Median rhomboid glossitis

Median rhomboid glossitis (MRG) is a benign condition of the tongue characterized by a smooth, red, and flat or slightly raised area on the dorsal midline of the tongue. It is typically located anterior to the circumvallate papillae and posterior to the filiform papillae. The condition is often asymptomatic and is usually discovered during routine dental examinations.

Etiology

The exact cause of median rhomboid glossitis is not well understood. However, it is commonly associated with a chronic Candida albicans infection. Other contributing factors may include smoking, use of corticosteroid inhalers, and immunosuppression.

Clinical Features

Median rhomboid glossitis presents as a well-demarcated, erythematous, and depapillated area on the midline of the dorsal surface of the tongue. The lesion is typically symmetrical and may have a rhomboid or oval shape. It is usually asymptomatic, but some patients may experience mild discomfort or a burning sensation.

Diagnosis

The diagnosis of median rhomboid glossitis is primarily clinical, based on the characteristic appearance of the lesion. A biopsy is rarely necessary but may be performed to rule out other conditions such as erythroplakia, geographic tongue, or squamous cell carcinoma. Microbiological culture or cytology may be used to confirm the presence of Candida albicans.

Treatment

Treatment of median rhomboid glossitis is often not required if the condition is asymptomatic. When treatment is necessary, it typically involves antifungal therapy to address the underlying Candida albicans infection. Topical antifungal agents such as nystatin or clotrimazole are commonly used. In cases where systemic antifungal therapy is needed, fluconazole may be prescribed. Patients are also advised to maintain good oral hygiene and to avoid smoking and the use of corticosteroid inhalers if possible.

Prognosis

The prognosis for median rhomboid glossitis is generally good. The condition is benign and does not predispose to malignancy. With appropriate antifungal treatment, the lesion may resolve, although recurrence is possible if predisposing factors are not addressed.

See Also

• Glossitis
• Candida albicans
• Oral candidiasis
• Geographic tongue
• Erythroplakia