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
unique to the midline posterior tongue.  It occurs in as many as 1% of adults.
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
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

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


American Association of Oral Medicine

Useful Articles:

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

Int J Pharm & Bio Sci 2016.  Median Rhomboid Glossitis.  A Peculiar Tongue Pathology, Report of a Case &
Review of Literature

Indian J Case Reports 2018.  Atypical Median Rhomboid Glossitis.  A Case Report