Most urgent danger is that of asphyxia from pressure, and of inspiration pneumonia, for the infected saliva in these cases will trickle down within the larynx and trachea. Even gangrene of the tongue has been observed as the result of pressure, while the teeth will leave their impress upon the sides of a swollen tongue.
The more chronic infections of the tongue are syphilis, tuberculosis, and actinomycosis. Syphilis may assume a primary type and occasionally typical chancres may be seen on the tongue. It is frequently the site of mucous patches and of other ulcerative lesions. Tuberculous ulcerations of the tongue assume less indurated and irregular borders, and may be suspected in connection with well-marked tuberculous lesions of other parts of the respiratory tract, being particularly common in consumptives. These ulcers yield best to cauterization and antiseptic mouth-washes, whereas syphilitic lesions rarely disappear without active antispecific medication. Both syphilis and tuberculosis produce gummatous tumors, the former more frequently than the latter. The former will disappear equally readily under suitable treatment.
Actinomycosis of the tongue is rare in man. It constitutes a granuloma which may soften and present a ragged, ulcerated surface. (See [Actinomycosis], Chapter VIII.)
Leukoplakia implies the appearance of opaque, white patches upon the mucous surfaces of the tongue as well as on the lining membrane of the mouth, lips, and palate. They are far more frequent, however, on the tongue and generally appear there first. Here they appear almost as if thin scales could be separated from the surface upon which they lie, but this will not be found possible when the effort is made. The patches are irregular, but sharply outlined, occasionally confluent, involving the entire upper lingual surface; while the plates become harder and more roughened as they grow older, and furrows, subsequently ulcerating, may appear between them. The affection is chronic and intractable. It occurs often in the mouths of smokers during middle and advanced life. While its etiology is unknown it may be due to chronic irritation.
Between leukoplakia and epithelioma of the part involved there seems to be a strong relation, and the former is often regarded as a precancerous stage of the latter. Epithelioma is a frequent terminal feature of leukoplakia. There often seems, moreover, a predisposition to it in syphilitic individuals. It is mainly to be distinguished from secondary syphilitic lesions, which may be done by recalling its chronicity and its obstinacy to the treatment which would disperse the latter.
In the way of treatment smoking must be prohibited, antiseptic mouth-washes often used, with cauterization to a mild degree. These methods, however, suffice only for the milder cases. If any caustic be used it may be either 10 per cent. chromic acid, chemically pure lactic acid, or nitric acid, caution being used in their application. The more serious forms of leukoplakia will usually yield to local anesthesia, followed by curetting of each patch until the raw surface beneath is exposed, and then the application of the actual cautery. Rigorous treatment is necessary when ulcerated and fissured patches are present.
The benign tumors of the tongue include nevi, often in connection with single or multiple papilloma, or which may assume the type of multiple papillomas, each of which is extremely vascular. Occasionally the tongue will be seen almost covered with these small growths. This condition is noted usually in young children, and is practically of congenital origin. It frequently subsides spontaneously, but may require the actual cautery or something equally radical. The other benign tumors are of occasional occurrence, even an enchondroma having been occasionally seen. Much more common are the retention cysts, especially that particular form of cyst occurring beneath the tongue or at its base, known as ranula. This term is vaguely applied to cysts produced by obstruction of one of the salivary ducts or by cysts of congenital origin. It is caused mainly by incomplete obliteration of the thyroglossal duct. A so-called ranula may contain colorless fluid, more or less thick, and mixed with epithelial or dermoid products.
Fig. 472
Macroglossia. (Tillmanns.)