A presentation talking about the basics of tongue and it's importance in Prosthodontics

1. TONGUE
DR SHUBHAM PARMAR
1ST YEAR MDS
DEPARTMENT OF PROSTHODONTICS
RURAL DENTAL COLLEGE, LONI

2. CONTENTS
 Introduction
 Development
 Anatomy
 Histology
 Clinical examination of tongue
 Disorders of tongue
2

3.  Applied anatomy
 Prosthetic implications
 Conclusion
 References
3

4. Introduction
 Tongue is a highly muscular organ
 Helps in speech, deglutition and taste
 Dorsal mucosa is covered by numerous
papillae, some of which bear taste buds
 The oral and pharyngeal parts of the tongue
differ in their mucosa, innervation and
developmental origins
4

5. Development Of Tongue
 Development - 4th week of gestation
 Tongue develops in relation to the
pharyngeal arches in the floor of the
developing mouth
5

6. Anterior 2/3rd of tongue
 Formed by fusion of –
 2 lateral lingual swellings
 Tuberculum impar
 Derived from 1st branchial
arch
 Supplied by lingual nerve
and chorda tympani
6

7. Posterior 1/3rd of tongue
 Formed from the cranial part of the
hypobranchial eminence
 Formed by 3rd arch
Development of posterior most part
is by the 4th arch
7

8. 8
Embryonic derivation of parts of tongue
Epithelium over anterior 2/3rd 1st arch
Epithelium over posterior 1/3rd 3rd arch
Epithelium over posterior most part 4th arch
Muscles Occipital Myotomes

9. Anatomy of Tongue
 It has a root, apex, dorsal and a ventral
surface
 Attaches to the hyoid bone, mandible,
styloid processes, soft palate and the
pharyngeal wall by its muscles
 Intrinsic and an extrinsic group of muscles
present
9

10.  Dorsum
Oral
Pharyngeal
 The limbs of the sulcus terminalis run
anterolaterally to the palatoglossal arches
 The dorsal mucosa has a longitudinal median
sulcus and is covered by papillae
10

11.  Ventral surface - smooth and purplish
 Lingual frenum attaches tongue to the
floor of the mouth
 Deep lingual veins lie lateral to the frenum
 Plica fimbriata fold - lateral to the lingual
vein, run anteromedially towards apex
11

12.  The posterior part of the tongue lies
posterior to the palatoglossal arches
 Forms the anterior wall of the oropharynx
 The pharyngeal part of the tongue is devoid
of papillae
12

13. Muscles of Tongue
 Median fibrous septum separates tongue
into halves
 The tongue consists of 4 intrinsic and
extrinsic muscles in each half
 Intrinsic muscles - wholly within the
tongue
 Extrinsic muscles - outside the tongue
13

14. Extrinsic muscles 14

15. Genioglossus
 Genioglossus is triangular in sagittal
section
 Lies parallel to the midline
 It fans out upwards and backwards
from the origin
 Origin – Short tendon attached to the
genial tubercle
15

16.  Inferior fibres of genioglossus
attach to the upper anterior
surface of the hyoid body by a
thin aponeurosis near the
midline
 The Intermediate fibres pass
backwards into the posterior part
of the tongue
 The superior fibres ascend
forwards to enter the ventral
surface of the tongue
16

17.  Action
 Protrusion of tongue
 Depress the dorsum and make it
concave
 Deviate tongue to opposite side
 Vascular supply
 Sublingual branch of lingual artery
 Submental branch of facial artery
 Nerve Supply
 Hypoglossal nerve
17

18. Hyoglossus
 Thin muscle, quadrilateral in shape
 Origin - greater cornu and front of the body of the hyoid bone
 Insertion – Lateral border of tongue
 Action – depression of tongue
 Vascular supply
 Sublingual branch of lingual artery
 Submental branch of facial artery
 Nerve supply
 Hypoglossal nerve
18

19. Styloglossus
 Shortest and smallest muscles
attached to styloid
 Origin – anterolateral aspect of the
styloid process
 Insertion – lateral border of tongue
 Action – moves the tongue
upwards and backwards
 Vascular supply - sublingual branch
of the lingual artery
 Nerve supply – hypoglossal nerve
19

20. Palatoglossus
 Origin – Inferior surface of palatine aponeurosis
 Insertion – lateral surface of tongue
 Action – elevates root, approximates palatoglossal arch,
closes oropharyngeal isthmus
 Vascular supply
 Ascending palatine branch of the facial artery
 Ascending pharyngeal artery
 Nerve supply
 Pharyngeal plexus
20

21. Intrinsic muscles of tongue 21

22. 22
Muscle Origin Insertion action
Superior Longitudinal Submucous fibrous
tissue near the
epiglottis
Median lingual septum
Lingual margins
mucous membranes
Shortens the tongue
Pulls apex upwards
Dorsum concave
Inferior Longitudinal Root of the tongue Apex of tongue Shortens tongue
Pulls apex downwards
Dorsum convex
Transverse Median septum of
tongue
Submucous fibrous
tissue of the lingual
margin
Narrowing and
elongation of tongue
Vertical Dorsal part of tongue Ventral part of tongue Makes tongue flatter
and wider

23. Vascular Supply
23
External Carotid Artery
Lingual Artery
Dorsal lingual
arteries -
posterior part
Deep lingual
artery -
anterior part
Sublingual artery -
sublingual gland
and floor of mouth

24. Venous drainage 24
Dorsal Lingual Vein
- dorsum and side of
tongue
Deep Lingual Vein – tip of
tongue
Internal Jugular Vein

25. Lymphatic drainage of tongue
 Tip of tongue – submental
nodes
 Anterior 2/3rd in
submandibular nodes
 Posterior 1/3rd in jugulo-
omohyoid
 Posterior most – upper deep
cervical lymph nodes
25

26. Nerve supply of tongue
 Sensory – it is of 2 types
 General somatic afferent (GSA) Touch/ temperature
 Special visceral afferent (SVA) Taste
 Motor – Hypoglossal nerve and pharyngeal plexus
26
Nerve supply Anterior 2/3rd Posterior 1/3rd Posterior most part
GSA Lingual nerve Glossopharyngeal Internal laryngeal
SVA Chorda tympani Glossopharyngeal Internal laryngeal

27. Papillae of tongue
 The epithelium on the dorsal surface of the tongue is irregular due to numerous
elevations or projections called papillae
 All papillae on the tongue are covered by stratified squamous epithelium
 Shows partial or complete keratinization
27

28. Filiform Papillae
 Most numerous and smallest papillae
 Cover the entire anterior part of the tongue
 Cone-shaped structures
 Increase the friction between the tongue and food, and facilitate the
movement of particles by the tongue within the oral cavity
 NO TASTE BUDS PRESENT
28

29. Fungiform papillae
 Fungiform papillae are smooth, round structures
 Exhibit a mushroom-like shape
 Interspersed among the filiform papillae
 More prevalent in the anterior region of the tongue
 Appear red in colour because of their highly
vascular connective tissue core
29

30. Circumvallate papillae
 Circumvallate papillae are large cylindrical structures
 8 to 12 in number, 1–2 mm in diameter
 Form a V-shaped row in front of the sulcus terminalis
 Characterized by deep moats or furrows that encircle them
 Excretory ducts from Von Ebner’s glands empty into the base of
the furrows
30

31. Foliate Papillae
 Red, leaf-like mucosal ridges, covered by a non-keratinized
epithelium
 Present on the lateral margins of the posterior part of the
tongue
 Alternate with deep grooves in the mucosa
 Taste buds are present in the epithelium of the lateral walls
 Well developed in some animals but are rudimentary or
poorly developed in humans
31

32. Glands of Blandin and Nuhn
 Anterior lingual glands
 Deeply placed seromucous glands
 Located on tip of tongue on each side of lingual frenum
 Found on ventral surface of apex of tongue
32

33. Glands Of Von Ebner
 Serous salivary
 Adjacent to the circumvallate and foliate papillae
 Secrete lingual lipase
 Secretion flushes material from base of the grooves to enable the
taste buds to respond rapidly to changing stimuli
33

34. Histology of tongue
 Dorsal mucosa thicker than the ventral and lateral mucosae
 Directly adherent to underlying muscular tissue with no discernible
submucosa
 The epithelium consists of non-keratinized stratified squamous
epithelium posteriorly and fully keratinized epithelium anteriorly
 The underlying lamina propria is a dense fibrous connective tissue,
with numerous elastic fibres
34

35. Taste Buds
 Barrel shaped
 Contain chemosensory cells
 Often referred to as paraneurones
 Seen on all papillae except filiform papillae
 Most abundant on posterior part of tongue
 Scattered over almost the entire dorsal and lateral surfaces of the tongue
 Average of 250 taste buds for 8–12 papillae
35

36. Structure of taste buds
36

37. Neural pathway of taste
37

38. Clinical Examination of tongue
 Colour
 Size
 Frenal attachment
 Swelling
 Ulcer
 Coating
 Crenations
 Fissures
38

39. 39
Eiti Reteactor TCL self Retaining
Retractor
Nira Dry Field System
Tongue Retractors

40. 40
Minnesota
Retractor
Austin
Retractor
Weider Retractor
Heartmann
Retractor

41. 41

42. 42

43. Developmental Anomalies Of Tongue
 Aglossia/Microglossia
 Macroglossia
 Ankyloglossia
 Bifid Tongue
 Fissured Tongue
 Median Rhomboid Glossitis
 Hairy Tongue
 Lingual Thyroid Nodule
43

44. 44

45. Aglossia/Microglossia Macroglossia
45

46. Ankyloglossia Bifid Tongue 46

47. Fissured Tongue Median Rhomboid
Glossitis
47

48. Hairy Tongue Lingual Thyroid
Nodule
48

49. • Proper designing of the lingual flange in the wax up
stage
• Add very little wax behind the incisors region, while a
flat or slightly concave surface behind the premolars is
established
• Narrower posterior teeth
Macroglossia
• Thick lingual flange in mandibular denture to obtain the
lingual seal
• Placement of wider posterior teeth
Microglossia
• Surgical excision of the tongue tie
• Fabrication of mandibular denture before surgery
• Prevent reattachment of frenum by acting as a barrier
Ankyloglossia
49
Prosthodontic consideration related to abnormalities of tongue

50. Prosthodontic considerations
50

51. Prosthodontic considerations
 Tongue and its role in impression making for complete denture
 Affect of tongue in phonetics of complete denture patients
 Neutral zone
 Tongue prothesis
51

52. Role of tongue during impression making
 For stability and retention of complete denture, border seal in the
floor of the mouth compliment seals in the vestibular space.
 Tongue movements during border molding procedures also play an
important role in positioning of the denture borders, designing of
denture flange thus influencing stability of the mandibular denture
52

53. Recording border seal anterior lingual sulcus 53
Protrusion
of tongue
Anterior region
of mouth raised
Height of anterior
lingual sulcus
recorded
Activation of
posterior fibres
of genioglossus
Activation of
anterior fibres
of
genioglossus
Retraction
of tongue
Greenstick
compressed
between
ventral surface
of tongue and
lingual surface
of mandible
Width of
anterior lingual
sulcus recorded

54. Mylohyoid region
 Extends from pre mylohyoid fossa to distal end of mylohyoid ridge
 Mylohyoid muscles directly influences denture border in this region
Protrusion of tongue followed by swallowing action
Mylohyoid muscle activated Floor of mouth raised
Border molded by action of mylohyoid
54

55. Retro Mylohyoid Region
 Superior constrictor
 Medial pterygoid
Add material to distolingual aspect
protrude tongue and close lower jaw
Superior constrictor muscle activated
Distolingual border recorded
55
Muscles influencing denture border in
RMC region

56. Retromolar pad
 Region under influence of many muscles
laterally by buccinator
Postero superiorly by temporalis
Pterygomandibular raphae
Medially by sup. constrictor of pharynx
The denture base should extend half to 2/3rd of retromolar pad
56

57.  The final lingual border should be so shaped
that it guides the tongue into the same position
it will occupy in relation to the finished
denture
 Tray should not dislodge when the tip of the
tongue is in contact with the Vermilion border
of the upper lips
 The final borders of the denture should be in
harmony with the anatomy of the floor of the
mouth interest and in function
57

58. Phonetics in Denture
58

59. Classification of consonants based on their place of
production
 Consonants are most important from dental point of view
 Palatolingual sounds – tongue and hard/ soft palate
 Linguodental sounds – tongue and teeth
 Labio dental sounds – lips and teeth
 Bilabial sounds - lips
59

60. Palatolingual sounds
 S, T, D, N, L are the palatolingual sounds
 ‘S’ sounds is formed by a hiss of air as it escapes the median groove
of the tongue when the tongue is behind the upper incisors
60

61.  Deeper grove - whistling sound
 Shallower groove - lisping or ‘Shh’sound – stigamtismus lateralis
 Further shallowing of groove - ‘th’sound
 Can be used to check proper placement of anterior teeth
 Can be used to check thickness of base
 Silverman used this word to establish proper vertical dimension of
occlusion
61

62.  T, D, N, L – rugae is very important for the production of these
sounds
 Tongue placed firmly against the anterior part of hard palate
 Teeth too lingual – T sounds like D
 Teeth to labial – D sounds like T
62

63.  K, ng, g represent palatolingual sounds
 Sounds is formed by raising the back of the tongue to occlude with
the soft palate and then suddenly depressing the middle portion of
the back of the tongue releasing the air in a puff
 If posterior area is over extended or no tissue contact is there K
sounds like Ch
63

64. Linguodental Sounds
 ‘Th’ sound - linguodental sound
 Made with the tip of tongue extending slightly between upper and
lower anterior teeth
 Sound is actually made closer to alveolus than the tip of teeth
 Careful observation of the amount of tongue that can be seen with
the words This, that, there this, will provide information as to the
Labio-lingual position of anterior teeth
64

65.  <3mm of tongue visible - anterior teeth are too far forward
 >6mm of tongue visible - teeth too lingual
65

66. Labiodental sounds
 Formed by contact of lips and teeth
 F and V
Upper teeth too high – V sounds like F
Upper teeth too down – F sounds like V
66

67. Post insertion speech apdaption
 Speech adaption to new prosthesis takes 2-4 weeks of regular usage
 Old dentures can act as guidance
 Bilabial, labiodental, linguodental and linguoalveolar sounds most
affected
 Patient must practice speaking with the new prosthesis in place
67

68. Neutral zone
 The potential space between the
lips and cheeks on one side and the
tongue on the other; that area or
position where the forces between
the tongue and cheeks or lips are
equal – GPT 9
68

69.  Aim of neutral zone - construct a denture in muscle balance
 Neutral zone concept is used for - highly atrophic mandible, partial
glossectomy, mandibulectomy, motor nerve damage to tongue
 Muscles influencing Neutral zone
 Modiolus
 Buccinator
 Orbicularis Oris and mentalis
 Tongue muscles
69

70. Effect of dental prosthesis on taste perception
 Principal taste centres located on lateral and posterior part of tongue
 Sense of taste of sweet and salty diminishes, and sour is more
pronounced
 Sense of taste may be interrupted by the interjection of an outside
stimulus such as a denture
 Thickness of denture, lack of rugae, insulation against heat and cold
 Irritation, pressure or substance on the surface of lower denture
70

71. Tongue prosthesis
 A total glossectomy or laryngectomy results in loss of basic vital
function and loss of speech
 In these patients fabrication of a mandibular tongue prosthesis can
be done
 Tongue prosthesis can be made for
 Swallowing
 Speech
71

72. 72

73. 73

74. Conclusion
 Knowledge of anatomy, physiology and functions of tongue is an
essence to understand the complex morphological and fuctional
changes in the tongue with aging or with complete and partial
edentulism
 This knowledge will help us to reach optimal prosthetic success, as
tongue plays a significant and perhaps dictating role in affevting the
stablility and retention of prosthesis
 So we can conclude a proper diagnosis of tongue is must before
proceeding and planning any type of dental prosthesis
74

75. References
 Gray’s Anatomy – the anatomical basis of clinical practice 41st e
 B D Chaurasia, Human Anatomy 4th e
 Guyton and Hall textbook of medical physiology 13st e
 Difiore’s atlas of Histology 11th e
 Inderbir Singh’s Human Embryology 11th e
 Tencate’s Oral Histology 8th e
 Shafer’s Textbook of oral Pathology 7th e
75

76.  Textbook of Prosthodontics, V Rangarajan 2nd e
 Johnson PF, Taybos GM, Grisius RJ. Prosthodontics diagnostic, treatment
planning and prognostic considerations. DCNA
 Bommarito S, Zanato LE, Vieira MM, Angelieri F. Aglossia: Case Report. Int
Arch Otorhinolaryngol. 2016 Jan;20(1):87-92
 Daniel-Spiegel E, Ben-Ami M. Bifid tongue, a rare congenital malformation,
is a prenatal clue for secondary cleft palate. J Ultrasound Med. 2012
Mar;31(3):505-7
 Thomas G, Hoilat R, Daniels JS, Kalagie W. Ectopic lingual thyroid: a case
report. Int J Oral Maxillofac Surg. 2003 Apr;32(2):219-2
76

77.  Beresin VE, Schiesser FJ. The neutral zone in complete dentures. J
Prosthet Dent. 1976 Oct;36(4):356-6
 Dhananjay G, Siddiqui A, Gangadhar SA and Lagdive SB. Anatomy
Of The Lingual Vestibule And Its Influence On Denture Borders.
Anat Phyiol.2013;3;122
 Kaur B, Gupta G, Sandhu N, Sandhu Sarabjeet Kaur, Gupta T.
Tongue : The Most Disturbing Element In Manibular Denture- How
To Handle It ?. Annals Of Dental Research 2012; 2(1):36-43
 Rotham R; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223
77

78.  Balasubramaniam MK, Chidambaranathan AS, Shanmugam G, Tah
R. Rehabilitation of Glossectomy Cases with Tongue Prosthesis: A
Literature Review. J Clin Diagn Res. 2016 Feb;10(2):ZE01-4
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