), T. N. Spiridonova (1971), point to pathogenetic communication of desquamative G. with diseases of the digestive system.

Patogistologiya: the thickening of epithelial layer and intracellular hypostasis, dystrophic change of the majority of epithelial Cells, intercellular spaces are filled with exudate. In the subject connecting fabric — resistant vasodilatation, pristenochny standing and migration of leukocytes, vascular membranes are thickened and partially razvoloknena, perivascular infiltrates.

Clinically on various sites of a mucous membrane of language whitish ochazhka of the bulked-up epithelium, then the central part them appear in the beginning it is torn away with formation of the pinkish-red spots surrounded with a rim of the exfoliating epithelium. The zone exfoliating gradually extends, at the same time on site a desquamated epithelium the strip of a bright hyperemia is formed, edges as if moves after a valikoobrazny eminence. In 2 — 3 days the center of a spot becomes covered by an epithelium again and gradually loses bright coloring whereas on the periphery the spot continues to increase. The figures reminding the map are formed.

Sites of desquamation occupy sometimes all upper surface of language. Threadlike nipples in places of defeat are maleficiated. Subjective feelings are a little expressed.

Sometimes there is a morbidity from spicy and hot food that often brings to cancerophobias (see).

T. N. Spiridonova (1971) on a basis a wedge. - morfol. researches suggests to distinguish the migrating and fixed desquamative G.'s forms, allocating superficial and erosive and ulcer options in the first of them. Most often the superficial migrating form proceeding with the low-expressed painful symptom, bystry formation patol, elements meets the short term of epithelization. The current is chronic, remissions arise spontaneously and happen, as a rule, short-term; changes of a mucous membrane are reversible.

The diagnosis is made on the basis of visual signs and character of a current. Differentiate with secondary recurrent syphilis; results of Wassermann reaction are decisive (see. Wasserman reaction ), detection or lack of pale treponemas in the centers of defeat.

There is no specific treatment, it is recommended to normalize function of digestive organs; in cases of a cancerophobia — psychotherapy (see) and sedatives (see).

Hairy black language

Hairy black language is formed owing to growth and keratinization of threadlike nipples; Raye (R. of F. Rayer) in 1835 is for the first time described.

The etiology is not clear, attempts to find the specific activator were not crowned with success. A. M. Ariyevich observed a significant amount of a leptotriks in scrapings from language, however in most cases at a bakterioskopichesky research banal flora, saprofitiruyushchy in an oral cavity is found. The factors able to provoke change of threadlike nipples, according to data of many authors, the local irritation of a mucous membrane, and also use of antibiotics orally are.

Patogistologiya: sharply expressed hypertrophy of threadlike nipples of language; on both parties the keratosic outgrowths in the form of the teeth directed by an edge up depart from the condensed core of a nipple; the stroma is not changed.

Clinically in a middle part of a back of the tongue — the site of evenly extended threadlike nipples (to 1 — 2 cm) from light brown till black color. Assume that the pigment is formed of the compounds of iron which are in the remains of food. On structure and color the expanded nipples remind the hair which are easily keeping within the pallet in any direction. It is observed more often at men of middle and advanced age. Subjectively in language the foreign subject is felt as if.

Treatment: removal of nipples tweezers or the pallet with after-treatment of a surface of language of 3% solution of copper sulfate; cancellation of provocative pharmaceuticals is recommended; perhaps spontaneous treatment.

The Gunterovsky glossitis

the Gunterovsky glossitis — one of precursory symptoms of a malignant anemia (see. Pernicious anemia ); the burning sensation, especially in a tip of language is subjectively noted; language has smooth, as if a lacquered surface in connection with an atrophy of nipples of language, especially threadlike. Results of blood test are important for the diagnosis.

The intersticial glossitis

the Intersticial glossitis — one of forms of syphilitic defeat of language in the tertiary period, differs from gummous defeat (the incorrect term «gummous glossitis») in the fact that all fabrics of language are surprised diffuzno.

Patogistologiya: diffusion infiltrate penetrates all thickness of language, further there is a growth of connecting fabric, a tyazha a cut as if involve inside a top coat of muscles.

Clinically language takes a form of a quilt, is condensed, quite often decreases, its mobility is sharply limited.

Intersticial G.'s diagnosis can be made only on the basis of data serol, a blood analysis and other signs syphilis (see).

In cases if antisyphilitic treatment was not carried out timely and fully, muscular tissue of language gradually is almost completely replaced with connecting fabric; there are irreversible changes of language, the malignancy is possible.

See also Language .

Bibliography Bohr E. V., Groshikov M. I. and Patrikeev V. K. Therapeutic stomatology, M., 1973; I.M's Baneberries. Rhomboid glossitis as precancerous disease of language, Doctor, business, No. 12, page 117, 1963; D m and t r and-e in and V. S., P about about with about in V. S. and With and in and the Central Committee and y V. A. Benign tumors of the person, oral cavity and Russian cabbage soup, page 40, M., 1968, bibliogr.; Kolesov A. A. Stomatology of children's age, page 257, etc., M., 1970; Olypanetskiya. S. O rhomboid glossitis, Klin, medical, t. 39, Nn 6, page 111, 1961, bibliogr.; P and sh to about in B. M., Stoyanov B. G. and Mashkilleyson A. L. Damages of a mucous membrane of a mouth and lips at some dermatosis and syphilis, page 119, M., 1970, bibliogr.; In £ n 6 with z at J. and. lake of Migratory glossitis, Oral Surg., at. 39, p. FROM, 1975, bibliogr.; Boozer of Page H., L a n g 1 n d O. E. a. Guillory M. B. Benign migratory glossitis associated with lichen planus/J. oral Med., v. 29, p. 58, 1974; P i n k e r t R. Kritische Betrachtung zur Genese und Therapie der Glossitis rhombica mediana, Dtsch. Stomat., Bd 17, S. 825, 1967; Weathers D. R. a. o. Psoriasiform lesions of the oral mucosa (with emphasis on «ectopic geographic tongue»), Oral Surg. * v. 37, p. 872, 1974, bibliogr.

G. D. Savkina.