The surface of the tongue normally varies grcatiy in regard to both colour and appearance. Shades of pink and red or even yellow, brown or almost black may be of no medical significance though they are a potential cause of anxiety to the subject. Variations in colour may be causcd by foods, particularly coloured sweets, or they may be due to quantitative or qualitative changes in the haemoglobin. Central cyanosis can best be assessed clinically by inspection of the tongue (p. 81). A clean tongue, often red with prominent papillae, can result from antibiotic treatment. Iron or vitamin Bl: deficiency causes a smooth clean-looking tongue from diffuse atrophy of the papillae.
The fungiform papillae are small, red, flat elevations on the surface, especially at the tip and edges. The filiform papillae are more numerous at the centre and give rise to the fur. Transient denuded islands (geographical tongue) constitute a symptomless change of no known significance.
Excessive furring occurs in healthy people and in lever or dehydration. Congenita] lissuring of the tongue has no pathological significance.
Separating the anterior two-thirds from the posterior third of the tongue are the circumvallate papillae set in a wide V with its apex pointing backwards. Patients who discover these may be alarmed by the thought that they might be cancerous. In contrast, leukoplakia is a precancerous condition. It is characterised by grey opaque areas interspersed with a few red inflamed patches. Ulcers of the tongue may be caused by sharp, damaged teeth, but malignancy should always be considered.
The request 'please put out your tongue' may provide general information. For example, a stuporous patient who responds obviously hears and understands. Neurological disease, a tight frenulum, a painful condition of the mouth or undue modesty may restrict protrusion. Fasciculation (p. 213), within the tongue at rest, is a feature of motor neurone disease. Lesions of the hypoglossal nerve causc wasting of half the tongue (p, 213), which protrudes toward the affected side. The tongue is enlarged in Down's syndrome, acromegaly, myxoedema and in some patients with amyloidosis.
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