tongue and palate

TONGUETONGUE
&&
PALATEPALATE
PALATE
Dr. Dipal Mawani
PG
Department of Prosthodontics

• Tongue
• Introduction
• Embryology
• Functions
• Parts of the tongue
• Muscles of the tongue
• Papilla
• Taste buds & taste discrimination
• Blood & nerve supply
• Applied anatomy
• Prosthodontic considerations
• Deglutition

• Palate
• Introduction
• Hard palate
• Soft palate
• Muscles of palate
• Blood supply
• Nerve supply
• Passavants ridge
• Movement and function of soft palate
• Prosthodontic consideration
• Conclusion
• References

Introduction
• Tongue is a solid conical muscular organ, covered
partially by mucous membrane and lies partly in the oral
cavity and partly in the pharynx.

Embryology
• Each pharyngeal arch arises
as a mesodermal thickening in
the lateral wall of the foregut.
• First (Mandibular) arch
• Second (Hyoid) arch
• Third arch
• Fourth arch
• Sixth arch

Functions
• It acts as an organ of taste, and helps in mastication,
deglutition and speech.
• In some lower animals (e.g. dog) it is used for thermo-
regulation by panting.
• Clinically, it acts as a diagnostic aids in various systemic
conditions.

ANATOMY OF TONGUE:
FRENULUM
DEEP
LINGUAL
VEIN
PLICA
FIMBRIATA

pharyngeal (post sulcal) part
• There are underlying lymphoid nodules which are
embedded in the submucosa and collectively termed the
lingual tonsil.

Muscles of the Tongue:
A middle fibrous septum divides the tongue into
right and left halves. Each half contains four
intrinsic and four extrinsic muscles.
….the former entirely within it and altering its shape.
….the latter extending outside the tongue and moving
it bodily.

The intrinsic muscles are
superior longitudinal,
inferior longitudinal,
transverse and
vertical.
The extrinsic musculature consists
genioglossus,
hyoglossus,
Styloglossus
palatoglossus.
Originate &
insert within
the tongue
Originate outside
the tongue &
insert within
the tongue

EXTRINSIC MUSCLES:
Genioglossus

Actions –
i. Genioglossus brings about the forward traction of the
tongue to protrude its apex from the mouth.
ii. Acting bilaterally, the two muscles depress the central
part of the tongue, making it concave from side to side.
iii. Acting unilaterally, the tongue diverges to the opposite
side.

• Hyoglossus:
Action - Hyoglossus depresses the tongue, makes the
dorsum convex, helps to retract the protruded tongue .

• Chondroglossus:
Sometimes described as a part of hyoglossus, the muscle is
separated from it by some fibres of Genioglossus, which
pass to the side of the pharynx.
It ascends to merge into the intrinsic musculature between
the hyoglossus and genioglossus muscles.

• Styloglossus:
Action- pulls
tongue upwards
& backwards

• Platoglossus:
Actions
It Elevates the Root
of the Tongue &
approximates the
Palatoglossal arch to
its contralateral
fellow, thus shunting
off the oral cavity
from the Oropharynx

INTRINSIC MUSCLE
Superior longitudinal—
Action - shortens tongue
- dorsum concave
Inferior longitudinal
Action- shortens the tongue
- dorsum convex
Transverse muscles—
Action— narrow & elongated
Vertical muscle
Action- broad & flattened

CIRCUMVALLATE PAPILLAE
Large in sizeLarge in size
1-2 mm diameter1-2 mm diameter
8-12 in number8-12 in number
Situated immediately in front of Sulcus TerminalisSituated immediately in front of Sulcus Terminalis
Each papilla is a cylindrical projection surrounded by aEach papilla is a cylindrical projection surrounded by a
circular sulcus,circular sulcus,
the walls of which are raised above the surface.the walls of which are raised above the surface.
in size
1-2 mm diameter
8-12 in number
Situated immediately in front of Sulcus
Termina
Taste buds:

FFUNGIFORM PAPILLAE:
 Numerous near the tip and margins of tongueNumerous near the tip and margins of tongue
 Smaller than vallate but larger than filiformSmaller than vallate but larger than filiform
 Each consists of a narrow pedicle and a large roundedEach consists of a narrow pedicle and a large rounded
headhead
 Distinguished by bright red colorDistinguished by bright red color

FILLIFORM PAPILLAE:
 Cover the pre-sulcal area of dorsum of tongueCover the pre-sulcal area of dorsum of tongue
 Give characteristic velvety appearanceGive characteristic velvety appearance
 SmallestSmallest
 Most numerousMost numerous
 Each is pointed and covered with keratinEach is pointed and covered with keratin
 Apex is often split into filamentous processesApex is often split into filamentous processes..

FFOLIATE PAPILLA:
Lie bilaterallyLie bilaterally
Red in colorRed in color
Leaf like mucosal ridgesLeaf like mucosal ridges
Bear numerous taste budsBear numerous taste buds

MECHANISM OF TASTE PERCEPTION
Adsorption of molecule onto membrane receptor of taste buds
Activation of cascade
Change in membrane polarization
Release of transmitter substance
Afferent fibers' of glossopharyngel nerve
Generation of taste stimuli
Mediated by transducing & gustaducin

VASCULAR SUPPLY
Arterial supply:Arterial supply:
lingual artery which is branch oflingual artery which is branch of
external carotid arteryexternal carotid artery
Root of tongue-also by tonsillar &Root of tongue-also by tonsillar &
ascending pharyngeal arteryascending pharyngeal artery
Venous drainage:
Deep lingual vein—largest &
principal route joins with
sublingual vein which joins
facial vein and internal jugular
vein

Lymphatic drainage
TIP— bilaterally— submental
nodes
ANTERIOR 23rd— unilaterally—
submandibular nodes
POSTERIOR 13rd— bilaterally
— juguloomohyoid nodes.
JUGULO-OMOHYOID NODES
known as Lymph nodes of the
tongue

INNERVATION OF THE TONGUE
MOTOR
SENSORY
TASTE

Applied Aspects of tongue
too large (macroglossia) seen in
Downs syndrome &
Beckwith-Wiedemann syndrome
too small (microglossia).
Very rarely the tongue may be absent (aglossia).

• The apical part of the tongue may be anchored to the floor of
the mouth by an overdeveloped frenulum. This condition is
called ankyloglossia or tongue-tie. It interferes with speech.
• Remnants of the thyroglossal duct may form cysts at the base
of the tongue.

• The tongue may
be bifid because of
non-fusion of the two
lingual swellings.
• Fissured tongue/Scrotal tongue: seen as grooves that
vary in depth & are noted along lateral & dorsal aspects
of the tongue seen in Down syndrome & Melkersson-
Rosenthal syndrome

• Median Rhomboid Glossitis:
Presents in the posterior midline of the dorsum of the
tongue ,just anterior to the V-shaped grouping of the
circumvalate papilla. This is due to failure of fusion of lingual
swellings with tuberculum impar.
• Benign migratory glossitis:
It is a psoriasiform mucositis of the tongue.
• Hairy tongue:
A condition of hypertrophy of filiform papillae.

•The under surface of the tongue is a good site (along with
the bulbar conjunctiva) for observation of jaundice
•In scarlet fever the atrophy of the lingual mucosa causes
the peculiar redness of the strawberry tongue.
•Pernicious anemia & vitamin deficiencies cause
characteristic changes such as magenta tongue & beefy
red tongue.

Injury to the hypoglossal nerve produces paralysis of the muscles
of the tongue on the side of lesion.
• If the lesion is infranuclear, there is gradual atrophy of the
affected half of the tongue (hemiatrophy).Seen typically in
motor neuron disease and in syringobulbia.
• Supranuclear lesions of the hypoglossal nerve produce
paralysis without wasting. This is best seen in pseudobulbar
palsy where the tongue is stiff, small and moves very
sluggishly resulting in defective articulation.

• Palpation:
The patient is asked to protrude the tongue onto the gauze.
Aided by the gauze the dentist can hold the tongue using a
mirror to examine it. Palpation should be done both left to
right & right to left & should be done quickly.
The targeted areas are the lateral borders & the region of
vallate papilla

• ‘Tongue function test’ to determine high lingual frenal
attachment. Normally the patient should be able to touch
the upper lip with the tip of the tongue without dislodging
the lower denture and thus the lingual frenum should be
relived when found necessary.
• A patient requiring lingual frenectomy, the denture should
be made before surgery is performed, where in the
denture acts as a stent to prevent future relapse

Prosthodontic aspect of tongue
-REST POSITION OF TONGUE
-EFFECTS OF TONGUE IN COMPLETE DENTURE
role of impression making in alveolingual sulcus
tongue position
tongue size
tongue space
-EFFECTS OF TONGUE ON SPEECH
-EFFECTS OF TONGUE ON MASTICATION
-ATTENTION DURING DENTURE DESIGN

Rest position of tongue
• Dorsum—rest against roof of mouth
• Tip—rest against lingual surface of lower ant teeth
• Lateral borders—against lingual borders of posterior
teeth

Role in impression making of alveolingual
sulcus
• A) anterior part
• It is mainly influenced by the genioglossus muscle, the
lingual frenum and to a lesser extent by the anterior
portion of the sublingual gland
• The lingual border of the impression in this region should
extend down to make contact with the floor of the mouth,
when the tip of the tongue touches the upper lip

b)Middle part
 This curvature is due to the prominence of the mylohyoidThis curvature is due to the prominence of the mylohyoid
ridge and the action of mylohyoid muscleridge and the action of mylohyoid muscle
 When the middle of the lingual flange is made to slope towardWhen the middle of the lingual flange is made to slope toward
the tongue, it can extend below the level of the mylohyoidthe tongue, it can extend below the level of the mylohyoid
ridgeridge
 In this way, the tongue rests on top of the flange and aids inIn this way, the tongue rests on top of the flange and aids in
stabilizing the lower denture on the residual ridgestabilizing the lower denture on the residual ridge

c)Posterior part
 Flange can turn laterally toward the ramus to fill the fossa andFlange can turn laterally toward the ramus to fill the fossa and
complete the typical s shaped lingual flangecomplete the typical s shaped lingual flange
 Floor of the mouth exhibits an active phase and a resting phaseFloor of the mouth exhibits an active phase and a resting phase
each with a differing lingual vestibular leveleach with a differing lingual vestibular level
 Between these 2 levels, the lingual flange of the denture mustBetween these 2 levels, the lingual flange of the denture must
be terminatedbe terminated

Tongue size
small - facilitate impression making but
jeopardize lingual
seal
large- problem in impression making
- denture instability
- tongue biting

Tongue space
• Artificial teeth must be arranged in neutral zone—
where inward pressure of cheeks & lips =
outward pressure of tongue
If tongue is cramped by denture
lateral pressure exerted
instability in denture when tongue moves

Effect of tongue on speech
• Voice principally produced—larynx, while tongue by
constantly changing its shape & position of contact with
teeth, alveolar process—gives its sound form & its
qualities

• Role in speech-
Vowels are Produced by the extrinsic muscles of the
tongue Which produce different configuration of the
resonating chamber for each vowel.
Consonants are produced by the intrinsic muscles of
the tongue so that the tongue is separated from the
teeth, gums or palate by a blast of expired air.

• Dental sounds(th)—
– Tip of tongue slightly bw upper & lower ant
teeth
– 3mm space-normal
– <3mm-ant teeth too far forward
-excessive vertical overlap
->6mm-ant teeth too far lingual

• Alveolar sounds(t,d,n,s,z)—
tip of tongue - ant most part of palate
t d(if teeth far lingual)
d t(if teeth far anterior)

Effects of tongue on Mastication
• Tip of tongue-
-incise piece of food
-if incising not required-shallow concavity at centre-
food is placed
-transfer backwards along concave surface
• Middle of tongue-
-rises & forces food laterally b/w occlusal
surface of teeth
- teeth divide food & tongue collect- forms BOLUS
-food reaches backwards-tongue & palate passes-
pharynx-oesophagus

Attention during denture design
• Occlusal plane of lower denture- low so that lateral
borders rest upon it
• Teeth never inside alveolar ridge
• Palate of upper denturethinaccording to strength of
material used
• Lingual cusp of lower posterior teeth should not
overhang tongue

Tongue in Geriatric Patients
• There is a tendency for the taste buds to
diminish in old aged
• when the person is edentulous for several
months without replacement of teeth the
tongue will be hypertrophied.

• Swallowing is initiated reflexly when food or liquid stimulates
sensory nerves in the oropharynx.
• In man, 600 swallows are reported to occur in each 24-
hour period, but of these, only some 150 relate to feeding.
The remaining swallows, which occur less frequently at night,
are unconscious 'empty' swallows that appear to relate
primarily to the clearance of saliva from the mouth.
ANATOMY OF SWALLOWING
(DEGLUTITION)
ANATOMY OF SWALLOWING (DEGLUTITION)

Swallows have been divided into three phases, usually
described as
the first or oral/Buccal- voluntary
the second or pharyngeal-Involuntary
the third or oesophageal phases-Involuntary

• ORAL PHASE:
The oral phase is voluntary bolus of food is moved from
the oral cavity up to or through the fauces.
Transport of the bolus through the mouth is accomplished
by first forming a shallow midline gutter along the tongue to
accommodate the bolus, and then by elevating the tongue and
the floor of that midline gutter from before backwards.
The gutter is probably formed by the co-contraction of the
styloglossi and the genioglossi.

At this stage a posterior oral seal exists which is associated
with elevation of the posterior tongue.
Elevation is accompanied by a relaxation of the posterior
oral seal and a forward movement of the posterior
tongue which is followed by bilateral contraction of the
palatoglossi.

pharyngeal stage:
the tongue raises
against the palate,
the nasopharynx is
closed off, the
larynx raises, the
epiglottis seals of
the larynx & the
bolus is passed
into the
oesophagus

• In this second stage, the three pharyngeal constrictor
muscles undergo sequential contraction which is usually
interpreted as the driving force which propels the bolus
towards the oesophagus

• OESOPHAGEAL PHASE: The third or oesophageal
stage involves the relaxation of cricopharyngeus (the
upper oesophageal sphincter) to allow the bolus to enter
the oesophagus. Once in the oesophagus, the bolus is
propelled by sequential waves of contractions of the
oesophageal musculature down to the lower
oesophageal sphincter, which opens momentarily to
allow the bolus to enter the stomach.

INTRODUCTION
• Palate: roof of the oral cavity.
• It has two parts – an anterior(bony) hard palate
– a posterior(muscular) soft palate

Hard Palate
 Lies in the roof of the oral cavity
 Forms the floor of the nasal cavity
 Formed by:
– Palatine processes of maxillae in front
– Horizontal plates of palatine bones behind
• Bounded by alveolar arches

 Posteriorly, continuous with soft palate
 Its undersurface covered by mucoperiosteum
 Shows transverse folds in the anterior parts

movable muscular fold
suspended from post border
of hard palate
Separates nasopharynx from
oropharynx

 Attached to the posterior border of the hard palate
 Covered on its upper and lower surfaces by mucous
membrane
 Composed of:
– Muscle fibers
– An aponeurosis
– Lymphoid tissue
– Glands
– Blood vessels
– Nerves

Palatine Aponeurosis
 Fibrous sheath
 Attached to posterior border of hard palate
 Is flattened tendon of tensor velli palatini
 Splits to enclose musculus uvulae
 Gives origin & insertion to palatine muscles

Palatine aponeurosis
Near median plane,Near median plane,
the aponeurosis splitsthe aponeurosis splits
to enclose theto enclose the
musculus uvulaemusculus uvulae..

 Tensor veli palatini
– Origin: spine of
sphenoid;,scapho
id fossa, auditory
tube
– Insertion: forms
palatine
aponeurosis
which is attached
to
– (a) Posterior
border of hard
palate
– (b)Inf surface of
palate behind
palatine crest
– Action: Tenses
soft palate,opens
auditory tube
MUSCLES
Spine ofSpine of
SphenoidSphenoid
bonebone
Soft palateSoft palate
UvulaUvula
MusculusMusculus
UvulaeUvulae
PalatinePalatine
aponeurosiaponeurosi
ss
PterygoidPterygoid
hamulushamulus
TensorTensor
veliveli
palatinipalatini

Muscles
• Levator veli palatini
– Origin:petrous temporal
bone, auditory tube.
– Insertion: palatine
aponeurosis
– Action: Raises soft palate
also dilates auditory tube

Muscles
• Musculus
uvulae
– Origin:
posterior
nasal spine
– Palatine
aponeurosis
– Insertion:
mucosa of
uvula
– Action:
Elevates uvula
uvula

Muscles
• Palatopharyngeus
• 2 fasciculi
– Origin: Ant Fasciculus(Post
border of hard palate)
– Post fasciculus(palatine
aponeurosis)
– Insertion: posterior border of
thyroid cartilage
– Action: Elevates wall of the
pharynx
palatopharyngeous

Muscles
• Palatoglossus
– Origin: palatine
aponeurosis
– Insertion: side of tongue
– Action: pulls root of tongue
upward, narrowing
oropharyngeal isthmus

Blood supply
Greater palatine branch of the
maxillary artery
Ascending palatine, branch of the
facial artery
Palatine branch of Ascending
pharyngeal, branch of the external
carotid artery
VEINS;
Pterygoid and tonsillar plexus of
veins
Lymphatics
Upper deep
cervical&retropharyngeal

Sensory Nerve Supply
• General Sensory:Mostly by the
maxillary nerve through its
branches:
– Greater palatine nerve
– Lesser palatine nerve
• Special Sensory:For taste
sensations: lesser palatine
nerves-greater petrosal nerve
-geniculate ganglion- facial nerve
nucleus of solitary tract.
Secretomotor: greater petrosal
nerves.

Motor Nerve Supply
• All the muscles, except tensor veli palatini, are supplied
by the:
– Pharyngeal plexus
• Tensor veli palatini supplied by the:
– Nerve to medial pterygoid, a branch of the
mandibular division of the trigeminal nerve

Passavants Ridge
• Upper fibres of palatopharyngeus
• Raises a ridge
• Morphology
• Best developed in cleft palate

Movements & functions of Soft
palate
• Controls 2 gates
• Isolates mouth from Oropharynx during chewing
• Separates Oropharynx from nasopharynx
• Vary degree of closure of pharyngeal isthmus to modify
quality of voice
• During coughing and sneezing

Clinical Notes
• Cleft palate:
– Unilateral
– Bilateral
– Median
Pharyngeal
isthmus

• Paralysis of the soft
palate
– The pharyngeal isthmus can
not be closed during
swallowing and speech
– Nasal regurgitation
– Nasal twang
– Flattening of Palatoglossal
arch

Classification of soft palate:

PALATAL THROAT FORMSPALATAL THROAT FORMS
11) CLASS 1

It is the area between the anterior and posterior
vibrating line found medially from one tuberosity to
other.
Cupid bow appearance.
POST PALATAL SEAL

An imaginary line across the posterior
part of the palate marking the division between the
movable and
immovable tissues of the soft palate. This can be
identified when
the movable tissues are functioning
-GPT 8*
* J. Prosthet Dent.2005Jul;94(1):10-92
VIBRATING LINE

Swenson described it as a
vibrating area.
Silverman describes the anterior
and posterior flexion line.
Johnson and Stratton described
them as the ah line (posterior flexion
line); blow line (anterior flexion line)
VIBRATING LINE

Anterior vibrating line
Is an imaginary line located at the
junction of the attached tissue overlying
the hard palate and the movable tissue
of the immediately adjacent soft palate.
Posterior vibrating line
It is an imaginary line at the junction of
the aponeurosis of the tensor veli
palatini muscle and the muscular
portion of the soft palate.
VIBRATING LINE

FUNCTION:
To maintain contact with the anterior
portion of the soft palate during functional
movements of the stomatognathic system.

WHY IS IT NECESSARY:
The distal border is then least advantageous for
providing a seal for retention. The labial and
buccal denture borders are generally well sealed
by the draping of the soft tissues over them, but
there is no lip or cheek to drape over the posterior
border of a denture

• Conclusion:
Tongue and Deglutition mechanism forms the
integral part of the oral cavity.
Better knowledge of the same will help us to
render our services in a better way .

Reference:
• Gray’s Anatomy-39th
Edition
• Clinical Anatomy-Richard S.Snell
• Grants Atlas of Anatomy
• Essentials of Human Anatomy-A.K.Datta
• Text Book of Human Anatomy B.D.Chaurasia
• Principals of Human Anat & Physio-Gerard
• Text Book of Human Histology-I.B.Singh
• Text Book of Human Embryology-I.B.Singh
• Shafer’s Text Book of oral pathology-5th
edt
• Prosthodontic related books- Winkler, Bouchers, sharry,
zarb-Bolender, Heartwell,

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