Full description of tongue

1. PRESENTED BY :-
DR. HARJEET YADAV
MODERATOR :- DR. JITENDER KUMAR
DEPT. OF ORAL AND MAXILLOFACIAL SURGERY
Date: 03-May-2021

2. INTRODUCTION
EMBRYOLOGY
EXTERNAL FEATURES
MUSCLES
ARTERIAL SUPPLY
VENOUS DRAINAGE
NERVE SUPPLY
LYMPHATIC DRAINAGE
SALIVARY GLANDS OF TONGUE
TASTE
DEVELOPMENTAL ANOMALIES
CLINICAL CONSIDERATIONS
TONGUE CANCER
TONGUE FLAP
REFERENCES

3. Muscular organ situated in the floor of the
mouth.
Anchored to Hyoid bone, Mandible,
Styloid process & Soft Palate
Comprises of skeletal muscle (voluntary)
Separated into two halves by median
fibrous septum
FUNCTIONS
SPEECH
TASTE
MASTICATION
DEGLUTITION

4. EMBRYOLOGY

5. EPITHELIUM
Anterior two-third:
FIRST BRANCHIAL ARCH
Posterior one third:
THIRD BRANCHIAL ARCH
Posterior most part:
FOURTH BRANCHIAL ARCH

6. 2ND arch is buried by the
overgrowth of 3RD arch

7. MUSCLES CONNECTIVE TISSUE
develop from
occipital myotomes,
supplied by
HYPOGLOSSAL
NERVE
develops from
the local
mesenchyme

8. EXTERNAL FEATURES

10. PAPILLAE

11. Ventrum of tongue

12. MUSCLES

13. EXTRINSIC MUSCLES INTRINSIC MUSCLES
1. Genioglossus
2. Hyoglossus
3. Styloglossus
4. Palatoglossus
1. Superior longitudinal
2. Inferior longitudinal
3. Transverse
4. Vertical

18. ARTERIAL SUPPLY

20. The root of tongue is also supplied by the
TONSILLAR BRANCH of FACIAL ARTERY and
ASCENDING PHARYNGEAL BRANCH of EXTERNAL
CAROTID ARTERY.

21. VENOUS DRAINAGE

23. NERVE SUPPLY

25. LYMPHATIC DRAINAGE

28. SALIVARY GLANDS
OF TONGUE

29. SALIVARY
GLANDS
GLANDS OF VON EBNER
GLANDS OF BLANDIN &
NUHN
GLANDS OF WEBER

30. GLANDS OF BLANDIN-NUHN
• Anterior lingual glands which are located near the tip of the
tongue on each side of the lingual frenum. These are
Seromucus glands.
• 12-25 mm in length, 8m in width.
• Each opens by 3-4 ducts on undersurface of tip of tongue .

31. GLANDS OF VON EBNER
• Serous glands found in moats of circumvallate &
foliate papillae .
• Secrete lingual lipase, the secretion flushes the
moats to enable the taste buds to respond rapidly to
changing stimuli .

32. GLANDS OF WEBER
• Purely mucous .
• Open into the crypts of lingual tonsils on the
posterior dorsum of tongue .
• Abscess formed due to accumulation of pus and
fluid in this gland is known as PERITONSILLAR
ABSCESS .

33. TASTE

36. DEVELOPMENTAL
ANOMALIES OF TONGUE

37. • Caused by an unusually short, thick lingual frenulum.
• Varies in degree of severity.
• Mild cases are characterized by mucous membrane bands.
• Severe cases shows complete ankyloglossia whereby the tongue is tethered to the
floor of the mouth.
 MILD FORM – Does not influence development, tooth position or phonation
 MODERATE FORM – Exhibits midline mandibular diastema
 SEVERE FORM – Complete attachment of tongue to the floor of the mouth or
alveolar gingiva

38. • Also known as LINGUA PLICATA or plicated or scrotal or furrowed tongue
• Benign condition characterized by deep grooves (fissures) on the dorsum of
the tongue.
• The condition is usually painless. Some individuals may complain of an associated
burning sensation
• The clinical appearance is considerably varied in both the orientation, number,
depth and length of the fissure pattern. There are usually multiple grooves/furrows
2–6 mm in depth present
• Fissured tongue is seen in Melkersson-Rosenthal syndrome, Down
syndrome, psoriasis, and Cowden's syndrome.

39. • Macroglossia is the medical term for an unusually large tongue.
• Severe enlargement of the tongue can cause cosmetic and functional difficulties in
speaking, eating, swallowing and sleeping.
• Most common causes are vascular malformations
(e.g. lymphangioma or hemangioma) and muscular hypertrophy(e.g. Beckwith–
Wiedemann syndrome or hemihyperplasia) and Down syndrome.
• It may lead to: Airway obstruction, difficult intubation, swallowing difficulty, and
mandibular deformities.

40. • Microglossia is another rare congenital anomaly in which only a tiny or rudimentary
tongue is present
• Although microglassia may develop as isolated cases but in most of the cases they
occur in association with other anomalies like oromandibular limb hypogenesis
syndrome or hypoglossia-hypodactylia syndrome etc.
• Severe speech difficulties as well as difficulty in taking food.
• As size of the tongue often determines the growth and size of the mandibular arch
in case of microglossia the length of the mandibular arch will be smaller due to the
smaller size of tongue

41. • Aglossia is the complete absence of tongue.
• The first known case was reported in the early 18th century in France and
cases to this day remain extremely rare.
• It is associated with craniofacial and limb defects.

42. • Children with bifid tongue have a split running along the length of their tongue.
• Cleft occurs because the tongue fails to completely develop in order to join the two
sides of the tongue together.
• The cause is usually unknown but sometimes exposure to certain viruses or drugs
during pregnancy may cause cleft tongue.
• The biggest problem with cleft tongue is difficulty eating.

43. • Depapillated ovoid or rhomboid, slightly raised area anterior to
circumvallate papillae.
• Occurs due to failure of tuberculum impar to retract.
• Related to chronic fungal infections.

44. • Lingual thyroid originates from failure of the thyroid gland to descend from the
foramen caecum (tongue) to its normal pre-laryngeal site.
• The ectopic gland located at the base of the tongue is often asymptomatic but may
cause local symptoms such as dysphagia, dysphonia, upper airway obstruction and
hemorrhage, often with hypothyroidism.
• Treatment could be conservative with substitutive hormone treatment in patients
with mild symptoms, while surgery is recommended in cases with airway obstruction.
• In mandibular setback surgeries, lingual thyroid may alter airway..

45. CLINICAL CONSIDERATIONS

46. Injury to any part of taste pathway causes abnormality in taste appreciation
INJURY TO HYPOGLOSSAL NERVE
PARALYSIS OF GENIOGLOSSUS MUSCLE
GLOSSITIS
The undersurface of tongue is a good site for observation of jaundice
Referred pain is felt in the ear in diseases of posterior part of tongue as 9th
nerve is common supply to both the regions

47. • Paralysis, atrophy of the affected side of tongue
• Tongue deviates to paralyzed side during protrusion due to action of
unaffected genioglossus
• Causes-
 Trauma like fractured mandible
 Infranuclear lesion – gradual atrophy & muscular twitching
 Supranuclear lesion – tongue is stiff, small and moves sluggishly

48. • Tongue tends to fall backward, obstructing airway and presenting the risk of
asphyxiation
• Causes –
- Unconscious patients as under GA
- Patients with grand mal epilepsy
- Parasymphyseal mandibular fracture

49. • Glossitis is usually a part of generalized ulceration of oral cavity or
stomatitis
• In certain anemia, like pernicious and iron deficiency anemia, the tongue
becomes smooth due to atrophy of filiform papilla
• The presence of a rich network of lymphatics & loose connective tissue
is responsible for enormous swelling in acute glossitis

50. TONGUE CANCER

52. Carcinoma tongue is the second most common oral carcinoma after
carcinoma lip.
SITE-WISE INCIDENCE:
- Middle 1/3rd of lateral border of tongue: 47% (Most common site).
- Posterior 1/3rd : 20%
- Tip of tongue: 15%
- Ventral surface & frenulum: 9%
- Dorsum: 6.5%
- Facio-lingual: 6%
- Age of presentation: 60 years
- Men > Women

53. PATHOLOGY
- 95% of carcinoma tongue are SCC.
- Others: Melenoma, Sarcoma, Minor salivary gland
cancer, Adenoid cystic carcinoma
Premalignant lesions of tongue:
- Leukoplakia
- Erythroplakia
- Chronic hyperplastic candidiasis

54. CLINICAL PRESENTATION
- Painless long-standing ulcer, which later becomes
painful due to infection or nerve involvement.
- Bleeding from the tongue
- Excessive salivation
- Dysphagia
- Halitosis
- Change in voice

55. TONGUE FLAP

56. • Tongue is an excellent donor site because of its
abundant vascularity and low morbidity.
• Eiselsberg was first to use pedicle tongue flaps
in 1901.
• Cadenet described rich submucous vascular
plexus in tongue, allowing elevation of flaps as
thin as 3 mm.
• Tongue flaps are locoregional.

57. • Excellent blood supply
• Low morbidity
Tongue flaps are used to cover defects in cheek, floor
of the mouth, palate, alveolus, oroantral fistulas and
vermillion & lip construction.

58. • Flaps from the dorsum of tongue – Posteriorly based
Anteriorly based
Transverse based
• Flaps from the lingual tip – Perimeter flap
Dorsoventrally disposed flap
• Flaps from the ventral surface of tongue
• Flaps from the lateral surface of tongue

59. • Also known as SLIDING POSTERIOR TONGUE FLAP
• Myomucosal flap is created by releasing the tongue from the hyoid bone
and maintaining dorsolingual branch of lingual artery.
• To allow complete mobilization, the entire ipsilateral base is freed from
vertical septum.
INDICATION
 Repair of oronasal fistula
 Repair of oroantral fistula
 Lip reconstructions
 Buccal mucosa reconstructions
 Reconstruction of hypo pharynx
POSTERIORLY BASED DORSAL TONGUE FLAP

60. ANTERIORLY BASED DORSAL TONGUE FLAP
To repair defects in the anterior cheek, lip, anterior floor of the
mouth, palate, alveolus.

61. TRANSVERSE BASED DORSAL TONGUE FLAP
 To repair anterior floor of the mouth and lower lip
PERIMETER FLAP
 For repair of vermillion border of either lip
 Upper and lower lip reconstruction
DORSOVENTRALLY DISPOSED FLAP
 Flap reflected ventrally on an anterior base: used
for lining in lower lip reconstruction
 Flap reflected dorsally on a posterior base: used
for lining in upper lip reconstruction

62. FLAPS FROM VENTRAL SURFACE OF TONGUE
 Cover defect on anterior floor of mouth
LATERAL TONGUE FLAP
 Cover defect on buccal mucosa, lateral palate,
alveolus, and lip.
 Incisions are made on ventral and dorsal surface
of tongue in a ‘v’ shaped pattern. This allows
primary closure of wound.

63. • BD Chaurasia’s Human Anatomy, Regional and Applied Dissection and Clinical –
Fifth Edition, Volume 3, HEAD & NECK, BRAIN
• ATLAS OF HUMAN ANATOMY, 7th ED.,NETTER
• Inderbir Singh, GP Pal; Human Embryology – Eighth Edition
• Neelima Anil Malik, Textbook of Oral and Maxillofacial Surgery – Third edition
• Shafer’s Textbook of Oral pathology – Seventh edition
• Manipal Manual of Surgery – Third edition
• Lingual thyroid causing dysphagia and dyspnea. Case reports and review of the
literature - A Toso, F Colombani,1 G Averono, P Aluffi, and F Pia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816370/
• http://www.aboutcancer.com/base_tongue.htm
• https://headandneckcancerguide.org/adults/cancer-diagnosis-
treatments/surgery-and-rehabilitation/cancer-removal-surgeries/glossectomy/