In the interests of a cosmetic result the incision should be small and well concealed by observatiod of the direction of the skin lines, using natural folds and hairy parts.
Aside from the defects and deformities in the buccal cavity which have already been mentioned, another important anomaly may occur, consisting of the complete occlusion or exaggerated diminution of the mouth fissure which, according to Amonn, Ahlfeld, is attributable to defective development of the entire first branchial arch. In rare eases there is total absence of the tongue (Spillcr, Griffith), while a median fissure of the tongue, or lingua bifida, is of more frequent occurrence.
Adherent tongue (ankyloglossum, tongue-tie) is a frequent anomaly that confronts the pediatrist. Owing to a shortened frenum the tongue is broadly adherent to the floor of the buccal cavity. The adhesion is often quite superficial and can be easily severed with a spatula, or the tongue can be promptly liberated by sharply nipping the frcnum with the scissors. There would seem to be no need for a deeper incision that may injure larger vessels. The operation is really only indicated in cases where the tongue can positively not be protruded beyond the alveo lar margin. Sucking or speaking is in no way impaired by a short fre num, as is often believed.
Macroglossia, or giant tongue, has seldom been observed as an independent pathological process (see Moro, vol. ii).
It is generally a symptom of other pathological conditions, such as idiocy, myxwdema, mongolism, acromegaly, and in these cases the entire interstitial tissue is augmented.
In other cases, however, a large swollen giant tongue of blue-red appearance, protruding through the open mouth, signifies a more or less extensive lymphangioma or hamangioma of the tongue (sec Tumors), according to whether the cavities with which the tongue is interspersed belong to the lymphatic system or to that of the blood-vessels. In many cases the tongue is abnormally large at birth, or at all events the anomaly is not at once noticed. The buccal cavity becomes only gradually filled by slow but steady growth of the tongue, which is finally forced out of the mouth, the impression of the teeth being distinctly visible on it. The growth of the teeth as well as of the jaws is interfered with by the constant pressure of the increasing enlargement.
The tongue is not always involved in its entire extent, but in all cases the mucous membrane is firmly and inseparably connected with the enlarged parts (differential diagnosis from other growths).
On account of the tendency of this congenital enlargement, even if only of slight extent, to bleed, there is always the possibility of infec tion as a source of danger to the child.
The treatment consists in the destruction of the enlargement by the thermocautery or excision of the parts involved.
If the enlargement is general, repeated partial excisions will be necessary and should be preceded by bilateral ligation of the lingual arteries owing to the degree of severe hemorrhage (von Bergmann, Fehleisen).
Similar congenital growths occur at the chin, lips, and eyelids.