TONGUE TPIC FOR EXAM 1ST YAER

1. TONGUE
PRESENTED BY:-
DR.PRIYANKA IPPAR
MDS 1ST YEAR
GUIDED BY:
Dry RANA K. VARGHESE, PROFESSOR AND
HOD
Dr. MALWIKA SISODIA, READER
Dr. RAUNAK SINGH, READER
Dr. NAVEEN KUMAR GUPTA, READER
Dr. CHANDRABHAN GENDLEY, SR. LECTURER
Dr. ANITA CHANDRAKAR, SR. LECTURER

2. CONTENTS
 INTRODUCTION
 DEFINATION
 EXTERNAL FEATURES
 DEVELPOMENT
 PAPILLAE OF TONGUE
 HISTOLOGY
 MUSCLES OF TONGUE
 BLOOD SUPPLY
 NERVE SUPPLY
 LYMPHATIC DRAINAGE
 DEVELOPMENTAL ANOMELIES
 CONCLUSION
 REFERENCES

3. EXTERNAL FEATURES OF TONGUE
• Parts of tongue:- 1. Root
2. Tip
3. Body

4. INTRODUCTION
• Tongue is a muscular organ situated in the floor of the mouth.
• It is anchored to hyoid bone, mandible, styloid process and soft
palate.
 Associated with functions of:
Taste
Speech
Mastication
Deglutition

5. DEFINATION
• Todd, 1926: Development is progress towards maturity.
• Enlow, 1960: Development connotes a maturational process involving
progressive differentiation at cellular and tissue levels.
• Moyers,1984: Development refers to all the naturally occurring unidirectional
changes in the life of an individual from its existence as a single cell to its
elaboration as a multifactorial unit terminating in death.Thus, it encompasses
the normal sequential events between fertilization & death.

6.  The ROOT is attached to:
. Mandible
. Soft palate
. Hyoid bone
. Styloid process
 TIP:-
The tip forms the anterior free end which, at rest, lies behind the upper incisor
teeth.

7. BODY:-
 It has a) a curved upper surface or dorsum
b) an inferior surface
 The dorsum of the tongue is convex in all directions. It is divided into:
a) An oral part or anterior two third
b) A pharyngeal part or posterior
one third
 Both parts are divided by V shaped groove, sulcus terminalis.
 The two limbs of the V meet at a median pit, named the foramen caecum..

8.  The pharyngeal or lymphoid part of the tongue lies behind the palatoglossal
arches and the sulcus terminalis.

9.  The inferior surface is covered with a smooth mucous membrane , which
shows a median fold called the frenulum linguae.
 On either side of the frenulum, there is a prominence produced by the deep
lingual veins.
 More laterally, there is a fold called the plica fimbriata that is directed
forwards and medially towards the tip of the tongue

10.  The posterior most part of the tongue is connected to the epiglottis by
three folds of mucous membrane.
 On either side of the median fold, there is a depression called the vallecula.

11. • The lateral folds separate the vallecula from the piriform fossa.

12. DEVELOPMENT OF TONGUE

13. ORIGIN OF DIFFERENT PARTS OF TONGUE

14. • Tongue starts development in 4th week of Intrauterine life.
• Pharyngeal pouches I, II, IV forms the mucosa of the tongue & Occipital
somites forms the muscle of tongue
• Two lingual swellings appear laterally, derived from 1st pharyngeal arch. These
lingual swellings contribute to the mucosa of anterior 2/3rd of tongue.

15. • Tuberculum impar a single medial swelling derived from 1st pharyngeal arch
contribute to the mucosa anterior 2/3rd of tongue.
• Hypobranchial eminence derived from II,III, IV pharyngeal arches. Also
known as cupola

16. • Hypobranchial eminence has two parts- Cranial and Caudal part.
• During 4th week, the two lingual swellings overgrow the tuberculum impar.
Merge together and forms the mucosa of anterior 2/3rd of tongue.
• Line of the fusion is marked by median sulcus of tongue.

17. • Within the Hypobrancheal eminence the third pharyngeal arch component
overgrows the second. Forms the mucosa of posterior 1/3rd of tongue.
• Foramen Caecum is a pit and represent the origin of thyroid gland
• Occipital Somites migrate from the neck anteriorly and gives rise to muscles of
tongue.

18. PAPILLAE OF THE TONGUE
 These are projections of mucous membrane or corium which
give the anterior two-thirds of the tongue, its characteristic
roughness.
 These are of the following four types:
1. Vallate or circumvallate papillae
2. Fungiform papillae
3. Filiform papillae or conical papillae
4. Foliate papillae

20. Vallate or Circumvallate papillae
• Large in size
• 8-12 in number
• Present infront of the sulcus terminalis
• Cylindrical projection surrounded by a circular sulcus.
ircumvallate

21. Fungiform papillae
Numerous near the tip and margins of the tongue
• Each papilla consists of a narrow pedicle and a large rounded head.
• Not keratinized.
• They are distinguished by their bright red color.

22. Filiform papillae
• Covers the dorsum of the tongue.
• Velvety appearance.
• Smallest and most numerous in number.
• Each is pointed and covered with keratin.
• Keratinized.

23. Foliate papillae
• Just in front of the palatoglossal arch, each margin shows 4 to 5 vertical
folds, named the foliate papillae.

24. HISTOLOGY
 The tongue is covered on both surfaces by stratified squamous
epithelium (nonkeratinized) .
 The ventral surface of the tongue is smooth, but on the dorsum
the surface shows numerous projections or papillae.
 Each papilla has a core of connective tissue covered by
epithelium.
 Some papillae are pointed (filiform), while others are broad
and at the top (fungiform).

25.  A third type of papilla is circumvallate, the top of this papilla broad
and lies at the same level as the surrounding mucosa.
IMAGE SHOWS (A) Filiform (B) Fungiform (C) Circumvallate
(D) Foliate

26. • The main mass of the tongue is formed by skeletal muscle seen below the
lamina propria.

27. TASTE BUDS:-
 Taste buds are present in relation to circumvallate papillae, fungiform papillae,
and foliate papillae.
 Taste buds are also present on the soft palate, the epiglottis, the palatoglossal
arches, and the posterior wall of the oropharynx.
 Each bud has a small cavity that opens to the surface through a gustatory pore.
The cavity is filled by a material rich in polysaccharide.
 Each cell has a central broader part containing the nucleus and tapering ends.

28. IMAGE SHOWS Taste buds. 1—elongated cells 2—pore 3—
stratified squamous epithelium

29.  The cells are of two basic types—receptor cells/gustatory
cells/neuroepithelial cells and supporting cells/ sustentacular cells.
 Gustatory cells are chemoreceptors, present in the central portion of the
taste bud. They are spindle-shaped with large spherical nucleus. They form
basal synapse with special afferent nerves of the tongue.
 Supporting cells are barrel-shaped cells, usually present toward the
periphery, and form an envelope for the taste bud.

30.  The average life of cells is about 10 days.
IMAGE SHOWS Arrangement of cells in a taste bud
(schematic representation).

31. SUMMARY OF DERIVATION OF COMPONENTS OF TONGUE

32. MUSCLES OF TONGUE
 During the 5th to 7th week of the IU Life, 3-4 occipital myotomes, migrate
anteriorly to form the musculature of the tongue
 A middle fibrous septum divides the tongue into right and left halves.
 Each half contains four intrinsic and four extrinsic muscles
 Extrinsic muscles arise from the bony selection and connect the tongue to the
mandible, hyoid bone, styloid process and palate.

33. • The intrinsic muscles the term implies and confined to the tongue itself.
• Intrinsic muscles
1. Superior longitudinal
2. Inferior longitudinal
3. Transverse
4. Vertical
• Extrinsic muscles
1. Genioglossus
2. Hyoglossus
3. Styloglossus
4. Palatoglossus

34. IMAGE SHOWS different muscles of tongue

35. IMAGE SHOWS placement of different muscles of tongue

36. INTRINSIC MUSCLES ACTIONS
SUPERIOR LONGITUDINAL SHORTENS THE TONGUE, MAKES THE
DORSAM CONCAVE
INFERIOR LONGITUDINAL SHORTENS THE TONGUE,MAKES IT’S
DORSAM CONVEX
TRANSVERSE MAKES THE TONGUE NARROW AND
ELONGATED
VERTICAL MAKES THE TONGUE BROAD AND
FLATTENED

37. CONCAVE TONGUE CONVEX TONGUE
NARROW TONGUE FLATTENED TONGUE

38. EXTRINSIC
MUSCLES
ACTIONS
GENIOGLOSSUS PROTRUDE
HYOGLOSSUS DEPRESS(SIDE OF
TONGUE & HYOID
BONE)
STYLOGLOSSUS RETRACTS (STYLOID
PROCESS OF TEMPORAL
BONE)
PALATOGLOSSUS ELEVATES (PALATINE
APONEUROSIS & SIDE
OF TONGUE)

39. PROTRUSION OF TONGUE DEPRESSION OF TONGUE
RETRUSION OF TONGUE

40. NERVE SUPPLY
• SENSORY SUPPLY
Anterior 2/3rd is supplied by lingual nerve for general sensation and
Chorda Tympani for special sensation.
Posterior 1/3rd is supplied by the glossopharyngeal nerve.
posterior most part supplied by Vagus nerve.
• MOTOR SUPPLY
1. The intrinsic and extrinsic muscles except the palatoglossus are supplied
by the hypoglossal nerve.
2. Palatoglossus is supplied by the cranial part of accesary nerve through
the pharyngeal plexus.

41. BLOOD SUPPLY OF TONGUE
Arterial supply: It is derived from the lingual artery a branch of
external carotid artery. The root of the tongue is also supplied by
tonsillar and ascending pharyngeal artery.

42. VENOUS DRAINAGE
• The deep lingual vein is the principal vein of tongue.

44. LYMPHATIC SYSTEM
1. The tip of the tongue drains bilaterally to the submental nodes .
2. The right and left halves of the remaining part of the anterior two-
thirds of the tongue drain unilaterally to the submandibular nodes.
A few central lymphatics drain bilaterally to the deep cervical nodes.
3. The posterior most part and posterior one-third of the tongue
drain bilaterally into the upper deep cervical lymph nodes
including jugulo digastric nodes.

45. 4. The whole lymph finally drains to the jugulo omohyoid nodes. These
are known as the lymph nodes of the tongue

46. DEVELOPMENT DISTURBANCES OF TONGUE
Macroglossia (tongue hypertrophy, enlarged tongue, pseudo
macroglossia)
 Macroglossia is a developmental disorder of tongue in which it is bigger than it’s
normal size.
 Associated syndromes :
Down syndrome
Beckwith– Wiedemann syndrome

47. Clinical features:-
 In children this anomaly can cause different symptoms such as-
1. Sleep apnea,
2. Respiratory distress,
3. Drooling,
4. Difficulty in swallowing.
 Long standing macroglossia gives rise to:-
1. Anterior open bite deformity,
2. Mucosal changes,
3. Exposure to potential trauma,

48. Treatment:-
 Various treatments include multivitamins, radiation.
 Patients with acromegaly & macroglossia who do not respond to
medical therapy may benefit from partial glossectomy.

49. CASE REPORT:-
• Sandesh Srivastava et al on March 2022 reported a case of a 7 year old male
patient arrived at the hospital with complain of enlarged tongue since birth. He
had difficulty in closing of mouth leads to drooling. On physical examination, the
increase of the length and width of the tongue is observed.Ultrasonography
(USG) Doppler study of the tongue is normal. Patient was advised to partial
glossectomy which leads to resolving of problem.

50. Ankyloglossia (tongue-tie)
 It is said to exist when the inferior frenulum attaches to the bottom of the
tongue, and subsequently restricts free movement of the tongue.
Complete ankyloglossia Partial ankyloglossia

51.  It can cause
1. Feeding difficulties in infants
2. Speech difficulties
3. Persistent gap between mandibular incisors

52.  CLASSIFICATION OF ANKYLOGLOSSIA BY KOTLAW
(based on “free tongue” length) given in 1999 :-
1. CLASS I (Mild ankyloglossia )- 12-16mm
2. CLASS II (Moderate ankyloglossia) - 8-11mm
3. CLASS III (Severe ankyloglossia) - 3-7mm
4. CLASS IV (Complete ankyloglossia) - <3mm

53. TREATMENT:-
 Frenactomy is the treatment of choice in most cases.
 Now –a –days LASER therapy along with Frenectomy can also
give satisfying results.

54. CASE REPORT:-
 Sakshi kabra et al on November 2022 reported a case of a 6 year old child
with chief complain of difficulty in speech and pronunciation. On
examination Class II or moderate ankyloglossia has been reported. A lingual
Frenectomy was planned utilizing the diode laser set at 980nm in continuous
mode at 1.8watts. The child came back after a week with satisfactory result
and no delayed wound healing.

55. 4.Cleft or bifid tongue
 It is a rare condition that is apparently due to lack of merging of the lateral lingual
swellings of this organ.
 A partially cleft tongue is considerably more common and is manifested simply as
a deep groove in the midline of the dorsal surface
Cleft tongue Partial cleft tongue

56. TREATMENT:-
• Until any pathological condition occurs no treatment is required in the case.
• Patients are prescribed multi vitamins.
• Maintaining oral hygiene is needed

57. CASE REPORT:-
M. M. Chidzonga et al in year 1997 reported a case of a female neonate. On
examination it was revealed that patient has median cleft on lower lip, complete
median cleft of the mandible allowing the free movement of mandibular
fragments, bifid tongue and part of which is fixed on the floor of the mouth.
After gaining satisfactory weight the treatment of the lip was repaired by a V-
plasty procedure, and the left side of the tongue from tip to base was freed from
the floor of the mouth. At 19 months, the mandibular teeth were not occluding
with the maxillary teeth because of a complete crossbite. It was decided to
correct this by stabilizing the mandibular segments with bone grafting.

58. Fissured tongue (Scrotal tongue, lingua plicata)
 It is characterized by grooves that vary in depth and are noted along the dorsal
and lateral aspects of the tongue.
 Fissured tongue is also seen in
1. Melkersson – Rosenthal syndrome
2. Down syndrome and
3. In frequent association with benign
migratory glossitis (geographic
tongue)
Fissured tongue

59. TREATMENT:-
• Patient is prescribed with multivitamins.
• Patient is asked to maintain oral hygiene. Brushing the dorsam part of the
tongue to remove debris from the fissures.

60. Median Rhomboid Glossitis
Median rhomboid glossitis presents in the posterior midline of the dorsum of the
tongue, just anterior to the V-shaped grouping of the circumvallate papillae
IMAGES SHOWING Median Rhomboid Glossitis

61. TREATMENT:-
• No treatment is required.
• Patient is kept under observation.
• For burning sensation of tongue, antifungal drugs are prescribed to kill
the yeast present thereby reducing the symptoms.

62. Benign Migratory Glossitis (Geographic Tongue)
 It is a psoriasiform mucositis of the dorsum of the tongue.
 Its dominant characteristic is a constantly changing pattern of serpiginous
white lines surrounding areas of smooth, depapillated mucosa.

63.  The changing appearance has led some to call this the wandering rash of the
tongue, with the depapillated areas have reminded others of continental outlines
on a globe, hence, the use of the popular term geographic tongue
IMAGE SHOWS Benign Migratory glossitis

64. TREATMENT:-
• Antihistamine mouth rinses.
• Vitamin B supplementation
• Mouth rinses with an anesthetic
• Corticosteroid ointments or rinses.

65. Hairy tongue (lingua nigra, lingua villosa, black hairy tongue)
 Hairy tongue (lingua villosa) is a commonly observed condition of defective
desquamation of the filiform papillae that results from a variety of precipitating
factors.
 Normal filiform papillae are approximately 1 mm in length, whereas filiform
papillae in hairy tongue are more than 15 mm in length.
IMAGE SHOWS Hairy tongue

66. TREATMENT:-
• Black hairy tongue doesn’t specifically required any treatment
• Maintaining good oral hygiene is needed.
• If the patient has any kind of oral habits like tobacco chewing, irritating
mouthwashes help in resolving the condition.

67. CONCLUSION
Tongue is the vital organ of the body through whih one can
communicate, one can taste, one can masticate. Also tongue is the
organ that reflects most of systemic diseases and abnormalities of G.I.T
thus a very useful aid in diagnosis. Basic understanding of normal
anatomy of tongue is very much essential for surgeons to treat
pathologies of tongue.

68. REFERENCES:-
1. B.D CHAURASIA, 9TH edition.
2. SHAFER’S Textbook of Oral Pathology, 8th edition.
3. Sandesh Srivastava et al,Congenital macroglossia: case report of a rare disease,
International Journal of Contemporary Pediatric, 2022
4. Sakshi Kabra et al, Management of Ankyloglossia in a Six-Year-Old Child After
Cleft Lip and Palate Surgery: A Case Report,2022
5. M. M. Chidzonga et al, Treatment of median cleft of the lower lip, mandible,
and bifid tongue with ankyloglossia, J. Oral Maxillofac. Surg. 1997