Macroglossia and the Current Evidence of Surgical and Clinical Management

Standardized technique and outcome of surgical reduction of macroglossia have yet to be determined. The aim of our study is to review current literature regarding the clinical and surgical management of primary macroglossia and postoperative outcomes in the pediatric population. A systematic review was performed between the years of 1995 and 2024 according to PRISMA guidelines. Search terms included "glossectomy," "children," and "macroglossia." Studies were analyzed for level of evidence, sample and control sizes, indications for surgery, surgical reduction technique, complications, follow-up length, and pre- and postoperative assessments of speech, feeding, orthodontics, oral incompetence, and airway obstruction. Of 1566 studies, 74 were selected for final use. Indications for surgery were airway obstruction (37.8%), oral incompetence (27%), orthodontic changes (46%), feeding/speech difficulties (39.2% and 41.9%, respectively), or cosmesis (14.9%). The most common surgical techniques used included keyhole (23.3%), followed by anterior tip (14.9%), central wedge (6.8%), and modified keyhole (6.8%). Surgical technique was not included in 22 studies (29.7%). Postoperative assessments were not included in 27 (36.5%); of those that did include, reported improvements included speech (29.7%), feeding (24.3%), orthognathic/orthodontic (12.1%), airway obstruction (17.6%), and oral incompetence (13.5%) with surgery alone. Complications, when reported, included dehiscence (13.5%), infection (1.35%), and recurrence (17.6%). This is the largest systematic review to date on macroglossia reduction. Prior studies lack characteristics of quality studies, inconsistently report treatment variables/outcomes, have poor levels of evidence, and lack long-term follow-up. No consensus on diagnosis, treatment, timing of surgery, surgical technique, or adjuvant treatments for macroglossia exist.