To the Editor.—The publication of Dr. Gupta's article, "Congenital Macroglossia," in the April 1971 Archives presents an opportunity to correct the widely held and mistaken impression that children with Down's syndrome have large tongues. Experimental work in progress at Children's Hospital of the District of Columbia, by Dr. Mary Coleman,1,2 has clearly shown that the apparent macroglossia (better called buccolingual dyskinesia), in this syndrome is secondary to serotonin imbalance in the central nervous system. Infants with Down's syndrome treated with serotonin precursors in order to raise their blood and CNS serotonin levels to normal show marked decrease in tongue protrusion. In later childhood, these children are notable for their total lack of "tonguing" and normal tongue-mouth relationships. Similarly, in other syndromes, such as cretinism (distinguished by abnormally high brain serotin levels), the tongue protrusion is secondary to biochemical, and not anatomical, abnormalities.
It is therefore apparent that partial
ROSENFELD PA. MACROGLOSSIA. Arch Otolaryngol. 1971;94(4):381–382. doi:10.1001/archotol.1971.00770070573024
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