Macroglossia may be associated with a number of clinical and radiographic findings. The findings may vary between individuals, but patients with true macroglossia will have several findings present.
Clinical Findings (after Table I, page 171)
(1) The tongue is grossly enlarged and/or wide, broad and flat.
(2) Chronic posturing of the tongue between the teeth when at rest, after excluding the habitual placing of a normal-sized tongue.
Changes in arches and/or dentition:
(3) Mandibular prognathism.
(4) Class III malocclusion with or without anterior and posterior crossbite.
(5) Buccal tipping of posterior teeth (increased curve of Wilson in maxillary arch, reverse curve in mandibular arch).
(6) Accentuated curve of Spee (or curve of occlusion; the curved line determined by the occlusal surfaces and incisal edges of teeth when viewed from the side) in the maxillary arch.
(7) Reverse curve of Spee in the mandibular arch.
(8) Decreased transverse width of mandibular and maxillary arches.
(9) Diastemata (space between teeth) in the mandibular or maxillary dentition.
(10) Asymmetry in the maxillary or mandibular arches associated with an asymmetric tongue.
(11) Instability in orthodontic mechanics or orthognathic surgical procedures that in usual circumstances would be stable.
Changes associated with the tongue:
(12) Crenation (scalloping) on the tongue.
(13) Glossitis from excessive mouth breathing.
(14) Speech articulation disorders.
(15) Difficulty in eating and swallowing.
(16) Airway difficulties, such as sleep apnea, due to oral or oropharyngeal obstruction.
Cephalometric features in Radiographs (after Table II, page 171):
(1) The tongue fills the oral cavity and extends through an anterior open bite.
(2) Dentoalveolar protrusion, either mandibular or bimaxillary.
(3) Overangulation of anterior teeth, involving maxillary and/or mandibular dentition.
(4) Disproportionately excessive mandibular growth with dentoalveolar protrusion.
(5) Decreased oropharyngeal airway.
(6) Increased gonial angle (gonion = the most posterior and inferior point on the angle of the mandible, formed by the junction of the ramus and the body of the mandible).
(7) Increased mandibular plane angle
(8) Increased mandibular occlusal plane angle.
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