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Tongue
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- 3. Terminal sulcus Hypobrachial eminence Startsto develop near the end of the fourth week
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- 7. Lies behindthe palatoglossal arches Forms the anterior wall of the oropharynx Devoid of papillae Underlying lymphoid nodules embedded in the submucosa collectively called as lingual tonsils Pharyngeal Part Epiglottis Lingual tonsil Median epiglotic fold Lateral epiglotic fold valleculae Palatine tonsil
- 8. Muscles of the tongue Intrinsic muscles Superior longitudinal Inferior longitudinal Transverse Vertical Extrinsic muscles Styloglossus Hyoglossus Genioglossus Palatoglossus
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- 10. MUSCLES ORIGIN INSERTIONACTION(S) Genioglossus Upper genial tubercle of mandible Upper fibres: tip of the tongue Middle fibres: dorsum Lower fibres: hyoid bone Upper fibres: retract the tip Middle fibres: depress the tongue Lower fibres: pull the posterior part forward (thus protrusion of the tongue from the mouth) Hyoglossus Greater cornu, front of lateral part of body of hyoid bone Side of tongue Depress the tongue Retracting the protruded tongue Styloglossus Tip, anterior surface of styloid process Side of tongue Pulls the tongue upwards and backwards during swallowing Palatoglossus Oral surface of palatine aponeurosis Side of tongue (junction of oral and pharygeal part) Pulls up root of tongue, approximates palatoglossal arches, closes oropharyngeal isthmus
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- 12. Superior longitudinalSuperior longitudinal • Origin: submucousfibrous layer below the dorsum of the tongue and lingual septum • Insertion: extends to the lingual margin • ActionAction • Turns the apex and sides of the tongue upward to make the dorsum concave
- 13. Inferior longitudinalInferior longitudinal • Narrow bandclose to the inferior surface of the tongue • Origin: root of tongue and body of hyoid bone • Insertion: apex of tongue • ActionAction • Curls the tip inferiorly and shortens the tongue
- 14. TransverseTransverse • Origin: medianfibrous septum • Insertion: fibrous tissue at the margins of tongue • ActionAction • Narrows and elongates the tongue
- 15. VerticalVertical • Origin: dorsumsurface of the borders of the tongue • Insertion: ventral surface of the borders of the tongue • ActionAction • Flattens and broadens the tongue
- 16. Vascular supply of the tongue Lingual arteryLingual artery •Abranch of external carotid artery(after passing deep to the hyoglossus muscles) •Divides into : •Dorsal lingual arteriesDorsal lingual arteries: supply posterior part •Deep lingual arteryDeep lingual artery : supplies the anterior part •Sublingual arterySublingual artery : supplies the sublingual gland and floor of the mouth
- 17. • Dorsal lingualvein-Dorsal lingual vein- drains the dorsum and sides of the tongue • Deep lingual veinsDeep lingual veins - drains the tip of the tongue and join sublingual veinssublingual veins from sublingual salivary gland • All these veins terminate directly or indirectly into internalinternal jugular veinsjugular veins
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- 20. Nerve Supply Motor: allmuscles of the tongue (intrinsic and extrinsic) are supplied by hypoglossal nerve except palatoglossus which is supplied by pharyngeal plexus Sensory: anterior 2/3 of the tongue: general sensation: lingual nerve - branch of the mandibular nerve (with cell bodies in the trigeminal ganglion) taste: chorda tympani (with cell bodies in the geniculate ganglion of facial nerve)
- 21. posterior 1/3of the tongue: innervated by the glossopharyngeal nerve (both general sensation and taste), with cell bodies in the glossopharyngeal ganglia in the jugular foramen posterior most part of the tongue: innervated by the vagus nerve through the internal laryngeal branch (with cell bodies in the inferior vagal ganglion)
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- 23. Mucous Membrane on Ventral Surface It isthin, smooth and loosely attached to the underlying Connective Tissue It is freely mobile and not raised into papillae because epithelium is closely adherent to underlying muscle by a thin lamina propria. It is covered with non- keratinized stratified squamous epithelium. .
- 24. Mucous Membrane On Dorsal Surface The dorsalsurface Of the tongue is covered with a mucous membrane, which is firmly adherent to the underlying C.T. It is raised into small projections similar to the villi, but known as papillae (limited only to anterior 2/3ra of tongue). The stratified squamous epithelium covering the dorsal surface of the tongue is mostly keratinized
- 25. Papillae of tongue They are 4varieties Filiform Fungiform Foliate Circumvallate
- 26. Filiform papillaFiliform papilla • Minute, conical,cylindrical projections which cover most of the presulcul dorsal area. • Give it a velvety appearanceGive it a velvety appearance • Increase the friction between the tongue and food • Smallest and most numerous. • Each is pointed and covered with keratin.
- 27. Fungiform papillaFungiform papilla These aremushroom shaped, more numerous near tip & margins of tongue but some of them scattered over the dorsum Smaller than vallate but larger than filliform. Differ from filiform because are larger, rounded and deep red in colour Bears one or more taste buds on its apical surface
- 28. Foliate papillaFoliate papilla Red leaf-likemucosal ridges Bilaterally at the sides of the tongue near sulcus terminalis Bear numerous taste buds
- 29. Circumvallate papillaCircumvallate papilla Large cylindricalstructures 1-2mm in diameter 8 to 12 in number Form a ‘V’ shaped row in front of sulcus terminalis on the dorsal surface of the tongue The entire structure is covered with squamous epithelium, in both sulcal walls & taste buds around
- 30. Taste budsTaste buds • Present inrelation to cirumvallate papilla, fungiform papillae and foliate papilla • Also present on the soft palate, the epiglottis, the palatoglossal arches, and the posterior wall of the oropharynx
- 31. Neuroepithelial taste cells or gustatory cells in taste buds: Theyare modified columnar elongated cells which act as receptors. They have darkly-stained' elongated central nuclei. The superficial part of these cells is provided with short hairs (hairlets or microvilli). These hairlets project into the taste pore. The base of the taste cells is surrounded by sensory nerve fibres, carry the impulses of taste sensation to the brain.
- 32. Supporting cells in taste buds : Theyare elongated columnar cells with dark cytoplasm but lightly-stained nuclei. They form the outer wall of the taste bud. They have long microvilli that extend from their surfaces into the taste pore. Basal cells are present at the base of the taste bud. They act as stem cells for renewal of taste cells and supporting cells.
- 33. Taste discrimination Gustatory receptorsdetect four main types of taste sensation Sweet: tip Sour: middle Salty: anterolateral Bitter: base However recent evidence indicates that all areas of tongue are responsive to all taste stimuli
- 34. Clinical considerations Injury to hypoglossal nerveInjury to hypoglossal nerve • Trauma likefractured mandible may injure hypoglossal nerve • Paralysis ,atrophy of one side of tongue • Tongue deviates to paralyzed side during protrusion due to action of unaffected genioglossus muscles.
- 35. Paralysis of genioglossus muscleParalysis of genioglossus muscle • Muscle tendsto fall backward, obstructing airway • Total relaxation of genioglossus occur during general anaesthesia so airway is inserted to prevent tongue from relapsing Sublingual absorption of drugsSublingual absorption of drugs • For quick absorption, pill or spray is put under the tongue where it dissolves and enter the lingual veins
- 36. Diseases of the tongue Inherited, congenital,and developmental anomalies Disorders of the lingual mucosa Malignant tumors of the tongue
- 37. Inherited, congenital, and developmental anomalies Variation inmorphology Ankyloglossia Fissured tongue Macroglossia Hypoglossia
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- 39. • Tongue tiecan be classified as: • Milder formMilder form: do not influence jaw development, tooth position or phonation • Severe formSevere form: exhibit Midline mandibular diastema, periodontal defects • Extreme formExtreme form: complete attachment of tongue to the floor of the mouth or alveolar gingiva
- 40. Microglossia (hypoglossia)Microglossia (hypoglossia) Uncommon developmentalcondition of unknown origin characterized by abnormally small tongue Entire tongue may be missing (aglossia) length of the mandibular arch will be smaller due to the smaller size of the tongue.
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- 43. Disorders of lingual mucosa • Geographic tongueGeographictongue • Hairy tongueHairy tongue • Nonkeratotic and keratotic white lesionsNonkeratotic and keratotic white lesions – Candidiasis – Leukoplakia, hairy leukoplakia
- 44. Geographic tongueGeographic tongue:: • Psoriasiform mucositisof the dorsum of the tongue • Dominant characteristic is constantly changing pettern of sepiginious white lines surrounding areas of smooth, depappilated areas. • Prevalence is 1% to 2% • Irregular reddish areas of depapillation • thinning of the dorsal tongue epithelium usually surrounded by a narrow zone of regenerating papillae -whiter than the surrounding tongue surface
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- 47. Squamous cell carcinoma of the tongueSquamous cell carcinoma of the tongue Most commonintraoral site 60% of lesions arise from the anterior 2/3rd of the tongue The affected side of the tongue is removed surgically. All the deep cervical lymph nodes are also removed, i.e. block dissection of neck. Unilateral block dissection of the neck should be efficacious for early carcinoma of the lateral border of the tongue but because of the bilateral lymphatic drainage bilateral dissection should be performed if the tip of the tongue, the frenulum ,or the dorsum of the tongue is involved.
Editor's Notes
- #2 Today I m going to give u a brief idea about development of tongue, normal anatomy of tongue, muscles nerve and vascular suuply of tongue , histology of tongue and clinical consideration of tongue.
- #3 The tongue is muscular hydrostat on the floors of the mouth which manipulates food for mastication. It is the primary organ of taste. In humans a secondary function of the tongue is phonetic articulation. it serves as a natural means of cleaning one's teeth. Also helps in maintaining equilibrium and development of proper occlusion It s avg length is 10 cm or 4inches from the oropharynx. Tongue has root, tip, body. Body has curved upper surface(dorsum) nd inferior surface. Inferior surface is confined to the oral part only. Root is attached to the mandible soft palate above and hyoid bone below. Between 2 bones it is related to geniohyoid and mylohyoid muscles. Tip ios free and rest behind upper incisor teeth.
- #4 Medial most part of mandibular arch-proliferate-2 lingual swelling-partially seprate by another swelling in midline-tuberculum impair. Very quickly swelling enlarge-merges each other to form large mass from which mucous membrane of ant.23 of tongue develops. Immediately behind TI epithelium proliferate-form downgrowth-marked by a depression-called foramen canceum-thyroid gland develops.-thyroglossal duct Arch 1- anterior 2/3rd foramen caecum – the site from which the thyroid diverticulum grows down in an embryoi Arch 2- initial contribution is lost Arch 3- posterior 1/3 (pharyngeal) Arch 4- epiglottis n adjacent structures
- #5 Another midline swelling seen in relation-2 3 4 arch- called hypobrachial aminence-soon shows-subdivision-cranial nd caudal Cranial-related to 2 nd 3 arch-post 13 derived from it. Caudal-4th-forms epiglottis-post. Most part of tongue 2nd arch mesoderm gets buried below surface-3rd arch mesoderm grows over it to fuse with mesoderm of 1st arch.
- #6 Oral part placed in the floor of the mouth.just infront of the palatoglossal arch .
- #7 Ventral surface is smooth purplish and reflected onto oral floor and gums The thin strip of tissue that runs vertically from the floor of the mouth to the undersurface of the tongue is called the lingual frenulum. It tends to limit the movement of the tongue. On either side of frenulum there is a prominence produced by deep lingual veins. more laterally there is a fold called plica fimbriata.
- #8 Posterior most part of the tongue is connected to the epiglottis by 3 folds of mucous membrane –medial n lateral epiglottic fold On either side of the median folds there is a depression called as vallecula Lateral folds separate the vallecula from the piriform fossa
- #9 Tongue is divided into two halfes by a median fibrous septum . Each half consists EXTRINSIC – ATTACHED TO THE BONE INTRINSIC- WITHIN THE TONGUE WHOLLY NOT ATTACHED TO THE BONE. Alter the shape of the tongue
- #10 1.Genioglossus –life saving muscle- fan shaped bulcky muscle ori:Upper genial tubercle of mandible Ins:Upper fibres: tip of the tongue Middle fibres: dorsum Lower fibres: hyoid bone Act:Upper fibres: retract the tip Middle fibres: depress the tongue Lower fibres: pull the posterior part forward (thus protrusion of the tongue from the mouth) 2.Hyoglossus Ori:Greater cornu, front of lateral part of body of hyoid bone Ins:Side of tongue Act:Depress the tongue Retractes the protruded tongue 3.Styloglossus Ori:Tip, anterior surface of styloid process Ins:Side of tongue Act:Pulls the tongue upwards and backwards during swallowing 4.Palatoglossus Ori:Oral surface of palatine aponeurosis Ins:Side of tongue (junction of oral and pharygeal part) Act:Pulls up root of tongue, approximates palatoglossal arches, closes oropharyngeal isthmus
- #17 Root – tonsillar and ascending pharyngeal arteries
- #19 Lymph from the posterior third – superior deep cervical lymphnodes on both sides Lymph from the medial part of the anterior two third – inferior deep cervical lymph nodes The deep cervical nodes usually involved: jugulodigastric and jugulo-omohyoid nodes All lymph from the tongue is believed to eventually drain through the jugulo-omohyoid node before reaching the thoracic duct or right lymphatic duct
- #21 The pharyngeal plexus is a plexus of nerves formed by: • The pharyngeal branch of the vagus, which includes the cranial root of the accessory. This provides the motor supply to the muscles except for the tensor palati which is supplied by the mandibular division of the trigeminal. • The glossopharyngeal nerve, which provides the sensory supply to the pharynx. • Branches from the sympathetic trunk.
- #23 MUCOUS MEMBRANE of tongue (covering both the surfaces) is formed of stratified squamous epithelium. The superficial cells of the mucous membrane of the tongue are continually shed off and are replaced by new cells
- #34 The distribution of taste was basically published by a PHD student Dr.hanig in his thesis. His mapping had a very rough picture of the taste distribution without any concrete data but it began to be passed down the generations. A few scientists tried correcting it nd finally 1974 virginia collins set it right n alsofound taste buds in other locations 5 taste – umami as found in 1901 – japaneses scientist ikeda – taste of sea vegetable , soy sauce , ripe tomato or monosodium glutamate
- #35 Color variation – white: leukoplakia, oral thrush , lichen planus : purple- vitamin b2 def; blue-copd , cyanosis Red- scarlet fever , vitamin deficiency ,; yellow-preceds black hairytongue, jaundice Black-hairy Swelling- food allergies, yellow fever , anaphylaxis , hereditary angioedema , glossitis Ulcer-cancer , lp , behcets Coating – lp , oral thrush, leukoplakia
- #36 nitroglycerin_- angina pectoris
- #39 after the formation of tongue massive cell degeneration occurs between the tongue and the floor of the mouth and the only part attaching them is the lingual frenum . Congenital shortness of the lingual frenum or the frenal attachment that extends nearly to the tip of the tongue binding the tongue to the floor of the mouth and restricting its extension Treatment: frenulectomy. Difficulties: speech, persistent gap btwn man. Incisor, feeding
- #40 Rx – frenulectomy
- #41 Mostly associated with other malformations – hands n feet , clefts Severe dentoskeletal malocclusion can result due to lack of muscular stimulation.
- #42 A relatively common condition characterized by an increase in the size of tongue. Either true or psuedo Characteristic – indentations on the lateral margins Syndrome- downs , beckwith – wiedemann Surgical intervention to get normal size and function – mastication , articulation , speech Treatment: surgery
- #43 Scrotal or lingua plicata due to lack of merging of lingual swelling Characterized by grooves that vary in depth upto 6mm in diameter dorsal and lateral aspects of the tongue accumulation of food debris n micro-organism Ssen in melkerson rosenthal(chilitis granulomatosa,bellsp alsy,fissuerd tongue) syndrome nd down.
- #45 Benign migratory glossitis or Wandering rash—stress Rx-topical or systemic for symptomatic lesion
- #46 Lingua nigra /villosa Hypertrophy of the filliform papilla of the dorsum of the tongue normally 1 mm bt in this 15mm in length Results from failure of normal desquamation of tongue papillae and epithelium Presipitating factors-poor oral hygiene , tobacco Hiv Cf- halitosis -food debris rx- surgical – electrodessication, co2 laser
- #47 Most common oral cancer – SCC , other kaposis sarcoma
- #48 Etiology – oncogenes – mutation genetic ; premalignant lesions , tobacco , alcohol, HPV Survival – 5yrs- us 63% Cf- non healing ulcer more that 14 days, small , painless, pale or, white or red patch: burning sensation and pain when tumour advances …………difficulty in tongue movement , swallowing , pain and parasthesia. Dignosis – clinical examination , biopsy ,