The document provides information about the anatomy and development of the tongue. It discusses the intrinsic and extrinsic muscles of the tongue, their actions, innervation, and blood supply. It also describes the papillae and taste buds on the dorsal surface of the tongue and various developmental disturbances and pathologies that can affect the tongue.

1. DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY
SEMINAR PRESENTATION
Presented By- Dr. Sooraj S Pillai (JR1) Guided By- Dr. Arunkumar K.V (HOD)

2. INTRODUCTION
• Mass of skeletal muscle covered
- mucous membrane
• muscular organ - posterior wall
forms anterior wall of the
oropharynx.
• separated from the dentition-
deep alveolo-dental sulcus
• 4 inches long (average)

3. Functions:
■Taste
■Speech
■Mastication
■Deglutition
■Barrier function
■Jaw development
■Thermal regulation
■Secretion
■Defence mechanism
■Maintenance of oral hygiene
■Sucking
■General sensitivity

4. DEVELOPMENT OF TONGUE

7. DEVELOPMENTAL DISTRUBANCES OF TONGUE
• very rare and the first publication was attributed by Gaillard and Nogue in
1718.
• Mostly associated with malformations of extremities, especially hands and
feet (Adactylia syndrome) ,cleft palate, dental agenesia.
• Aglossia syndrome →microglossia with extreme glossoptosis. no
muscular stimulation to mandible retrognathia.
• It is believed to be in the family of OLHS (oromandibular limb hypogenesis
syndrome)
AGLOSSIA OR MICROGLOSSIA SYNDROME

9. MACROGLOSSIA/TONGUE HYPERTOPHY/PROLAPSUS OF
TONGUE/ENLARGED TONGUE
• The earliest description of this lesion comes from the egyptian papyrus around
1500BC
• Numerous etiology, difficult to quantify, also associated with syndromes-
Downs, Beckwith-wiedmann syndrome (97.5%) acc to shaefer’s.
• divided into 2→ True Macroglossia
Pseudo macroglossia

10. ANKYLOGLOSSIA
• inferior frenulum attaches to the bottom of the tongue and subsequently
restricts free movement of the tongue.
• It may be total or complete where the ventral surface of the tongue is
fused to the floor of the mouth, or partial, where lingual frenulum is
shorter

11. • No gender predilection
• occurs in 1.7% of all neonates.
• sometimes self corrected by
spontaneous tear of frenulum during
infacny
• can cause → feeding problems
articulation issues

12. CLEFT TONGUE
• Due to non merging of lateral lingual
swellings and incomplete groove obliteration
by mesenchymal proliferation.
• most common - Partial Cleft tongue- deep
groove in the midline (dorsally)
• Sometimes in ass. with ORAL-FACIAL-
DIGITAL SYNDROME.
• Any clinical significance?

13. FISSURED TONGUE/ LINGUA PLICATA/SCROTAL TONGUE
• Grooves of varying depth on the lateral and dorsal surface.
• no definitive etiology found- incidental finding
• seen in Melkersson- rosenthal syndrome, downs
• also seen with benign migratory glossitis.
• prevalance- 21% (shaefers)
• fissures vary in sizes , upto 6mm dia.

15. MEDIAN RHOMBOID GLOSSITIS
• Defect in the posterior dorsal fusion of the lateral lingual swellings.
Rhomboid-shaped, smooth erythematous mucosa lacking
in papillae or taste buds. (3:1 male predilection)
• Area is susceptible to reoccuring candidiasis- Chronic atrophic
candidiasis-posterior midline atrophic candidiasis.

16. DD→ Chronic atropic
candidiasis?
kissing lesion?
erythroplakia?- biopsy

17. BENIGN MIGRATORY GLOSSITIS (geographic tongue)
• psoriasiform mucositis of dorsum of tongue.
• constantly changing pattern of serpiginous white lines surrounding areas of
smooth, depapillated mucosa.- wandering rash of the tongue.
• unknown aetiology- more prominent during psychological stress- in
persons with psoriasis of skin (10%)
• all histologic features similar to psoriasis of skin- presence of monros
abscess( micro abscess produced by inflammatory cells)
• ass. reiters syndrome (rete ridges are not elongated)

19. HAIRY TONGUE
• lingua nigra/lingua villosa/black hairy tongue.
• hypertrophy of filiform papillae- lack of
mechanical stimulation.
• filiform papilla 1mm 15mm in length.
• M>F, found frequently in HIV +ve patients,IV
drug abusers.
• usually asymptomatic, overgrowth of candida-
Glossopyrosis
tickling , gagging sensation

20. LINGUAL VARICES (LINGUAL OR SUBLINGUAL
VARICOSITIES)
• Dilated , tortuous vein- subjected to
increased hydrostatic pressure but
poorly supported by the surrounding
tissue
• involves lingual ranine veins-appears
red or purple shot like clusters of
vessels- ventral and lateral borders of
the tongue and floor of the mouth.
• represents the ageing process, no
association with other systemic
diseases

21. SURFACES :
 Two surfaces
• Superior surface
• Inferior surface
Superior surface is divided into three parts
• Anterior 2/3 part called as Oral part
• Posterior 1/3 part called as Pharyngeal part
• Base(root) of tongue
GENERAL FEATURES

22.  TERMINAL SULCUS
V-shaped sulcus- divides tongue into anterior &
posterior parts
Apex of sulcus marked by a pit-
FORAMEN CECUM

23. Foramen cecum ,embryological
remnant- marks the upper end of thyroglossal
duct
Sometime a thyroglossal duct persists and
connects the foramen cecum with the thyroid
gland in neck(thyroglossal cyst)

25. SURFACES
SUPERIOR SURFACE
Oral Part(anterior 2/3):
• median furrow
• Rough surface -presence of
papillae
• Surrounded by anterior and
lateral teeth

26. Pharyngeal Part(Posterior 1/3)
• Lies behind the sulcus terminalis
• No papillae - nodular surface-presence of
lymphatic nodules and lingual tonsils
• Contributes to the anterior wall of
oropharynx

28. - Is connected to the epiglottis by 3
folds of mucous membrane.
- These are the median
glossoepiglottic fold and the right
and left lateral glossoepiglottic
folds.
- On either side of the median fold
there is a depression called vallecula.
- The lateral folds separate the
vaellecula from the piriform fossa.
POSTERIOR MOST PART OF TONGUE

29. Base of tongue
far back -bottom of tongue
Contributes to the front wall of pharynx
Movement can affect the diameter of
pharynx i.e
• When it push forwards, thereby
expanding the pharynx
• When it pull backwards, thereby
constricting the pharynx
• Lacks papillae

30. INFERIOR SURFACE
Covered -smooth mucous membrane
In the midline-mucosal fold Frenulum connects the tongue
with the floor of the mouth
Lateral to frenulum- deep lingual vein seen through the mucosa
Lateral to the lingual vein , mucosal fold called as
plica fimbriata is present

31. Frenulum
Lingualveins
Plica
fimbriata

32. PAPILLAE OF TONGUE
 Indentation of any structure in the overlying
epithelium is called papillae
 Superior surface of tongue covered by numerous
papillae (with taste buds)
 Types of of papillae;
• Vallate/circumvallate
• Filiform
• Fungiform
• Foliate

34. VALLATE PAPILLAE
 Largest among papillae
 SHAPE: Blunt-ended cylindrical
 NUMBER: 8 to 12
LOCATION:infront of sulcus terminalis
ARRANGEMENT: Occur in V shape line

35. FILIFORM
PAPILLAE
 SHAPE: Thin, long papillae having pointed ends
 ‘V’ shaped cones
 Only papillae having no taste buds
numerous
These papillae are mechanical and not involved in
gustation
Identified by increased keratinization
Present at pre-sulcal area of the tongue

36. FUNGIFORM PAPILLA
SHAPE: slightly mushroom-shaped if looked at
in longitudinal section
 Taste buds on their surfaces
LOCATION:apex of the tongue as well as the margins
Larger than filiform papillae

37. FOLIATE PAPILLA
 SHAPE: Short vertical folds
LOCATION: Present lateral to terminal sulcus and
at margins

40. TONGUE DISCOLORATIONS
• Black discolouration- oral bismuth preparations (bismuth subsalicylate-
H.Pylori inf.)

41. • Blue black discolouration- amalgam tattoo.

42. • pale/smooth tongue- atrophic glossitis ( fe deficiency, vit b 12
deficiency)

43. Magenta tongue- Vit B 12 deficiency

44. stawberry red tongue- Kawasaki disease/scarlet fever

45. Smooth red tongue- part of general inflammation - Niacin deficiency

46. MUSCLES OF TONGUE
MUSCLES
OF TONGUE
EXTRINSIC
MUSCLES
INTRINSIC
MUSCLES

47. The tongue is divided into two halves by a
median septum and the muscles of each
half consist of Intrinsic And Extrinsic
Muscles
 Therefore each muscle occur in Pair.

48. INTRINSIC MUSCLES
 They are confined to the tongue,
 They originate and inserts within the tongue,
 No bony attachments,
 FUNCTION: They alter the shape of tongue
4 types-
1. Superior Longitudinal
2. Inferior Longitudinal
3. Vertical muscle
4. Horizontal muscle

49. SUPERIOR LONGITUDINAL MUSCLE
• ACTION: It curls the tip upward and rolls
it posteriorly
• It lies just beneath the dorsum
of the tongue.

50. ACTION

51. INFERIOR LONGITUDINAL MUSCLE
 Lies on each side lateral to the
Genioglossus muscles,
 ACTION:
They curl the tip of tongue inferiorly.

53. TRANSVERSE MUSCLE
 Lies inferior to the superior longitudinal
muscle and run from the septum to margins
 ACTION:
They narrow the tongue and increase its
height.

54. VERTICAL MUSCLE
 It runs inferolaterally from the dorsum,
 ACTION:
Flattens the dorsum.

55. EXTRINSIC MUSCLES
 These muscles take origin from parts outside the tongue, therefore move
the tongueas well as alterthe shape.
 Divided into fourtypes namely;
1 ) GENIOGLOSSUS
2 ) HYOGLOSSUS
3 ) STYLOGLOSSUS
4 ) PALATOGLOSSUS

56. • STYLOGLOSSUS and PALATOGLOSSUS attach the tongue superiorly,
• GENIOGLOSSUS and HYOGLOSSUS attach the tongue inferiorly.

57. GENIOGLOSSUS
 Attachment- superior mental spines,
Into the mucous membrane of the tongue.
 Action: Protrudes the tongue, depress central part of
tongue and increase the volume of mouth as in
sucking.

59. HYOGLOSSUS
 Attachments: greater horn and body of hyoid
bone,→Side of tongue.
 ACTION: It depresses side of tongue assisting
GENIOGLOSSUS to enlarge oral cavity.
• HYOGLOSSUS

61. STYLOGLOSSUS
 Attachments- Lower part of Styloid process and
upper part of stylohyoid ligament, →Side of tongue.
 ACTION: Elevates and retracts the tongue.

63. PALATOGLOSSUS
 Attachments - soft palate→Lateral margin
of tongue.
 ACTION: Elevates back of tongue and
depresses soft palate.

64. MOVEMENTS
• Protrusion:
• Genioglossus on both sides acting together
• Retraction:
• Styloglossus and hyoglossus on both sides acting together
• Depression:
• Hyoglossus and genioglossus on both sides acting together
• Elevation:
• Styloglossus and palatoglossus on both sides acting together

65. INNERVATION
 Both extrinsic and intrinsic muscles are supplied by
HYPOGLOSSAL NERVE except PALATOGLOSSUS muscle
which is in turn supplied by VAGUS NERVE.

66. VASCULARTURE
Arterial Supply
 Lingual artery - supplies tongue and floor of the
mouth.
 Originates from external carotid artery in neck
 Passes between hyoglossus and genioglossus
muscles of tongue
Lingual
artery
• Lingual artery gives three branches
within the tongue namely
• Dorsal lingual artery
• Deep lingual artery
• Sub lingual artery

67.  Also secondary supply to the tongue by:
 Tonsillar branch of facial artery
 Ascending pharyngeal artery (branch of external
carotid artery)

68. Venous Drainage
 Drained by dorsal lingual vein and deep
lingual veins
 Deep Lingual Veins:
 Begins near tip of tongue and run beneath
the mucous membrane
 Visible on the inferior surface of
tongue
 Anterior to lingual artery
 Ultimately drains into internal jugular
vein
Deep lingual vein
Dorsal lingual vein

69. Deep lingualvein

70.  Dorsal Lingual Veins
 Drain the dorsum and sides of tongue
 Runs along the lingual artery
 Drains into internal jugular vein

71. LYMPHATICS
Apical Vessels:
Drains into Submental nodes &
deep cervical nodes
Marginal Vessels:
Drains into Submandibular nodes &
deep cervical nodes
Basal Vessels:
Drains into Deep cervical nodes
(jugulodigastric mainly)

73. LYMPH
VESSELS
AFFERENT(RECEIVING) EFFERENT(DRAINING)
1. APICAL i. TIP
ii. FRENULUM
- SUBMENTAL
( MAJOR LYMPH NODE )
2. MARGINAL
- SUBMANDIBULAR NODE
-JUGULODIGASTRIC
-JUGULO- DIGASTRIC
(deep
cervical nodes)
3. BASAL
SIDE OF TONGUE IN FRONT OF
SULCUS TERMINALIS
POSTERIOR 1/3RD or Base

74. Central vessels
The regions of the lingual surface draining into the marginal or
central vessels are not distinct.
Central lymphatic vessels ascend between the fibres of the two
genioglossi; most pass between the muscles and diverge to the
right or left to follow the lingual veins to the deep cervical
nodes
• Some pierce mylohyoid to enter the submandibular nodes.

75. INNERVATION
 Innervation consists of three different supplies
 Motor supply
 General sensory supply
 Special sensory supply

76. MOTOR SUPPLY
 All extrinsic and intrinsic muscles are supplied by HYPOGLOSSAL NERVE
except PALATOGLOSSUS muscle which is supplied by VAGUS NERVE.

77. SENSORY SUPPLY
 General sensory sensation is by
three nerves
 Lingual nerve – anterior 2/3rd
of tongue
 Glossopharyngeal nerve –
posterior 1/3rd of tongue
 Vagus nerve – posterior most part of
tongue

78. SPECIAL SENSORY SUPPLY
 Supplied by three nerves
 Chorda tympani (facial)
– taste sensation of anterior 2/3rd of
tongue
 Glossopharyngeal (ix) – taste sensation
of posterior 1/3rd of tongue
 Vagus nerve (x) – taste sensation of
posterior most part

79. TASTE PATHWAYS
Chorda tympani→ Geniculate ganglion
central process→Tractus solitarius
IX nerve→ inferior ganglion
central process→ Tractus Solitarius
X nerve→ inferior ganglion of vagus
central process→ Tractus Solitarius
After relay in TS- Solitario thalamic
tract is formed, becomes part of
trigeminal leminscus.

80. Applied aspects
• Fibroma
• Papilloma
• Hemangioma
• Lymphangioma
• Granular cell myoblastoma
• Lipoma

81. 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
• 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

83. PAPILOMA
• Papilloma is a general medical term for a tumor of the skin or
mucous membrane with finger-like projections.
• Papillomas are either pedunculated or sessile growth on any
surface of oral mucous membrane.
• Multiple papillomae are occur in cowden’s syndrome, down’s
syndrome.
• Surgical excision.

85. 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.
• 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

87. LYMPHANGIOMA
• Lymphangiomas 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
emovilization with silicon spheres.

89. LIPOMA
• Lipoma is a rare benign tumour 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 tumours

91. References
1. Shafer’s Oral Pathology
2. Greys Anatomy
3. B D charasia Anatomy head and neck
4. IB singh embryology
4. Internet sources.

92. THANK YOU.....