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Tongue ppt

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A detailed presentation on anatomy , embryology , functions , clinical considerations , diseases and examination of tongue

Published in: Health & Medicine
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Tongue ppt

  1. 1. Anatomy of Tongue And Its Applied Aspects Presented by: Niti Sarawgi
  2. 2. Contents  Introduction  Development of tongue  Anatomy of tongue  Parts and surfaces of the tongue  Muscles of the tongue  Vascular supply of the tongue  Lymphatic drainage of the tongue  Innervation of the tongue  Examination of the tongue  Clinical considerations and diseases of the tongue  Conclusion  References
  3. 3. Introduction Pharyngeal part
  4. 4. Development of tongue  Starts to develop near the end of the fourth week Epithelium:  Anterior 2/3:  from 2 lingual swellings and one tuberculum impar, i.e., from first branchial arch  supplied by lingual nerve (post-trematic) and chorda tympani (pre-trematic)  Posterior 1/3:  from the cranial half of the hypobranchial eminence, i.e., from the third arch  supplied by glossopharyngeal nerve
  5. 5.  Posterior most:  from the fourth arch  supplied by vagus nerve  Muscles develop from the occipital myotomes which are supplied by hypoglossal nerve  Connective tissue develops from local mesenchyme
  6. 6. Terminal sulcus Hypobrachial eminence
  7. 7. Parts and surfaces of the tongue Oral Part • Apex • Dorsum part • Ventral part
  8. 8. Ventral surface   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
  9. 9. Glands of Blandin­Nuhn  Anterior lingual glands (also called apical glands) are deeply placed seromucous glands that are located near the tip of the tongue on each side of the frenulum linguae.  They are found on the under surface of the apex of the tongue, and are covered by a bundle of muscular fibers derived from the Styloglossus and Longitudinalis inferior.  They are between 12 to 25 mm. in length, and approximately 8 mm. wide, and each opens by three or four ducts on the under surface of the tongue's apex
  10. 10. Glands of Von­Ebner  They are serous salivary glands  Located adjacent to the moats surrounding the circumvalate and foliate pappilae  Von Ebner's glands secrete lingual lipase  This secretion flushes material from the moat to enable the taste buds to respond rapidly to changing stimuli  Von Ebner's glands are innervated by cranial nerve IX, the glossopharyngeal nerve.
  11. 11. Gland of Weber  They lie along the lateral border of the tongue  These glands are pure mucous secreting glands.  These open into the crypts of the lingual tonsils on the posterior tongue dorsum.  Abscess formed due to accumulation of pus and fluids in this gland is called Peritonsillar Abscess
  12. 12.  Lies behind the palatoglossal arches  Forms the anterior wall of the oropharynx  Devoid of papillae  Underlying lymphoid nodules embedded in the submucosa collectively called as lingual tonsils Pharyngeal or Postsulcal Part Epiglottis Lingual tonsil Median epiglotic fold Lateral epiglotic fold valleculae Palatine tonsil
  13. 13. Muscles of the tongue  Intrinsic muscles  Superior longitudinal  Inferior longitudinal  Transverse  Vertical  Extrinsic muscles  Styloglossus  Hyoglossus  Genioglossus  Palatoglossus
  14. 14.  Intrinsic muscles
  15. 15. GenioglossusGenioglossus  Arises from superior genial tubercle above the origin of geniohyoid Hyoid bone Insertion : the fibres radiate widely to be inserted into the mucous membrane of the tongue; the lowest fibres passing down to the hyoid body
  16. 16. Action  Protrusion  Bilaterally –Central part depression  Unilaterally – Diverges to the Opposite side
  17. 17. HyoglossusHyoglossus • Origin: greater cornu, front of body of hyoid bone • Insertion: side of the tongue between styloglossus and inferior longitudinal ActionsActions • Depresses the tongue
  18. 18. Chondroglossus  A part of hyoglossus Separated from it by genioglossus Origin: medial side and base of lesser cornua Insertion: intrinsic musculature between hyoglossus and genioglossus
  19. 19. StyloglossusStyloglossus • Origin : styloid process near its apex • Insertion : longitudinal part into the inferior longitudinal muscles Oblique part into hyoglossus • ActionAction • Draws the tongue upwards and backward hyoglossushyoglossus styloglossus Inferior longitudinal muscles Styloid process
  20. 20. PalatoglossusPalatoglossus  Origin: palatine aponeurosis of soft palate  Insertion: side of the tongue  ““more a part of soft palate thanmore a part of soft palate than the tonguethe tongue””  ActionAction: elevates the posterior part of the tongue  Bilaterally- approximates the palatoglossal folds to constrict the isthmus of the fauces
  21. 21. 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
  22. 22. Intrinsic muscles
  23. 23. 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
  24. 24. 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
  25. 25. TransverseTransverse • Origin: median fibrous septum • Insertion: fibrous tissue at the margins of tongue • ActionAction • Narrows and elongates the tongue
  26. 26. 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
  27. 27. Vascular supply of the tongue Lingual arteryLingual artery •A branch of external carotid artery(after passing deep to the hyoglossus muscles) •Divides into : •Dorsal lingual arteriesDorsal lingual arteries: supply posterior part •Deep lingual arteryDeep lingual artery : supplies the anterior part •Sublingual arterySublingual artery : supplies the sublingual gland and floor of the mouth
  28. 28. • Dorsal lingual vein-Dorsal lingual vein- drains the dorsum and sides of the tongue • Deep lingual veinsDeep lingual veins (Ranine veins) - drains the tip of the tongue and join sublingualsublingual veinsveins from sublingual salivary gland • All these veins terminate directly or indirectly into internalinternal jugular veinsjugular veins
  29. 29. Lymphatic drainageLymphatic drainage  Lymph from one side (esp. of the posterior side), may reach the nodes of the both sides of the neck (in contrast to the blood supply which remains unilateral)  Tip - drain to submental nodes or directly to deep cervical nodes  Marginal lymphatics from the anterior part tend to drain to ipsilateral submandibular nodes or directly to inferior deep cervical nodes
  30. 30.  Central lymphatics - drain to deep cervical nodes of either side  Posterior part - drains directly and bilaterally to deep cervical 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
  31. 31. Innervation of the tongue
  32. 32. Nerve Supply  Motor: all muscles of the tongue (intrinsic and extrinsic) are supplied by hypoglossal nerve except palatoglossus which is supplied by pharyngeal plexus Sensory:  anterior 2/3 of the tongue:  general sensation: lingual nerve - branch of the mandibular nerve (with cell bodies in the trigeminal ganglion)  taste: chorda tympani (with cell bodies in the geniculate ganglion of facial nerve)  parasympathetic secretomotor fibres to the anterior lingual gland run in the chorda tympani from the superior salivary nucleus, and relay in the submandibular genglion
  33. 33.  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  posterior most part of the tongue: innervated by the vagus nerve through the internal laryngeal branch (with cell bodies in the inferior vagal ganglion)
  34. 34. HISTOLOGY OF TONGUE 
  35. 35. Mucous Membrane on Ventral Surface  It is thin, smooth and loosely attached to the underlying Connective Tissue  It is freely mobile and not raised into papillae because epithelium is closely adherent to underlying muscle by a thin lamina propria.  It is covered with non- keratinized stratified squamous epithelium. .
  36. 36. Mucous Membrane On Dorsal Surface   The dorsal surface Of the tongue is covered with a mucous membrane, which is firmly adherent to the underlying C.T.  It is raised into small projections similar to the villi, but known as papillae (limited only to anterior 2/3ra of tongue).  The stratified squamous epithelium covering the dorsal surface of the tongue is mostly keratinized
  37. 37. Papillae of tongue They are 4 varieties Filiform Fungiform Foliate Circumvallate
  38. 38. Filiform papillaFiliform papilla  • Minute, conical, cylindrical projections which cover most of the presulcul dorsal area. • Increase the friction between the tongue and food • They bear many secondary papillae which are more pointed than those of vallate and fungiform papillae and covered with keratin
  39. 39. Fungiform papillaFungiform papilla  Located mainly on the lingual margin  Differ from filiform because are larger, rounded and deep red in colour  Bears one or more taste buds on its apical surface  These are mushroom shaped, more numerous near tip & margins of tongue but some of them scattered over the dorsum
  40. 40. Foliate papillaFoliate papilla  Red leaf-like mucosal ridges  Bilaterally at the sides of the tongue near sulcus terminalis  Bear numerous taste buds
  41. 41. Circumvallate papillaCircumvallate papilla  Large cylindrical structures  8 to 12 in number  Form a ‘V’ shaped row in front of sulcus terminalis on the dorsal surface of the tongue  The entire structure is covered with squamous epithelium, in both sulcal walls & taste buds around
  42. 42. Special sensory innervation of the tongueSpecial sensory innervation of the tongue
  43. 43. 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
  44. 44.  Neuroepithelial taste cells or gustatory cells in taste buds:  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.
  45. 45.  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.  Basal cells are present at the base of the taste bud. They act as stem cells for renewal of taste cells and supporting cells.
  46. 46. Taste discrimination  Gustatory receptors detect four main types of taste sensation  Sweet: tip  Sour: middle  Salty: anterolateral  Bitter: base  However recent evidence indicates that all areas of tongue are responsive to all taste stimuli
  47. 47. Clinical examination of tongue • InspectionInspection • The tongue is examined for:The tongue is examined for:  ColourColour  Swelling  Ulcer  Coating  Size variation  Distribution of filiform and fungiform papilla  Crenations  Fissures  Atrophy or hypertrophy of papilla
  48. 48.  Frenal attachment and deviations as patient moves out the tongue
  49. 49. Palpation
  50. 50.  Gently palpate the muscles of the tongue
  51. 51. Clinical considerations Injury to hypoglossal nerveInjury to hypoglossal nerve • Trauma like fractured mandible may injure hypoglossal nerve • Paralysis ,atrophy of one side of tongue • Tongue deviates to paralyzed side during protrusion due to action of unaffected genioglossus muscles • Others  infranuclear lesion (i.e., in motor neuron disease and in syringobulbia): gradual atrophy and muscular twitchings of the affected half of the tongue observed  supranuclear lesion (i.e., in pesudobulbar palsy): produce paralysis without palsy (tongue is stiff, small and moves sluggishly)
  52. 52. 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 (nirtroglycerin in angina pectoris)
  53. 53.  The presence of rich network of lymphatics and loose areolar tissue in the substance of tongue is responsible for enormous swelling of tongue in acute glossitis  The undersurface of the tongue is a good site for observation of jaundice  Carcinoma of Tongue is quite common. The affected side of the tongue is removed along with all the deep cervical lymph nodes  Carcinoma of posterior 1/3 of the tongue is more dangerous due to bilateral lymphatic spread  In unconscious patients , the tongue may fall and obstruct the airway.  In grand mal epilepsy, the tongue is commonly bitten by the front incisors during the attack
  54. 54. Diseases of the tongue  Inherited, congenital, and developmental anomalies  Disorders of the lingual mucosa  Diseases affecting the body of the tongue  Malignant tumors of the tongue
  55. 55. Inherited, congenital, and  developmental anomalies  Variation in morphology  Ankyloglossia  Fissured tongue  Macroglossia  Hypoglossia  Lingual thyroid and thyroglossal duct
  56. 56. Partial ankyloglossia (tongue­tie)Partial ankyloglossia (tongue­tie)
  57. 57. • 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
  58. 58. Microglossia (hypoglossia)Microglossia (hypoglossia)   Uncommon developmental condition of unknown origin characterized by abnormally small tongue  Entire tongue may be missing (aglossia)  length of the mandibular arch will be smaller due to the smaller size of the tongue.
  59. 59.     MacroglossiaMacroglossia 
  60. 60. Fissured, plicated, or scrotal tongueFissured, plicated, or scrotal tongue
  61. 61.   Lingual thyroid Lingual thyroid 
  62. 62. Proliferation of floor of pharyngeal wall 4th week Descends the neck anterior to trachea and larynx 7th week Pathophysiology of lingual thyroid
  63. 63. Disorders of lingual mucosa • Geographic tongueGeographic tongue • Hairy tongueHairy tongue • Nonkeratotic and keratotic white lesionsNonkeratotic and keratotic white lesions – Candidiasis – Leukoplakia, hairy leukoplakia • Nutritional defficiencies and hematologicNutritional defficiencies and hematologic abnormalitiesabnormalities – Vitamin B12 deficiency – Iron deficiency anemia • InfectionsInfections – Tertiary syphilis
  64. 64. Geographic tongueGeographic tongue:: • Psoriasiform mucositis of the dorsum of the tongue • 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
  65. 65. Hairy tongueHairy tongue
  66. 66. CandidiasisCandidiasis (Moniliasis) • Most common intraoral oppertunistic fungal infection • Causative agent: Candida albicans • Factors determining the clinical evidence of candidiasis:  Immune status of the host  Oral mucosal enviroment  Strains of Candida
  67. 67. LeukoplakiaLeukoplakia
  68. 68. Pernicious anemiaPernicious anemia • Most common forms of vitamin B12 deficiency Clinical featuresClinical features • Beefy red tongueBeefy red tongue • Erythematous areas on tip and margins • De-papilation • Candidal infection
  69. 69. Iron deficiency anemiaIron deficiency anemia • Most common form of anemia found in 50% females
  70. 70. Plummer­Vinson syndromePlummer­Vinson syndrome Also known as Paterson Kelly Syndrome • Clinical featuresClinical features • Microcytic hypochromic anemia • Smooth and sore tongue • Angular chelitis • Spoon shaped nails Disorders of lingual mucosaDisorders of lingual mucosa
  71. 71. Tertiary syphilis and Tertiary syphilis and  interstitial glossitisinterstitial glossitis • Tongue may be affected by gumma formation • Non-ulcerating, irregular • indurations • Asymmetric pattern of grooves • Leukoplakia
  72. 72. Blandin and Nuhn mucocele  The Blandin and Nuhn mucocele occurs exclusively on the anterior ventral surface of the tongue at the midline.  Although the lesions may have clinical features similar to those of the mucocele, which is found elsewhere they tend to be more polypoid with a pedunculated base  Because of repeated trauma against the lower teeth, the surface may be red and granular or white and keratotic.
  73. 73. Malignant tumors Of Tongue           Malignant tumors Of Tongue                   Squamous cell carcinoma
  74. 74. Squamous cell carcinoma of the tongueSquamous cell carcinoma of the tongue  Most common intraoral site  60% of lesions arise from the anterior 2/3rd of the tongue  The affected side of the tongue is removed surgically.  All the deep cervical lymph nodes are also removed, i.e. block dissection of neck.  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.
  75. 75. CONCLUSIO N
  76. 76. • ReferencesReferences  B.D Chaurasia(2006) Human Anatomy,Regional and Applied,Dissection.  Henry Gray(2004),Gray's Anatomy .  Neelima Anil Malik, Textbook of Oral and Maxillofacial Surgery.  Frank H.Netter,MD. Atlas of human anatomy.  William Henry Hollinshead. Anatomy for Surgeons: The head and neck  T.W. Sadler ,Langman’s Medical Embryology  Internet source.

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