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Median Rhomboid Glossitis
Median Rhomboid Glossitis (MRG), also known as
Central Papillary Atrophy, Posterior Lingual Papillary
Atrophy
or Posterior Midline Atrophic Candidiasis, is a
type of
erythematous candidiasis unique to the midline
posterior tongue
.  It occurs in as many as 1% of adults.
What is Median Rhomboid Glossitis (MRG)?

This affects the tongue.  There is a central area on the tongue dorsum (just in front
of the
sulcus terminalis, approx 2/3’s of the way back on the tongue) that has no
papillæ (depapillated).  This is rhomboid in shape.


What are the signs & symptoms (+ demographics)?

It occurs at any age & is has not related to gender, ethnicity or geography.

Papillary atrophy is characteristic in MRG.  The rhombus-shaped, well-demarcated
and central denuded area of the tongue exhibits a red to dark pink appearance.


What are the causes of Median Rhomboid Glossitis (MRG)?

MRG was once thought to be a developmental defect that occurred during
embryogenesis, caused by the failure of the tuberculum impar to be covered
completely by the
lateral processes of the tongue.

MRG is found anterior to the circumvallate papillæ.  Since MRG is not found in
children, a developmental ætiology has been largely discounted; however, a direct
cause has not been established.


How is it diagnosed?

Prior to biopsy, the clinician should be certain that the midline lesion does not
represent a
lingual thyroid as it may be the only thyroid tissue present in the
patient's body.  Additional clinical look-alike lesions include the
gumma of tertiary
syphilis
, the granuloma of tuberculosis, deep fungal infections and granular cell
tumour
.


How is it treated?

No treatment is necessary for MRG but nodular cases are often removed for
microscopic evaluation.

Anti-fungal therapy (topical troches or systemic medication) will reduce clinical
erythema
and inflammation due to candida infection.  This therapy should ideally be
given prior to the biopsy, in order to reduce the
candida-induced pseudo-
epitheliomatous hyperplasia
features.

Some lesions will disappear entirely with
anti-fungal therapy.

If the patient is a denture wearer, as with the treatment of any type of
candida, the
appliances, dentures or any other oral devices should be treated with
anti-fungal
agents
.

Differential diagnosis:
Candida infection, chemical burns, syphilis patches
depending upon the clinical appearance, geographic tongue, nutritional
deficiencies
, lichen planus and traumatic ulcerations would be considerations.  
With any unexplained lesion,
oral cancer is always considered, although the centre
of the tongue is not a common area for malignancy.


Useful Websites & Articles:

Registered Dental Hygienist Magazine

Maxillofacial Center

Wikipedia



American Academy of Oral Medicine 2007.  Patient Information Sheet.  Median
Rhomboid Glossitis

ENT Journal 2007.  Median Rhomboid Glossitis

New Engl J Med 2010.  Images in Clinical Medicine.  A Smooth Patch on the
Tongue

Winter 2010.  Pathology Snapshot. Median Rhomboid Glossitis

Iran Red Crescent Med J 2011.  The Prevalence of Median Rhomboid Glossitis in
Diabetic Patients.  A Case-Control Study

2014.  Median rhomboid glossitis with palatal 'kissing lesion'.  A Case Report
Last Updated 4th December 2015
Photos of Median Rhomboid Glossitis