tongue

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1 G ood Morning Presented by Dr Hansa Kundu

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2 TONGUE

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3 CONTENTS Introduction Location Parts of tongue Muscles Arterial supply Venous drainage Embryological origin Innervations Lymphatic's Functions Applied aspects

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4 TONGUE - Glossa [Greek] TONGUE - Lingua [Latin] According to Life Sciences & Allied Applications / Anatomy) it is defined as a movable mass of muscular tissue attached to the floor of the mouth in most vertebrates which is the organ of taste and aids the mastication and swallowing of food. In man it plays an important part in the articulation of speech sounds INTRODUCTION

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5 Tongue is partly oral and partly pharyngeal in position . Tongue is attached by its muscles to the hyoid bone, styloid process, soft palate and the pharyngeal wall . LOCATION

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6

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7 The tongue has a- Root Apex Curved dorsum Inferior surface ‘V’ shaped terminal sulcus of tongue. Foramen caecum. Lingual frenulum Vallecular region PARTS

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8 The dorsum of the tongue is covered by mucosa – soft, pink and moist. The dorsal mucosa consists of numerous LINGUAL PAPILLAE in the anterior 2/3 rd . The dorsum of the tongue contains numerous lymphoid tissue elevations called LINGUAL TONSILS in the posterior 1/3 rd . DORSUM

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9 Lingual papillae are projections of the mucosa covering the dorsal surface of the tongue There are 4 principal types namely FILIFORM PAPILLAE FUNGIFORM PAPILLAE FOLIATE PAPILLAE CIRCUMVALLATE PAPILLAE LINGUAL MUCOSA

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12 There are 5 basic taste sensations:

INFERIOR SURFACE : 

INFERIOR SURFACE Inferior surface has frenulum linguae On either side of frenulum, deep lingual veins are seen. Still lateral plica fimbriata are present

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Near the base of the tongue – sublingual folds which open through sublingual papillae are seen Submandibular duct opens in sublingual papillae Rivinus ducts open on the surface of sublingual folds

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TONGUE IS DIVIDED BY A MEDIAN FIBROUS SEPTUM ATTACHED TO THE BODY OF HYOID BONE. THERE ARE EXTRINSIC AND INTRINSIC MUSCLES IN EACH HALF. MUSCLES OF THE TONGUE

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THE EXTRINSIC MUSCLES EXTEND OUTSIDE THE TONGUE MOVING IT BODILY. THE EXTRINSIC MUSCULATURE CONSISTS OF 4 PAIRS OF MUSCLES NAMELY GENIOGLOSSUS HYOGLOSSUS STYLOGLOSSUS PALATOGLOSSUS EXTRINSIC MUSCLES

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18 ORIGIN :SUPERIOR GENIAL TUBERCLE ,SYMPHYSIS MENTI. INSERTION : UPPER AND MIDDLE FIBRES –ROOT TO THE APEX OF TONGUE LOWER FIBRES-BODY OF THE HYOID BONE NERVE SUPPLY :HYPOGLOSSAL NERVE[XII] VASCULAR SUPPLY : SUBLINGUAL BRANCH OF LINGUAL ARTERY AND SUB MENTAL BRANCH OF FACIAL ARTERY ACTION :PROTRUSION OF TONGUE GENIOGLOSSUS GENIOGLOSSUS

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21 ORIGIN: UPPER SURFACE OF THE GREATER CORNU AND BODY OF THE HYOID BONE INSERTION: LATERAL SURFACE OF TONGUE NERVE SUPPLY :HYPOGLOSSAL NERVE[XII] VASCULAR SUPPLY : SUBLINGUAL BRANCH OF LINGUAL ARTERY AND SUB MENTAL BRANCH OF FACIAL ARTERY ACTION :IT DEPRESSES THE TONGUE HYOGLOSSUS

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23 ORIGIN : ANTERO- LATERAL SURFACE OF STYLOID PROCESS AND STYLOMANDIBULAR LIGAMENT INSERTION: LATERAL SURFACE OF TONGUE NERVE SUPPLY: HYPOGLOSSAL NERVE [XII] VASCULAR SUPPLY : SUBLINGUAL BRANCH OF LINGUAL ARTERY ACTION: ELEVATES AND RETRACTS THE TONGUE STYLOGLOSSUS

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25 ORIGIN :UNDER SURFACE OF PALATINE APONEUROSIS INSERTION :LATERAL MARGIN OF TONGUE NERVE SUPPLY : CEANIAL PART OF ACCESSORY NERVE VIA VAGUS VIA PHARYNGEAL PLEXUS VASCULAR SUPPLY :ASCENDING PALATINE BRANCH OF FACIAL ARTERY ACTION :ELEVATION OF TONGUE PALATOGLOSSUS

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27 THE INTRINSIC MUSCLES LIE WITHIN THE TONGUE ALTERING ITS SHAPE THE INTRINSIC MUSCLES ARE SUPERIOR LONGITUDINAL INFERIOR LONGITUDINAL TRANSVERSUS VERTICALIS INTRINSIC MUSCLES

Superior longitudinal: 

28 Superior longitudinal ORIGIN : sub-mucosal connective tissue at the back of the tongue and from the median septum of the tongue INSERTION :lingual margin of the tongue INNERVATION : hypoglossal nerve [xii] FUNCTION : shortens tongue; curls apex and sides of tongue

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29 Superior longitudinal

Inferior longitudinal: 

30 Inferior longitudinal ORIGIN : root of tongue(some fibers from hyoid ) INSERTION : Apex of tongue INNERVATION : hypoglossal nerve[xii] FUNCTIONS : shortens tongue; uncurls apex and turns it downwards.

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31 Inferior longitudinal

Transversus: 

32 Transversus ORIGIN : median septum of the tongue INSERTION : sub mucosal connective tissue on lateral margins of tongue INNERVATION : hypoglossal nerve [xii] FUNCTION : narrows and elongates tongue

Verticalis : 

33 Verticalis ORIGIN : Sub mucosal connective tissue on lateral margins of tongue. INSERTION : sub mucosal connective tissue on dorsum of tongue INNERVATION : hypoglossal nerve [xii] FUNCTION : flattens and widens tongue.

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34 Verticalis and transversus VETRICALIS AND TRANSVERSUS

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35 The tongue and floor of the mouth are supplied chiefly by tortuous lingual artery. It passes between hyoglossus and the middle constrictor of the pharynx to reach the floor of the mouth accompanied by lingual veins and glossopharyngeal nerves. The branches of lingual artery which form a rich anastomotic network and supply the musculature of the tongue are Dorsal lingual arteries and Profunda lingual arteries Arterial supply

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36 LINGUAL ARTERY

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37 TONSILLAR BRANCH It supplies the pharyngeal portion.

DORSAL LINGUAL ARTERIES: 

38 DORSAL LINGUAL ARTERIES Dorsal lingual arteries arise medial to hyoglossus and ascend to the posterior part of the dorsum of the tongue The vessel supply its mucous membrane, and the palatoglossal arch, tonsil, soft palate and epiglottis.

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39 The deep lingual artery is the terminal part of the lingual artery It supplies the inferior surface of the tongue DEEP LINGUAL ARTERY

VENOUS DRAINAGE: 

40 VENOUS DRAINAGE Veins of tongue are arranged into superficial and deep sets. Superficial vein , the vena comitans nervi hypoglossi, drains the tip and undersurface of the tongue and passes superficial to the hyoglossus. It accompanies the hypoglossal nerve and is formed by the deep lingual and sublingual vein.it ends in internal jugular vein

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41 The dorsal lingual veins drain the dorsum of the tongue and accompay the lingual artery, pass deep to the hyoglossus and end in the internal jugular vein either directly or after joining the superficial vein.

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42 INNERVATION OF TONGUE IS COMPLEX AND CONSISTS OF THREE DIFFERENT SUPPLIES Motor supply General sensory supply Special sensory supply INNERVATION

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43 The muscles of the tongue, with exception of palatoglossus, are supplied by the hypoglossal nerve The palatoglossus is supplied by vagus via the pharyngeal plexus

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44 The general sensory sensation is supplied by three nerves Lingual nerve – anterior 2/3 rd of tongue Glossopharyngeal nerve – posterior 1/3 rd of tongue. Vagus nerve – posterior most part of the tongue

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45 Special sensation is supplied by three nerves Chorda tympani [facial] – taste sensation of the anterior 2/3 rd of tongue. Glossopharyngeal [ix] – taste sensation of the posterior 1/3 rd of tongue. Vagus [x] – taste sensation of the posterior most part of the tongue

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50 Lymphatic system of tongue consists of some peculiarities namely Do not accompany the blood vessels Tip of tongue presents richest lymph drainage and drains bilaterally Lymphatic in the posterior 1/3 rd of tongue drains bilaterally Lymphatic of the tongue ultimately drains into jugulo omohyoid nodes, hence they are called lymph nodes of tongue

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52 LYMPH NODE AFFERENT(RECEIVING) EFFERENT(DRAINING) 1. APICAL i. TIP ii. FRENULUM - SUBMENTAL ( MAJOR LYMPH NODE ) 2. MARGINAL SIDE OF TONGUE IN FRONT OF SULCUS TERMINALIS - SUBMANDIBULAR NODE - JUGULODIGASTRIC - JUGULO OMOHYOID 3. CENTRAL ANTERIOR 2/3 RD LYMPHATIC OF TONGUE IN FRONT OF VALLATE PAPILLAE 4. BASAL POSTERIOR 1/3 RD - BILATERALLY INTO JUGULAR AND DIGASTRIC (MAJOR PART) - JUGULO OMOHYOID LYMPH NODES Lymphatic drainage

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53 Origin- Tongue develops from the ventral wall of primitive oropharynx. It is derived primarily from 1 st ,2 nd and 3 rd branchial arches as well as from occipital myotomes The tongue appears in embryo approximately 4 weeks in the form of 2 lateral swellings and 1 median swelling, the tuberculum impar. From the mesoderm of 2 nd ,3 rd and part of 4 th arch develops a second median swelling called the copula or hypobranchial eminence. EMBRYOLOGICAL ORIGIN

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56 The lateral lingual swellings increase in size, they overgrow the tuberculum impar and merge forming the anterior 2/3 rd of the tongue. The cranial part of hypobranchial eminence forms posterior 1/3 rd of the tongue. Union of anterior and posterior part corresponds to the angulated sulcus. The nerve supply varies as the arches.

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58 The muscles of the tongue are derived from the occipital myotomes which invade the mesenchyme of the tongue.

FUNCTIONS:-: 

59 FUNCTIONS:- Speech Mastication Deglutition Digestion Taste Barrier function Jaw development Thermal Regulation Defence mechanism Sucking Symbolic function

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60 The tongue-operated assistive technology, called the Tongue Drive system, was described on June 29 at the 2008 Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Annual Conference in Washington, D.C . Also a Tongue Operated Switch Array as an Alternative Input device has been developed by university of wisconsin-madison. The article presents a tongue operated switch array that provides not only an alternate input for computer but also an approach for silent hands free communication among humans or between humans and machine. This is useful for quadriplegics and can even be used to operate wheelchair

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61 Georgia Tech Electrical and Computer Engineering graduate student Xueliang Huo moves his tongue to direct the Tongue Drive system to move the powered wheelchair in a different direction

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62

APPLIED ASPECTS: 

63 APPLIED ASPECTS LOCAL TONGUE DISORDERS Fissured tongue Median rhomboid glossitis Geographical tongue Hairy tongue

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64 CONGENITAL AND DEVELOPMENTAL DISORDERS Aglossia Macroglossia Ankyloglossia Cleft Tongue Lingual varices Lingual thyroid Tongue thrusting

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65 NEUROLICAL DISORDERS Glossodynia Glossoplegia Dysgeusia PREMALIGNANT LESION Leukopkalia MALIGNANT TUMOR Squamous cell carcinoma

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66 IMPORTANT MUSCLE OF TONGUE GAG REFLEX SUBLINGUAL ABSORPTION OF DRUGS

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67 LOCAL TONGUE DISORDERS

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68 68 Fissured tongue/Scrotal tongue/Plicated tongue

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69 Median Rhomboid Glossitis/ Central papillary atrophy of tongue

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70 70 An irregular smooth red area with a sharply- defined edges, extends for a few days, then heals, only to appear again in another area. Unknown etiology but some times there is a clear family history of its presence in several generations, and In many patients seems to be a developmental anomaly, There also appear to be associated with: Psoriasis, Stress, and Nutritional deficiency. Benign migratory glossitis / Geographic tongue

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71 HAIRY TONGUE / LINGUA VILLOSA

DEVELOPMENTAL ANAMOLIES: 

72 DEVELOPMENTAL ANAMOLIES

AGLOSSIA: 

73 AGLOSSIA

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74 74 Macroglossia describes a tongue enlarged out of proportion to the size of the jaw. The pressure of the teeth on the enlarged tongue can produce scalloping along the border and patients may complain of tongue biting. Important causes: A-Congenital (haemangeoma or lymphangeoma). B-Downs syndrome C-Critinisim D-Acromegaly E-Amyloidosis F-Lingual thyroid Other causes of macroglosia: hypothyroidism, tongue inflammation, tongue infection, syphilis, amebic dysentery, Ludwig angina, pneumonia, pemphigus vulgaris, rheumatic fever, small pox, typhoid, tuberculosis, actinomycosis, giant cell arteritis, candidiasis, scurvy, pellagra, diabetes, uremia, myxedema, radiation therapy, neoplasm, carcinoma, plasmacytoma, neurofibromatosis, sarcoidosis, tongue trauma. -Macroglossia

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75

BIFID TONGUE/CLEFT TONGUE: 

76 BIFID TONGUE/CLEFT TONGUE

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77 77 Ankyloglossia, commonly known as tongue tie, is a congenital which may decrease mobility of the tongue and is caused by an unusually short, thick lingual frenulum. Ankyloglossia

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78 78 Raised asymptomatic mass about 2 cm in diameter. Hemorraghe, dysphagia, dysphonia, sympotoms of hypothyroidism can be associated with this condition. It presents as an asymptomatic nodular mass of the posterior lingual midline, usually less than a centimeter in size but sometimes reaching more than 4 cm. in size . Larger lesions can interfere with swallowing and breathing , Up to 70% of patients with lingual thyroid have hypothyroidism and 10% suffer from cretinism. The lingual thyroid is four times more common in females than in males. Lingual thyroid

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79 TONGUE THRUSTING

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80 LEUKOPLAKIA It is defined as whitish patch or plaque that cannot be characterized clinically or pathologically as any other disease and which is not associated with any other physical/chemical agent except tobacco Clinical staging of leukoplakia on the tongue:- Stage I- appearance of thin gray transparent film on the affected part of the tongue. Stage II- the thin film turns opaque and white. In the beginning it looks soft, but later on cracks and fissures appear.

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81 StageIII- hyperplasia causes small nodules and warty outgrowth. Desquammation also appears simultaneously which leaves areas of smooth red and shiny surface StageIV- appearance of detectable carcinoma

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82 SQUAMOUS CELL CARCINOMA ULCERATIVE VARIETY WARTY VARIETY

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83 INDURATION PLAQUE OR MASS

IMPORTANT MUSCLE OF THE TONGUE: 

84 IMPORTANT MUSCLE OF THE TONGUE GENIOGLOSSUS SAFETY MUSCLE OF THE TONGUE Suffocation if this muscle is injured Air tube should be inserted when anesthesia is given. Used to detect the paralysis of tongue

GAG REFLEX: 

85 GAG REFLEX VOMITING SENSATION WHEN THE POSTERIOR 1/3 RD OF THE TONGUE IS IRRITATED. AFFERENT: GLOSSOPHARYNGEAL NERVE EFFERENT: CRANIAL PART OF ACCESSORY NERVE via VAGUS

SUBLINGUAL ABSORPTION OF DRUGS: 

86 SUBLINGUAL ABSORPTION OF DRUGS Used in case of ANGINA PECTORIS VASO DILATORS are kept beneath the tongue as they are absorbed directly into the DEEP LINGUAL VEINS

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87 India has one of the highest incidence of oral cancer in world as in 4 in 10 in all cancers occurring are oral cancers. Statistics show that annually 130000 people succumb to oral cancer which translates approx 14 deaths per hour. So ORAL CANCER FOUNDATION was made which is a professionally led “call to action” program to eradicate oral cancer ,strive for cancer free India & then improve oral health by 2020.

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88 Essex County Dental Society – it celebrates dental health month in which dental awareness programs are done to prevent oral cancer so that Canadians can celebrate the smile. Regional cancer screening programs were are taking place by oral cancer consortium- Columbia university, New York univ, stony brook univ & univ of medicine & dentistry new jersy along with hospitals corporation and ABC-TV formed a coalition to increase public awareness of oral cancer.

REFERENCES: 

89 REFERENCES Ghom Govindrao Anil.Textbook of ORAL MEDICINEA.2 ND ED;Jaypee:New Delhi 2010pg 533-556 Henry Gray.Gray’s Anatomy.38 th ed pg 1721-1725 McMinn,R.T Hutchings,J.Pegington, P.Abrahams.Color Atlas Of Human Anatomy.3 rd ed;osby-Wolfe:Hongkong 1995pg 23,46,50,57-58

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90 B.K.Berkovitz,G.R Holland,B.J oxham.A Color Atlas & Text Of Oral Anatomy,Histology&Embryology.2 nd ed;Mosby-Wolfe:Aylesbury1992pg75-77 T.W Saddler.Medical Embryology 4 th ed;Wolters Kluwer:New Delhi 2010 pg 27-278

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91 Shafer,Levy,Hine.Textbook of Oral Pathology.5 th ed;Elsevier:New Delhi 2005 pg35-44 Halim.A.Human Anatomy Regional and Clinical for Dental students; I.K International Publishing House:New Delhi 2008pg 215-220 Chaurasia B.D.Human Anatomy.4 th ed;CBS Publishers:New Delhi2007pg211

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92 10/22/2012 92 THANK YOU