An abnormally enlarged tongue is one that protrudes beyond the teeth or the alveolar ridge in the resting position.
Broadly categorized as true and pseudomacroglossia.
True macroglossia associated with histological abnormalities and pseudo where the enlargement is apparent.
Pseudomacroglossia can be due to

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Tongue posture - poor neuromuscular control, edentulousness.
Maxillofacial skeletal deficiencies - shallow palatal vault.
Effects on surrounding structures- enlarged adenoids, cysts, tumour.

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True macroglossia can be due to:

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Congenital causes - downs syndrome, congenital hypothyroidism, trisomy 22, muscular hypertrophy.

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Acquired causes

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1. Endocrinal disturbances (myxedema, acromegaly, pituitary gigantism)
2. Infections (TB, actinomycosis)
3. Neoplasms(sarcoma, carcinoma, neurofibroma)
4. Nutritional and metabolic disorders (amyloidosis, scurvy, pellagra)

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CLINICAL FEATURES

Crenated lateral borders of the tongue, open bite, mandibular prognathism and airway obstruction.

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There may be ulcerations secondary infections and necrosis.
In infants lisping speech, noisy breathing, drooling and difficulty in eating.
Tongue pebbled with multiple vesicle-like blebs in lymphangioma diffuse smooth enlargement in hypothyroidism, multinodular in amyloidosis and neurofibromatosis.
Tongue Will be fissured in down's syndrome.

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MANAGEMENT:

Unless causing functional disturbance need not be corrected.
The surgical technique was chosen in accordance with the functional results that one want to achieve.