Fetal Micro and Macroglossia: Defining Normal Fetal Tongue Size

Natalie Koren*, Shir Shust-Barequet, Tal Weissbach, Oshrat Raviv, Samar Abu Snenh, Efrat Abraham, Tal Cahan, Vered Eisenberg, Vered Yulzari, Efrat Hadi, Laura Adamo, Shali Mazaki Tovi, Reuven Achiron, Zvi Kivilevitch, Boaz Weisz, Eran Kassif

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Abnormal fetal tongue size is a phenotypic feature of various syndromes including Beckwith-Wiedemann, Pierre-Robin, oromandibular limb hypoplasia, chromosomal aberrations, etc. Current data regarding normal fetal tongue size are limited. Hence, micro/macroglossia are subjectively determined. The aim of the study was to construct a contemporary fetal tongue nomogram and to assess its clinical contribution. Methods: A prospective cross-sectional study was performed in well dated, low risk, singleton pregnancies. Fetal tongues were measured by 5 trained sonographers. Highest quality images were selected. Intra- and interobserver variability was assessed. Tongue length, width, area, and circumference 1st to 99th centiles were calculated for each gestational week. Based on the normal tongue size charts, we created a Tongue Centile Calculator. Results: Over 18 months, 664 tongue measurements were performed. A cubic polynomial regression model best described the correlation between tongue size and gestational age. The correlation coefficient (r2) was 0.934, 0.932, 0.925, and 0.953 for tongue length, width, area, and circumference, respectively (P <.001). Intra- and interobserver variability had high interclass correlation coefficients (>0.9). Using the new charts, we were able to identify 2 cases of macroglossia, subsequently diagnosed with Beckwith-Wiedemann, and 4 cases of microglossia, 3 associated with Pierre-Robin sequence, and 1 associated with persistent buccopharyngeal membrane. Conclusions: We present novel fetal tongue size charts from 13 to 40 weeks of gestation. Clinical application of these nomograms may be beneficial in the prenatal diagnosis of syndromes or malformations associated with abnormal fetal tongue size.

Original languageEnglish
JournalJournal of Ultrasound in Medicine
StateAccepted/In press - 2022


  • Beckwith-Wiedemann
  • Pierre Robin Sequence
  • fetal tongue nomogram
  • hypoglossia
  • macroglossia
  • microglossia


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