Surgical aspects of a multidisciplinary approach to the treatment of children with syndromic macroglossia
DOI:
https://doi.org/10.32782/2415-8127.2026.73.15Keywords:
maxillofacial area, oral cavity, children, reduction, tongue, syndrome, open biteAbstract
Restructuring, hyper- or hypotonus, modification of the position and shape of the tongue, usually with an increase in size, is reflected in violations of its functional ability and anatomical and topographic relationships with the surrounding tissues of the maxillofacial region.
Goal: To systematize experience and establish patterns of surgical aspects of a multidisciplinary approach to the treatment of children with macroglossia.
The subject of scientific interest was patients with confirmed or unconfirmed, by molecular genetic testing, syndromic pathology (n=13).
Considering that macroglossia is a criterion for the appointment of surgical interventions in case of violation of vital functions, the paper describes two clinical cases of patients with confirmed and not confirmed by molecular genetic tests Becwith-Wiedemann syndrome, who underwent partial tongue resection. It is emphasized that the degree of functional impairment should also be emphasized when conducting and planning orthodontic preventive treatment. The objective impossibility of preventing most syndromic pathologies, the manifestations of which are an enlarged tongue, indicates the need to focus on limiting its negative impact on the growth of the facial skeleton. Conservative treatment consists of measures to reduce inflammation and bleeding of the tongue. Invasive surgical treatment, if necessary, is aimed at reducing the size while maintaining the mobility and function of the tongue.
The task of the maxillofacial surgeon in the multidisciplinary support of patients with confirmed or unconfirmed, molecular genetic testing, syndromic pathology in explicit macroglossia is to reduce the size of the tongue (subtotal resection) while preserving its functionality. This facilitates breathing, restores cognitive functions, contributes to the effectiveness of orthodontic treatment of patients and improves the quality of life.
References
Melnyk AО, Bidenko NV, Filonenko VV, Iefimenko VP, Kiselyova NV. Multidisciplinary approach to the rehabilitation of children with macroglossia. Kharkiv Dental Journal. 2025;2(4):192-204. doi: 10.26565/3083-5607-2025-4-07 [In Ukrainian]
Melnyk A, Filonenko V. Clinical and phonetic features of dentognathic deformations, their orthodontic treatment (Chapter). In: Ardelean LC and Rusu L-CC, editors. Human teeth – from function to esthetics. UK: IntechOpen. 2023. рр. 315-333. doi: 10.5772/intechopen.109636
Melnyk AO, Kaniura AА, Filonenko VV. Macroglossia: signs, symptoms, methods of diagnostic and treatment, influence on the formation of dentognathic deformations. Bulletin of dentistry. 2024;4(129):164-173. doi: 10.35220/2078-8916-2024-54-4.30 [In Ukrainian]
Ruscelloa DM, Douglasa C, Tysona T, Durkeeb M. Macroglossia: a case study. J Commun Disord. 2005;38(2):109-122. doi: 10.1016/j.jcomdis.2004.06.001
Deshkar M, Thosar NR, Kabra SP, Yeluri R, Rathi NV. The influence of the tongue on the development of dental malocclusion. Cureus. 2024;16(5): e61281. doi: 10.7759/cureus.61281
Li K, Hua H, Wie P. Macroglossia. J Am Dent Assoc. 2023;154(4):350-354. doi: 10.1016/j.adaj.2022.02.006
Kutti Sridharan G, Rokkam VR. Macroglossia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls. 2023. URL: https://www.ncbi.nlm.nih.gov/books/NBK560545/
Cohen JL, Cielo CM, Kupa J, Duffy KA, Hathaway ER, Kalish JM, Taylor JA. The utility of early tongue reduction surgery for macroglossia in Beckwith-Wiedemann syndrome. Plast Reconstr Surg. 2020;145(4):803-813. doi: 10.1097/PRS.0000000000006673
Hikita R, Kobayashi Y, Tsuji M, Kawamoto T, Moriyama K. Long-term orthodontic and surgical treatment and stability of a patient with Beckwith-Wiedemann syndrome. Am J Orthod Dentofacial Orthop. 2014;145(5):672-684. doi: 10.1016/j.ajodo.2013.08.019
Miyawaki S, Oya S, Noguchi H, Takano-Yamamoto T. Long-term changes in dentoskeletal pattern in a case with Beckwith-Wiedemann syndrome following tongue reduction and orthodontic treatment. Angle Orthod. 2000;70:326-331. doi: 10.1043/0003-3219(2000)070<0326:LTCIDP>2.0.CO;2
Meazzini MC, Besana M, Tortora C, Cohen N, Rezzonico A, Ferrari M, Autelitano L. Long-term longitudinal evalutation of mandibular growth in patients with Beckwith-Wiedemann syndrome treated and not treated with glossectomy. J Craniomaxillofac Surg. 2020;48(12):1126-1131. doi: 10.1016/j.jcms.2020.09.004
Wang KH, Kupa J, Duffy KA, Kalish JM. Diagnosis and management of Beckwith-Wiedemann syndrome. Front Pediatr. 2020;7:562. doi: 10.3389/fped.2019.00562
Giancotti A, Romanini G, Docimo R, Arcuri C. Clinical treatment of oral manifestations of Beckwith-Wiedeman syndrome in a child. J Clin Pediat Dent. 2003;27(4):377-380. doi: 10.17796/jcpd.27.4.6356k0231w213386
Nerurkar S, Kamble R, Kaiser J. Non-extraction orthodontic treatment protocol of moderate crowding. Cureus. 2023;15(4):e37483. doi: 10.7759/cureus.37483
Koycheva I. Orthodontic Treatment Protocols [eBook]. Sofia: Unicorn Publishing Group. 2020. 184 p.
de Felício CM, Ferreira CLP. Protocol of orofacial myofunctional evaluation with scores. Int J Pediatr Otorhinolaryngol. 2008;72(3):367-375. doi: 10.1016/j.ijporl.2007.11.012
Mittal TK, Achal K, Taylor JT, Kindelan JD. Partial glossectomy as an adjunct to orthodontic treatment of anterior open bite associated with macroglossia: a case report. Dental Update. 2025;14(1):707-709. URL: https://www.orthodontic-update.co.uk/content/orthodontics/partial-glossectomy-as-an-adjunct-to-orthodontic-treatment-of-anterior-open-bite-associated-with-macroglossia-a-case-report/
Marsh JL, Perlyn CA. Beckwith-Widemann macroglossia: the role of surgical tongue reduction. Cleft Palate Craniofac J. 2024;61(4):599-609. doi: 10.1177/10556656221148900
Balaji SM. Reduction glossectomy for large tongues. Ann Maxillofac Surg. 2013;3(2):167-172. doi: 10.4103/2231-0746.119230
McCrossan S, Martin S, Hill C. Tongue reduction for macroglossia. J Craniofac Surg. 2021;32(5):1856-1859. doi: 10.1097/SCS.0000000000007276
Kim DW, Kim JK, Huh G, Lee DY, Kwon SK. Tongue reduction surgery improves mandibular prognathism in Beckwith-Wiedemann syndrome without compromising tongue function. Clin Exp Otorhinolaryngol. 2023;16(1):67-74. doi: 10.21053/ceo.2022.00976.
Ainuz BY, Geisler EL, Hallac RR, Perez JK, Seaward JR, Kane AA. Anterior “W” Tongue reduction for macroglossia in Beckwith-Wiedemann syndrome. Cleft Palate-Craniof J. doi: 10.1177/10556656211036607
Thuman J, Zilinskas K, Hoey A, Brantley R, Scomacao I, Patel N. Macroglossia and the Current Evidence of Surgical and Clinical Management. J Craniofac Surg. 2025. doi: 10.1097/SCS.0000000000011849
Gasparini G, Saltarel A, Carboni A, Maggiulli F, Becelli R. Surgical management of macroglossia: discussion of 7 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:566-571. doi: 10.1067/moe.2002.127583
Bahgat A, Bahgat Y, Alzahrani R, Montevecchi F, Cammaroto G, Vicini C. Transoral endoscopic coblation tongue base surgery in obstructive sleep apnea: resection versus ablation. J Otorhinolaryngol Relat Spec. 2020;82(4):201-208. doi: 10.1159/000506994
Iannella G, Bellizzi MG, Eplite A., Meccariello G. Base of tongue surgery for obstructive sleep apnea treatment in a multilevel setting: trans-oral robotic surgery (TORS) vs endoscopic coblation surgery. Indian J Otolaryngol Head Neck Surg. 2025. doi: 10.1007/s12070-025-06278-7
Lu Y-A, Wang C-J, Chiang Y-T, Li H-Y. Volumetric changes after coblation ablation tongue (CAT) in obstructive sleep apnea patients. J of Clin Med. 2022;11(14):4186. doi: 10.3390/jcm11144186
Hotokezaka H, Matsuo T, Nakagawa M, Mizuno A, Kobayashi K. Severe dental open bite malocclusion with tongue reduction after orthodontic treatment. Angle Orthod. 2001;71(3):228-236. doi: 10.1043/0003-3219(2001)071<0228:SDOBMW>2.0.CO;2
