Big Tongue (Macroglossia) Symptoms, Causes, and Treatment (2024)

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Macroglossia happens when your tongue is enlarged or oversized. It’s also called a “big tongue” or “enlarged tongue.” Since the tongue is part of your digestive system, it’s considered to be a digestive system disorder.

In most cases, macroglossia is a symptom of an underlying condition. The condition might be congenital (present at birth) or acquired (developed later in life). However, it’s possible to be born with macroglossia without a known underlying cause.

Having a large tongue can cause complications, like difficulty eating or breathing. For some people, having a big tongue is also a cosmetic issue.

Read on to learn about the symptoms, causes, and treatment of macroglossia.

Symptoms of macroglossia include:

  • tongue sticking out of the mouth
  • snoring
  • difficulty talking, eating, or breathing
  • high-pitched sound while breathing (stridor)
  • drooling
  • abnormal growth of jaws and teeth
  • frequently biting or injuring your tongue

There are many possible causes of macroglossia:

Congenital syndromes

Commonly, macroglossia that’s present at birth is caused by a syndrome like:

  • Down syndrome
  • Beckwith Wiedemann syndrome
  • Hunter syndrome
  • Hurler syndrome
  • Robinow syndrome
  • Maroteux-Lamy syndrome
  • Crouzon syndrome
  • Apert syndrome

Congenital muscular dystrophy

Congenital muscular dystrophy (CMD) is a group of genetic disorders that affect the muscle. It causes low muscle tone, also called hypotonia, and muscle weakness that worsens over time.

Macroglossia is a symptom of CMD. Other symptoms include:

  • overgrowth of leg muscles
  • weakness of arm muscles
  • delays in motor development
  • difficulty breathing


Acromegaly is when the body of an adult makes too many growth hormones. This causes tissues, like the tongue, to overgrow.

Other symptoms include:

  • large hands and feet
  • difficulty sleeping
  • larger facial features

Typically, acromegaly develops gradually.


Amyloidosis is a rare disease that may be inherited or acquired. It occurs when amyloid, an abnormal protein, builds up in the organs. This causes organ damage, affecting how the organs work.

Amyloidosis may involve the:

  • digestive system
  • heart
  • kidneys
  • nervous system
  • liver
  • spleen

A 2020 case report showed that if amyloidosis affects the digestive system, it may cause macroglossia. This is the most common oral symptom of amyloidosis.


Hypothyroidism, which is an underactive thyroid, happens when the body doesn’t produce enough thyroid hormones. It can be present at birth or develop later in life.

The condition can lead to a buildup of sugar molecules inside the tongue, leading to macroglossia.


A hemangioma is a noncancerous tumor made of blood vessels. Most hemangiomas become visible soon after birth.

Often, hemangiomas occur in the head and neck area. A hemangioma on the tongue can lead to macroglossia.

Inflammatory conditions

Inflammatory disorders can cause macroglossia, such as:

  • glossitis
  • tuberculosis
  • syphilis
  • sarcoidosis
  • polymyositis
  • certain cancers

Physical trauma

Physical trauma to the tongue can lead to swelling, resulting in macroglossia. In this case, it’s known as traumatic macroglossia.

This may happen as a complication of certain surgeries, like those that involve the:

  • cervical spine
  • craniofacial area
  • posterior fossa

An injury to the tongue may also cause macroglossia.

Sometimes, an enlarged tongue is a symptom of a congenital syndrome.

Syndromes that may cause an enlarged tongue include:

  • Down syndrome
  • Beckwith Wiedemann syndrome
  • Hunter syndrome and Hurler syndrome
  • Robinow syndrome
  • Maroteux-Lamy syndrome
  • Crouzon syndrome
  • Apert syndrome

If left untreated, macroglossia can cause complications.

Macroglossia that’s present at birth can affect physical development. This includes issues like:

  • misaligned teeth spacing
  • abnormal jaw formation
  • difficulty learning how to speak

Other complications of having a big tongue can affect people of all ages:

  • difficulty breathing
  • airway obstruction
  • difficulty chewing
  • pain in the temporomandibular joint
  • high risk of tongue injury (due to exposure)
  • dry mouth
  • recurrent upper respiratory tract infections
  • drooling

In severe cases, an airway obstruction can prevent oxygen from reaching the brain, and eventually lead to cardiac arrest.

If your tongue changes in any way, call a doctor. You should also have an appointment with a doctor if you have:

  • tongue swelling
  • discoloration on your tongue
  • tongue pain
  • difficulty talking, eating, or breathing
  • frequently accidentally biting your tongue
  • new or increased snoring

If your child experiences any of the above symptoms, you should schedule an appointment with your child’s doctor.

A doctor will use various tests to diagnose macroglossia. This includes:

  • Physical exam. A doctor will check the size of your tongue in proportion to the rest of your mouth. They’ll also look for lesions, swelling, or discoloration.
  • Medical history. To narrow down what’s causing your enlarged tongue, your doctor will ask questions about your other symptoms.
  • Blood tests. Depending on your physical exam and medical history, your doctor will recommend certain blood tests. This might include tests like a thyroid function test.
  • Imaging tests. An imaging test, like a CT or MRI scan, will let your doctor examine the tissues in and around your mouth.

In general, macroglossia treatment involves treating the underlying condition. Treatment options include:

Speech therapy

Speech therapy is used to treat mild macroglossia. A speech therapist teaches you how to control your tongue position and improve how you speak.


If the underlying cause can be treated with medication, a doctor will likely prescribe it. Some conditions that can be treated with medication include:

  • hypothyroidism
  • acromegaly
  • tuberculosis

Orthodontic treatment

Macroglossia may be associated with dental issues, like misaligned teeth spacing. If so, orthodontic treatment is necessary. This may also be used after macroglossia surgery.


About 10 percent of macroglossia cases require surgery. This involves a glossectomy, which is a surgery that removes part of the tongue.

Surgery has several benefits for macroglossia, including:

  • reduced drooling
  • improved ability to eat
  • improved speech

Macroglossia is usually caused by an underlying condition. When it’s present at birth, it’s often caused by genetic disorders like Down syndrome or congenital hypothyroidism. It can also develop later in life due to physical trauma, acromegaly, acquired hypothyroidism, or inflammatory conditions.

Symptoms of macroglossia include difficulty talking, breathing, and eating. It can also increase your risk of biting or injuring your tongue. If left untreated, it can cause an airway obstruction and prevent oxygen from getting to your brain.

Contact a doctor if your tongue changes in any way. Depending on your symptoms, you might need speech therapy, dental treatment, or medication to treat the underlying cause. Severe macroglossia may require surgery.

Big Tongue (Macroglossia) Symptoms, Causes, and Treatment (2024)
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