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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
3. Muscular organ situated in the floor of the
mouth.
Anchored to Hyoid bone, Mandible,
Styloid process & Soft Palate
Comprises of skeletal muscle (voluntary)
Separated into two halves by median
fibrous septum
FUNCTIONS
SPEECH
TASTE
MASTICATION
DEGLUTITION
30. GLANDS OF BLANDIN-NUHN
• Anterior lingual glands which are located near the tip of the
tongue on each side of the lingual frenum. These are
Seromucus glands.
• 12-25 mm in length, 8m in width.
• Each opens by 3-4 ducts on undersurface of tip of tongue .
31. GLANDS OF VON EBNER
• Serous glands found in moats of circumvallate &
foliate papillae .
• Secrete lingual lipase, the secretion flushes the
moats to enable the taste buds to respond rapidly to
changing stimuli .
32. GLANDS OF WEBER
• Purely mucous .
• Open into the crypts of lingual tonsils on the
posterior dorsum of tongue .
• Abscess formed due to accumulation of pus and
fluid in this gland is known as PERITONSILLAR
ABSCESS .
37. • Caused by an unusually short, thick lingual frenulum.
• Varies in degree of severity.
• Mild cases are characterized by mucous membrane bands.
• Severe cases shows complete ankyloglossia whereby the tongue is tethered to the
floor of the mouth.
MILD FORM – Does not influence development, tooth position or phonation
MODERATE FORM – Exhibits midline mandibular diastema
SEVERE FORM – Complete attachment of tongue to the floor of the mouth or
alveolar gingiva
38. • Also known as LINGUA PLICATA or plicated or scrotal or furrowed tongue
• Benign condition characterized by deep grooves (fissures) on the dorsum of
the tongue.
• The condition is usually painless. Some individuals may complain of an associated
burning sensation
• The clinical appearance is considerably varied in both the orientation, number,
depth and length of the fissure pattern. There are usually multiple grooves/furrows
2–6 mm in depth present
• Fissured tongue is seen in Melkersson-Rosenthal syndrome, Down
syndrome, psoriasis, and Cowden's syndrome.
39. • Macroglossia is the medical term for an unusually large tongue.
• Severe enlargement of the tongue can cause cosmetic and functional difficulties in
speaking, eating, swallowing and sleeping.
• Most common causes are vascular malformations
(e.g. lymphangioma or hemangioma) and muscular hypertrophy(e.g. Beckwith–
Wiedemann syndrome or hemihyperplasia) and Down syndrome.
• It may lead to: Airway obstruction, difficult intubation, swallowing difficulty, and
mandibular deformities.
40. • Microglossia is another rare congenital anomaly in which only a tiny or rudimentary
tongue is present
• Although microglassia may develop as isolated cases but in most of the cases they
occur in association with other anomalies like oromandibular limb hypogenesis
syndrome or hypoglossia-hypodactylia syndrome etc.
• Severe speech difficulties as well as difficulty in taking food.
• As size of the tongue often determines the growth and size of the mandibular arch
in case of microglossia the length of the mandibular arch will be smaller due to the
smaller size of tongue
41. • Aglossia is the complete absence of tongue.
• The first known case was reported in the early 18th century in France and
cases to this day remain extremely rare.
• It is associated with craniofacial and limb defects.
42. • Children with bifid tongue have a split running along the length of their tongue.
• Cleft occurs because the tongue fails to completely develop in order to join the two
sides of the tongue together.
• The cause is usually unknown but sometimes exposure to certain viruses or drugs
during pregnancy may cause cleft tongue.
• The biggest problem with cleft tongue is difficulty eating.
43. • Depapillated ovoid or rhomboid, slightly raised area anterior to
circumvallate papillae.
• Occurs due to failure of tuberculum impar to retract.
• Related to chronic fungal infections.
44. • Lingual thyroid originates from failure of the thyroid gland to descend from the
foramen caecum (tongue) to its normal pre-laryngeal site.
• The ectopic gland located at the base of the tongue is often asymptomatic but may
cause local symptoms such as dysphagia, dysphonia, upper airway obstruction and
hemorrhage, often with hypothyroidism.
• Treatment could be conservative with substitutive hormone treatment in patients
with mild symptoms, while surgery is recommended in cases with airway obstruction.
• In mandibular setback surgeries, lingual thyroid may alter airway..
46. Injury to any part of taste pathway causes abnormality in taste appreciation
INJURY TO HYPOGLOSSAL NERVE
PARALYSIS OF GENIOGLOSSUS MUSCLE
GLOSSITIS
The undersurface of tongue is a good site for observation of jaundice
Referred pain is felt in the ear in diseases of posterior part of tongue as 9th
nerve is common supply to both the regions
47. • Paralysis, atrophy of the affected side of tongue
• Tongue deviates to paralyzed side during protrusion due to action of
unaffected genioglossus
• Causes-
Trauma like fractured mandible
Infranuclear lesion – gradual atrophy & muscular twitching
Supranuclear lesion – tongue is stiff, small and moves sluggishly
48. • Tongue tends to fall backward, obstructing airway and presenting the risk of
asphyxiation
• Causes –
- Unconscious patients as under GA
- Patients with grand mal epilepsy
- Parasymphyseal mandibular fracture
49. • Glossitis is usually a part of generalized ulceration of oral cavity or
stomatitis
• In certain anemia, like pernicious and iron deficiency anemia, the tongue
becomes smooth due to atrophy of filiform papilla
• The presence of a rich network of lymphatics & loose connective tissue
is responsible for enormous swelling in acute glossitis
52. Carcinoma tongue is the second most common oral carcinoma after
carcinoma lip.
SITE-WISE INCIDENCE:
- Middle 1/3rd of lateral border of tongue: 47% (Most common site).
- Posterior 1/3rd : 20%
- Tip of tongue: 15%
- Ventral surface & frenulum: 9%
- Dorsum: 6.5%
- Facio-lingual: 6%
- Age of presentation: 60 years
- Men > Women
53. PATHOLOGY
- 95% of carcinoma tongue are SCC.
- Others: Melenoma, Sarcoma, Minor salivary gland
cancer, Adenoid cystic carcinoma
Premalignant lesions of tongue:
- Leukoplakia
- Erythroplakia
- Chronic hyperplastic candidiasis
54. CLINICAL PRESENTATION
- Painless long-standing ulcer, which later becomes
painful due to infection or nerve involvement.
- Bleeding from the tongue
- Excessive salivation
- Dysphagia
- Halitosis
- Change in voice
56. • Tongue is an excellent donor site because of its
abundant vascularity and low morbidity.
• Eiselsberg was first to use pedicle tongue flaps
in 1901.
• Cadenet described rich submucous vascular
plexus in tongue, allowing elevation of flaps as
thin as 3 mm.
• Tongue flaps are locoregional.
57. • Excellent blood supply
• Low morbidity
Tongue flaps are used to cover defects in cheek, floor
of the mouth, palate, alveolus, oroantral fistulas and
vermillion & lip construction.
58. • Flaps from the dorsum of tongue – Posteriorly based
Anteriorly based
Transverse based
• Flaps from the lingual tip – Perimeter flap
Dorsoventrally disposed flap
• Flaps from the ventral surface of tongue
• Flaps from the lateral surface of tongue
59. • Also known as SLIDING POSTERIOR TONGUE FLAP
• Myomucosal flap is created by releasing the tongue from the hyoid bone
and maintaining dorsolingual branch of lingual artery.
• To allow complete mobilization, the entire ipsilateral base is freed from
vertical septum.
INDICATION
Repair of oronasal fistula
Repair of oroantral fistula
Lip reconstructions
Buccal mucosa reconstructions
Reconstruction of hypo pharynx
POSTERIORLY BASED DORSAL TONGUE FLAP
60. ANTERIORLY BASED DORSAL TONGUE FLAP
To repair defects in the anterior cheek, lip, anterior floor of the
mouth, palate, alveolus.
61. TRANSVERSE BASED DORSAL TONGUE FLAP
To repair anterior floor of the mouth and lower lip
PERIMETER FLAP
For repair of vermillion border of either lip
Upper and lower lip reconstruction
DORSOVENTRALLY DISPOSED FLAP
Flap reflected ventrally on an anterior base: used
for lining in lower lip reconstruction
Flap reflected dorsally on a posterior base: used
for lining in upper lip reconstruction
62. FLAPS FROM VENTRAL SURFACE OF TONGUE
Cover defect on anterior floor of mouth
LATERAL TONGUE FLAP
Cover defect on buccal mucosa, lateral palate,
alveolus, and lip.
Incisions are made on ventral and dorsal surface
of tongue in a ‘v’ shaped pattern. This allows
primary closure of wound.
63. • BD Chaurasia’s Human Anatomy, Regional and Applied Dissection and Clinical –
Fifth Edition, Volume 3, HEAD & NECK, BRAIN
• ATLAS OF HUMAN ANATOMY, 7th ED.,NETTER
• Inderbir Singh, GP Pal; Human Embryology – Eighth Edition
• Neelima Anil Malik, Textbook of Oral and Maxillofacial Surgery – Third edition
• Shafer’s Textbook of Oral pathology – Seventh edition
• Manipal Manual of Surgery – Third edition
• Lingual thyroid causing dysphagia and dyspnea. Case reports and review of the
literature - A Toso, F Colombani,1 G Averono, P Aluffi, and F Pia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816370/
• http://www.aboutcancer.com/base_tongue.htm
• https://headandneckcancerguide.org/adults/cancer-diagnosis-
treatments/surgery-and-rehabilitation/cancer-removal-surgeries/glossectomy/
Editor's Notes
Lingual swelling along with tuberculum impar forms Anterior 2/3rd
The lateral lingual swellings increase in size, eventually merging and overlapping the tuberculum impar. The merger of these two swellings forms the anterior two-thirds of the tongue. The mucosa overlying this part of the tongue originates from the first arch; thus, the sensory innervation to this area is from the mandibular branch of the trigeminal nerve (CN V3). Meanwhile, the second, third, and fourth portions of the pharyngeal arch, which make up the copula, develop into the posterior one-third of the tongue. The mucosa overlying this part of the tongue has sensory innervation from the glossopharyngeal nerve (CN XI), which is a sign that the third arch overlaps that of the second. The third arch derivatives typically are associated with glossopharyngeal sensory innervation.
Vallate papillae are arranged in a V-shape anterior to the sulcus terminalis and studded with numerous taste buds. Innervation is by the glossopharyngeal nerve (CN IX).
Fungiform papillae are mushroom-shaped papillae with erythematous domes, located on the lateral aspects and at the apex of the tongue.
Filiform papillae are slim, cone-shaped projections organized in rows parallel to the sulcus terminalis.
Foliate papillae are rarely found in humans
Tip of the tongue drains into submental lymph nodes .
Marginal collecting vessels drains into submandibular lymph nodes .
Central collecting vessels drains into juguloomohyoid lymph nodes .
Basal connecting vessels drains into jugulodigastric lymph nodes .
Umami was first scientifically identified in 1908 by Kikunae Ikeda .
People taste umami through taste receptors that typically respond to glutamates, which are widely present in meat broths and fermented products and commonly added to some foods in the form of monosodium glutamate (MSG) and others.
Foods that have a strong umami flavor include broths, gravies, soups, shellfish, fish and fish sauces, tomatoes, mushrooms, hydrolysed vegetable protein, meat extract, yeast extract, cheeses, soy sauce, and human breast milk.
Chemicals that interact with the taste buds in the tongue are referred to as "tastants.“
Tastants interact with gustatory cell receptors in the taste buds, resulting in transduction of a taste sensation.