A 3-year-old male child presented with a gradually increasing tongue size since birth. The child had difficulty in chewing and swallowing solid food with impairment of speech. He had no obvious signs of surface bleeding, paroxysms of lesion expansion, or repeated respiratory infections or respiratory distress. On examination, an enlarged, dry, fissured tongue occupied the entire oral cavity impeding visualization of posterior pharyngeal structures. Computed tomography revealed the lymphangioma involving the entire tongue. The child was treated with multiple intralesional bleomycin injections under monitored anesthesia care which resulted in marked symptomatic relief over a period of 9 weeks.

Fig. 1 Large fissured dry tongue.

Lymphangiomas are rare congenital hamartomas of malformed lymphatics. Children with tongue lymphangiomas present with macroglossia, dryness with fissures on tongue leading to difficulty in chewing, swallowing, speaking and occasionally airway obstruction. Differential diagnosis of tongue lymphan-giomas include vascular malformations, neurofibromas, thyroglossal cysts, congential hypothyroidism and Down syndrome. Treatment options include complete or partial surgical excision, aspiration, steroids, sclerosant therapy, laser and chemotherapy.