applied anatomy of tongue

1. APPLIED ANATOMY OF TONGUE
Dr Sauvik Singha
1st year P.G. Resident
Dept of OMFS
HDC&H

2. INDEX
 Introduction
 Development
 Morphology
 Anatomy
 Applied Anatomy
 Bibliography

3. INTRODUCTION
 Tongue is a muscular organ situated in the floor of the
mouth. It is associated with the function of taste, speech,
mastication, deglutition.
 It has an oral part that lies in the mouth, & a pharyngeal part
that lies in the pharynx.
 The oral and pharyngeal parts are separated by a V –
shaped sulcus, the sulcus terminalis.

60. PICHLER

61. HARRIS, BLAIR, & HENDRICK

62. PICHLER & EDGERTON

63. BUTLIN & ENSIGN

64. EGYEDI

65. EGYEDI & OBWEGESER

66. KOLE

67. KOLE & DAVALBHAKTA

68. AUSTERMAN & MACHTENS

69. KRUCHINSKY

70. MIXTER

71. MODIFICATION OF MIXTER

72. HARDA & ENOMOTO

73. MORGAN ET AL. & KACKER

74. MODIFIED KEYHOLE

75. PLESS

76. RHEINWALD

77. GUPTA

78. DEPLANGE

79. DINGMAN & GRAB

80. MAGEE

81. STELLATE- ANTERIOR WEDGE

82. BUTLIN & HANDLEY

83. PICHLER, MODIFIED KEYHOLE, KOLE

84. BUTLIN, ENSIGN

85. HARDA,ENOMOTO

88. TONGUE FLAPS
 Posterior based dorsal flap
 Anterior based dorsal flap
 Transverse dorsal flap
 Perimeter flap
 Dorsoventral disposed flap
 Ventral based flap

118. Glossectomy
Definition of Glossectomy
Partial glossectomy 1/3 or less of tongue
Hemiglossectomy 1/3 to ½ of tongue
Near total glossectomy ½ to ¾ of tongue
Total glossectomy ¾ or greater of tongue

119. Treatment planning in patients with cancer of the
tongue depends on involvement of the floor of
mouth, mandible and other surrounding
landmarks,
the size of the cancer, and the presence of lymph
node disease.
Oral Cancer may be treated with radiation or
surgery, but surgery still remained the favored
treatment of primary choice.

120. For T1/T2 lesion, a transoral partial glossectomy
provided adequate margins of resection.
This maintains articulation and swallowing
function
However, even early stage cancer may be
associated
with rates of nodal metastasis of 30%.
Also, an increase in loco-regional and disease
free
survival after elective neck dissections for
clinically
tumor negative necks mandates aggressive
treatment.

121. For T3/T4 cancers, a hemiglossectomy or total
glossectomy is usually necessary.
This is because they usually involve adjacent
structures such as the floor of the mouth, tonsillar
pillar, and or mandible

125. As stated before, small defects can be closed
primarily
Defect size of 1/3 the volume can be closed.
Resection of ½ the tongue results in loss of
tongue
bulk and scar contracture if limited reconstruction
option are pursued
The decrease in lingual contact with the palate,
lip, and
teeth can result in impaired articulation and
Reconstruction

126. Therefore larger than 1/3 defects required
some form
of reconstruction
Local flap vs regional flap can be used for this
purpose
Goal is to achieve mastication, speech, and
acceptable aesthetic results
Reconstruction

127. Local flaps
Limited amount of tissue
Inferior functional results
Not useful for tongue defects- can cause
limited tongue
motions
Tongue flap – divide tongue anteriorly and
rotate posteriorly
Reconstruction

128. Regional flaps are well vascularized
Need single state reconstruction
Harvest not too difficult
However, they have limited reach,
Can be bulky
Necrosis at distal end
Reconstruction

129. Pectoralis major
Latissimus dorsi
Trapezius
Sternocleidomastoid
Reconstruction

130. Microvascular flaps can overcome the
limitations of
regional flaps
Forearm
Lateral arm
Lateral thigh
Latissimus dorsi
Rectus abdominus
Iliac crease
Reconstruction

131. The preferred method of reconstruction of
hemiglossectomy to near total is free tissue flaps.
Able to select donor site to match requirements
of
defect
Also, donor site may provide tissue that is no
subject
to locoregion therapy such as radiation.
Reconstruction

132. BIBLIOGRAPHY
 Grays Anatomy;Textbook of Anatomy
 B.D. Chaurasia:A Textbook of Anatomy
 Textbook of Embryology: Inderbeer Singh
 Hine ,Levy , Shafer’s textbook of Oral
Pathology
 Peterson’s principles of Oral surgery
 Fonseca volume 7

133. THANK YOU