7. ďľ Lies behind the
palatoglossal arches
ďľ Forms the anterior wall
of the oropharynx
ďľ Devoid of papillae
ďľ 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
10. MUSCLES ORIGIN INSERTION ACTION(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
12. Superior longitudinalSuperior longitudinal
⢠Origin: submucous fibrous
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 band close 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: median fibrous
septum
⢠Insertion: fibrous tissue at
the margins of tongue
⢠ActionAction
⢠Narrows and elongates the
tongue
15. VerticalVertical
⢠Origin: dorsum surface 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
â˘A branch of external carotid
artery(after passing deep to the
hyoglossus muscles)
â˘Divides into :
â˘Dorsal lingual arteriesDorsal lingual arteries: supply
posterior part
â˘Deep lingual arteryDeep lingual artery : supplies
the anterior part
â˘Sublingual arterySublingual artery : supplies the
sublingual gland and floor of
the mouth
17. ⢠Dorsal lingual vein-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
20. Nerve Supply
ď˛ Motor: all muscles of the tongue (intrinsic and extrinsic) are
supplied by hypoglossal nerve except palatoglossus which is
supplied by pharyngeal plexus
Sensory:
ď˛ anterior 2/3 of the tongue:
ď˛ general sensation: lingual nerve - branch of the
mandibular nerve (with cell bodies in the trigeminal
ganglion)
ď˛ taste: chorda tympani (with cell bodies in the geniculate
ganglion of facial nerve)
21. ď˛ posterior 1/3 of the tongue: innervated by the
glossopharyngeal nerve (both general sensation and
taste), with cell bodies in the glossopharyngeal ganglia
in the jugular foramen
ď˛ posterior most part of the tongue: innervated by the
vagus nerve through the internal laryngeal branch
(with cell bodies in the inferior vagal ganglion)
23. Mucous Membrane on Ventral Surface
ď˛ It is thin, smooth and
loosely attached to the
underlying Connective
Tissue
ď˛ It is freely mobile and not
raised into papillae
because epithelium is
closely adherent to
underlying muscle by a
thin lamina propria.
ď˛ It is covered with non-
keratinized stratified
squamous epithelium.
.
24. Mucous Membrane On Dorsal SurfaceÂ
ď˛ The dorsal surface Of the
tongue is covered with a
mucous membrane, which is
firmly adherent to the
underlying C.T.
ď˛ It is raised into small
projections similar to the villi,
but known as papillae (limited
only to anterior 2/3ra
of tongue).
ď˛ The stratified squamous
epithelium covering the dorsal
surface of the tongue is mostly
keratinized
26. Filiform papillaFiliform papillaÂ
⢠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
ď˛ These are mushroom
shaped, more numerous
near tip & margins of
tongue but some of them
scattered over the dorsum
ď˛ Smaller than vallate but
larger than filliform.
ď˛ Differ from filiform because
are larger, rounded and
deep red in colour
ď˛ Bears one or more taste
buds on its apical surface
29. Circumvallate papillaCircumvallate papilla
ď˛ Large cylindrical structures
ď˛ 1-2mm in diameter
ď˛ 8 to 12 in number
ď˛ Form a âVâ shaped row in front
of sulcus terminalis on the
dorsal surface of the tongue
ď˛ The entire structure is covered
with squamous epithelium, in
both sulcal walls & taste buds
around
30. Taste budsTaste buds
⢠Present in relation 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. ď˛ Neuroepithelial taste cells or gustatory cells in taste buds:
ď˛ They are 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. ď˛ Supporting cells in taste buds : They are 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.
ď˛ 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
ď˛ Gustatory receptors detect
four main types of taste
sensation
ď˛ Sweet: tip
ď˛ Sour: middle
ď˛ Salty: anterolateral
ď˛ Bitter: base
ď˛ However recent evidence
indicates that all areas of
tongue are responsive to all
taste stimuli
35. Paralysis of genioglossus muscleParalysis of genioglossus muscle
⢠Muscle tends to 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
39. ⢠Tongue tie can 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
44. Geographic tongueGeographic tongue::
⢠Psoriasiform mucositis of 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
47. Squamous cell carcinoma of the tongueSquamous cell carcinoma of the tongue
ď˛ Most common intraoral site
ď˛ 60% of lesions arise from the anterior 2/3rd
of the tongue
ď˛ The affected side of the tongue is removed surgically.
ď˛ All the deep cervical lymph nodes are also removed, i.e. block
dissection of neck.
ď˛ 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.
Hinweis der Redaktion
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.
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.
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 â 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
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.
Oral part placed in the floor of the mouth.just infront of the palatoglossal arch .
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.
Posterior most part of the tongue is connected to the epiglottis by 3 folds of mucous membrane âmedial 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
Tongue is divided into two halfes by a median fibrous septum . Each half consists
EXTRINSIC â ATTACHED TO THE BONE
INTRINSIC- WITHIN THE TONGUE WHOLLY NOT ATTACHED TO THE BONE. Alter the shape of the tongue
1.Genioglossus âlife 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
Root â tonsillar and ascending pharyngeal arteries
Lymph from the posterior third â superior deep cervical lymphnodes on both sides
Lymph from the medial part of the anterior two third â 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
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.
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
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 â umami as found in 1901 â japaneses scientist ikeda â taste of sea vegetable , soy sauce , ripe tomato or monosodium glutamate
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
Rx â frenulectomy
Mostly associated with other malformations â hands n feet , clefts
Severe dentoskeletal malocclusion can result due to lack of muscular stimulation.
A relatively common condition characterized by an increase in the size of tongue.
Either true or psuedo
Characteristic â indentations on the lateral margins
Syndrome- downs , beckwith â wiedemann
Surgical intervention to get normal size and function â mastication , articulation , speech
Treatment: surgery
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.
Benign migratory glossitis or Wandering rashâstress
Rx-topical or systemic for symptomatic lesion
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 â electrodessication, co2 laser
Most common oral cancer â SCC , other kaposis sarcoma
Etiology â oncogenes â mutation genetic ; premalignant lesions , tobacco , alcohol, HPV
Survival â 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 âŚâŚâŚâŚdifficulty in tongue movement , swallowing , pain and parasthesia.
Dignosis â clinical examination , biopsy ,