Congenital genetic syndromes (Down syndrome, Beckwith-Wiedemann syndrome, Hemihypertrophy, Triploid syndrome, Behmel syndrome, Gargoylism, Tollner syndrome, Gangliosidosis etc.)

Congenital vascular lesions (hemangioma, lymphangioma, etc.)

Lingual thyroid gland

Relatively large tongue as a result of the upper or lower jawbone being smaller than normal

Large tongue in isolation without a genetic disorder (congenital overdevelopment of the musculature)

- The most common cause of a congenitally large tongue is Beckwith-Wiedemann syndrome.

- On average, 7 out of 10,000 babies are born with Beckwith-Wiedemann syndrome.

- 82% of infant patients with large tongue are patients with Beckwith-Wiedemann syndrome.

- In 85% of cases, Beckwith-Wiedemann syndrome is not familial (inherited); there are no other people in the family with Beckwith-Wiedemann syndrome. In these patients, the disease has developed as a result of a new mutation. 15% of patients are familial (inherited). In these people, a genetic disorder is passed down from generation to generation and there are other people with Beckwith-Wiedemann syndrome in the family.

- This syndrome was first presented by Dr. Beckwith at a congress in 1963 with the title "Is it a new syndrome?" and in 1964, it was announced to the scientific world as Beckwith-Wiedemann syndrome by listing its symptoms.

- In this disease, there are defects in the abdominal wall, deformation of the earlobe, excessively large tongue, microcephaly, large and prominent ears, gigantism (large trunk and limbs), enlargement of the internal organs, various tumors in the internal organs, congenital low blood sugar, cleft lip.

- If there is a defect in the abdominal wall (Exomphalos), tongue size (Macroglossia), excessive size of the trunk and limbs (Gigantism), this condition is called EMG syndrome.

- In Beckwith-Wiedemann syndrome, the large tongue is due to overdevelopment of the tongue muscle. The surgery is performed by appropriately reducing the muscle tissue of the tongue, stopping the bleeding and suturing the muscle and mucous membrane layer by layer.

Some exercises to improve speech (for example, exercises such as holding a pencil with the tongue to strengthen the tongue muscle can lead to tongue enlargement)

Diseases such as amyloidosis, lipidoid proteinosis or mucopolysaccharidosis (Hurler's syndrome, etc.), which cause enlargement of the tongue due to the accumulation of certain substances

Tumors developing in the tongue (teratoma, myoblastoma, rhabdomyoma, carcinoma, sarcoma, lipoma, leiomyoma, granular cell tumor, etc.)

Infection of the root of the tongue or floor of the mouth (Ludwig's angina) and bleeding

Hypothyroidism

Cystic lesions

Inflammation of the tongue (chronic and acute glossitis)

Infections such as tuberculosis, Riga's syndrome, syphilis, actinomycosis, gingival infections.

Prolonged steroid treatments

Acromegaly

- Speech impairment: This is the most common reason for pediatric patients. These children usually bite their tongues when they speak because their tongues do not fit into the oral cavity. Therefore, speech is impaired. After surgical tongue reduction, they may need speech therapy.

- Malnutrition: This is usually the reason why infant patients are brought in. Feeding is problematic because the baby has a large tongue. Normal anesthesia cannot be given because the tongue fills the oral cavity. In these babies, anesthesia must be given through the nose. A tracheostomy, which means making a hole in the cartilage of the larynx, can also be opened. Anesthesia is risky because the patient is still a baby, but surgery should be performed without waiting because of malnutrition. These patients also have breathing difficulties. The decisions to be taken in such patients determine the success of the treatment.

- Snoring in the adult patient: The tongue filling the oral cavity can cause snoring in the adult patient. It is not certain that reducing the tongue will stop snoring, because the physiology of snoring is very complex. There is usually no single cause of snoring. Snoring is caused by many factors. If the tongue is larger than normal, tongue reduction may reduce snoring or improve it completely, but as I said, we cannot guarantee that tongue reduction will stop snoring completely.

- Defects in jaw and dental structures: This is a common aesthetic defect in patients with a congenitally large tongue. The patient has had a large tongue since infancy. As the patient develops over the years, the large tongue pushes the teeth from behind. Over the years, as the tongue pushes the teeth from behind, the teeth grow inclined outwards and as they turn outwards, the space between the teeth opens. In advanced cases, the teeth are turned out and spaced like a wolf's mouth. In these patients, brace treatment is required to correct the teeth, but first the tongue that pushes the teeth from behind must be reduced. First the tongue is reduced, then the teeth are treated with braces.

- Defects in diction: This is an interesting situation that we encounter in our clinical practice. Sometimes patients with perfect diction are admitted to our clinic, but they have difficulty in making some sounds while speaking. These patients are usually theater, cinema or TV artists. While these patients speak with perfect diction, they have difficulty in making some sounds only because their tongue is a little too long. When making some sounds, the long tongue extends out between the teeth and a "sss" sound is produced. It is a serious problem for patients with generally excellent diction to make a "sss" sound out of the blue while speaking. This problem is solved by shortening the tongue sufficiently. When the tongue is shortened appropriately, this problem can be solved without impairing the patient's diction.

- Saliva flow: In cases where the tongue does not fit in the mouth, there may be a constant flow of saliva from the mouth. This will cause both hygienic and social problems. After tongue reduction, the patient will be able to close his/her mouth and the drooling will stop.