Macroglossia - Differential Diagnosis

1. Pseudomacroglossia – secondary to condition which forces the tongue to sit in an abnormal position, making it look enlarged.

-  Enlarged tonsils/adenoids
-  Low palate
-  Abnormalities in maxillary or mandibular arches
-  Oral cavity neoplasms causing tongue displacement

2. True Macroglossia

1) Congenital – i.e. Down Syndrome, Beckwith-Widemann Syndrome, Mucopolysaccharidoses, and many more

2) Acquired
- Hypothyroidism – due to accumulation of matrix glycosaminoglycans
- Acromegaly
- Infiltrative disease – AL Amyloidosis, Sarcoidosis
- Neoplasms of the tongue – Carcinoma, Plasmacytoma, Hemangioma, Lymphangioma
- Trauma – Surgery, biting, intubation injury, radiation therapy
- Infection – Ludwig Angina, Candidiasis, more
- Vitamin Deficiencies – e.g. Pellagra (B3 niacin deficiency), B12 deficiency, others

(Chanu Rhee MD, 12/14/10)