brief description of anatomy, embryology and disorders of tongue with their management.

1. SEMINAR
ON
TONGUE
Submitted by:
Dr. Amit Swarnakar
1st year P.G. student
DEPARTMENT OF ORAL MEDICINE AND
RADIOLOGY
GUIDED BY:-
Dr. SANJAY B. NAYAMATI
Dr. SHWETHA HEGDE
Dr. SALONA KALRA
TRIVENI INSTITUTE OF DENTAL SCIENCES, HOSPITAL &
RESEARCH CENTRE, BODRI, BILASPUR

2. TONGUE

3. CONTENTS
 INTRODUCTION
 DEVELOPMENT OF THE TONGUE
 ANATOMY OF THE TONGUE
 PARTS AND SURFACES OF THE TONGUE
 MUSCLES OF THE TONGUE
 VASCULAR SUPPLY OF THE TONGUE
 LYMPHATIC DRAINAGE OF THE TONGUE
 INNERVATION OF THE TONGUE
 HISTOLOGY OF TONGUE
 EXAMINATION OF THE TONGUE
 CLINICAL CONSIDERATION AND DISEASES OF THE TONGUE
 CONCLUSION
 REFERENCES

4. INTRODUCTION
 The TONGUE is a muscular organ in the human
mouth that manipulate food for mastication and is
used in the act of swallowing.
 A major function of the tongue is the enabling of
speech
 It is of importance in digestive system and is the
primary organ of taste in the gustatory system.
 It is sensitive and kept moist by saliva, and is
richly supplied with nerves and blood vessels.
 The tongue also serves as a natural means of
teeth cleaning.

5. DEVELOPMENT OF TONGUE
 Starts to develop near the end of 4th week of
embryonic life(intrauterine)
 Contribution from all the pharyngeal arches
which change with time
Arch 1st oral part of tongue(anterior 2/3rd)
2nd arch initial contribution to the surface is lost
3rd arch pharyngeal part of the tongue(posterior
1/3rd)
4th arch epiglottis and adjacent regions

7. DEVELOPMENT OF TONGUE
 Tongue arises from the ventromedial wall of the
primitive oropharynx from the inner lining of first
four branchial arch
Near the end of 4th week of intrauterine life a
median triangular elevation appears from the 1st
arch on the floor of primordial pharynx it is
called median tongue bud(tuberculum impar)
Then two oval distal tongue buds(lateral swellings)
develop on each side of median tongue bud.
These swelling merges with each other and forms the
mucous membrane of anterior 2/3rd of the tongue

9. DEVELOPMENT OF TONGUE
Posterior 1/3rd of tongue develop from the cranial half of
hypobranchial eminences which is developed in floor of
primordial pharynx opposite 3rd pharyngeal arch and is
supplied by glossopharyngeal and vagus cranial nerve
Sulcus terminalis separates anterior 2/3rd and posterior
1/3rd of tongue
Connective tissue develop from local
mesenchyme
Tongue muscles develop from occipital myotomes,
which migrates forward dragging with them their nerve
supply hypoglossal cranial nerve

10. ANATOMY OF TONGUE
Parts and surfaces
of the tongue
Oral part
Apex/tip
Body
Dorsal surface
Ventral surface
Pharyngeal
part(root)

11. DORSAL
SURFACE
OF
THE
TONGUE

12. VENTRAL SURFACE OF TONGUE
in strip of tissue that
vertically from the
of the mouth to
urface of the tongue
alled the lingual
um. It tends to limit
movement of the
e.
he either side of
um there is
nence produced by
lingual veins. More
ly there is a fold
Plica Fimbriata.

13. FLOOR OF THE MOUTH
WHARTON’S DUCT/SUBMANDIBULAR
DUCT OPENING
DUCT OF RIVINUS OR OPENINGS
OF MINOR SUBLINGUAL DUCTS

14. Salivary Glands of the Tongue
Glands Of Blandin &
Nuhn
Glands Of Von-Ebnor
Gland Of Weber

15. Gland Of Blandin And Nuhn
 Anterior lingual
glands/ apical
glands
 Seromucous salivary
gland
 Located near the
tip of the tongue on
each side of
frenulum linguae

16. Glands Of Von Ebner
 Serous salivary gland
 Located adjacent to the moats
surrounding the circumvallate and
foliate papillae
 Secrete lingual lipase which flushes
material from moats to enable the
taste buds to respond rapidly to
changing stimuli

17. Glands Of Von Ebner

18. Gland Of Weber
 Lie along the lateral border of tongue
 Pure mucous salivary gland
 Open into the crypts of the lingual tonsils on
the posterior tongue dorsum
 Abscess formed due to accumulation of pus and
fluids in this glands is called Peritonsillar Abscess.

19. POST SULCAL OR PHARYNGEAL PART
Epiglottis
MEDIAN EPIGLOTTIC
FOLD
LATERAL EPIGLOTTIC
FOLD
LINGUAL TONSILS
PALATINE TONSILS

20. POST SULCAL OR PHARYNGEAL
PART
• Lies behind the PALATOGLOSSAL
arches
• Forms the anterior wall of the
oropharynx
• Devoid of papillae
• Underlying lymphoid nodules
embedded in the submucosa
collectively called as lingual tonsils

21. MUSCLES OF TONGUE
EXTRINSIC MUSCLES
GENIOGLOSSUS
HYOGLOSSUS
STYLOGLOSSUS
PALATOGLOSSUS
INTRINSIC MUSCLES
SUPERIOR
LONGITUDINAL
INFERIOR
LONGITUDINAL
TRANSVERSE
VERTICAL

23. GENIOGLOSSUS

24. GENIOGLOSSUS
 ORIGIN- Superior genial tubercle of mandible
above the origin of GENIOHYOID muscle
 INSERTION-
 Upper fiber into the tip of the tongue
 Middle fibers into the dorsum of tongue
 Lower fibers into the body of hyoid bone
 Action
 Retracts the tongue
 Depress the central part of tongue
 Pull the posterior part forward

25. HYOGLOSSUS
 Origin-greater
cornau , front body
of hyoid bone
 Insertion- side of the
tongue between
STYLOGLOSSUS and
INFERIOR
LONGITUDINAL
 action-depress the
tongue, retract the
protruded tongue

26. CHONDROGLOSSUS
 A part of HYOGLOSSUS muscle
 Separated from it by GENIOGLOSSUS fibers
 Origin-medial side and bone of the lesser
cornau of hyoid bone
 Insertion-intrinsic musculature between
HYOGLOSSUS and GENIOGLOSSUS
 Action- assist the hyoglossus to depress the
tongue

27. CHONDROGLOSSUS

28. STYLOGLOSSUS Styloid process
styloglossusInferior
longitudinus
hyoglossus

29.  Origin-styloid process near its apex
 Insertion-
 Longitudinal part into the inferior
longitudinal muscle
 Oblique part into the hyoglossus
muscle
 Action-draws the tongue upwards
and backwards during swallowing

30. PALATOGLOSSUS

31. PALATOGLOSSUS
 More a part of soft palate than the
tongue
 Origin-palatine aponeurosis of soft palate
 Insertion- side of the tongue(oral and
pharyngeal part)
 Action-
Elevates the posterior part of the tongue
Bilaterally approximates the palatoglossus
folds to constrict the isthmus of fauces

32. INTRINSIC MUSCLES

33. SUPERIOR LONGITUDINAL

34. SUPERIOR LONGITUDINAL
 Origin- sub mucous fibrous layer
below the dorsum of the tongue and
lingual septum
 Insertion-extend to the lingual
margin
 Action- turns the apex and side of
the tongue upwards to make the
dorsum concave

35. INFERIOR LONGITUDINAL

36. INFERIOR LONGITUDINAL
 Narrow band close to the inferior
surface of the tongue
 Origin-root of the tongue and body
of the hyoid
 Insertion- apex of the tongue
 Action- curls the tip inferiorly and
shortens the tongue

37. TRANSVERSE MUSCLES

38. TRANSVERSE MUSCLES
 Origin- median fibrous septum
 Insertion- fibrous tissue at the
margins of the tongue
 Action-narrows and elongates
the tongue

39. VERTICAL MUSCLES

40. VERTICAL MUSCLES
 Origin- dorsum surface of the
border of the tongue
 Insertion-ventral surface of the
border of the tongue
 Action-flattens and broadens
the tongue

41. VASCULAR SUPPLY OF THE TONGUE

42.  Lingual artery- a branch of external
carotid artery(after passing deep into
the hyoglossus muscle)
 Divides into:
Dorsal lingual artery-posterior part of
the tongue
Deep lingual artery-anterior part of the
tongue
Sublingual artery-supplies the subligual
salivary gland and floor of the mouth

44.  Dorsal lingual vein- drains the dorsum
and sides of the tongue
 Deep lingual vein- drains the tip of the
tongue and joins the sublingual vein
from sublingual salivary gland
 All the veins directly or indirectly
terminate into INTERNAL JUGULAR VEIN

45. LYMPHATIC DRAINAGE

46.  Lymph from the one side(especially from posterior
part)may reach to the both side of nodes of the
neck(in contrast to the blood supply which
remains unilateral)
 Lymph from the tip drains in submental nodes or
directly into the deep cervical nodes.
 Marginal lymphatics from the anterior part tends to
drain into the submandibular nodes ipsilateral or
directly into the inferior deep cervical nodes
 Central lymphatics drain into deep cervical nodes of
either
 Posterior part drains directly and bilaterally into deep
cervical nodes

47.  Deep cervical lymph node usually involved
jugulo-digastric and jugulo-omohyoid
nodes.
 All the lymph from the tongue is believed
to eventually drain through jugulo-
omohyoid node before reaching the
thoracic duct or right lymphatic duct.

48. INNERVATION OF THE TONGUE

49. NERVE SUPPLY
 Motor supply
 All the muscles(extrinsic and extrinsic) of the tongue are
supplied by hypoglossal nerve 12th cranial nerve except
palatoglossal muscle which is supplied by vagus nerve 10th
cranial nerve
 Sensory supply
 Anterior 2/3rd
 General sensation by lingual nerve branch of mandibular nerve(5th
cranial nerve)
 Special sensation by chorda tympani(7th cranial nerve)
 Posterior 1/3rd
 General and special sensation by glossopharyngeal nerve(9th cranial
nerve)
 Posterior most part of the tongue is supplied by vagus
nerve(10th cranial nerve)

50. HISTOLOGY OF THE TONGUE
A. Mucous membrane of
ventral surface
 It is thin, smooth and
loosely attached to the
underlying connective
tissue.
 Freely mobile and not
raised into papillae
because epithelium is
closely adherent to
underlying muscles by a
thin lamina propria.
 It is covered with non
keratinized stratified
squamous epithelium

51. HISTOLOGY OF TONGUE
B. Mucous membrane of
dorsal surface
 Firmly adherent to
underlying connective
tissue
 It is raised into small
projections similar to
villi, but known as
papillae
 The stratified
squamous epithelium
covering the dorsal
surface of the tongue
is mostly keratinized.

52. PAPILLAE OF TONGUE
There are 4
varieties of
papillae-
1.Filiform papillae
2.Fungiform papillae
3.Foliate papillae
4.Circumvallate
papillae

53. FILIFORM PAPILLAE
 Minute, conical cylindrical
projection which cover
most of the presulcal
dorsal area
 Increase the friction
between food and tongue
 They bear many
secondary papillae which
are more pointed than
those of vallate and
fungiform and covered
with keratin.

54. FUNGIFORM PAPILLAE
 Located mainly at lingual
margin
 Differ from filiform
papillae because of large
rounded and deep red in
color
 Bears one or more taste
buds on its apical surface
 Mushroom shaped, more
numerous near tip of
tongue

55. FOLIATE PAPILLAE
Red leaf-like
mucosal ridges
Bilaterally at the
sides of the
tongue near
sulcus terminalis
Bear numerous
taste buds

56. CIRCUMMVALLATE PAPILLAE
 Large cylindrical papillae
which are 8 to 12 in
numbers
 Forms v-shaped row in
front of sulcus terminalis
on the dorsal surface of
the tongue
 The entire structure is
covered with squamous
epithelium
 Taste buds present inner
side of papillae in trough
region

57. Taste Buds
 Taste buds are small
ovoid barrel-shaped
intraepithelial organs
 Extends from the basal
lamina to the surface of
epithelium
 Present on the inner wall
of folds of vallate
papillae, tip of the
fungiform papillae,
posterior surface of
epiglottis and lateral
border of the tongue.

58. STRUCTURE OF TASTE BUDS

59. 1. Neuroepithelial cells/gustatory cells in
taste buds-
Modified columnar elongated cells which
acts as receptors (base is surrounded by
sensory nerve fibres)
Dark stained elongated nuclei
Superficial part of these cells are provided
with short hairs(hairlets or microvilli) which
projects into taste pore(visible at light
microscopic level)

60. 2. Supporting cells-
Elongated columnar cells with dark stained
cytoplasm and light stained nuclei
Forms outer wall of taste bud
3.Basal cells-
stem cells present at the base of taste buds
For renewal of taste cells and supporting
cells

62. TASTE DISCRIMINATION
 Gustatory receptors detects
four main types of taste
sensation :-
Sweet: tip
Sour: middle
Salty: anterolateral
Bitter: base(posterior)
 However according to other
authors all the areas of
tongue are responsive to all
the taste stimuli.

63. CLINICAL EXAMINATION OF THE TONGUE
 Inspection
 The tongue is examined for :
 Color
 Swelling
 Ulcer
 Coating
 Size variation
 Distribution of filiform and fungiform papillae
 Crenation
 Fissures
 Atrophy or hypertrophy of papillae
 Frenal attachment
 Deviation of the tongue as patient move out the tongue

64. CLINICAL CONSIDERATIONS
Injury To Hypoglossal Nerve
 Trauma like fractured mandible may injure the
hypoglossal nerve
 Paralysis or atrophy of one side of tongue
 Tongue deviates to paralyzed side during
protrusion due to action of unaffected genioglossus
muscle
 Others
o Infranuclear lesion-muscular twitching of the affected
half of the tongue observed
o Supranuclear lesion-produce paralysis without
palsy(tongue is stiff, small and moves sluggishly)

65. PARALYSIS OF GENIOGLOSSUS MUSCLE
 Muscle tends to fall backward, obstructing airway.
 Total relaxation of genioglossus muscle occur during
general anesthesia so endotracheal tube or supraglotticg
airway is inserted to prevent tongue from relapsing
SUBLINGUAL ABSORPTION OF DRUGS
 for quick absorption, pill or spray is put under the tongue
where it dissolves and enter the lingual veins(e.g.
nitroglycerine in angina pectoris)

66.  The presence of rich network of lymphatics and loose areolar
tissue in the substance of tongue is responsible for enormous
swelling of tongue in acute glossitis.
 The undersurface of the tongue is good site for observation of
jaundice
 Carcinoma of lateral border tongue is quite common
 Carcinoma of posterior 1/3rd of the tongue is more dangerous
due to bilateral lymphatic spread.
 In grand mal epilepsy. The tongue is commonly bitten by the
front incisors during the attack.

67. CLASSIFICATION OF TONGUE DISORDERS
A)Inherited, congenital and developmental
anomalies:
a) Minor variations:
1.Partial Ankyloglossia
2.Variations in tongue movement
3.Tongue thrusting
4.Fissured tongue
5.Patent Thyroglossal duct and cyst
6.Lingual thyroid
7.Median rhomboidal glossitis

68. b) Major variations:
1.Cleft, Lobed, Bifurcated And
Tetrafurcared Tongue
2.Aglossia, Hypoplasia And Macroglossia
3.Hamartoma And Desmoids
4.Bald And Depapillated Tongue
5.Papilomatous Changes

69. B)Disorders of the lingual mucosa:
a)changes in the tongue papillae:
1.geographic tongue
2.coated or hairy tongue
b)Non-keratotic lesions:
1.thrush
2.white sponge nevus
3.vesiculobulous and other desquamative
disorders

70. c) keratotic white lesions:
1.lichen planus
2. leukoplakia
d) Depapillation and atrophic lesions:
1. Chronic trauma
2. Nutritional deficiency

71. C) Disorders affecting body of tongue:
1.Amyloidosis
2.Infections
3.Neuromuscular disorders
4.Sleep apnea syndrome
5.TMJ Myofascial dysfunction
6.Vascular disease of body of tongue
7.Angioneurotic edema

72. D) Tumors of tongue:
Benign
Malignant

73. PARTIAL ANKYLOGLOSSIA
 Partial Ankyloglossia refers to congenital
shortness of the lingual frenum or a Frenal
attachment that extends nearly tip of tongue,
binding the tongue to floor of mouth and
restricting its extension.
 Clinical features:
 Restricted tongue movements
 Feeding problems
 Speech defects: lisping, inability to pronounce
words such as ta, te, time, water, cat etc.
 Tongue biting

75. Syndromes associated are:
 Ankyloglossum superioris syndrome
 Trisomy of 13
 Pirrie robin syndrome
 Rainbow syndrome
 Management:
 counselling
 surgery

76. VARIATION IN TONGUE MOVEMENT
 Ability to curl up the lateral borders of tongue
into a tube is noted in 65% of Caucasians and is
inherited as an autosomal dominant trait.
 Unusual extensibility of tongue, both forward
to touch tip of NOSE(GORLIN sign)and
backward into the pharynx occurs in Ehlers-
Danlos syndrome.
 The tongue in tuberous sclerosis-long and
narrow
 The mobility of tongue is also restricted in
epidermolysis bullosa as a result of fibrous
scars secondary to blister formation.

77. Tongue Thrusting
 Tongue thrust is a forward placement
of the tongue between the anterior
teeth and against the lower lip
during swallowing, speaking or at
rest.
 It is an infantile swallowing pattern.
 It may be associated with
macroglossia.

78. And:
1. Proclination of anterior teeth
2. Anterior open bite
3. Bimaxillary protrusion
4. Posterior open bite in case of
lateral tongue thrust
5. Posterior cross bite

79. Fissured Tongue
 Also called as scrotal tongue, plicated tongue, and
lingua dissecta.
 Characterized by furrows, one extending
anteroposteriorly and others laterally over the
entire anterior surface.
 Patterns: plication, central longitudinal fissuring,
double fissures, transverse fissuring, lateral
longitudinal.
 Bacteria and debris retained in the fissures causing
irritation or burning sensation.

80.  Syndromes: trisomy 21 (mongolism) ,melkerson
rosenthal syndrome.
 Management: maintenance of oral hygiene.

81. Patent Thyroglossal Ducts and
Cysts
 Thyroid gland develops from an analogue of
endothelial cells in the midline of the floor of the
pharynx, between the first and second brachial
arches, just posterior to tubercular impar.
 These cells sink into the base of developing
tongue, descent into the neck and proliferate
below the larynx to form thyroid gland.
 Remnant of the epithelium along this path are
referred as Thyroglossal duct.
 Cystic degeneration of it is called as duct cyst.

82.  In 70% of those with heterotopic thyroid ,the
thyroid gland is contained entirely within the
tongue.
 Enlargement of the lingual thyroid , cystic
changes, or malignancy may be first recognized
due to symptoms of an enlarging tongue,
dysphagia or less commonly, hypoglossal palsy.
 Dysphagia with firm cystic mass in midline of
neck will give clue to the diagnosis.
 The cyst is lined by columnar, respiratory or
stratified squamous epithelium.
 Management: surgically excised or enucleated.

83. Median Rhomboid Glossitis
 ‘central papillary atrophy of tongue’
 Median rhomboid glossitis (MRG) is a benign uncommon
usually asymptomatic condition of tongue superimposed
by secondary infection usually by candida.
 It is characterized by central papillary atrophy of dorsal
surface of tongue particularly anterior to the
circumvallate papillae.
 The etiopathogeness of MRG is uncertain but it was once
attributed to an embryologic fault caused by failure of
tuberculum impar to unite completely with lateral
processes of the tongue which results in area of smooth,
erythematous oral mucosa on posterior dorsal surface of
tongue with scarcity of papillae.

84. REFERENCE-
MEDIAN RHOMBOID GLOSSITIS: A PECULIAR TONGUE PATHOLOGY, REPORT OF A CASE
AND REVIEW OF LITERATURE
authors-1Daud Mirza, 2 Ghazal Raza, 3Zubair Ahmed Abassi
International Journal of Pharmacy and Biological Sciences ISSN: 2321-3272 (Print),
ISSN: 2230-7605 (Online) IJPBS | Volume 6 | Issue 4| OCT-DEC| 2016 | 51-53
 A recent development revealed that posterior dorsal
surface of tongue is the main reservoir of candidal
microorganisms in oral cavity. However, there are some
local factors which include trauma or surface variation in
the anatomy which may allow candidal hyphae to
proliferate leading to the development of MRG.
 Studies has shown diverse predisposing factors associated
with median rhomboid glossitis such as denture wearing,
smoking, diabetes mellitus.

85.  c/f: m>f
Generally asymptomatic
The surface is dusky red and completely
devoid of filiform papillae and usually
smooth.
Kissing lesion-soft palate erythema may be
seen where the lesion of median rhomboid
glossitis touch the palate.
 Management:
antifungal agents,
Long standing cases: cryosurgery, excisional
biopsy

86. Median Rhomboid Glossitis
Atrophic changes with clear margins
were visible at the tongue dorsum
Regeneration of filiform papillae is seen
after 2 weeks of anti-fungal treatment
CASE OF PARTIAL ATROPHIC TONGUE
Terai H, et al.,Clinical Features of Partial Atrophic Tongue Associated with
Candida. Int J Dentistry Oral Sci. 2016;03(1):177-180

87. Cleft, Lobed, Bifurcated and Tetrafurcated
Tongue:
 Separation of the dorsal
surface of tongue into 2
or 4 by deep grooves.
 Associated with
orofacial-digital
syndrome, fetal face
syndrome, Meckel's
syndromes.
 Management: regular
cleaning of tongue.

88. AGLOSSIA,HYPOGLOSSIA,
MICROGLOSSIA
 Aglossia: complete absent of tongue at birth.
 Hypoplasia: small rudimentary tongue.
 c/f:
 difficulty in eating
 Speaking
 High arched palate
 narrow constricted mandible
 Airways problems
 Associated with hypoglossia-hypodactylia
syndrome, hypomelia, Pierre Robin syndrome

89. AGLOSSIA,HYPOGLOSSIA,
MICROGLOSSIA

90. MACROGLOSSIA
 LARGE TONGUE,
TONGUE
HYPERTROPHY
 Two broadest
categories
 True macroglossia
 Pseudomacroglossia
 Physical examination
of the oral cavity and
head morphology is
helpful to deduce true
macroglossia from
pseudomacroglossia

91. MACROGLOSSIA
True macroglossia can be
subdivided into following
categories:
Congenital causes
Idiopathic muscle hypertrophy
Gland hyperplasia
Down syndrome
Beckwith-Wiedemann syndrome
Laband syndrome

92. MACROGLOSSIA
Acquired causes
Metabolic causes(hyperthyroidism,
cretinism)
Inflammatory causes (syphilis, amebic
dysentery)
Systemic(uremia, myxedema)
Traumatic(surgery, hemorrhage,
intubation injury)
Neoplastic(lingual thyroid, hemangioma)
Infiltrative(amyloidosis, sarcoidosis)

93. MACROGLOSSIA
Pseudomacroglossia includes any of the
following conditions which force the tongue in
an abnormal position
Habitual posturing of the tongue
Enlarged tonsils and/or adenoids displacing tongue
Low palate and decreased oral cavity volume
displacing tongue
Trans verse, vertical, or anterior/posterior
deficiency in the maxillary or mandibular aches
displacing the tongue
Severe mandibular deficiency (retrognathism)
Neoplasm displacing the tongue
Hypotonia of the tongue

94. MACROGLOSSIA
 C/F: noisy breathing, drooling of saliva,
difficulty in
 eating, speech and airways problems.
 Recurrent upper respiratory tract
infection.
 Displacement of teeth ,malocclusion
 Crenation of lateral border of tongue
 Management: surgical, orthodontic,
speech therapy

95. MACROGLOSSIA

96. HAMARTOMAS AND
DERMOIDS
 The tongue may be enlarged or
distorted by the presence of
variety of tumor like growths of
 developmental origin( hamartomas
neurofibroma, hemangiomas)
 or by epithelial inclusion cysts(
dermoids, branchial cleft cysts).

97. BALD OR DEPAPILLATED
TONGUES
 An erythematous , edematous
and painful tongue that appears
smooth because of loss of filiform
papillae and sometime fungiform
papillae secondary to certain
nutritional deficiency .
 Atrophy or loss of papillae may
be caused by a congenital
anomaly ,or develop as a
secondary features

98. BALD OR DEPAPILLATED
TONGUES
 Local causes:
 Eosinophilic granuloma
 Traumatic injuries-jagged teeth , rough
margins of restorations and inadvertent
contact of tongue with dental
medicaments such as eugenol.
 Allergic stomatitis: monomer of denture,
mouthwash, chewing gum, and lipstick.
 Facial hemiatrophy

99. BALD OR DEPAPILLATED TONGUES
 Systemic causes:
 Iron deficiency anemia: first appears at
tip,lateral border of tongue with loss of filiform
papilla. In extreme cases , the entire dorsum
becomes smooth and glazed. Very painful either
pale or fiery red.
 Plummer Vinson syndrome: siderophenic anemia,
atrophic glossitis, angular chelitis, generalized
atrophic oral mucosa, oral ulceration and
secondary candidiasis
 Pernicious anemia: atrophy of filiform
&fungiform papilae.
 Niacin deficiency:

100. BALD OR DEPAPILLATED TONGUES
 Folic acid deficiency: tongue is fiery red and
atrophy of filiform & fungiform papillae. Tongue is
swollen and small cracks may appear on dorsal
surface.
 Scleroderma: tongue shrinks, losing its mobility
and papillary pattern. Color of the tongue changes
to a vivid appearance due to circulatory
disturbances. In the end stages, the tongue lies as
a stiff, reduced body in the floor of mouth.
 Dermatomyositis: in early stages, tongue is
markedly swollen and later becomes harder. In
the late phase, tongue is atrophic.

101. BALD OR DEPAPILLATED TONGUES
 Diabetes: central papillary atrophy of the dorsum in
which low flat papillae are noticed just ant. to row of
circumvallate papillae.
 Syphilis: Depapillation of tongue usually occurs in
secondary and tertiary syphilis. Single or multiple
mucous patch on the tongue. A more diffuse, chronic,
non-ulcerating, irregular induration, with an
asymmetrical pattern of grooves and atrophic field
covering the entire dorsum.
 Zoster infection: numerous vesicles occur on ventral
surface of tongue.
 Atrophic gastritis:

102. Peripheral vascular disease
 decreased nutrition of the lingual papillae as a
result of vascular changes affecting the sub
papillary dorsal capillary plexus.
 Using fluorescence-enhanced capillary
microscopy in humans have documented
variations in the fungiform papillae associated
with age, sex, and the number and shape of
terminal vessels in the papillae.
 Infarcts of the tongue may be associated with
shrinkage of the affected side of tongue and
atrophic changes in the overlying mucosa.

103. BALD OR DEPAPILLATED
TONGUES

104. BALD OR DEPAPILLATED TONGUES

105. BALD OR DEPAPILLATED
TONGUES
Deficiency:
 Vitamin-A
 Vit-B1
 Vit-B2
 Pantothenic acid
 Vit-B6(niacin)
 Vit-B2,B6,B12,niacin
 Folic acid,vit-B6,zinc
Symptoms:
 Poor sense of taste
 Furrowed tongue
 Purplish or magenta tongue
 Beefy enlarged tongue
 Scarlet red tongue
 Burning sore tongue
 Ulcer on tongue

106. PAPILLOMATOUS CHANGES
 In several congenital disorders the surface of tongue is
covered with multiple papilloma. When extensive this
abnormalities is known as pebbly tongue.
 Lesions of this type is associated with congenital lingual
Lymphangioma, neurofibromatosis and the Anderson-
Fabry syndrome and Meckel’s syndrome.
 Management:

107. PAPILLOMATOUS CHANGES

108. GEOGRAPHIC TONGUE
 Also called as BENIGN MIGRATORY
GLOSITIS,WANDERING RASH, GLOSSITIS AREATA
EXFOLIATIVA, and ERYTHEMA MIGRANS
 It refers to irregularly shaped reddish areas of
Depapillation and thinning of the dorsal epithelium
which is surrounded by a narrow zone of
regenerating papillae that are whiter than the
surrounding tongue surface.
 Etiology:
 Hypersensitive patient: h/o-asthma, hay fever, eczema.
 Other factors: immunological reaction, emotional stress ,
hereditary factors, nutritional deficiencies.

109. GEOGRAPHIC TONGUE
 C/F-
 common in young & middle age.
 Female predilection
 Commonly on dorsal surface & lateral border
 Asymptomatic but patient may complain of
burning sensation, stinging, pain
 Initially appears as a small erythematous,
nonindurated, atrophic lesion, bordered by a
slightly elevated distinct rim that varies from gray
to white to light yellow.
 Loss of filiform papillae pink to red smooth shiny
surface , fungiform papillae persist in
desqaumated areas as small elevated red dots.

111. GEOGRAPHIC TONGUE
 The condition may persist for weeks to
months and then regress spontaneously
only to occur at later date.
 The lesion is not always restricted to
tongue and similar irregular or circinate
lesions occur elsewhere in the oral
cavity and are called as ectopic
geographic tongue or erythema circinate
migrans or annulus migrans.

112. GEOGRAPHIC TONGUE
 Diagnosis:
 clinically
 Biopsy shows loss of filiform papillae with hyper
parakeratosis and acanthosis.
 D/D-
 Psoriasis
 Reiter’s syndrome: skin, ocular, urethral lesion +
 Lichen planus: absence of raised whitish yellow rim.
 Use of strong mouth wash-h/o
 Anemic condition: hematological study and absence of
raised yellowish white border.

113. GEOGRAPHIC TONGUE
 Management:
 For control of burning-topical local
anesthetic agents like lidocaine,
dyclonine hydrochloride, or
diphenhydramine can be given.
 Topical therapy: topical corticosteroids
and topical application of salicylic acid
and tretinoin (retinoic acid)
 Psychological assurance

114. HAIRY TONGUE
 Lingua Villosa, Lingua Nigra,
Black Hairy Tongue
 An overgrowth of filiform papillae
on the dorsum of tongue , giving the
tongue a superficial resemblance as
that of hairiness.
 There is marked accumulation of
keratin on the filiform
papillae.(defective desquamation of
cells in filiform papillae)

116. HAIRY TONGUE
 Etiology:
 Fungal and bacterial overgrowth:
 Use of certain drugs: sodium perborate, sodium
peroxide, and antibiotics like penicillin and
Aureomycin
 Poor oral hygiene
 After surgery
 Lowered ph-blocks the normal desquamation of
epithelial cells covering the filiform papillae

117. HAIRY TONGUE
 In Debilitated, dehydrated, terminally ill patients
can lead to very thick, leathery coatings on the
tongue that are referred to as earthy or encrusted
tongue.
 C/F:
 papillae may reach a length of 2cm which
occasionally brush the palate and may produce
gagging or bad taste.
 The hyperplastic papillae then become pigmented
by the colonization of Chromogenic Bacteria,
which can impart a variety of colors ranging from
green to brown to black to yellow.

118. HAIRY TONGUE
This gives it a coated or hairy
appearance and retains debris and
pigments from substances from food,
tobacco, smoke, medicines.
 Management:
Maintenance of oral hygiene
Elimination of predisposing factors
Topical keratolytic application-
podophyllum in acetone or alcohol
suspension

119. THRUSH
 Acute pseudomembranous candidiasis
 Often appears as pearly white , pinhead size flecks
scattered over the dorsal surface.
 Etiology:
 overgrowth of Candida albicans in patient taking
antibiotics, immunosuppressant drugs, or having a
disease that supresses the immunity.
 C/F:
 f> m
 Prodromal symptoms like rapid onset of bad taste,
discomfort on spicy food, burning sensation
 White patches are easily wiped out

120. THRUSH
d/d-
Plaque form of lichen planus
Leukoplakia
Gangrenous stomatitis
Chemical burn

121. THRUSH

122. THRUSH
 Management:
 Topical application of clotrimazole
cream-2-3 times daily for 3-4
weeks.
 Ketoconazole 200-400 mg od for 2
weeks
 Fluconazole 50-100mg od for 2-3
weeks

123. White Sponge Nevus
 Congenital anomaly in which the surface
of tongue as well as other parts of oral
mucosa are involved by white spongy
plaques without significant
hyperkeratosis.
 c/f-
children are most commonly affected
Friction may strip superficial keratotic
area leaving zone of normal looking
epithelium or raw area.
 No treatment

124. White sponge nevus

125. VASICULOBULLOUS AND OTHER
DESQUAMATING DISORDERS
 Desquamating disorders are often
mistakenly identified as white lesions
because coalescence of whitish
desquamating epithelium with areas of
papillary atrophy and scarring.
 Patches of regenerating papillae may also
be interspersed, giving red and white
areas in a marble like pattern.

126. LICHEN PLANUS
 Oral lichen planus is defined as a common
chronic immunological mucocutaneous
disorder that varied in appearance from
keratotic to erythematous and ulcerative.
 Lacelike , erosive and bullous variety of
this disorder may affect the tongue in
addition to the cheeks, lips, and gingiva.
 Etiology: unknown
 Immune system has primary role in
development of this disease.

127. LICHEN PLANUS
 Other factors: stress, habits, hypertension,
diabetes
 c/f-
 oral lesions are characterized by radiating white
and gray velvety thread like papules in linear,
angular or reticular form arrangement.
 Tiny white elevated dots rays present at the
intersection of white lines, called as Wickham’s
striae.
 In some cases superimposed candida
infection

128. LICHEN PLANUS

129. LICHEN PLANUS
d/d-
Leukoplakia
Candidiasis
Drug induced reaction
Geographic tongue

130.  Management:
Removal of cause
Steroids –topical and systemic
Topical application of antifungal agents
Retinoids
Psychotherapy

131. LEUKOPLAKIA
 It is whitish patch or plaque that can not be
characterized, clinically or pathologically,
as any other disease and which is not
associated with any other physical or
chemical causative agent except the use of
tobacco.
 It can occur anywhere in the oral cavity but
tongue is one of the commonest site.
 If it occurs on tongue ,it is called as ‘chronic
superficial glossitis’

132. LEUKOPLAKIA
 Etiological factors are classically known
as 6 S….smoking, syphilis, sharp tooth,
sepsis, sprit, and spices.
 Alcohol-facilitates the entry of
carcinogen into exposed cells and thus
alters the oral epithelium and its
metabolism.
 Vitamin deficiency

133. LEUKOPLAKIA

134. LEUKOPLAKIA
 c/f- confined to ant. 2/3rd of
tongue, dorsum and lateral border.
 The affected area show milky-white
patches with fissure and cracks.
 Some patient may complain of
burning sensation

135. LEUKOPLAKIA
 Management:
 Stop habits
 Conservative treatment-
 Use of beta carotenes, lycopene,
L-ascarbic acid, vit.E, retinoic
acid,
 Surgical treatment: cold knife
surgical excision, laser surgery

136. PIGMENTATION
 Tongue may exhibit various patterns of racial
melanin pigmentation.
 Jaundice may be apparent on ventral mucosa
 Exogenous pigmentation of the filiform papillae of
the normal and coated or hairy tongue is very
common and results from microbial growth and
metabolic products, food debris, and dyes from
candy, beverages, and mouth rinses.
 Pigmentation by chemotherapeutic agent,
doxorubicin hydrochloride

137. PIGMENTATION
 Extravasation of red cells around
lingual varicocities may give a
patchy, bluish red discoloration,
usually on ant. Ventral surface of
tongue.

138. PIGMENTATION
Actas Dermosifiliogr 2011;102:739-40 - Vol. 102 Num.9 DOI: 10.1016/j.adengl.2011.11.010
Pigmentation of the Fungiform Papillae of the Tongue: A Report of 2 Cases
Pigmentación de las papilas fungiformes linguales. A propósito de dos casos
J. Marcoval, J. Notario, S. Martín-Sala, I. Figueras

139. ULCERS AND INFECTIOUS DISEASES
 Quite severe ulcers, which are more in nature
of lacerations and contusions, are produced by
sudden biting trauma, either during epileptic
seizure or as a result of a sudden blow to the
jaw while tongue lies b/w upper and lower
teeth.
 Rough surface of restorations and jugged,
broken cusps rapidly cause ulceration of the
tongue.
 Lateral margins and ventral surface of tongue
are also frequently damaged by contact with
rapidly revolving burs, discs, or other dental
equipment.

140. ULCERS AND INFECTIOUS DISEASES
 Ulcers on lingual frenum in neonates with natal lower
incisors are referred as Riga’s ulcer or Riga-Fede
disease.
 Shallow but persistent tongue ulcers , especially along
the posterior ventral surfaces, are common in patients
with lichen planus, various nutritional deficiencies,
and hematological problems.
 The lateral margins and tip of tongue are frequently
involved in severe episode of recurrent aphthous
ulcers.

141. ULCERS AND INFECTIOUS
DISEASES
 Vesicobullous disorders also may involve lingual
mucosa.
 Tuberculosis-post. ventral surface
 The ant. 1/3rd of the tongue may also be site of an
extra genital chancre in primary syphilis.
 In primary herpes simplex gingivostomatitis, the
dorsum, ventral and lateral margin may be ulcerated.
 In infections with erythrogenic, toxin producing
Streptococcus pyogens (scarlet fever), the sign of
strawberry tongue.

142. ULCERS AND INFECTIOUS
DISEASES

143. ULCERS AND INFECTIOUS
DISEASES

144. ULCERS AND INFECTIOUS
DISEASES
MANAGEMENT
 The most effective treatment to get rid of tongue ulcer
is to increase your body's immunity power by taking
Vitamin B complex tablets and vitamins tablets.
 Glycerin: Rinsing your mouth and tongue with glycerin
on the affected parts of tongue is the best way to
alleviate the pain caused by ulcers under tongue and
throat.
Rinsing your mouth with glycerin also controls the
wounds or lesions further spreading and expanding
inside the mouth and throat.
 Topical application of lignocaine

145. SUPERFICIAL VASCULAR CHANGES
 Lingual varicosities are evident as prominent purplish
blue spots, nodules, and edges, usually on the
anterior ventral surface of the tongue and around the
submandibular-sublingual gland orifices.
 But they are rarely symptomatic
 They represent a normal age change
 Petechial hemorrhages and telangiectasia's also can
demonstrated on ventral surface
 Hemangiomas are relatively common on tongue.

146. SUPERFICIAL VASCULAR
CHANGES

147. AMYLOIDOSIS
 Involvement of the tongue is
described in both the primary and
secondary forms of amyloidosis.
 The characteristic fibrous glycoprotein
of this disease is deposited in the
submucosa as well as in deeper
muscular layers of tongue.
 Generalized enlargement of the
tongue(macroglossia) and fungating
swelling may result.

148. AMYLOIDOSIS

149. NEUROMUSCULAR DISORDERS
 Neuromuscular disorders of central, peripheral,
or muscular origin may produce symptom of
dysphagia and choking as well as disordered
mastication and speech problems.
 Repetitive , uncontrolled movement of the
tongue, head, and jaws, Depapillation, burning
sensations and traumatic ulcers of tongue are
common in buccolingaul-facial dyskinesia,
parkinsonism, and the tardive dyskinesia.
 Weakness of tongue can occur in polymyositis,
multiple sclerosis and Duchene's muscular
dystrophy.

150. NEUROMUSCULAR
DISORDERS
Damage to hypoglossal nerve,
leads to hypoglossal palsy.
If bilateral, the tongue can not
be extended
If unilateral, the tongue
deviates to the unaffected side
when extended.

151. Sleep Apnea Syndrome
 Sleep apnea is a disorder characterized by a
reduction or pause of breathing (airflow) during
sleep.
 It is common among adults becoming more common
in children
 Obstructive sleep apnea is caused by the collapse of
the airway during sleep.
 Obstructive sleep apnea is diagnosed and evaluated
by history, physical examination and
polysomnography (sleep study).
 One of the most common signs of obstructive sleep
apnea is loud and chronic (ongoing) snoring.

152. Sleep Apnea Syndrome
 Sleep apnea is treated with lifestyle
changes, mouthpieces, breathing devices,
and surgery.
 Medicines typically aren't used to treat
the condition.
 The mouthpiece will adjust your lower
jaw and your tongue to help keep your
airways open while you sleep.

153. Vascular disease of the body of
the tongue
 The lingual artery is very susceptible
to the development of
atherosclerotic changes.
 The extent of the lingual
atherosclerosis increases with age,
but age does not bring ischemic
complications secondary to
atherosclerosis.
 Infarcts of tongue are fairly rare

154. Angioneurotic Edema
 Angioneurotic edema is one form of
acute anaphylactic reaction
representing an immediate
hypersensitivity response allied to
urticaria, allergic rhinitis, and asthma.
 Antigenic stimuli are-respiratory
allergens, food such as shellfish,
chocolate, nuts, various drugs and
occasionally cold and physical trauma to
tongue.

155. Angioneurotic Edema
 Medications used to treat
angioedema include:
 Antihistamines
 Anti-inflammatory medicines
(corticosteroids)
 Epinephrine shots (people with a
history of severe symptoms can carry
these with them)
 Inhaler medicines that help open up
the airways

156. Benign Tumors Of Tongue
 A benign mouth tumor is an abnormal
growth located in the mouth or
tongue.
 The growths are not cancerous and
very rarely spread to other body
parts.
 The condition is most common in
adults over the age of 60.
 The risk of developing an abnormal
growth within the mouth is greater
increased in smokers.

157. Benign tumors of tongue
 c/f:
bleeding lump –
Mouth dentures don't fit
difficulties swallowing
lump in any part of the mouth
poor pronunciation
sore lump - mouth

158. Benign Tumors Of Tongue
 Benign tumors of tongue are as:
 Fibroma
 Papilloma
 Hemangioma
 Lymphangioma
 Granular cell myoblastoma
 Lipoma

159. Fibroma
 A fibroma is a benign, tumor-like growth
made up mostly of fibrous or connective
tissue.
 Tumor-like growths such as fibroma
develop when uncontrolled cell growth
occurs for an unknown reason, or as a
result of injury or local irritation.
 Fibromas can form anywhere in the body
and usually do not require treatment or
removal.
 Usually painless
 Surgical exicision- management

160. Fibroma

161. Papilloma
 Papilloma is a general medical term
for a tumor of the skin or mucous
membrane with finger-like
projections.
 Papilloma are either pedunculated or
sessile growth on any surface of oral
mucous membrane.
 Multiple papilloma are occur in
Cowden's syndrome, down’s
syndrome.
 Management-Surgical excision.

162. Papilloma

163. Hemangioma
 Hemangioma is a benign tumor of
dilated blood vessels.
 It is also known as port-wine stain,
strawberry hemangioma, and Salmon
patch.
 They are characterized by hyperplasia
of blood vessels, usually veins and
capillaries, in a focal area of
submucosal connective tissue.

164. Hemangioma

165. Hemangioma
 Surgical or invasive treatment of oral
hemangiomas has evolved.
 Complete surgical excision of these
lesions offers the best chance of
cure, but, often, because of the
extent of these benign lesions,
significant sacrifice of tissue is
necessary.
 For example, lesions of the tongue
may require near-total GLOSSECTOMY

166. Lymphangioma
 Lymphangioma are benign hamartomatous tumors of
the lymphatic channels. They are thought to be
developmental malformations arising from
sequestration of lymphatic tissue that do not
communicate with the rest of the lymphatic
channels
 Oral lesions are most frequently found on the
tongue.
 Treatment: injection of sclerosing solutions,
cryosurgery, intravascular remobilization with silicon
spheres.

167. Lymphangioma

168. Granular Cell Myoblastoma
 Granular cell tumor, is a relatively uncommon
benign neoplasm, which is more commonly
found in females in the 4th to 6th decades of
life even though it can occur in all ages.
 Most of the intraoral lesions occur on the
tongue, usually on the lateral aspect.
 Granular cell tumors are slow-growing,
painless tumors with no known cause.
 They may start in nerve cells.
 They occur mostly on the top of the tongue.

169. Granular Cell Myoblastoma

170. Lipoma
 Lipoma is a rare benign tumor of
mesenchymal origin which infiltrates
adjacent muscle and tend to recur after
excision
 It is prevalently found in the cheek and
tongue, but also in the lip, gingival and floor
of the mouth.
 Particularly, lipoma accounts for 0.3% of all
lingual tumors

171. Lipoma

172. Malignant Tumors Of Tongue
 Cancer of the tongue is a malignant tumor that
begins as a small lump, a firm white patch, or a
sore (ulcer) on the tongue.
 If untreated, the tumor may spread throughout the
tongue to the floor of the mouth and to the gum
(jaws).
 As a tumor grows, it becomes more life threatening
by spreading (metastasizing) to lymph nodes in the
neck and later to the rest of the body
 Eg: squamous cell carcinoma,

173. Squamous Cell Carcinoma
 It is most common oral carcinoma with 60%
cases arising from the ant. 2/3rd of the
tongue and reminder from base of tongue.
 Etiology: physical trauma, alcohol, tobacco,
smoking, candidiasis, syphilis, sepsis,
chronic dental trauma and chronic
superficial glossitis.
 About 80% of all people who develop tongue
cancer are smokers.

174. Squamous Cell Carcinoma

175. Squamous Cell Carcinoma

176. Squamous Cell Carcinoma
 c/f:
 middle and later decades, m>f ,
 Painless mass or ulcer later becomes painful
 Excessive salivation
 Offensive smell in mouth occurs due to bacterial
stomatitis.
 Sore throat
 Immobility of tongue-causes difficulty in speech.
 Hoarseness of voice and dysphagia
 It spread by infiltration and invasion

177. Squamous Cell Carcinoma
 Management:
 Early carcinoma of tongue(T1 and
small T2) responds equally well to
surgical excision or by radiation.
 T1 and T2 with no evidence of lymph
node metastasis, surgical treatment
is usually restricted to partial
glossectomy.
 If it is T2 or T3 without node
involvement, prophylactic neck
dissection is advised.

178. Squamous Cell Carcinoma
 Treatment of carcinoma of the ant. 2/3rd of
tongue with evidence of node involvement
may include radical neck dissection, partial
mandibulectomy, and intraoral
dissection(commando operation) in addition
to glossectomy
 Better cure rates obtained with combined
chemotherapy(cis-platinum and bleomycin)-
surgery radiation approaches, use of neutron
irradiation, immunotherapy, and trans oral
laser resection for accessible early stage
carcinoma.

179. CONCLUSION

180. REFERANCE
 B. D. CHAURASIA (2006) HUMAN ANATOMY, REGIONAL AND
APPLIED, DISSECTION
 ORBAN’S ORAL HISTOLOGY & EMBRYOLOGY 12TH EDITION
 FRANK H NETTER, MD ATLAS OF HUMAN ANATOMY
 NEELIMA ANIL MALIK, TEXTBOOK OF ORAL AND MAXILLOFACIAL
SURGERY
 SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION
 HENRY GRAY(2004) GRAY’S ANATOMY
 Terai H, et al.,Clinical Features of Partial Atrophic Tongue
Associated with Candida. Int J Dentistry Oral Sci.
2016;03(1):177-180
 J. Marcoval, J. Notario, S. Martín-Sala, I. Figueras
Pigmentation of the Fungiform Papillae of the Tongue: A Report
of 2 Cases Actas Dermosifiliogr 2011;102(9):739-40
 INTERNET SOURCE..

181. THANKYOU