TONGUE

By
Dr. Arpita Sankhwar
MDS 1st year
 • INTRODUCTION
• DEVLOPMENT OF TONGUE
CONTENT
• MUSCLE OF TONGUE
S • BLOOD SUPPLY
• LYMPHATIC DRINAGE
• NERVE SUPPLY
• HISTOLOGY OF TONGUE
• FUNCTIONS OF TONGUE
• TASTE AND TASTE SENSATION
• TASTE BUD
• APPLIED ASPECTS
INTRODUCTION:

Tongue is a muscular organ

situated in floor of the
mouth.
• it is associated with functions of
• taste
• speech
• swallowing
• deglutition.
•DEVELOPMENT OF TONGUE:
• Tongue develops in relation to the pharyngeal arches in the floor of the
developing mouth in the 4th week of intra uterine life.

• Each pharyngeal arches arises as a mesodermal thickening in the lateral

wall of the foregut and grows ventrally to become continuous with the
corresponding of the opposite arch.

• The medial most part of the mandibular arches proliferate to form two
lingual swellings.
• The lingual swellings are partially separated from each other by
another swelling that appear in the midline- Tuberculum impar.

• Immediately behind tuberculum impar the epithelium proliferates to

form downward growth -Thyroglossal duct(thyroid gland develops

• The site of this down growth is subsequently marked by a depression

called- Foramen caecum

• Another midline swelling is seen in relation to the medial ends of

2nd ,3rd ,4th arches.

• The eminence soon shows a sub division into

• Cranial part- related to 2nd and 3rd arches,(copula)

• Caudal part- related to 4th arch(forms the epiglottis)

DEVELOPMENT OF
TONGUE:
• Anterior 2/3rd of tongue: Formed by fusion of :Tuberculum impar and the
two lingual swellings.

• Thus anterior 2/3rd derived from mandibular arch.

• Posterior 1/3rd of tongue: Is derived from cranial part of hypobranchial

eminence (copula).

• In this situation 2nd arch mesoderm gets buried below the surface.

• The 3rd arch mesoderm grows over it to fuse mesoderm of 1st arch.

• The posterior 1/3rd of tongue is thus formed by 3rd arch mesoderm.

• Posterior most part of tongue: Is derived from 4th arch.

DEVELOPMENT OF TONGUE
• Musculature of tongue:

• Derived from occipital myotomes.

• Nerve supplied by hypoglossal nerve .

• Epithelium of tongue:

• First made up of a single layer of cells , later it becomes stratified, and

papillae becomes evident.

• Taste buds are formed in relation to terminal branches of the innervating

nerve fibers.
DEVELOPME
NT OF
TONGUE
MUSCLES
Tongue has two parts:
•Oral part: lies in the mouth
•Pharyngeal part lies in the pharynx
•Oral and pharyngeal parts are separated by V-shaped also called as sulcus
terminalis.
External features:

The tongue has-

A root
A tip
A body-
. Has curved upper surface or dorsum
1

2.inferior surface- confined to oral part .

• The root:

• The root is attached to-

mandible and soft palate above

Hyoid bone below

• Because of these attachments we are not able to swallow the tongue.

• The tip: Forms the anterior free end which at rest lies behind the
upper incisor teeth.
• The body:

Dorsum of the tongue:

Convex in all directions.

Divided into:

1. oral part or anterior two third

2.Pharyngeal part or posterior one third

• Divided by v shaped groove sulcus terminalis.

• Two limbs of V meet at the median pit – FORAMEN CAECUM

• It represents the site from which thyroid diverticulum grows down in the embryo

• Oral and pharyngeal parts differ in development , topography, structure and function
 nerve
Embryonic part supply
Part of
of which
tongue General sensation taste motor
derived

Epithelium First arch Lingual branch of Facial (chorda

over ant 2/3rd man. nerve tympani)
of tongue
Glossopharyngeal
POst1/3 rd of 3rd arch Glossopharyngeal
tongue Superior laryngeal br.
Of vagus Sup laryngeal br .of
Post most 4 arch
th
vagus
part

Muscle Occipital
myotomes Hypoglossal
DORSUM OF THE TONGUE:
• Oral part or papillary part: placed in the floor of the mouth , margins are
free in contact with gums and teeth.

• Superior part: shows median furrow and is covered with papillae which
make it rough.

• Inferior part :is covered with smooth mucous membrane , which shows a
median fold called the frenulum linguae.

• More laterally there is a fold – PLICA FIMBRIATA

• Pharyngeal or lymphoid part: Lies behind palatoglossal arches and sulcus
terminalis.

• It forms the anterior wall of oropharynx .

• The mucous membrane has no papillae but has many lymphoid follicles known
as lingual tonsil.

• Posterior most part of tongue: connected to epiglottis by 3 mucous

membrane folds.

Median gloss epiglottic fold

Right gloss epiglottic fold

Left gloss epiglottic fold

• On either side of median fold depression called- VALLECULA

• Lateral folds separate the vallecula from piriform fossa.

 Muscles of tongue

• A middle fibrous septum divides the tongue into right and left
halves.

• Each half contains four extrinsic and intrinsic muscles.

• Intrinsic muscles: Extrinsic muscles:

• Superior longitudinal Genioglossus

• Inferior longitudinal Hyoglossus

• Transverse Styloglossus

• Vertical Palatoglossus
• INTRINSIC MUSCLES: occupy the upper part of tongue and are attached to sub mucous
fibrous layer and median fibrous septum.

• They alter the shape of tongue.

• Superior longitudinal: Lies beneath the mucous membrane.

• It shortens the tongue and makes its dorsum concave.

• Inferior longitudinal; Lying close to inferior surface of tongue b/n genioglossus and
hyoglossus.

• Shortens the tongue and makes dorsum convex.

Transverse muscle: Vertical muscle:
• Extends from median • Found at the border of
septum to margin. tongue.
• It makes tongue narrow • It makes the tongue
and elongated. broad and flattened.
INTRINSIC MUSCLES OF TONGUE:
EXTRINSIC MUSCLES:
Genioglossus:
Fan shaped muscle which forms the main bulk of tongue.
Origin Insertion Function
upper genial tubercle of Upper fibres - tip of Upper fibres: retract the tip
mandible. tongue Middle fibres: depress the
Middle fibres- dorsum tongue
Lower fibres -hyoid bone Lower fibres ; pull the
posterior part of tongue
forwards thus protrude the
tongue from mouth.
• HYOGLOSSUS:
origin insertion function

Greater cornua Side of tongue b/n Depresses the tongue

and lateral part of stylohyoid and makes dorsum
body of hyoid inferior convex , retracts the
bone. longitudinal protruded tongue.
muscle of tongue.
• STYLOGLOSSUS:

origin insertion function

Tip and adjacent Side of tongue During swallowing it
part of anterior intermingling with pulls the tongue
surface of styloid fibers of hyoglossus. upwards and
process. backwards.
• PALATOGLOSSUS:
origin insertion function
Oral surface of Side of tongue at the Pulls up the root of
palatine junction of oral and tongue approximate
aponeurosis. pharyngeal parts. the palatoglossal
arches ,thus closes the
oropharyngeal
isthmus.
EXTRINSIC MUSCLES OF TONGUE:
EXTRINSIC MUSCLES OF TONGUE:
• Arterial supply of tongue: Chiefly
from-
lingual artery branch of external carotid
artery.
Roof of tongue also supplied by:
• Tonsillar artery
• Ascending pharyngeal artery
• Venous drainage of tongue:

• In to deep lingual vein ,it is principle vein of tongue.

• It is visible in the inferior surface of the tongue.

LYMPHATIC DRAINAGE:

Tip of the tongue-

Drains bilaterally to the submental lymph nodes.

The right and left parts of remaining halves of anterior 2/3 rd of tongue-

Drains into unilaterally to sub mandibular lymph nodes.

The posterior 1/3rd of the tongue –

Drains bilaterally to the jugulo omohyoid nodes. These are known as

 Histology of tongue:
 The bulk of the tongue is made up of a striated muscles.
 The mucous membrane consists of layer of connective tissue (corium), lined
by stratified squamous epithelium .
• Taste buds are most numerous on the sides of vallate papillae , and foliate
papillae and posterior 1/3rd of tongue.
 There are no taste buds on the mid dorsal region of the oral part of the
tongue.
• Functions of the tongue:

• Speech

• Mastication

• Deglutition

• Taste

• Digestion

• Jaw development

• Sucking

• General sensitivity
• TASTE AND TASTE SENSATION:

• Taste is a sensation of flavor perceived in the mouth and throat on contact with a
substance.

• Taste is primary function of taste buds in the mouth , but common experience that
ones smell of smell contributes strongly taste perception.

• Primary sensations of taste:

• Specific chemicals that excite different taste receptors .

• Some studies have identified 13 possible receptors in taste cells:

• 2 sodium receptors, 1 chloride receptors, 1 adenosine receptor, 1 inosine receptor,

2 sweet receptors, 2 bitter receptors, 1 glutamate receptor , 1 hydrogen ion
receptor.
• The receptor capabilities have been collected into 4 general categories called
primary sensation of taste.

• They are sour, salty, bitter, sweet.

• Taste bud and function:

• The taste cells are continually being replaced by mitotic division from
surrounding epithelial cells so that young cells and other mature cells that lie
toward center of the bud and soon break up and dissolve.

• The taste buds are small ovoid or barrel shaped intraepithelial organs about
0.08mm in high, 0.04 in height.

• They extend from basal lamina to the surface epithelium.

• Their outer surface is almost covered by few flat epithelial cells ,which

surround small opening the taste pore.

• It leads into narrow space lined by supporting cells of the taste bud.

• outer supporting cells are arranged like a staves of a barrel.

• Inner and shorter ones are spindle shaped .

• Between the latter are arranged 10 to 12 neuroepithelial cells ,the

receptors of taste stimuli.

• From the tip of each cell several microvilli or taste hairs ,protrude outward

into the taste pore to approach the cavity of the mouth.

• The microvilli provide the receptor surface for taste.

• Interwoven among the bodies of the taste cells in a branching terminal

network of a taste nerve fibers that are stimulated by taste receptor cells.

• Many vesicles from beneath the cell membrane, these vesicles contain a

neurotransmitter substance that is released through cell membrane to

excite the nerve fiber findings in response to taste stimulation.

Structure of taste bud
Structure of
taste bud:
• The primary taste sensations that is sweet, salt, sour, bitter are perceived in
different regions of tongue and palate:

• Sweet: tip of the tongue

• Salt: lateral border of the tongue

• Bitter: Palate and middle posterior part of tongue

• Sour: palate and posterior lateral parts of tongue

Taste sensations:
• LOCATION OF TASTE BUDS:

• The body and the base of the tongue differ widely in the structure and mucous
membrane.

• The anterior part is termed as papillary part and posterior part is called lymphatic part of
dorsolingual mucosa.

• Taste buds or located in inner side of papillae , posterior surface of epiglottis.

• Types of papillae:

• Fungiform papillae

• Fili form papillae

• Foliate papillae

• Circumvallate papillae
• Filiform papillae:

• On the anterior part are found numerous fine-pointed , cone

shaped papillae that gives rise to velvet like appearance.

• These projections , filiform papillae (threaded shaped

papillae),are epithelial structures containing a core of epithelial
connective tissue from which secondary papillae protrude
towards epithelium.

• The covering epithelium is keratinized .

• The filiform papillae do not contain taste buds.

• Fungiform papillae(mushroom-shaped):

• Interspersed between filiform papillae.

• They are round reddish prominences.

• Their color is derived from rich capillary network visible

through the surface epithelium.

• Contains a few taste buds 1 to 3 found only on their dorsal

surface.
• Vallate or circumvallate papillae(walled):

• Infront of the dividing v shaped terminal sulcus b/n the body and base of
tongue , 8 to 10 vallate papillae .

• They do not protrude above the surface of tongue .

• On the lateral surface of vallate papillae epithelium contains numerous

taste buds.

• The ducts of small serous glands called von Ebner glands open into mouth.

• They may serve to wash out the soluble contents of food and are main
source of salivary lipase.

• Foliate papillae:

• located in lateral border of posterior surface of tongue.

• They contain taste buds.

Papillae of tongue
Type of taste papillae Type of taste carried Mediated nerve

Vallate papillae Bitter taste Glossopharyngeal nerve

Foliate papillae Sour taste Glossopharyngeal nerve

Fungiform papillae(tip of Sweet taste Intermediofacial nerve by

the tongue) chorda tympani.

Fungiform papillae(lateral Salt taste Intermediofacial nerve by

borders) chorda tympani.
Nerve
supply of
papillae:
ANAMOLIES OF TONGUE:

Developmental diseases of tongue:

 Aglossia and macroglossia

 Macroglossia

 Ankyloglossia

 Median rhomboid glossitis

 Benign migratory glossitis

 Fissured tongue

 Cleft tongue

 Lingual thyroid nodule

 Lingual varices

 Hairy tongue
• Neurological diseases that affects the tongue:

• Glossodynia

• Dyskinesia

• Paralysis

• Premalignant lesions and conditions that affects the tongue:

• Leukoplakia

• Lichen planus

• Oral sub mucous fibrosis

• Malignant tumors that affects the tongue:

• Squamous cell carcinoma

• Malignant lymphoma

• Malignant melanoma

• Metastatic tumor

• Sarcoma
• Hamartomata's lesions affecting the tongue:

Hemangioma

Lymphangioma

• Aglossia and microglossia:

Aglossia is complete absence of tongue at birth.

• Macroglossia: (tongue hypertrophy, enlarged tongue, prolapsus of tongue, pseudo macroglossia)

1. True macroglossia

2. Pseudo macroglossia

• True macroglossia :

Congenital causes , acquired causes

• Congenital causes:

Idiopathic muscular hypertrophy

Gland hyperplasia

Hemangioma

Lymphangioma
• Down syndrome

• Beckwith – Wiedemann syndrome

• Lingual thyroid

• Trisomy 22

• Acquired causes: Metabolic or endocrine:

Hypothyroidism, cretinism , Diabetes

• Inflammatory:

Syphilis, Amebic dysentery, Ludwig's angina, pemphigus

Smallpox, TB ,Typhoid, Scurvy, pellagra

• Systemic or medical conditions:

• Myxedema

• Hypertrophy

• Acromegaly

• Neurofibromatosis

• Traumatic:

• Surgery, trauma, radiation injury

• Neoplastic:

• carcinoma, lymphangioma , hemangioma, lingual thyroid

• Infiltrative:

• Amyloidosis, sarcoidosis
• Pseudo macroglossia:

• Which force the tongue into abnormal position.

• Habitual posturing of tongue

• Enlarged tonsils or adenoids

• low palate and decreased oral cavity volume displacing the tongue

• Retrognathism

• Hypotonia of the tongue

• Commonly associated syndromes are:

• Downs syndrome

• Beckwith- Wiedemann syndrome

PICTURE OF MACROGLOSSIA:
Ankyloglossia or tongue- tie:
Inferior frenulum attaches to the bottom of the tongue and
subsequently restricts the free movement of tongue.
Types:
Partial: Short lingual frenum
Complete: fusion of tongue and floor of the mouth.
c/f:
Restricted tongue movement
Speech defects
Management:
Frenectomy
PICTURE OF ANKYLOGLOSSIA(PARTIAL)
COMPLETE ANKYLOGLOSSIA(FUSION OF THE TONGUE AND
FLOOR OF MOUTH)
• Fissured tongue:(scrotal tongue, lingua plicata)

• Frequently seen.

• Characterized by grooves that vary in depth are noted along the dorsal and lateral
surface.

• Etiology: unknown

• Polygenic mode of inheritance is suspected.

Usually, asymptomatic

• Associated syndromes are: Melkersson-Rosenthal syndrome: Triad of: Fissured tongue,

cheilitis granulomatous, Bells palsy

Downs syndrome

• Management:

• No definitive treatment is necessary.

FISSURED TONGUE:
• Median rhomboid glossitis:

• (central papillary atrophy, posterior lingual papillary atrophy)

• Etiology:

• The posterior dorsal point of fusion is occasionally defective, leaving a

rhomboid shaped smooth erythematous area lacking a papillae

• C/f: presents in the posterior midline of the dorsum of tongue , just

anterior to v –shaped grouping of circumvallate papillae.
• male predilection.

• Is a focal area of susceptibility to chronic atrophic candidiasis.

• Commonly referred as KISSING LESION.

• Treatment: No treatment necessary.

• Anti-fungal therapy will reduce the clinical erythema.

MEDIAN RHOMBOID GLOSSITIS
• Benign migratory glossitis: (geographic tongue, wandering rash of
tongue):

• Is a form of psoriasiform mucositis of the dorsum of the tongue.

• Constantly changing pattern of serpiginous white lines

surrounding areas of smooth depapillated mucosa.

• Depapillated areas of tongue have reminded others of continental

outlines of globe – hence the name geographic tongue .

• Treatment:

• No treatment is necessary.

• Symptomatic treatment with topical prednisolone.

BENIGN MIGRATORY GLOSSITIS
• Hairy tongue:( Lingua nigra, Black hairy tongue)

• Hypertrophic filiform papillae.

• With lack of normal desquamation which may be

extensive and form a thick matted layer on the dorsal
surface.

• Color may vary from yellow white to brown or even black.

• Etiology:

• Use of certain drugs

• Poor oral hygiene

• Fungal growth
• Orolingual paranesthesia:
• (Glossodynia or painful tongue , Gloss pyrosis or burning tongue) :
• Etiology:
• Deficiency states such as pernicious anemia and pellagra
• Diabetes
• Gastric disturbances such as hyperacidity and hypoacidity
• psychogenic factors
• Trigeminal neuralgia
• Periodontal diseases
• Xerostomia
• Hypothyroidism
• Angioneurotic edema
• Moeller's glossitis

• Oral habits: tobacco, spices,

• Antibiotic therapy
• Local dentures
• C/F:

• Pain , burning sensation, itching

• Management:

• Topical anesthetics

• Analgesics

• Anti bacterial and antifungal agents

• Anti histamines

• Vitamins
Atrophy of tongue papillae:
Causes:
Streptococcal infections
HIV infections
Candidiasis
Herpes infections
Cancer of the tongue
Trauma
Nutritional disorders like:
Vit b12 deficiency's(pernicious anaemia)
Iron deficiency anaemia
Folic acid deficiency – Pernicious anaemia
vit b2 deficiency
Niacin deficiency(pellagra)
Diabetes
Pyridoxine deficiency
• Also seen in:

• Plummer Vinson's syndrome

• Vitamin c deficiency- scurvy

• Chemotherapy :

• anti- cancer drugs

• Developmental :
• Benign migratory glossitis
• Median rhomboid glossitis

• Mucocutaneous :
• Atrophic lichen planus
• OSMF
• Scleroderma
• Xerostomia
 • Ulcers on tongue:

• Local causes:
• Mechanical trauma

• Chemical injury

• Thermal injury

• Recurrent aphthous stomatitis

• Infections:
• Oral candidiasis

• Malignant conditions:
• Squamous cell carcinoma

• Malignant melanoma

• Irradiation
 Auto immune Inflammatory
Systemic causes:
diseases: conditions:
• Bechet's • Erythema
syndrome multiforme
• Kawasaki • Stevens
disease Johnson's
• Lichen planus syndrome
• Systemic lupus • Chrons
erythematosus diseases
• Discoid lupus • Reiter's
erythematosis syndrome
Infections:
Epstein bar virus
Hand foot and mouth disease
Herpes simplex virus 1 and 2
Varicella zoster virus
HIV
Bacterial:
TB, Syphilis, ANUG
Drugs:
chemotherapeutic agents
Miscellaneous:
Thrombocytopenic purpura, Chronic renal failure
Streptococcus pyogenes FOCAL EPITHELIAL HYPERPLASIA
(scarlet fever), the classic
sign of "strawberry tongue"

Plasma Cell Glossitis

Cyanosis of the tongue
NIACIN DEFICIENCY RIBOFLAVIN DEFICIENCY

Acanthosis Nigricans Peutz- jegher’s syndrome

Bifid tongue Thyroglossal Duct Cyst

GORLINS SIGN
LINGUAL THYROID HYPERTROPHY OF
CIRCUMVALLATE PAPILLA

COATED TONGUE MOLLERS GLOSITIS- PERNICIOUS ANEMIA

 Bechet syndrome
Recurrent aphthous stomatitis of tongue:

Kawasaki disease Reiter's syndrome

CANDIDIAIS
 FIBROMA PAPILOMA

Giant Cell Fibroma

LIPOMA
Changes in colour of the tongue:
• Central cyanosis: Bluish colour
• Jaundice: Yellowish colour
• Advanced uraemia: Brown colour
• Riboflavin deficiency: Magenta colour
• Niacin deficiency: Bald tongue of sandwith, beefy red
• Anemia- pale
• Pernicious anemia- Beefy red(Hunter’s or Moeller’s glossitis)
• Scarlet fever-Strawberry and Raspberry tongue
• Lesions commonly occurring in the dorsal and lateral surfaces:

• Geographic lesion

• Fissured lesion

• traumatic ulcer

• Recurrent aphthous ulcer

• Inflammatory hyperplasia

• Hemangioma

• Leucoplakia, speckled leucoplakia, erythroplakia

• Median rhomboid glossitis

• Lichen planus

• Hairy tongue, SCC(lateral border)

• Bald tongue- vitamin, iron deficiency

• Syphilis+
Lesions commonly occurring on ventral surface of
tongue:

• Ankyloglossia

• Traumatic ulcer

• Benign mesenchymal tumor

• mucous retention phenomenon

• SCC

• Leukoplakia, erythroplakia
• REFERENCES:
• B D Chourasia's HUMAN ANATOMY- 4TH EDITION
• INDERBIR SINGH- HUMAN EMBRYOLOGY – 8TH EDITION
• SHAFER’S ORAL PATHOLOGY- 5TH EDITION
• ORBAN’S ORAL HISTOLOGY AND EMBRYOLOGY-13TH EDITION
• NORMAN K.WOOD , PAUL W.GOAZ- Differential diagnosis of oral and maxillo facial
lesions