Běžná onemocnění jazyka v primární péči

Souhrn

Ačkoli je jazyk snadno dostupný pro vyšetření, mohou abnormální nálezy na něm pro lékaře představovat diagnostické i léčebné dilema. Podmínkou rozpoznání a správné diagnostiky těchto nálezů je podrobný rozbor anamnézy zahrnující dobu vzniku a trvání obtíží, předchozí příznaky i užívání tabákových výrobků a alkoholu. Významné je též posouzení morfologie jazyka a pečlivé zhodnocení případné lymfadenopatie. Nejběžnějšími stavy, které postihují jazyk a nevyžadují léčbu, jsou mapovitý jazyk, zbrázděný jazyk (lingua plicata) a chlupatý jazyk. Glossitis rhombica mediana bývá spojena s kandidovou infekcí a odpovídá na topické podávání antimykotik. Atrofická glositida bývá spojena s deficitem železa, kyseliny listové, vitaminu B12, riboflavinu nebo niacinu ve stravě a po vyřešení zmíněného základního problému vymizí. Chlupatá leukoplakie v ústech, jež může upozorňovat na přítomnost imunodefi citu, je způsobována virem Epsteina a Barrové a léčí se perorálně podávanými antivirotiky. V případech nádorů postihujících jazyk bývá nutno provést biopsii za účelem odlišení benigních lézí (např. nádorů z granulárních buněk, fi bromů, lymfoepiteliálních cyst) od prekancerózní leukoplakie nebo skvamo celulárního karcinomu. Syndrom pálení v ústech často zahrnuje i pálení jazyka a v ověřovaných studiích odpovídal na léčbu kyselinou ?-lipoovou a clonazepamem i na kognitivně-behaviorální terapii. V několika studiích bylo též potvrzeno, že chirurgická discize uzdičky jazyka při ankyloglosii je z hlediska optimalizace úspěšnosti kojení účinnější než pouhá edukace matky. Léze nejasné etiologie postihující jazyk mohou vyžadovat biopsii nebo odeslání pacienta k ústnímu a maxilofaciálnímu chirurgovi, k odborníkovi na chirurgii hlavy a krku nebo ke stomatologovi se zkušenostmi v patologii ústní dutiny.

Summary

Although easily examined, abnormalities of the tongue can present a diagnostic and therapeutic dilemma for physicians. Recognition and diagnosis require a thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use. Examination of tongue morphology and a careful assessment for lymphadenopathy are also important. Geographic tongue, fissured tongue, and hairy tongue are the most common tongue problems and do not require treatment. Median rhomboid glossitis is usually associated with a candidal infection and responds to topical antifungals. Atrophic glossitis is often linked to an underlying nutritional deficiency of iron, folic acid, vitamin B12, riboflavin, or niacin and resolves with correction of the underlying condition. Oral hairy leukoplakia, which can be a marker for underlying immunodeficiency, is caused by the Epstein-Barr virus and is treated with oral antivirals. Tongue growths usually require biopsy to differentiate benign lesions (e.g., granular cell tumors, fibromas, lymphoepithelial cysts) from premalignant leuko plakia or squamous cell carcinoma. Burning mouth syndrome often involves the tongue and has responded to treatment with alpha-lipoic acid, clonazepam, and cognitive behavior therapy in controlled trials. Several trials have also confi rmed the effectiveness of surgical division of tongue-tie (ankyloglossia), in the context of optimizing the success of breastfeeding compared with education alone. Tongue lesions of unclear etiology may require biopsy or referral to an oral and maxillofacial surgeon, head and neck surgeon, or a dentist experienced in oral pathology.

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