1. ORAL PATHOLOGY PROJECT Amanda Mirabello 2014

2. MEDICAL HISTORY 18 year old Caucasian female Negative medical history Non-tobacco user Adequate home care

3. INTRA-ORAL EXAMINATION During routine intra-oral examination a short lingual frenum and splitting of the anterior tip of tongue were noted.

4. DESCRIPTION Lingual frenum attached anterior on the tongue. Tongue splits at anterior one third. Intra-oral exam WNL

5. INTRA-ORAL PHOTOGRAPHS

7. HISTORY OF ABNORMALITY Patient states that her tongue has been split since birth. Splitting of tongue has not caused any difficulties in speech, swallowing, or oral hygiene. No history of trauma or piercings

8. SYMPTOMS No pain reported Normal upon palpation, no masses noted Salivary glands WNL Oropharynx and Larynx WNL Voice WNL No dysphagia noted All other intra-oral and extra-oral exam findings WNL

9. DIFFERENTIAL DIAGNOSIS 1) Ankyloglossia: - Pulling anteriorly on tongue causing it to appear bifid - “Tongue Tied” - Congenital - Decreases mobility of the tongue tip - Short, thick lingual frenum - Mild-Complete - Affects eating, speech and oral hygiene in more severe cases

10. DIFFERENTIAL DIAGNOSIS 2) Bifid Tongue: - Congenital disorder occurring during fetal development in the 4 th week - Divided longitudinally at anterior - Rare without other orofacial abnormalities - Commonly seen in conjunction with syndromes and other orofacial abnormalities

11. DIFFERENTIAL DIAGNOSIS 3) Trauma to tongue: - Possible biting of tip of tongue, or oral piercing causing splitting and scarring. - Possible cosmetic surgery to achieve “snake tongue”

12. DIAGNOSIS PROCESS AND DIAGNOSIS Consulted on call dentist in clinic Evaluated patient and ruled out any syndromes in conjunction with abnormality Negative medical history Bifid tongue in the absence of other orofacial abnormalities/syndromes = very rare. No history of trauma or piercing to her tongue. Due to the rarity of this abnormality without other symptoms or syndromes, and lack of trauma/piercing history: Ankyloglossia = diagnosis from the dentist on staff. Intra-oral photographs were taken and Ankyloglossia bifid tongue was reported under intra-oral exam.

13. HEALTH PROMOTION METHODS Routine treatment was provided as planned. Abnormality noted under patient’s intra-oral exam findings. No effect on speech No dysphagia Prognosis abnormality is good.

14. BIBLIOGRAPHY DMB Hall, M. R. (2005). Tongue Tie. Retrieved from Archives of Disease in Childhood : http://adc.bmj.com/content/90/12/1211.1.full http://adc.bmj.com/content/90/12/1211.1.full Kumar L. K. Surej, N. M. (2010). Isolated Congenital Bifid Tongue. Retrieved from National Journal of Maxillofacial Surgery: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304211/. P.S Flemming, T. F. (2005). Bifid Tongue- a complication of tongue piercing. Retrieved from British Dental Journal: http://www.nature.com/bdj/journal/v198/n5/full/4812117a.html

15. THANK YOU !