Introduction
The tongue is a key oral structure for speech and oral swallowing, which is highly mobile and capable of making fine muscular adjustments. Macroglossia is an uncommon clinical condition characterised by abnormal tongue size. The tongue protrudes beyond the alveolar ridge or teeth when it is in resting position.1 The aetiology of macroglossia is multifactorial, can be inherited as congenital or acquired, can be tissue overgrowth, tissue infiltration, infectious or inflammatory causes. An enlarged tongue can influence an individual’s growth, development, and psychosocial well-being. While the medical aspects of macroglossia are well-documented, the negative impact it can have on an individual's well-being is often overlooked. The review explores the various consequences of macroglossia and highlights the emotional and social challenges faced by individuals with this condition.
Consequences of macroglossia: A psychological point of view
The eyes of the society will easily catch the unique, uncommon, unfamiliar, unnatural or unusual things first, likewise the individual with the facial, oral or any abnormality will be the one first to get disrupted in the amalgamation process of living with the society. The consequences of that clinical condition and their consequences are in detail below.
Impact of macroglossia: Physiological
Dental impacts
The abnormal size and positioning of the tongue can cause morphological changes including mandibular protrusion, class III malocclusion,2 anterior or/and posterior cross bite,3 impressions by teeth cusps, increased transverse maxillary and or mandibular width,4 dentoalveolar protrusion of the lower incisors, pain in temporomandibular joint, generalised teeth spacing5 and negative impact on articulation.6
Speech and communication
The macroglossia can impede proper tongue placement and movement, leading to problems with articulation of dentition and clarity in the speech. The individual may struggle in understanding, leading to frustration and hindering communication.
Chewing and swallowing
This condition does not affect aesthetics of the face but creates problems with chewing and biting, leading to difficulties in swallowing. This problem can cause temporomandibular pain and dysfunctions. This impacts the nutrition and overall well being of the individual.
Disturbances in sleep
The enlarged tongue may obstruct the nasopharynx and lead to total obstruction of the airway and cerebral anoxia.7 Such an obstruction of the airway is usually exacerbated when the person is in a supine position, because of gravity, an enlarged base may more easily obstruct the oropharynx and hypopharynx and might even affect swallowing.8
Social interaction and its impacts
Anxiety and isolation
The abnormality caused by macroglossia leads to social anxiety and withdrawal. The individual may avoid social situations or feel self-conscious, hindering the ability to form meaningful relationships.
Bullying and teasing
The extraoral features, improper speech, other complications, and visible nature of the macroglossia can unfortunately make the individual targets for teasing and bullying in the workspace or school and colleges. This can be particularly detrimental for children and adolescents, damaging their self-esteem and social development.
Relationships
“Man is by nature a social animal” by the legendary Greek philosopher Aristotle, society is something that precedes the individual and man cannot live alone. The challenges and social anxiety caused by the abnormal features make it difficult for individuals to build relationships, this leads to feelings of loneliness and isolation.
Body image concerns
Anything which is not similar or not symmetric or an altered appearance may lead to significant body image concerns and low self esteem to people with macroglossia. The drowned self-esteem can negatively affect the individual’s self-perception and confidence.
Social withdrawal and onset of depression
In severe cases, downfall of self-confidence, self-esteem causes, and the combined effects of social anxiety and isolation leads to depression and social withdrawal. Numerous people in the modern world are stuck in a depressive state because of negative body image and more because of cyberspace.
Daily activities and quality of life
Eating and drinking
The morphological limitations caused by macroglossia can make basic activities like eating and drinking difficult, this leads to frustration, social weakness and even nutritional deficiencies.
Physical activities restrains
Participation in certain physical activities depends upon the severity of the condition. It may negatively impact participation in certain sports especially swimming, diving or other sports activities or participation in singing.
Communication challenges and social amalgamation
The voice of an individual in social space depends upon the vox, the speech difficulties and social anxiety associated with macroglossia can significantly hinder communication and participation in social activities. The cumulative impact of the physical and psychological consequences of macroglossia can significantly reduce an individual’s overall wellbeing and quality of life.
Mitigating plans
Medical Interventions
The treatment of macroglossia entirely depends on its aetiology and the correction of the systemic disease underlying the abnormal tongue size, orthodontic treatment, surgery and radiotherapy.
Surgical interventions
The most frequently reported treatment for the macroglossia is glossectomy which needs to be applied only in desirable effect and cannot be achieved in conservative treatment care. This glossectomy is strictly selective, since the number of people indicated for surgery is limited and probably under 10 % of all patients.9 Indications are extreme sizable tongue mass, tooth impressions on the tongue, speech problems or psychological problems.2
Rehabilitation and speech therapy
Conservative treatment includes medication, use of leeches, orthotic appliances, specific training and effort to give up parafunctional habits. Speech therapy is mainly to develop strategies to improve the articulation, clarity of speech, and overall communication skills. This efficient conservative means of treatment believes to empower the individual to express more effectively and participate more confidently in social interactions.
Orthodontic treatments
The malocclusions and other dental abnormalities caused by macroglossia, the dental orthodontic treatments like appliances improving the dental health and potentially enhancing facial aesthetics. This contributes to improved self-esteem and body image.
Psychosocial support
Individual and group therapy
The social isolation and avoidance can be addressed through individual therapy especially those who have anxieties, depression and body image concerns. Group therapy can provide a similar space for connecting people facing similar challenges, fostering support and to reduce the feeling of isolation. Social skill training can equip individuals with macroglossia with strategies for navigating social situations more effectively. Peer support groups can positively offer a sense of support and connection with others who understand the unique challenges associated with the condition.
Importance of family and community support
Friends and family are crucial for healing and mitigating the psychological stress the people who undergo due to body image. Creating a supportive and understanding environment can help individuals feel accepted and valued, fostering self-resilience and self-esteem. Implementation of the combination of medical intervention and psychosocial support strategies can significantly improve the overall wellbeing and quality of life in these individuals.
Conclusion
Macroglossia, a physical condition, can impact the individual's psychosocial well-being. By recognizing the challenges and potential psychosocial consequences and developing and implementing a comprehensive treatment approach can address both the physical and emotional aspects of the individual who needs care with macroglossia.
FAQs
Can macroglossia be fixed?
Yes, with help of medical surgery interventions.
Can people with macroglossia talk?
In macroglossia your tongue may stick out of your mouth, making it difficult to talk.
How rare is macroglossia?
Exact incident rate in the general population is unknown, it can be found in some congenital syndromes such as Down syndrome and Beckwith Wiedemann syndrome.
Is macroglossia reversible?
For acquired macroglossia, reversible etiologies can be treated like endocrine abnormalities to prevent progression of disease. In mild cases, speech therapy, orthodontic treatment, supportive and positional therapy may be sufficient.
References
- Gupta OP. Congenital macroglossia. Arch Otolaryngol. 1971; 93(4):378–83.
- Wolford LM, Cottrell DA. Diagnosis of macroglossia and indications for reduction glossectomy. Am J Orthod Dentofacial Orthop. 1996; 110(2):170–7.
- Friede H, Figueroa AA. The Beckwith-Wiedemann syndrome: a longitudinal study of the macroglossia and dentofacial complex. J Craniofac Genet Dev Biol Suppl. 1985; 1:179–87.
- Ruff RM. Orthodontic treatment and tongue surgery in a class III open-bite malocclusion. A case report. Angle Orthod. 1985; 55(2):155–66.
- Kawakami S, Yokozeki M, Takahashi T, Horiuchi S, Moriyama K. Siblings with spaced arches treated with and without partial glossectomy. Am J Orthod Dentofacial Orthop. 2005; 127(3):364–73.
- Margar-Bacal F, Witzel MA, Munro IR. Speech intelligibility after partial glossectomy in children with Down’s syndrome. Plast Reconstr Surg. 1987; 79(1):44–9.
- Bell C, Oh TH, Loeffler JR. Massive macroglossia and airway obstruction after cleft palate repair. Anesth Analg. 1988; 67(1):71–4.
- Hillman DR, Platt PR, Eastwood PR. The upper airway during anaesthesia. Br J Anaesth. 2003; 91(1):31–9.
- Deguchi T. Case report: three typical cases of glossectomy. Angle Orthod. 1993; 63(3):199–207.
