TONGUE PPT.pptx FR TONGE EXAM TOPIC STUDY

TONGUE TPIC FOR EXAM 1ST YAER

1. TONGUE PRESENTED BY:- DR.PRIYANKA IPPAR MDS 1 ST 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 4 th 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 1 st pharyngeal arch. These lingual swellings contribute to the mucosa of anterior 2/3 rd of tongue.

15. Tuberculum impar a single medial swelling derived from 1 st pharyngeal arch contribute to the mucosa anterior 2/3 rd 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 4 th week, the two lingual swellings overgrow the tuberculum impar . Merge together and forms the mucosa of anterior 2/3 rd 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 1/3 rd 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

19. 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

20. 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.

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

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

23. 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) .

24. 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

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

26. 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.

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

28. 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.

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

30. SUMMARY OF DERIVATION OF COMPONENTS OF TONGUE

31. MUSCLES OF TONGUE During the 5 th to 7 th 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.

32. The intrinsic muscles the term implies and confined to the tongue itself. Intrinsic muscles Superior longitudinal Inferior longitudinal Transverse Vertical Extrinsic muscles Genioglossus Hyoglossus Styloglossus Palatoglossus

33. IMAGE SHOWS different muscles of tongue

34. IMAGE SHOWS placement of different muscles of tongue

35. 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

36. CONCAVE TONGUE CONVEX TONGUE NARROW TONGUE FLATTENED TONGUE

37. 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)

38. PROTRUSION OF TONGUE DEPRESSION OF TONGUE RETRUSION OF TONGUE

39. NERVE SUPPLY SENSORY SUPPLY Anterior 2/3 rd is supplied by lingual nerve for general sensation and Chorda Tympani for special sensation. Posterior 1/3 rd 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.

40. 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.

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

42. 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.

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

44. 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

45. 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,

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

47. 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.

48. 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

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

50. 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

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

52. 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.

53. 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

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

55. 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.

56. 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

57. 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.

58. 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

59. 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.

60. 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.

61. 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

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

63. 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

64. 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.

65. 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 .

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