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Health Inset > Diseases and Conditions > Median Rhomboid Glossitis

Median Rhomboid Glossitis

Median Rhomboid Glossitis (MRG) is a rare ailment of the tongue that gives rise to diamond-shaped lesions on the tongue. To know how it is caused or diagnosed apart from the treatment it may require, you may keep reading.

Median Rhomboid Glossitis Definition

It is a cutaneous condition of the tongue which is characterized by the occurrence of diamond-shaped smooth lesions on the dorsal plane of the tongue. It is the unique shape of the lesions that gives the condition its singular name.

Median Rhomboid Glossitis Symptoms

MRG is mostly asymptomatic. In some patients, however, general discomfort can be sensed – especially in the site which is evident of atrophic changes. Itching or burning sensation can be caused in the dorsal line of the tongue but it is not painful. Even in such cases, symptoms seem to be transitory.

Picture of Median Rhomboid Glossitis

Picture 1 - Median Rhomboid Glossitis

The MRG lesions measure around 2 cm or less but not beyond this dimension. It usually develops in the middle line of the tongue, following the circumvellate papillae. It can attain whitish color due to an overproduction of keratin. With an infection caused by candida, the soft palate is likely to develop kissing lesion characterized by redness.

Median Rhomboid Glossitis Incidence

It is a rare condition, which may affect only 1% of the masses. It is comparatively more prevalent in men than women, in the age bracket of 30 to 40 years.  A study conducted on individuals with MRG confirmed 6% of them to be diabetics. Whether smoking is associated with the risks of MRG is not clear.

Median Rhomboid Glossitis Causes

No direct cause of MRG has been established. An old theory suggested that it occurs during the formation and development of the embryo before becoming a fetus. It was believed that MRG was caused as a failure of the formation of the tuberculum impar. However, it was questioned as the occurrence of this condition was less frequently noted in children.

Recent theories suggest the role of Candida albicans – a type of yeast, which causes fungal infection. Hence it can be said to be a type of Candidiasis, which may lead to excessive surface keratin. By studying the biopsies of some patients with MRG in 1975, Cooke discovered that Candida caused mucosa colonization on the tongue. This infection may be caused along with secondary hyperplasia.

Though MRG is not transmissible, a person can contract Candida infection from another person if he or she has low resistance or immunity. Candida is usually present in the oral cavities of people as a part of the microbial flora. When resistance in systemic host is lowered, they start growing rapidly. This condition, like few other forms of Glossitis, is not caused due to dry mouth or allergic reactions.

 

Median Rhomboid Glossitis Diagnosis

It is common to diagnose this condition accidentally while performing other investigations. In other cases, the medical history of a patient can be consulted for diagnosis. If there has been any lifestyle modification or dietary changes, it might be used as parameters for diagnosis to some extent.

The diagnosis of MRG can effectively be done by identifying its microscopic features. Identification can be done on the basis of Candidal hyphae, which is present in the external epithelium. The histological findings may include:

  • The reduction in the papillae of the tongue
  • Inflammation
  • A pattern resembling psoriasis caused by long epithelial rete ridges beside parakeratosis (a benign skin condition)

Apart from that, digital photography depicts the lesions pretty well. It is also helpful in detecting future occurrences.

Differential diagnosis is essential to rule out the possibilities of squamous cell carcinoma, pyogenic granuloma, amyloidosis, haemangioma and granular cell tumour. Oral cancer may be considered if the lesion cannot be explained but the location where it occurs is not the seat of malignancy.

Median Rhomboid Glossitis Treatment

Treatment is not be required in general. However, it might become necessary in some cases. Administration of antifungal treatment is the primary step taken for healing this infection. Some of the regular antifungal medicines may include ketoconazole, clotrimazole, nystatin and fluconazole. These topical medications help in reducing the fungus but it may recur.

Image of Median Rhomboid Glossitis

Picture 2 - Median Rhomboid Glossitis Image

Alongside this treatment, patients are also advised on replacing their toothbrushes and dental equipments to avoid recurrence of infection. Treating oral devices and dentures with antifungal agents is also advised. Surgery might be required to remove lesions that have elevated appearance. In certain cases, a biopsy can be ordered if it doesn’t subside with the antifungal treatment. Corticosteroids can be useful in complicated cases which show no improvement with antifungal treatment.

Median Rhomboid Glossitis Prognosis

The prognosis of this benign condition is good. It is often cured without any specific treatment.

Median Rhomboid Glossitis and Angular Cheilitis

Several clinical variants exist for Candidiasis. Its erythematous variant, developing in the dorsal part of the tongue, is known as MRG. Angular cheilitis, on the other hand, is formed around the corners in the mouth – also including the skin.

Median Rhomboid Glossitis and Geographic tongue

Geographic tongue is one of the common tongue ailments which require no treatment. It manifests as bare regions on the dorsal region of the tongue bordered by elevated faded border. It is different from MRG, which is smooth and shiny with shapely plaques.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170022/

http://www.aaom.com/patients/median-rhomboid-glossitis/

http://www.exodontia.info/Median_Rhomboid_Glossitis.html

http://www.wisegeek.com/what-is-median-rhomboid-glossitis.htm

By   Last updated October 13th, 2012

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