Dab solver - Median rhomboid glossitis

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{{Infobox disease
 | Name = Median rhomboid glossitis
 | Image = 
 | Caption = 
 | DiseasesDB =  
 | ICD10 = {{ICD10|K|14|2}} 
 | ICD9 = {{ICD9|529.2}}
 | ICDO = 
 | OMIM = 
 | MedlinePlus = 
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 | MeshID = 
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Median rhomboid glossitis (MRG, also known as central papillary atrophy,^ref or glossal central papillary atrophy.^ref ) is a condition characterized by an area of redness and loss of lingual , situated on the [[Dorsum (anatomy)|]] of the tongue in the midline immediately in front of the [[circumvallate papillae]].^ref{{rp|803}} Median rhomboid glossitis is thought to be created by a chronic fungal infection, and usually is a type of [[oral candidiasis]].

[[File:Median Glossitis (edit).jpg|thumbnail|Madian rhombiod glossitis in a child. Note atypical appearance of the lesion, which is more commonly an erythematous, atrophic area of depapillation]]

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{{Infobox disease
 | Name            = Median rhomboid glossitis
 | Image           = 
 | Caption         = 
 | DiseasesDB      =  
 | ICD10           = {{ICD10|K|14|2}} 
 | ICD9            = {{ICD9|529.2}}
 | ICDO            = 
 | OMIM            = 
 | MedlinePlus     = 
 | eMedicineSubj   = 
 | eMedicineTopic  = 
 | MeshID          = 
}}

'''Median rhomboid glossitis''' (MRG, also known as '''central papillary atrophy''',<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref> or '''glossal central papillary atrophy'''.<ref name="OMF medicine textbook">{{cite book|last=Scully|first=Crispian|title=Oral and maxillofacial medicine : the basis of diagnosis and treatment|year=2008|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780443068188|pages=196–198|edition=2nd ed.}}</ref> ) is a condition characterized by an area of redness and loss of lingual <<link:0>>, situated on the [[Dorsum (anatomy)|dorsum]] of the tongue in the midline immediately in front of the [[circumvallate papillae]].<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: Clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref>{{rp|803}} Median rhomboid glossitis is thought to be created by a chronic fungal infection, and usually is a type of [[oral candidiasis]].

[[File:Median Glossitis (edit).jpg|thumbnail|Madian rhombiod glossitis in a child. Note atypical appearance of the lesion, which is more commonly an erythematous, atrophic area of depapillation]]

==Signs and symptoms==
Rarely is any soreness associated with the condition. Apart from the appearance of the lesion, there are usually no other signs or symptoms. The typical appearance of the lesion is an oval or rhomboid shaped area located in the midline of the dorsal surface of the tongue, just anterior (in front) of the [[terminal sulcus (tongue)|sulcus terminalis]]. The lesion is usually symmetric, well demarcated, erythematous and depapillated, which has a smooth, shiny surface. Less typically, the lesion may be [[hyperplasia|hyperplastic]] or lobulated and exophytic. There may be candidal lesions at other sites in the mouth, which may lead to a diagnosis of [[Oral candidiasis#Chronic multifocal oral candidiasis|chronic multifocal oral candidiasis]]. Sometimes an approximating erythematous lesion is present on the palate (a "kissing lesion").<ref name="OMF medicine textbook" /><ref name="OMF path textbook" /> The lesion is typically 2 – 3&nbsp;cm in its longest dimension.

==Causes==
Predisposing factors include smoking, denture wearing, use of [[corticosteroid]] sprays or inhalers and [[human immunodeficiency virus]] (HIV) infection.<ref name="OMF medicine textbook" /> ''Candida'' species even in healthy people mainly colonizes the posterior dorsal tongue.<ref name="OMF medicine textbook" /> Median rhombiod glossitis is thought to be a type of chronic atrophic (or erythematous) candidiasis. Microbiological culture of the lesion usually shows ''Candida'' mixed with bacteria.<ref name="OMF medicine textbook" />

==Diagnosis==
The diagnosis is usually made on the clinical appearance, and tissue [[biopsy]] is not usually needed. The [[Histology|histologic]] picture is one of superficial candidal [[hyphae|hyphal]] infiltration and a [[polymorphonuclear leukocyte|polymorphonuclear leukocytic]] inflammatory infiltrate present in the epithelium. The [[rete ridges]] are elongated and hyperplastic (pseudoepitheliomatous hyperplasia, which may be mistaken for [[carcinoma]]).<ref name="OMF medicine textbook" />

==Treatment and prognosis==
Treatment may involve smoking cessation and prescription of topical or systemic [[antifungal medication]]. Usually the mucosal changes resolve with antifungal therapy, but sometimes the lesion is resistant to complete resolution.<ref name="OMF medicine textbook" /><ref name="OMF path textbook" />

==Epidemiology==
It is uncommon condition, occurring with equal prevalence in males and females and at any age.<ref name="OMF medicine textbook" />

==History==
Historically, this lesion was believed to be a developmental defect of the tongue, caused by failure of the  [[tuberculum impar]] to be covered by the lateral processes of the tongue. This was disproved when a study of 10,000 children were examined and no medium rhomboid glossitis lesions were found at all. Since, a consistent correlation with ''C. albicans'' has been demonstrated.<ref name="OMF path textbook">{{cite book|last=Bouquot|first=Brad W. Neville , Douglas D. Damm, Carl M. Allen, Jerry E.|title=Oral & maxillofacial pathology|year=2002|publisher=W.B. Saunders|location=Philadelphia|isbn=0721690033|edition=2. ed.|page=192}}</ref>

== References ==
{{reflist|2}}

[[Category:Conditions of the mucous membranes]]
[[Category:Tongue disorders]]
[[Category:Oral pathology]]

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Dab solver - Median rhomboid glossitis

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