Introduction Development of tongue. Anatomy of tongue Arterial supply & nerve supply of tongue. functions of the tongue. Pathologic consideration of tongue. Conclusion. References

1. TONGUE

2. CONTENTS
• Introduction
• Development of tongue.
• Anatomy of tongue
• Arterial supply & nerve supply of tongue.
• Function of tongue.
• Pathologic consideration of tongue.
• Conclusion.
• References

3. INTRODUCTION
 Tongue is a muscular organ situated in the floor
of the mouth.
 It has oral part that lies in mouth
 Pharyngeal part lies in pharynx.
 Oral and pharyngeal part are separated by a v
shaped sulcus,
The Sulcus Terminalis

4. DEVELOPMENT

5. Anatomy Of Tongue

6. Anatomy Of Tongue

7. Papillae Of Tongue

8. • Barrel shaped cluster
• 50-150 fusiform cells.
• Converge apically on
gustatory pore (2µm
wide).
• 70µm in height
• 40µm across
Taste Buds

9. The primary sensations of taste.
• Sour Taste.
 The sour taste is caused by acids.
 By the hydrogen ion concentration.
• Salty Taste.
 The salty taste is elicited by ionized salts,
mainly by the sodium ion concentration.
Sense of Taste

10. • Sweet Taste.
 The sweet taste is not caused by any
single class of chemicals.
 Note specifically that most of the
substances that cause a sweet taste
are organic chemicals.
• Bitter Taste.
 Two particular classes of substances
 Long-chain organic substances that
contain nitrogen and alkaloids
(drugs used in medicines).

11. • Umami Taste.
 Meaning “delicious” designating a
pleasant taste sensation that is
qualitatively different from sour, salty,
sweet, or bitter.
 Umami is the dominant taste of food
containing l-glutamate , such as meat
extracts and aging cheese.
Guyton

12. Muscles Of Tongue
Intrinsic Extrinsic
• Superior longitudinal
• Inferior longitudinal
• Transverse
• Vertical
• Genioglossus
• Hyoglossus
• Styloglossus
• Palatoglossus

13. Muscle Origin Insertion Action
Superior
longitudinal
Submucosal CT
at back of tongue
& from median
septum of tongue
Muscle pass
forward and
oblique to
submucosal CT &
mucosa on
margin of tongue
Shorten the
tongue, curls apex
and sides of
tongue.
Inferior
longitudinal
Root of tongue Apex of tongue Shorten the
tongue , uncurls
apex, turns it
downward
Transverse Median septum of
tongue
Submucosal
connective tissue
on lateral margin
of tongue
Narrow ,elongates
tongue
Vertical Submucosal CT
of dorsum of
tongue
CT in more
ventral region of
tongue
Flatten and widen
tongue

14. Muscle Origin Insertion Action
Genioglossus Superior mental
spines
Body of hyoid Protrude tongue,
depressess center
of tongue
Hyoglossus Greater part and
adjacent part of
body of hyoid
bone
Lateral surface of
tongue
Depresses tongue
Styloglossus Styloid process Lateral surface of
tongue
Elevates and
retract tongue
Palatoglossus Inferior surface of
palatine
aponeurosis
Lateral surface of
tongue
Elevates the back
of the tongue

15. Arterial Supply Of
Tongue

16. Nerve Supply Of Tongue

17. Ingestion
 Suckling
 Swallowing
 Taste Perception
 Phonation
Function of Tongue

18.  FAST DAM
Tongue management during
operative procedures
WEIDER TONGUE
RETRACTORS
ISOLITE LIP CHEEK &
TONGUE
RETRACTOR

19. Developmental Disorder Of
Tongue.

20. Aglossia & Microglossia Syndrome:
• Microglossia with extreme glossoptosis.
• Etiology: -Failed embryogenesis of
developmental swellings
during 4th & 8th IU weeks.
-Diazepam, Chlorpromazine,
Meclizine, Tigan.
Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral
pathology.6th edition pg no. 26.

21. Clinical Features:
• Maxillo-mandibular Hypoplasia
• Microstomia
• Micrognathia
• Hypertrophy of salivary glands
• Oligodontia presented with congenitally missing
mandibular incisors.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 26.

22. Macroglossia:
• Etiology:
- Most frequently Vascular
malformations and muscular
hypertrophy.
-Down Syndrome and
Beckwidth-Weidmann Syndrome.
Categorized as :
a) True macroglossia
b) Pseudo macroglossia
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 27.

23. TRUE MACROGLOSSIA PSEUDO
MACROGLOSSIA
CONGENITAL ACCQUIRED INFLAMMATOR
Y
• Idiopathic tongue
muscle
hypertrophy
• Salivary gland
tumor
• Hemangioma
• Lymphangioma
• Syndromes (eg,
Beckwith-
Wiedemann,
Behmel, Laband)
• Lingual thyroid
• Mucopolysaccha
ridoses
• Hamartomas
• Hypothyroi
dism
• Cretinism
• Amyloidosi
s
• Acromegaly
• Myxedema
• Ludwig angina
• Pemphigus
vulgaris
• Diphtheria
• Tuberculosis
• Actinomycosis
• Sarcoidosis
• Candidiasis
• Allergic reactions to
medications that cause
the tongue to swell
• Enlarged tonsils
and/or adenoids that
displace the tongue
• Low palate and
decreased oral cavity
volume
• Severe maxillary
deficiency with
narrow palatal arch
• Severe mandibular
deficiency
(retrognathism)
• Local oral tumor
that displaces the

24. Ankyloglossia / Tongue Tie:
• When inferior frenum attaches to the
bottom of tongue.
• Clinical features:
• Limitation of tongue movement
• Difficulties in eating and swallowing.
• Lower incisor deformity
• Gingival recession
• Malocclusions
• Dental caries
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 27.

25. Cleft Tongue:
Etiology: Due to lack of merging of
lateral lingual swelling of this
organ.
Partial cleft tongue:
• Deep groove in midline of the dorsal
surface.
• Due to incomplete merging and failure
of groove obliteration by underlying
mesenchymal proliferation.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 27-28.

26. Fissured tongue:
• Characterized by grooves on dorsal and
lateral surface of tongue.
• Etiology: -Polygenic mode of
inheritance is suspected.
- Melkerson-Rosenthal
syndrome and Down
syndrome
• Clinically asymptomatic unless debris
are entrapped or is associated with
geographic tongue.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 28-29.

27. Benign migratory glossitis:
• Psoriasiform mucositis of dorsum of
tongue.
• Etiology: Associated with stress and
psoriasis
• Clinical feature:
• Pain, burning sensation, discomfort,
dysgeusia, sensitivity to hot, spicy and
sour food ipsilateral submandibular
lymphadenopathy.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 28-29.

28. • According to Seiden and Curland ,circular pattern is
indicate more likely that tongue is gradually affected
and is subsequently healing .
• While spiral patterns tend to be self-sustaining and will
linger for a longer duration of time and resulting due to
inhomogenities in the medium.
ShivanandB.B, Byathnal S D, Ramakrishna A. Paediatric Geographic Tongue: A Case
Report, Review and Recent Updates. Journal of Clinical and Diagnostic Research. 2016
Feb, Vol-10(2): ZE05-ZE09.

29. Median Rhomboid Glossitis:
• Defective fusion of posterior dorsal
point.
• Clinical feature:
• Rhomboidal shape
• Smooth erythematous mucosa
lacking in papillae.
• Kissing lesion( midline area od SP)
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no. 29.

30. Hairy Tongue:
• Hypertrophy of filiform papillae on dorsal
surface of tongue.
• Lack of debridement.
• Clinical feature:
• ≥15mm
• Candida albicans may result in
glossopyrosis.
• Tickling sensation of soft palate and
oropharynx during swallowing.
• Gagging sensation.
• Altered taste sensation.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no.31.

31. Lingual varices:
• Occur to the vein which is subjected to
increased hydrostatic pressure but
poorly supported by surrounding
tissue.
• Involves the lingual vein
• Clinical feature:
• Appear Red / Purple shot like cluster of
vessel on ventral surface and lateral
border of tongue.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no.31.

32. Lingual Thyroid Nodule:
• Follicles of thyroid tissue are found in
substance of tongue.
• Clinical feature:
• Nodular mass near the base of the
tongue.
• 2-3cm in diameter.
• Dysphagia, dysphonia, dyspnea,
hemorrhage with pain, feeling of
tightness in the throat.
Developmental disturbance of oral and paraoral structures. Shafer’s
textbook of oral pathology.6th edition pg no.32-33.

33. Red and White Lesion of Tongue.

34. Oral hairy leukoplakia:
• Most common HIV associated oral
mucosal lesion.
• Strongly associated with Epistein
Barr virus and low level of CD4+ T-
Lymphocytes.
• Lateral border of tongue.
• Vertical white folds oriented as
palisade along the borders of tongue.
• Treatment: Antiviral medication.
Red and white lesion of oral mucosa. Burket’s oral medicine 12th
edition pg no. 99-100.

35. Lichenoid contact reaction:
• Due to delayed hypersensitivity
reaction to constituent derived
from dental materials.
• Drug induced lichenoid
reaction:
Metronidazole
NSAIDs
Penicillins
Red and white lesion of oral mucosa. Burket’s oral medicine 12th
edition pg no. 95-97.

36. Metabolic Diseases Affecting
Tongue.

37. Addisons disease:
• Autoimmune destruction of
adrenal glands.
• Increased level of ACTH in blood
and increase in melanocyte
stimulating hormone .
• Induces deposition of melanin.
• Multiple focal dark spots.
• Pale brown to deep chocolate
pigmentation.
Oral aspects of metabolic diseases .Sahfer’s textbook of oral
pathology 6th edi . Pg . No. 654.

38. Pellagra :
• Inability to absorb niacin (vitB3) /
amino acid tryptophan.
• Erythematous and edematous
tongue.
• Beefy red tongue with smooth
glazed appearance.
Oral aspects of metabolic diseases .Sahfer’s textbook of oral
pathology 6th edi . Pg . No. 644-45.

39. Diseases of Blood Affecting
Tongue.

40. Vitamin B-12 deficiency:
• Pernicious anemia (lack of production of
IF).
• Beefy red tongue (dorsum and lateral
border of tongue)
• 3G- Glossitis
Glossodynia
Glossopyrosis
• Bald tongue (Atrophy of papillae)
• Hunter’s glossitis and Moeller’s glossitis .
Diseases of the blood and blood forming organs. Shafer’s textbook of oral
pathology.6th edition.pg no. 755-57.

41. Celiac Sprue:
• Malabsorption syndrome.
• Many sign & symptom in common
with Pernicious anemia.
• Glossitis with atrophy of filiform
papillae.
• Painful burning sensation of tongue.
• Avoid gluten (protein found in wheat ,
barley, oats ) .
• Treatment : vitamin B12 & Folic
Acid supplements
Diseases of the blood and blood forming organs. Shafer’s textbook
of oral pathology.6th edition.pg no. 758.

42. Iron deficiency anemia:
• Inadequate dietary intake, faulty iron
absorption.
• Glossitis(smooth red painful tongue)
with atrophy of filiform papillae and
later fungiform papillae.
• Treatment: iron therapy and high
protein diet.
Diseases of the blood and blood forming organs. Shafer’s textbook
of oral pathology.6th edition.pg no. 764-65.

43. Polycythemia Vera:
• Absolute increase in number of
circulating red blood cells.
• Deep purplish red tongue.
• Treatment: No specific trratment
• Recent isotope of
phosphorous,p32 has
been used.
• Remission may
occur.
Diseases of the blood and blood forming organs. Shafer’s textbook
of oral pathology.6th edition.pg no. 766-67.

44. Disease of Skin Affecting
Tongue.

45. Acanthosis Nigricans:
• Unusual dermatosis.
• Benign(insulin /IGF stimulate the epidermal
cells).
• Malignant form (substances either secreted
by tumor/in response to tumor).
• Hypertrophy of the filiform papillae .
• Shaggy , papillomatous surface to the
dorsal tongue .
• Treatment: correction of hyperinsulinemia
• Prognosis poor with
malignant AN.
Diseases of the skin. Shafer’s textbook of oral pathology.6th edition.pg no. 814-15.

46. Pemphigus Vulgaris:
• Chronic skin disease with appearance
of vesicles and bullae ,fluid filled
blisters that develop in cycles.
• Ill defined , irregular erosion seen.
• Difficulty to eat and drink is
experienced by patients.
• Treatment: Decrease blister
formation
Promote healing
Diseases of the skin. Shafer’s textbook of oral pathology.6th
edition.pg no. 816.

47. Disease of Nerves Affecting
Tongue.

48. Burning mouth syndrome:
• Burning sensation in absence of any
mucosal lesion.
• Treatment: Antidepressants
Vitamins/dietary supplements
Analgesic
Salivary substitute
Diseases of the nerves and muscle. Shafer’s textbook of oral
pathology.6th edition.pg no. 847.

49. Burning tongue:
• Orolingual paraesthesia.
• Glossopyrosis and Glossodynia
• Pain , burning , itching ,stinging of the
mucous membrane.
• Treatment: Topical anesthetics
Analgesics
Sedatives
Antibacterial and antifungal
agent
Vasodilators
Saliva stimulators
Diseases of the nerves and muscle. Shafer’s textbook of oral
pathology.6th edition.pg no. 847-48.

50. Bell palsy:
• Seventh nerve paralysis.
• Difficulty in speech ,eating .
• Alter taste sensation in anterior portion
of tongue.
• Treatment: Use of vasodilator
Flushing dose of nicotinic
acid.
Surgical anastomoses of
tongue.
Diseases of the nerves and muscle. Shafer’s textbook of oral
pathology.6th edition.pg no. 848-49.

51. Glossopharnygeal Neuralgia:
• Severe sharp shooting pain.
• Posterior portion of the tongue.
• Treatment: Injection of alcohol into
nerve.
Resection of the nerve.
Diseases of the nerves and muscle. Shafer’s textbook of oral
pathology.6th edition.pg no. 849-50.

52. Bacterial Infection of Tongue.

53. Scarlet fever:
• Contagious systemic infection caused by β-
haemolytic streptococci.
• Strawberry Tongue : Tongue exhibit
white coating, fungiform papillae are
edematous and hyperemic, projecting
above as small red knobs.
• Raspberry tongue: This coating is soon
lost and tongue becomes deep red ,
glistening and smooth.
Bacterial infection of oral cavity. Shafer’s textbook of oral
pathology.6th edition.pg no. 311-12.

54. Tuberculosis :
• Specific infectious granulomatous disease
caused by Mycobacterium tuberculosis.
• Tuberculous ulcers of the tongue occur on the
tip, lateral borders, dorsum, towards the midline
and base .
• They are irregular, pale, shallow, oval, indolent
painful ulcers with undermined margins, with
granulations in the floor and sometimes with a
thin slough.
• Treatment : Multi drug Therapy.
Bacterial infection of oral cavity. Shafer’s textbook of oral pathology.6th edition.pg no. 313-17.

55. Leprosy:
• Chronic granulomatous infection caused
by M. leprae.
• Lepromas (small tumor like masses)
• These have tendency to break down and
ulcerate.
• Treatment : Multi drug Therapy.
(rifampicin dapsone ,
clofazimine)
Bacterial infection of oral cavity. Shafer’s textbook of oral
pathology.6th edition.pg no. 317-18.

56. Syphilis :
• Caused by T. pallidum characterized by
episodes of active disease interrupted by
period of latency.
• Primary lesion: Elevated ,ulcerated ,
nodule showing local induration, covered
by grayish white membrane.
• Secondary lesion: Mucous patches.
• Intraoral gumma
• Syphilitic glossitis: Atrophy and fibrosis
of tongue (fissured
appearnce)
Bacterial infection of oral cavity. Shafer’s textbook of oral
pathology.6th edition.pg no. 322-25.

57. Viral Infection of Tongue.

58. Herpes zoster :
• Acute infectious viral disease of
extremely painful and incapaciting in
nature.
• Involves the trigeminal nerve.
• Extremely painful vesicles
• Rupture of vesicles leaves areas of erosion.
• Treatment : anti viral drugs
Viral infection of oral cavity. Shafer’s textbook of oral pathology.6th
edition.pg no. 344-46.

59. Human Immunodeficiency virus:
• Affect the quality of life of patient and
important marker for disease progression
and immunosuppression.
• Strongly associated : candidiasis , hairy
leukoplakia .
Viral infection of oral cavity. Shafer’s textbook of oral pathology.6th
edition.pg no. 352-53.

60. Fungal infection of Tongue.

61. Candidiasis:
• Opportunistic fungal infection
affecting the oral mucosa.
• Pseudomembranous candidiasis.
• Soft, white ,slightly elevated plaques
(resemble milk curd).
• Plaque can be wiped away with gauze
• Erythematous candidiasis.
• Sequelae to broad spectrum antibiotics,
corticosteroids, common in HIV
patients
Mycotic infections of oral cavity. Shafers textbook of oral pathology
6th edi .pg no. 363-67

62. Candidiasis:
• Chronic hyperplastic
candidiasis:
• Leukoplakia type of candidiasis.
• Firm , white persistent plaques.
Treatment : antifungal agents (nystatin)
Mycotic infections of oral cavity. Shafers textbook of oral pathology
6th edi .pg no. 363-67

63. Ulcerative Lesion of Tongue.

64. Traumatic ulcer:
• Physical , Thermal & Chemical.
• Posterior and lateral aspect of tongue.
• Ulcer appears to be cleanly punched
out with erythema and keratosis if
present for weeks.
• Treatment : Intralesional steroid
injection.
Wound debridement.
Night guards to reduce
trauma.
Ulcerative ,vesicular and bullous lesion Burket’s oral medicine 12th
edition .pg no. 88-89.

65. Recurrent apthous ulcer:
• Floor of the ulcer is yellowish initially
then becomes grayish as
epithelialization occurs.
• Minor Aphthae are 2-4 cm, usually
seen on the non-keratinizing mucosa
on ventrum of tongue and dorsal
surface of tongue.
• Major aphthae are ≥1 cm or more, seen
on keratinized mucosa like dorsum of
tongue.
Allergic and immunologic disease of oral cavity.shafers textbook of
oral pathology 6t edi. Pg no. 662-67.

66. Benign And Malignant Tumor of
Tongue.

67. Squamous cell carcinoma of
tongue :
• Lateral border/ ventral surface of
tongue.
• Superficially indurated ulcer with
slightly raised borders .
• Infiltrate the deep layers of tongue
producing fixation and induration
without much surface change.
Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral
pathology . 6th edi. Pg. no. 110-12.

68. Granular cell tumor:
• It is not clear whether it is a true
neoplasm / developmental anomaly /
trauma induced proliferation.
• Occur as sessile ,painless, somewhat
firm nodule , < 1.5 mm.
• Pallor / yellowish discoloration.
• Treatment : conservative excision.
Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral
pathology . 6th edi. Pg. no. 189.

69. Osler –Weber- Rendu Syndrome:
• Hereditary hemorrhagic telangiectasia.
• Spider like telangiectasia.
• Epistaxis and bleeding from oral
cavity.
• Treatment: Depends on severity of
disease .
Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral
pathology . 6th edi. Pg. no. 144.

70. Hemangiomas:
• Tumors identified by rapid endothelial
cell proliferation in early infancy.
• Flat raised regions of oral mucosa.
• Deep red/bluish red , well circumscribed.
• Treatment : Surgery
• Radiation therapy
• Compression
• Cryotherapy.
Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral
pathology . 6th edi. Pg. no. 140-43.

71. CONCLUSION:
• Among the broad-spectrum of lesions that occur on
the tongue a few tongue lesions present more
commonly.
The most important thing to remember is diagnosing
such common tongue lesions which will be in the
best interest of the patient.

72. REFERENCES:
 Grays anatomy: The anatomical basis of clinical practise
14th edition.
 B. D. Chaurasia human anatomy volume 3 4th edition.
 Guyton and Hall Textbook of Medical Physiology.12th
edition.
 Human embryology .inderbir singh 8th edi.
 Burket’s oral medicine 12th edition .
 Shafer’s textbook of oral pathology . 6th edi
 Sunil A, Kurien J, Mukunda A, Basheer AS, Deepthi.
Indian. Common Superficial Tongue Lesions. Journal of
Clinical Practice, Vol. 23, No. 9 February 2013.
 Geographic tongue and psoriasis: clinical,
histopathological, immunohistochemical and genetic
correlation – a literature review. An Bras Dermatol.
2016;91(4):410-21.

73. THANK YOU