The document provides an overview of the anatomy and development of the tongue. It discusses the following key points in 3 sentences: The tongue develops from the first, second and third pharyngeal arches by the 4th week of development. It has intrinsic and extrinsic muscles that allow it to carry out functions like speech, taste, swallowing and digestion. The tongue has various papillae that contain taste buds and is supplied by nerves, blood vessels and lymphatics which facilitate its many roles in the oral cavity.

1. DR. SUMIT ASRANI

2. CONTENTS
 Introduction
 Development
 Morphology
 Anatomy
 Function
 Applied Anatomy
 Examination
 Diseases
 C0nclusion
 References

3. INTRODUCTION
 Tongue is a muscular organ situated in the floor of
the mouth.
 It is associated with the function of taste, speech,
mastication and deglutition.
 It has an oral part that lies in the mouth, & a
pharyngeal part that lies in the pharynx.
 The oral and pharyngeal parts are separated by a
V-shaped sulcus-the sulcus terminalis.

4. INTRODUCTION

5. DEVELOPMENT
 The tongue begins to develop around the fourth
week of intrauterine life.
 By the following arches .First arch
Third arch
Fourth arch.
Anterior 2/3rd
 From 2 lingual swellings and 1 tuberculum impar i.e from 1st brachial
arch
 Supplied by lingual nerve(post- trematic ) and chorda tympani(pre-
trematic ).

6. DEVELOPMENT
Posterior 1/3rd
 From the cranial half of the hypobranchial eminence i.e
from the 3rd arch
 Supplied by glossopharyngeal nerve.
Posterior most
 From the fourth arch
 Supplied by Vagus nerve.
Immediately behind the tuberculum impar, the epithelial
proliferates to form a down growth thyroglossal duct from which
the thyroid gland develops.

7. DEVELOPMENT
 Tongue seperates from the floor of the mouth by
downgrowth of the ectoderm around its periphery
degenerates to form lingual sulcus-mobility of tongue
 Muscles develops from occipital myotomes which are
supplied by Hypoglossal nerve.
 Connective tissue develops from local mesenchyme.
 EPITHELIUM:Formed First by single layers of cell.
 Later- Stratified and papillae become evident.
 Taste buds are formed in relation to the terminal
branches of innervating nerve fibers.

8. DEVELOPMENT

9. DEVELOPMENT
 Another important developmental aspect of tongue
is it’s contribution for normal development of palate.

10. Morphology of the Tongue
 The Tongue has,
 A root
 A tip (apex)
 Body

11. Morphology of the Tongue
The root
 It is attached to styloid process and soft palate above
and to mandible and hyoid bone below.
 Because of these we are not able to swallow the
tongue itself.

12. Morphology of the Tongue
 Tip of the tongue
 Lies behind the upper incisor teeth.
 Forms the anterior free end.

13. Morphology of the Tongue
 Body of the tongue
1.Dorsum : convex in all directions.
a.Oral Part : anterior 2/3
b.Pharyngeal part : posterior 1/3
 They are divided by faint V shaped groove called
sulcus terminalis
 Two limbs of V meet at median pit named as
foramen caecum.

15.  2. Inferior surface: is covered with a smooth
mucous membrane , which shows a median fold
called the ‘ frenulum linguae’ .
 On either side of frenulum , there is a prominence
produced by deep lingual veins.
 More laterally there is a fold called plica fimbricata

16. INFERIOR SURFACE OF THE TONGUE

17. Pharyngeal part or lymphoid part of tongue:
• It lies behind the palatoglossal arches and sulcus terminalis
• Its posterior surface (base of tongue) forms anterior wall of oropharynx.
• The mucous membrane has no papillae but has many lymphoid follicles
that collectively constitute the lingual tonsil.

18. PAPILLAE OF TONGUE
These are projections of mucous membrane (or)
corium which give the anterior 2/3rd of tongue its
characteristic roughness.
They are –
1.Filliform papillae ( conical /thread shape)
2.Fungiform papillae (mushroom shape)
3.Circumvallate / vallate papillae (ring or circle shape )
4.Foliate papillae ( leaf shape )

19. CIRCUMVALATE PAPILLAE: ( circular or ringed shape )
•They are larger in size i.e 1-2 mm in diameter .
•Situated immediately in front of V- shaped sulcus terminals.
•8-12 in number.
•The walls of papillae have taste buds
•They are associated with ducts of Von Ebner's glands

20. TASTE BUDS
 Small ovoid barrel shaped intrapapillary organ 40μm
thick.
 They are modified epithelial cells arranged in a flask –
shaped form.
 Also called as gustatory calyculi.
 Found in maximum numbers on circumvallate and
fungiform papillae
 Outer surface- covered by few flat epithelial cells which is
surrounded by small opening called taste pores
 Taste buds may have one or more taste pores

21. • Taste buds contain the receptors for taste.
• These structures are involved in detecting the five (known)
elements of taste perception: salty, sour, bitter, sweet, and
savory (or umami).
• Via small openings in the tongue epithelium, called taste
pores, parts of the food dissolved in saliva come into contact
with taste receptors.
TASTE BUDS
• The taste receptor cells send information detected by clusters
of various receptors and ion channels to the gustatory areas of
the brain via the seventh, ninth and tenth cranial nerves.
• On average, the human tongue has 2,000–8,000 taste buds

22. TASTE BUDS

23. Muscles of tongue
Tongue is made of intrinsic and extrinsic muscles
•Divided into right & left by median sagittal septum of
connective tissue.
Intrinsic muscles
• Inferior longitudinal
• Superior longitudinal
• Transverse
• Vertical
Extrinsic muscles
•Genioglossus
•Hyoglossus
•Styloglossus
•Palatoglossus

24. Muscles of tongue

25. SUPERIOR LONGITUDINAL MUSCLE:
Lies beneath the mucous membrane
Origin: sub mucosal connective tissue at the back of the
tongue and from the median septum of tongue.
Insertion: muscle fiber pass forward and obliquely to sub
mucosal connective tissue and mucosa on margin of
tongue.
Innervation: Hypoglossal nerve.
Function: Shorten tongue.
curl apex and sides of tongue.
INFERIOR LONGITUDINAL MUSCLE:
Is a narrow band lying close to the Inferior surface of the
tongue between genioglossus & hyoglosssus
Origin: root of tongue
Insertion: Apex of tongue.
Innervation: Hypoglossal nerve.
Function: Shorten tongue.
Uncurls apex and turn it downward.

26. TRANSVERSE MUSCLE:
Origin: median septum of tongue
Insertion: submucosal connective tissue on lateral
margin of tongue.
Innervation: hypoglossal nerve
Function: narrow and elongates tongue
VERTICAL MUSCLE:
Origin: submucosal connective tissue dorsum of tongue.
Insertion: connective tissue in ventral region of tongue.
Innervation: Hypoglossal nerve.
Function: Flattens and widens tongue.

28. EXTRINSIC MUSCLES

29. Muscle Origin Insertion Action
Palatoglossus
Oral surface of
palatine
aponeurosis
Lateral border
of tongue
Initiation of
swallowing
Styloglossus
Anterior
lateral styloid
process of
temporal bone
Lateral border
of tongue
Pulls the sides
of the tongue
up and pulls
tongue back
(this creates a
trough for
swallowing)
Hyoglossus
Greatr cornua
of hyoid bone
Side of tongue
Depresses the
tongue
Genioglossus
Inferior
mental spine
(process) of
mandible
Tongue and
hyoid
Depresses and
extends the
tongue

31. Blood supply of tongue
Arterial supply
 Mainly by lingual artery which is a branch of external
carotid artery.
 The root is also supplied by tonsillar artery which is a
branch of facial artery & ascending pharyngeal
artery.
 Due to the median fibrous septum of tongue, there is
no anastomosis of arteries between 2 sides.

33. VENOUS DRAINAGE
The deep lingual veins are largest & principle veins. Seen
along the inferior surface of tongue.
2 veins accompany the lingual artery & 1 vein is seen
. alongside hypoglossal nerve.
These veins unite at posterior border of hyoglossal muscle &
form the Lingual Vein.
This lingual vein drains into common facial or internal
jugular vein

34. Neurovascular supply of tongue

35. NERVE SUPPLY:
Motor – all intrinsic & extrinsic muscles, except the palatoglossus
muscle is supplied by
HYPOGLOSSAL NERVE ( XII) .
Palatoglossus is supplied by –pharyngeal branch of the vagus
nerve (CN X).
Sensory components–
1. Lingual nerve is the nerve of general sensation
2. Chorda tympani is the nerve of taste for anterior
2/3rd of tongue except circumvallate papillae
3. Glossophayngeal nerve is the nerve for both general
sensation & taste for the posterior 1/3rd of tongue
including circumvallate papillae
4. Posterior most part of tongue is supplied by vagus
nerve through the internal laryngeal branch.

36. NERVE SUPPLY:

37. Lymphatic drainage:
Tip: drains bilaterally to submental nodes
The right & left halves of remaining part of the anterior 2/3rd of tongue
drain unilaterally to Submandibular nodes.
A few central lympahtics drain bilaterally to the deep
cervical nodes.
Posterior most part & posterior
1/3rd of tongue drain bilaterally into
upper deep cervical lymph nodes
including jugulodiagastric.
• The whole lymph finally drains into
“juguloomohyoid nodes”
• These are known as lymph nodes of
tongue.

38. FUNCTIONS OF TONGUE :
 Mastication & deglutition
 Taste Perception
 Phonation
 Equilibrium & development of the dental occlusion
 Jaw Development

39. APPLIED ASPECTS
 Gag reflex: Posterior most part of the tongue when touched
produces gagging. IX and X nerves are responsible for
muscular contraction of each side of pharynx.
 When the genioglossus muscle is paralyzed, the tongue has
a tendency to fall posteriorly obstructing the airway and
creating the risk of suffocation.
 Total relaxation of the genioglosus muscle occurs during
G.A therefore the tongue of an anesthetized patient must be
prevented from relapsing by inserting an airway.
 Sublingual absorption of drugs possible due to thin mucosa
& rich vasculature.

40.  Trauma such as fractured mandible may injure the
hypoglossal Nerve resulting in paralysis of tongue.
 The tongue deviated to the paralyzed side during
protrusion because of the action of unaffected
genioglosuss muscles on the other side.
 Injury on both sides causes tongue to be motionless.
 In many elderly patients, there is nodular
enlargement of superficial veins on the ventral
surface of the tongue. The presence of such lingual
varicosities (varicose tongue) is not of special
significance and should not be regarded as evidence
of disease of blood vessels.
APPLIED ASPECTS

41.  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 a good site for
observation of jaundice
 Carcinoma of Tongue is quite common. The affected
side of the tongue is removed along with all the deep
cervical lymph nodes
 Carcinoma of posterior 1/3 of the tongue is more
dangerous due to bilateral lymphatic spread
APPLIED ASPECTS

42.  Snoring may be reduced by anterior displacement of
the tongue with the intention to compensate
inadequate pharyngeal muscle activity. Direct
anterior displacement of the tongue leads to an
amplification of the airway space, but is difficult to
achieve with clinical manoeuvres at night.
 However, the use of tongue retaining devices &
tongue repositioning manouvre has been
reported to reduce the time of loud snoring during
sleep
APPLIED ASPECTS

43. EXAMINATION OF TONGUE

44. Inspection
• Inspect the dorsum of the tongue at rest
for variation in size,color, and texture.
• Observe and note
– the distribution of papillae,
– margins of the tongue.
– depapillated areas,
– fissures, ulcers, and keratotic areas.
• Note frenal attachment
• Any deviations as the patient protrudes
tongue and attempts to move it to the
right and left.
• Note tongue thrust on swallowing.
• Wrap a piece of gauze (4 x 4 cm) around
the tip of the protruded tongue to steady
it.

45. CINERADIOGRAPHY :
 It is the making of a motion picture
record of successive images appearing
on a fluoroscopic screen.
• Eg: use cineradiographic images to
investigate tongue movement during
deglutition in anterior open bite
patients with tongue thrust.
• Each subject had semi-spherical lead
markers attached to the tip and dorsal
surface of the tongue and was asked to
swallow 5 ml of diluted liquid barium.
• Tongue movement during deglutition
was recorded in the midsagittal
plane with an X-ray VTR system.
( video tape recorder)

46. Pulsed (Doppler) Ultrasound
Noninvasive ultrasound technique has recently been applied to
study laryngeal activity, pharyngeal wall displacement and
tongue movements.
Two types of echo ultrasound equipment can be used to
monitor tongue movements in speech-1. A scan and 2.Sector scan.
It has been used to study the characteristics of arterial
blood flow in the tongue, and abnormal pulse waves have
been noted in the lingual arteries of individuals with
evidence of compromised flow in other branches of the
carotid arterial tree.
The most widely used applications in medicine are
operative (usually has a frequency that ranges between
2-8 K Hz), therapeutic (between 20 K Hz-3 M Hz either in continuous or
pulsed modes), and diagnostic (between 1.6-12 M Hz).

47. Electromyography:
• Electromyography is a test to study the muscle functions.
• It has been used to study the action potentials in actively
contracting muscles and has contributed to an
understanding of lingual and masticator muscular function
and also in detecting uncoordinated muscular movements
in diseases like dyskinesia, dystonia, and various
neuromuscular disorders.
• It is a noninvasive technique.

48. Computer-Assisted Tomography:
It can be used to identify space occupying lesions and muscular atrophy
secondary to hypoglossal nerve damage, in cases where the lesion is deep
in the base of the tongue and not detectable by other approaches.
Isotopic Scanning Techniques:
It can be used when a mass in the tongue is composed of
specialized secretory tissue or other tissue, such as thyroid,
which selectively concentrates intravenously administered
radioactive 131I or 99Tc-pertechnetate
Scanning Electron Microscope:
SEM is a well-established tool for in vitro study of the surface
topography of tongue dorsum, the character and morphology
of the different types of tongue papillae and distribution and
morphology of bacteria on the papillated areas of the dorsum.

49. EXAMINATION OF TONGUE

50. Diseases of the tongue
 Inherited, congenital, and developmental anomalies
 Disorders of the lingual mucosa
 Diseases affecting the body of the tongue
 Tumors of tongue

51. CLASSIFICATION OF TONGUE DISORDERS
A)Inherited, congenital and developmental anomalies:
a) Minor variations:
1 .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

52. b) Major variations:
1.Cleft, lobed, bifurcated and tetrafurcared tongue
2.Aglossia, hypoglossia and macroglossia
3.Hamartoma and dermoid
4.Bald and depapillated tongue
5.Papilomatous changes
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

53. C)Keratotic white lesions:
1.Lichen planus
2. Leukoplakia
D) Depapillation and atrophic lesions:
1. Chronic trauma
2. Nutritional deficiency
3. Hematological abnormalities
4. Medication
5. Peripheral vascular disease
6. Diabetes and chronic candidiasis
7. Tertiary syphilis and interstitial glossitis
E)Pigmentation
F)Ulcer and infectious disease
G)Superficial vascular disease

54. 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
D) Tumors of tongue:
1.Benign
2.Malignant

55. The ankyloglossia can be
classified into 4 classes based on
Kotlow's assessment as follows;
Class I: Mild ankyloglossia: 12
to 16 mm,
Class II: Moderate
ankyloglossia: 8 to 11 mm,
Class III: Severe ankyloglossia:
3 to 7 mm,
Class IV: Complete
ankyloglossia: Less than 3 mm
Ankyloglossia
•Types:
1.Complete Ankyloglossia (fusion of tongue to the floor
of the mouth)

56. Syndromes associated are:
1. Ankyloglossum superioris syndrome
2. Trisomy of 13
3. Pierre robin syndrome
4. Rainbow syndrome
MANAGEMENT-1. Counselling 2. Surgery
Clinical features:
1. Restricted tongue movements
2. Feeding problems
3. Speech defects
4. Tongue biting
Partial ankyloglossia:
Partial ankyloglosia 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 extention.

57. Frenectomy with the use of one hemostat
A) Thick and short lingual
frenulum with anterior insertion.
B) Restricted central tongue tip
elevation caused by abnormal
attachment of the base of the
tongue. C) Frenulum being held
with a small curved hemostat with
the convex curve facing the ventral
surface of the tongue. D) First
incision following the curvature of
the hemostat, cutting through the
upper aspect of the frenulum. E)
Second incision at the lower aspect
of the frenulum. F) Wound edges
being dissected with the tips of
blunt-ended scissors. G)
Absorbable sutures placed over the
wound. H) Clinical aspect of the
surgical site on the seventh
postoperative day

58. Frenectomy with the use of two hemostats
A) Clinical aspect of the
tongue during
protrusion.
B) Short and tight lingual
frenulum.
C) Frenulum held with two
hemostats, with their tips
meeting in the deep
aspect near the base of
the tongue.
D) Excised triangular tissue
held with the hemostats.
E) Excision of fiber
remnants.
F) Silk sutures placed over
the wound

59. Laser frenectomy
Laser frenectomy.
A) Short lingual frenulum.
B) Infiltrative anesthesia of the lingual
nerve.
C) Diode laser application to the central
area of the frenulum.
D) Laser application from the tip to the
base of the tongue.
E) Clinical aspect of the surgical site on the
fourteenth postoperative day
The frenulum incision was
carried out with diode laser at a
wavelength of 800 nm and
power of 2 W in non-contact
mode, which was applied
continuously to the central area
of the frenulum from the tip to
the base of the tongue.

60. Microglossia and
Aglossia
1. Uncommon developmental
condition of unknown origin
2. Characterized by abnormally
small tongue
3. Entire tongue may be
missing (aglossia)
4. Length of the mandibular
arch will be smaller due to
the smaller size of the
tongue.

61. Treatment and prognosis
• Depends on the nature and severity of the condition
• Surgery and orthodontics may improve oral function
• Speech development is quite good but depends on
tongue size
Clinical Features:
•Difficulty in speech and mastication.
•High arched palate, narrow constricted mandible
•Missing lower incisors
•There may be airway obstruction, due to negative
pressure generated by deglutition and inspiration

62. Moebius syndrome
Variable degrees of limb hypogenesis.
Strabismus, micrognathia, mask-like faces.
Small tongue

63. Macroglossia
•Tongue enlargement which leads to
functional and cosmetic
problems.
Classification:
1.True macroglossia
 Congenital- •Idiopathic muscle hyperthrophy
•Hemangioma
•Lymphangioma
 Acquired- a)Metabolic • Cretinism
• Hypothyroidism • Diabetes
2.Pseudomacroglossia- maybe due to severe
retrognathic maxilla or mandible.
b)Inflammatory:• Syphilis• Rheumatic fever• Typhoid
• Tuberculosis
c)Traumatic• Surgery• Hemorrhage

64. Clinical features:
• Age: more common in infants
• Symptoms: tongue protrusion, which exposes the
tongue to trauma.
• Other symptoms include swallowing difficulties,
airway obstruction, drooling and failure to thrive.
• Signs: Displacement of teeth and malocclusion
Crenation or scalloping of lateral borders of tongue
Associated syndrome:
i. Beckwith’s- Wiedemann syndrome
ii.Down syndrome
iii.Behmel syndrome
iv.Laband syndrome
Treatment:
• Removal of primary cause
• Majority of cases are treated surgically.

65. Surgical Treatment of Congenital True Macroglossia
Figure 1: The tongue was increased
both in length and in width, with
anterior open bite with
interposition of the tongue and loss
of 31 and 41 teeth.
Figure 2: The tongue was pulled out of
the oral cavity through three repairs
with nylon suture 3-0 fixed to the
surgical field to maintain the
symmetry between the sides and
facilitate the demarcation of the
incisions, which was performed which
methylene blue.
“keyhole” technique,

66. Figure 3: A partial thickness elliptical wedge incision starting at the
midline and 4mm distance from tongue taste buds using electrocautery,
the dorsum, and incisions on belly anterior tongue were united resulting in
a full-thickness flap, proceeding the excision of excess tissue.
Surgical Treatment of Congenital True Macroglossia

67. Surgical Treatment of Congenital True Macroglossia
Figure 4: The suture was
made by planes with
polyglactin 910 suture 3-0,
good tissue repair,
perfect symmetry, and
no tongue interposition.

68. PICHLER, MODIFIED KEYHOLE TECHNIQUE

69. By BUTLIN, ENSIGNSurgical Treatment of Macroglossia

70. BY HARDA,ENOMOTO
Surgical Treatment of Macroglossia

72. Pierre Robin anomalad
CLEFT PALATE , RETROGNATHIA , GLOSSOPTOSIS

73. Fissured/ Plicated /Scrotal tongue
Clinical features:
• In elderly, mentally retarded &
psychotic individuals.
• Deep furrows – food lodgement-
symptomatic
Associated syndrome:
-Melkersson - Rosenthal syndrome
- Down’s syndrome
Treatment: no definative t/t.
-oral hygiene- soft bristle brush,
mouthwash/diluted H2O2.
It is characterized by grooves that vary in depth and are noted along
the dorsal and lateral aspect of the tongue.

74. CLEFT OR BIFID TONGUE
It is a condition in which there is
Cleavage of the tongue due to lack
of fusion of lateral lingual swellings
of the tongue.
• Partial cleft tongue is more
common and is manifest as
a deep groove in the midline of the
dorsum of tongue.
Associated syndrome: oro-facial-
digital syndrome

75. Surgical correction of the defect was
undertaken under local anesthesia. The
median parts of the defect were freshened
and the tongue was reconstructed by
suturing the muscles in layers. Post
surgical healing was uneventful and no
speech therapy sessions were required .
SURGICAL REPAIR OF CLEFT TONGUE
PREOP
POSTOP
Intraoperative

76. LINGUAL THYROID NODULE
• It is an anomalous condition in which
follicles of thyroid tissue are found in the
tongue, arising from remnants of thyroid
that may fail to migrate to its
predestinated position or from remnants
that became detached and were left
behind.
Symptoms: dysphagia, dysphonia, dyspnea,hemorrhage with pain
or fullness in throat.
Treatment and prognosis
• Most cases require no treatment and biopsy should be
considered with caution because of the potential for
hemorrhage, infection or release of large amounts of hormone
into the vascular system (thyroid storm).
•Surgical excision or radioiodine therapy

77. Median Rhomboid Glossitis:
‘central papillary atrophy of tongue’
Developmental defect resulting from
an incomplete descent of tuberculum
impar and entrapment of a portion
between fusing lateral halves of the
tongue.
Management:Antifungal agents,
Long standing cases:cryosurgery,
excisional biopsy
Papillomatous changes:
In several congenital disorders the
surface of tongue is covered with
multiple papillomas. When extensive
this abnormalities is known as pebbly
tongue.

78. Geographic Tongue:
Also called as benign migratory glossitis,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.
Management:
For control of burning-topical local anaesthetic agents
like lidocaine or diphenhydramine can be given.
Topical therapy: topical corticosteroids and topical
application of salicylic acid and tretinoin(retinoic acid)
Psychological assurance

79. Oral leukoplakia :
Oral leukoplakia may be found at all sites
of the oral mucosa.
• Nonsmokers have a higher percentage of
leukoplakia at the border of the tongue
compared with smokers.
• The floor of the mouth and the lateral
borders of the tongue are high-risk sites for
malignant transformation
Verrucous leukoplakia-
Large, diffuse, and corrugated white lesions of
the buccal mucosa and tongue.

80. Erythroleukoplakia
Nonhomogeneous leukoplakia is
subdivided into speckled and nodular
types, both of which can be regarded
as erythroleukoplakia
Hairy leukoplakia
 Most common HIV lesion
• Also associated with:
– Immunosuppressive
drugs Cancer
chemotherapy
– Organ transplantation
• Etiology: EBV with low CD4+
T lymphocytes

81. HAIRY TONGUE
•Also called as Lingua nigra, Lingua villosa, Lingua villosa nigra,
Black hairy tongue.
•Commonly observed condition of
defective desquamation of
the filiform papillae.
•Lesion can also appear brown, white,
green, pink, or any of a variety of hues
depending on the specific etiology and
secondary factors.
CLINICAL FEATURES:-
Affects the mid line just anterior to
circumvallate papilla.
Filliform papillae more than 15mm in
length.

82. Thrush / Acute pseudomembraneous
Candidiasis
Acute Atrophic Candidiasis/
Erythmatous candidiasis
The infection is predominantly
encountered in the palate and the
dorsum of the tongue of patients who
are using inhalation steroids.

83. HERPES SIMPLEX Recurrent Aphthous
Stomatitis (RAS):
A 42-year-old woman with a
recent increase in severity
of recurrent aphthous ulcers.
Iron deficiency was detected,
and the ulcers
resolved when this deficiency
was corrected
Within a few days of the prodrome,
erythema and clusters of vesicles
and/or ulcers appear on the
keratinized mucosa of the hard palate,
attached gingiva and dorsum of the
tongue
HSV-1

84. SYPHILIS
Chancre of primary syphilis.
Ulceration of the dorsal surface of
the tongue on the left side .
Characteristic slightly raised, grayish
white, glistening patches ‘mucous
patches,’ of the tongue
caused by T. pallidum, spirochete.

85. TUBERCULOSIS
Chronic mucosal
ulceration of the
ventral surface of the
tongue
SCARLET FEVER
Strawberry tongue (also called raspberry
tongue),refers to glossitis which manifests
with hyperplastic (enlarged) fungiform
papillae , giving the appearance of a
strawberry.

86. Variations in tongue movement
EDS Syndrome
Hyperextensibility
of tongue

87. NEUROLOGICAL DISORDERS
Dyskinesias are involuntary movement that have no purpose
and are not fully controllable by the patient.

88. Gustatory disorders of the tongue
Stimulated dysgeusia - Distortion in perception of taste.
Unstimulated dysgeusia/ phantogeusia - perception of taste in absence of
. any recognized stimulus.
 Hypergeusia: Increased sensitivity for all taste stimuli.

89. Benign tumors of tongue:
Fibroma - is a benign, tumor-like
growth made up mostly of fibrous or
connective tissue.
Hemangioma:
Hemangioma is a benign tumor of
dilated blood vessels.
It is also known as port-wine stain,
strawberry hemangioma, and Salmon
patch.
Lipoma:

90. 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 other organs
of the body
Eg: squamous cell carcinoma,

91. CLINICAL FEATURES
1. Painless mass or ulcer later becomes painful
2. Excessive salivation
3. Offensive smell in mouth occurs due to bacterial stomatitis.
4. Sore thraot
5. Immobility of tongue-causes difficulty in speech.
6. Hoarseness of voice and dysphagia
7. It spread by infiltration and invasion.
SQUAMOUS CELL CARCINOMA:
The lesion usually appears as a
nodular mass that often resembles a
hyperplastic or reactive growth.
Tongue is the site for 25% of SCC
cases.

92. 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 transoral laser resection for accessible
early stage carcinoma.
MANAGEMENT:
1) Early carcinoma of tongue(T1 and small T2) responds equally well to
surgical excision or by radiation.
2) T1 and T2 with no evidence of lymph node metastasis,
3) surgical treatment is usually restricted to partial glossectomy.
4) If it is T2 or T3 without node involvement ,prophylactic neck
dissection is advised.

93. Recurrent oral squamous cell
carcinoma (OSCC) patient
(A) Local recurrence of OSCC
in the right side of the tongue;
(B) regional recurrence in right
cervical level II;
(C) intraoperative hemi-
glossectomy;
(D) intraoperative view of the
resected specimen;
(E) classical radical neck
dissection;
(F) design of the "Iberic graft"
technique for reconstruction of
the defect with a radial forearm
free flap (RFFF);
(G) RFFF harvesting;
(H) intraoral view of the
reconstruction, with the RFFF
showing arterial bleeding and
viability
The role of salvage surgery in oral squamous cell carcinoma
Raúl González-García

94. F
O
L
L
O
W
U
P

95. F
O
L
L
O
W
U
P

97. Tongue flap
 Distant full thickness
pedicle flap
 Used to close large OAF
 Rich blood supply
Disadvantage
 Requirement of GA
 Requirement of 2 stage
and 3 stage procedure

98. Tongue flap for the closure of Oro antral fistula
Posteriorly based Full
thickness Lateral tongue
flap
Anteriorly based Partial
thickness Dorsal tongue flap

99. Tongue flap for the closure of Palatal fistula

100. PEDICLE TONGUE FLAP SURGERY IN
ORAL SUBMUCOUS FIBROSIS
Muthubabu, Srinivasan M., Jeeva, Metali Rai, Gayathri
RESULT: Pedicle tongue flap surgery facilitated better
articulation, mastication and swallowing. Appreciable
increase in the interincisor distance was noted. Colour of soft
palate and cheek were noted to turn pink from the pale
colour after surgery due to revascularisation of the areas.
None of the patients complained of any impairment of taste
sensation after surgery.

101. CONCLUSION
 The tongue is an important organ of the body.
Any pathology concerning its boundaries may spread to distant
areas of the body via its lymphatic and vascular supply.
Correct and an early diagnosis during the examination of
tongue.
Differential diagnosis of the lesions need the knowledge, the
skill and the experience of the clinician.

102. •
REFERENCES
 Grays Anatomy;Textbook of Anatomy
 B.D. Chaurasia:A Textbook of Anatomy
 Textbook of Embryology: Inderbeer Singh
 Hine ,Levy , Shafer’s textbook of Oral Pathology
 Peterson’s principles of Oral surgery
 Fonseca volume 7
 Netter’s Head and Neck Anatomy for Dentistry, 2nd
Edition