Tongue

Introduction
Development of tongue.
Anatomy of tongue
Arterial supply & nerve supply of tongue.
functions of the tongue.
Pathologic consideration of tongue.
Conclusion.
References

1. TONGUE

2. CONTENTS Introduction Development of tongue. Anatomy of tongue Arterial supply & nerve supply of tongue. Function of tongue. Pathologic consideration of tongue. C onclusion. References

3. INTRODUCTION Tongue is a muscular organ situated in the floor of the mouth. It has oral part that lies in mouth Pharyngeal part lies in pharynx. Oral and pharyngeal part are separated by a v shaped sulcus, The Sulcus Terminalis

4. DEVELOPMENT

5. Anatomy Of Tongue

6. Anatomy Of Tongue

7. Papillae Of Tongue

8. Barrel shaped cluster 50-150 fusiform cells. Converge apically on gustatory pore (2µm wide). 70µm in height 40µm across Taste Buds

9. T he primary sensations of taste . Sour Taste. The sour taste is caused by acids. By the hydrogen ion concentration. Salty Taste. The salty taste is elicited by ionized salts, mainly by the sodium ion concentration. Sense of Taste

10. Sweet Taste. The sweet taste is not caused by any single class of chemicals. Note specifically that most of the substances that cause a sweet taste are organic chemicals . Bitter Taste. Two particular classes of substances L ong-chain organic substances that contain nitrogen and alkaloids (drugs used in medicines).

11. Umami Taste. Meaning “delicious” designating a pleasant taste sensation that is qualitatively different from sour, salty, sweet, or bitter. Umami is the dominant taste of food containing l-glutamate , such as meat extracts and aging cheese. Guyton

12. Muscles Of Tongue Intrinsic Extrinsic Superior longitudinal Inferior longitudinal Transverse Vertical Genioglossus Hyoglossus Styloglossus Palatoglossus

13. Muscle Origin Insertion Action Superior longitudinal Submucosal CT at back of tongue & from median septum of tongue Muscle pass forward and oblique to submucosal CT & mucosa on margin of tongue Shorten the tongue, curls apex and sides of tongue. Inferior longitudinal Root of tongue Apex of tongue Shorten the tongue , uncurls apex, turns it downward Transverse Median septum of tongue Submucosal connective tissue on lateral margin of tongue Narrow ,elongates tongue Vertical Submucosal CT of dorsum of tongue CT in more ventral region of tongue Flatten and widen tongue

14. Muscle Origin Insertion Action Genioglossus Superior mental spines Body of hyoid Protrude tongue, depressess center of tongue Hyoglossus Greater part and adjacent part of body of hyoid bone Lateral surface of tongue Depresses tongue Styloglossus Styloid process Lateral surface of tongue Elevates and retract tongue Palatoglossus Inferior surface of palatine aponeurosis Lateral surface of tongue Elevates the back of the tongue

15. Arterial Supply Of Tongue

16. Nerve Supply Of Tongue

17. Ingestion Suckling Swallowing Taste Perception Phonation Function of Tongue

18. FAST DAM Tongue management during operative procedures WEIDER TONGUE RETRACTORS ISOLITE LIP CHEEK & TONGUE RETRACTOR

19. Developmental Disorder Of Tongue.

20. Aglossia & Microglossia Syndrome: Microglossia with extreme glossoptosis . Etiology: - Failed embryogenesis of developmental swellings during 4 th & 8 th IU weeks . -Diazepam, Chlorpromazine, Meclizine, Tigan . Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 26.

21. Clinical Features : Maxillo -mandibular Hypoplasia Microstomia Micrognathia Hypertrophy of salivary glands Oligodontia presented with congenitally missing mandibular incisors . Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 26.

22. Macroglossia : Etiology: - Most frequently Vascular malformations and muscular hypertrophy. -Down Syndrome and Beckwidth-Weidmann Syndrome. Categorized as : True macroglossia Pseudo macroglossia Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 27.

23. TRUE MACROGLOSSIA PSEUDO MACROGLOSSIA CONGENITAL ACCQUIRED INFLAMMATORY Idiopathic tongue muscle hypertrophy Salivary gland tumor Hemangioma Lymphangioma   Syndromes ( eg , Beckwith- Wiedemann , Behmel , Laband ) Lingual thyroid Mucopolysaccharidoses Hamartomas Hypothyroidism Cretinism Amyloidosis Acromegaly Myxedema Ludwig angina Pemphigus vulgaris Diphtheria Tuberculosis Actinomycosis Sarcoidosis Candidiasis Allergic reactions to medications that cause the tongue to swell Enlarged tonsils and/or adenoids that displace the tongue Low palate and decreased oral cavity volume Severe maxillary deficiency with narrow palatal arch Severe mandibular deficiency ( retrognathism ) Local oral tumor that  displaces the tongue

24. Ankyloglossia / Tongue Tie: When inferior frenum attaches to the bottom of tongue. Clinical features: Limitation of tongue movement Difficulties in eating and swallowing. Lower incisor deformity Gingival recession Malocclusions Dental caries Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 27.

25. Cleft Tongue: Etiology: Due to lack of merging of lateral lingual swelling of this organ. Partial cleft tongue: Deep groove in midline of the dorsal surface. Due to incomplete merging and failure of groove obliteration by underlying mesenchymal proliferation. Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 27-28.

26. Fissured tongue: Characterized by grooves on dorsal and lateral surface of tongue. Etiology: - Polygenic mode of inheritance is suspected. - Melkerson -Rosenthal syndrome and Down syndrome Clinically asymptomatic unless debris are entrapped or is associated with geographic tongue. Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 28-29.

27. Benign migratory glossitis: Psoriasiform mucositis of dorsum of tongue. Etiology: Associated with stress and psoriasis Clinical feature: Pain, burning sensation, discomfort, dysgeusia , sensitivity to hot, spicy and sour food ipsilateral submandibular lymphadenopathy. Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 28-29.

28. According to Seiden and Curland ,circular pattern is indicate more likely that tongue is gradually affected and is subsequently healing . While spiral patterns tend to be self-sustaining and will linger for a longer duration of time and resulting due to inhomogenities in the medium. ShivanandB.B , Byathnal S D, Ramakrishna A. Paediatric Geographic Tongue: A Case Report, Review and Recent Updates . Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2): ZE05-ZE09.

29. Median Rhomboid Glossitis: Defective fusion of posterior dorsal point. Clinical feature: Rhomboidal shape S mooth erythematous mucosa lacking in papillae . Kissing lesion ( midline area od SP) Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no. 29.

30. Hairy Tongue: Hypertrophy of filiform papillae on dorsal surface of tongue. Lack of debridement. Clinical feature: ≥ 15mm Candida albicans may result in glossopyrosis . Tickling sensation of soft palate and oropharynx during swallowing. Gagging sensation. Altered taste sensation. Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no.31.

31. Lingual varices: Occur to the vein which is subjected to increased hydrostatic pressure but poorly supported by surrounding tissue. Involves the lingual vein Clinical feature: Appear Red / Purple shot like cluster of vessel on ventral surface and lateral border of tongue. Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no.31.

32. Lingual Thyroid Nodule: Follicles of thyroid tissue are found in substance of tongue. Clinical feature: Nodular mass near the base of the tongue. 2-3cm in diameter. Dysphagia, dysphonia, dyspnea, hemorrhage with pain, feeling of tightness in the throat. Developmental disturbance of oral and paraoral structures. Shafer’s textbook of oral pathology.6 th edition pg no.32-33.

33. Red and White Lesion of Tongue.

34. Oral hairy leukoplakia: M ost common HIV associated oral mucosal lesion. Strongly associated with Epistein Barr virus and low level of CD4+ T-Lymphocytes. Lateral border of tongue. Vertical white folds oriented as palisade along the borders of tongue. Treatment: Antiviral medication. Red and white lesion of oral mucosa. Burket’s oral medicine 12 th edition pg no. 99-100.

35. Lichenoid contact reaction: Due to delayed hypersensitivity reaction to constituent derived from dental materials. Drug induced lichenoid reaction: Metronidazole NSAIDs Penicillins Red and white lesion of oral mucosa. Burket’s oral medicine 12 th edition pg no. 95-97.

36. Metabolic Diseases Affecting Tongue.

37. Addisons disease: Autoimmune destruction of adrenal glands. Increased level of ACTH in blood and increase in melanocyte stimulating hormone . Induces deposition of melanin. Multiple focal dark spots. Pale brown to deep chocolate pigmentation. Oral aspects of metabolic diseases . Sahfer’s textbook of oral pathology 6 th edi . Pg . No. 654.

38. Pellagra : Inability to absorb niacin (vitB3) / amino acid tryptophan. Erythematous and edematous tongue. Beefy red tongue with smooth glazed appearance. Oral aspects of metabolic diseases . Sahfer’s textbook of oral pathology 6 th edi . Pg . No. 644-45.

39. Diseases of Blood Affecting Tongue.

40. Vitamin B-12 deficiency: Pernicious anemia (lack of production of IF). Beefy red tongue (dorsum and lateral border of tongue) 3G- Glossitis Glossodynia Glossopyrosis Bald tongue (Atrophy of papillae) Hunter’s glossitis and Moeller’s glossitis . Diseases of the blood and blood forming organs. Shafer’s textbook of oral pathology.6 th edition.pg no. 755-57.

41. Celiac Sprue: Malabsorption syndrome. Many sign & symptom in common with Pernicious anemia. Glossitis with atrophy of filiform papillae. Painful burning sensation of tongue. Avoid gluten (protein found in wheat , barley, oats ) . Treatment : vitamin B12 & Folic Acid supplements Diseases of the blood and blood forming organs. Shafer’s textbook of oral pathology.6 th edition.pg no. 758.

42. Iron deficiency anemia: I nadequate dietary intake, faulty iron absorption. Glossitis(smooth red painful tongue) with atrophy of filiform papillae and later fungiform papillae. Treatment: iron therapy and high protein diet. Diseases of the blood and blood forming organs. Shafer’s textbook of oral pathology.6 th edition.pg no. 764-65.

43. Polycythemia Vera: Absolute increase in number of circulating red blood cells. Deep purplish red tongue. Treatment: No specific trratment Recent isotope of phosphorous,p 32 has been used. Remission may occur. Diseases of the blood and blood forming organs. Shafer’s textbook of oral pathology.6 th edition.pg no. 766-67.

44. Disease of Skin Affecting Tongue.

45. Acanthosis Nigricans : Unusual dermatosis. Benign(insulin /IGF stimulate the epidermal cells). Malignant form (substances either secreted by tumor/in response to tumor). Hypertrophy of the filiform papillae . Shaggy , papillomatous surface to the dorsal tongue . Treatment: correction of hyperinsulinemia Prognosis poor with malignant AN. Diseases of the skin. Shafer’s textbook of oral pathology.6 th edition.pg no. 814-15.

46. Pemphigus Vulgaris: Chronic skin disease with appearance of vesicles and bullae ,fluid filled blisters that develop in cycles. Ill defined , irregular erosion seen. Difficulty to eat and drink is experienced by patients. Treatment: Decrease blister formation Promote healing Diseases of the skin. Shafer’s textbook of oral pathology.6 th edition.pg no. 816.

47. Disease of Nerves Affecting Tongue.

48. Burning mouth syndrome: Burning sensation in absence of any mucosal lesion. Treatment: Antidepressants Vitamins/dietary supplements Analgesic Salivary substitute Diseases of the nerves and muscle. Shafer’s textbook of oral pathology.6 th edition.pg no. 847.

49. Burning tongue: Orolingual paraesthesia . Glossopyrosis and Glossodynia Pain , burning , itching ,stinging of the mucous membrane. Treatment: Topical anesthetics Analgesics Sedatives Antibacterial and antifungal agent Vasodilators Saliva stimulators Diseases of the nerves and muscle. Shafer’s textbook of oral pathology.6 th edition.pg no. 847-48.

50. Bell palsy: Seventh nerve paralysis. Difficulty in speech ,eating . Alter taste sensation in anterior portion of tongue. Treatment: Use of vasodilator Flushing dose of nicotinic acid. Surgical anastomoses of tongue. Diseases of the nerves and muscle. Shafer’s textbook of oral pathology.6 th edition.pg no. 848-49.

51. Glossopharnygeal Neuralgia: Severe sharp shooting pain. Posterior portion of the tongue. Treatment: Injection of alcohol into nerve. Resection of the nerve. Diseases of the nerves and muscle. Shafer’s textbook of oral pathology.6 th edition.pg no. 849-50.

52. Bacterial Infection of Tongue.

53. Scarlet fever : Contagious systemic infection caused by β - haemolytic streptococci. Strawberry Tongue : Tongue exhibit white coating, fungiform papillae are edematous and hyperemic, projecting above as small red knobs. Raspberry tongue: This coating is soon lost and tongue becomes deep red , glistening and smooth. Bacterial infection of oral cavity. Shafer’s textbook of oral pathology.6 th edition.pg no. 311-12.

54. Tuberculosis : Specific infectious granulomatous disease caused by Mycobacterium tuberculosis. Tuberculous ulcers of the tongue occur on the tip , lateral borders, dorsum, towards the midline and base . They are irregular, pale, shallow, oval, indolent painful ulcers with undermined margins, with granulations in the floor and sometimes with a thin slough . Treatment : Multi drug Therapy. Bacterial infection of oral cavity. Shafer’s textbook of oral pathology.6 th edition.pg no. 313-17.

55. Leprosy: Chronic granulomatous infection caused by M. leprae . Lepromas (small tumor like masses) These have tendency to break down and ulcerate. Treatment : Multi drug Therapy. (rifampicin dapsone , clofazimine ) Bacterial infection of oral cavity. Shafer’s textbook of oral pathology.6 th edition.pg no. 317-18.

56. Syphilis : Caused by T. pallidum characterized by episodes of active disease interrupted by period of latency. Primary lesion: Elevated ,ulcerated , nodule showing local induration, covered by grayish white membrane. Secondary lesion: Mucous patches. Intraoral gumma Syphilitic glossitis: Atrophy and fibrosis of tongue (fissured appearnce ) Bacterial infection of oral cavity. Shafer’s textbook of oral pathology.6 th edition.pg no. 322-25.

57. Viral Infection of Tongue.

58. Herpes zoster : Acute infectious viral disease of extremely painful and incapaciting in nature. Involves the trigeminal nerve. Extremely painful vesicles Rupture of vesicles leaves areas of erosion. Treatment : anti viral drugs Viral infection of oral cavity. Shafer’s textbook of oral pathology.6 th edition.pg no. 344-46.

59. Human Immunodeficiency virus: Affect the quality of life of patient and important marker for disease progression and immunosuppression. Strongly associated : candidiasis , hairy leukoplakia . Viral infection of oral cavity. Shafer’s textbook of oral pathology.6 th edition.pg no. 352-53.

60. Fungal infection of Tongue.

61. Candidiasis: Opportunistic fungal infection affecting the oral mucosa. Pseudomembranous candidiasis. Soft, white ,slightly elevated plaques (resemble milk curd). Plaque can be wiped away with gauze Erythematous candidiasis. Sequelae to broad spectrum antibiotics, corticosteroids, common in HIV patients Mycotic infections of oral cavity. Shafers textbook of oral pathology 6 th edi . pg no. 363-67

62. Candidiasis: Chronic hyperplastic candidiasis: Leukoplakia type of candidiasis. Firm , white persistent plaques. Treatment : antifungal agents (nystatin) Mycotic infections of oral cavity. Shafers textbook of oral pathology 6 th edi . pg no. 363-67

63. Ulcerative Lesion of Tongue.

64. Traumatic ulcer: Physical , Thermal & Chemical. Posterior and lateral aspect of tongue. Ulcer appears to be cleanly punched out with erythema and keratosis if present for weeks. Treatment : Intralesional steroid injection. Wound debridement. Night guards to reduce trauma. Ulcerative ,vesicular and bullous lesion B urket’s oral medicine 12 th edition . pg no. 88-89.

65. Recurrent apthous ulcer: Floor of the ulcer is yellowish initially then becomes grayish as epithelialization occurs. Minor Aphthae are 2-4 cm, usually seen on the non-keratinizing m ucosa on ventrum of tongue and dorsal surface of tongue. Major aphthae are ≥1 cm or more, seen on keratinized mucosa like dorsum of tongue. Allergic and immunologic disease of oral cavity.shafers textbook of oral pathology 6t edi . Pg no. 662-67.

66. Benign And Malignant Tumor of Tongue.

67. Squamous cell carcinoma of tongue : Lateral border/ ventral surface of tongue. Superficially indurated ulcer with slightly raised borders . Infiltrate the deep layers of tongue producing fixation and induration without much surface change . Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral pathology . 6 th edi . Pg. no. 110-12.

68. Granular cell tumor: I t is not clear whether it is a true neoplasm / developmental anomaly / trauma induced proliferation. Occur as sessile ,painless, somewhat firm nodule , < 1.5 mm. Pallor / yellowish discoloration. Treatment : conservative excision. Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral pathology . 6 th edi . Pg. no. 189.

69. Osler –Weber- Rendu Syndrome: Hereditary hemorrhagic telangiectasia. Spider like telangiectasia. Epistaxis and bleeding from oral cavity. Treatment: Depends on severity of disease . Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral pathology . 6 th edi . Pg. no. 144.

70. Hemangiomas: Tumors identified by rapid endothelial cell proliferation in early infancy. Flat raised regions of oral mucosa. Deep red/bluish red , well circumscribed. Treatment : Surgery Radiation therapy Compression Cryotherapy. Beinign and Malignant tumor of oral cavity. Shafer’s textbook of oral pathology . 6 th edi . Pg. no. 140-43.

71. CONCLUSION: Among the broad-spectrum of lesions that occur on the tongue a few tongue lesions present more commonly. The most important thing to remember is diagnosing such common tongue lesions which will be in the best interest of the patient.

72. REFERENCES: Grays anatomy: The anatomical basis of clinical practise 14 th edition. B. D. Chaurasia human anatomy volume 3 4 th edition. Guyton and Hall Textbook of Medical Physiology.12 th edition. Human embryology . inderbir singh 8 th edi . Burket’s oral medicine 12 th edition . Shafer’s textbook of oral pathology . 6 th edi Sunil A, Kurien J, Mukunda A, Basheer AS, Deepthi . Indian. Common Superficial Tongue Lesions. Journal of Clinical Practice, Vol. 23, No. 9 February 2013. Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation – a literature review. An Bras Dermatol . 2016;91(4):410-21.

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