TONGUE & IT’S APPLIED

ASPECTS.

Guided by- Presented by-

Dr. Vinaya Kumar Kulkarni. Dr. Prachi Mulay.
Dr. Jyothi B.
 CONTENTS..
• Introduction
• Development of tongue
• Parts of tongue
• Muscles of tongue
• Papillae
• Arterial Supply & Venous Drainage
• Lymphatic Drainage
• Nerve Supply
• Histology
• Taste Discrimination
• Taste Pathway
• Abnormalities of taste sensation.
• Variations in tongue movements.
• Development disturbances of tongue.
• Neurological disorders.
• Malignant tumors of the tongue.
• Summary.
• References.
 INTRODUCTION
• Tongue is a muscular organ concerned with taste,
speech, mastication and deglutition.

• It is situated –
partly in oral cavity proper
& partly in oropharynx.
 DEVELOPMENT OF TONGUE
• Starts to develop near the end
of the fourth week
• Epithelium:
Anterior 2/3RD - from 2 lingual
swellings and one tuberculum impar.
Posterior 1/3 -from the cranial half of the
hypobranchial eminence.
Posterior most - from the fourth arch.
All muscles of tongue are developed from occipital
myotomes except palatoglossus.
Palatoglossus develops from sixth arch mesodern .

Connective tissue develops from local mesenchyme

 PARTS OF TONGUE
• The tongue has-
a root,
a tip
and a body.
Body has an upper surface (dorsum) and an inferior surface.
The dorsum is convex in all directions & is divided into – oral
part (anterior 2/3rd)
pharyngeal part (posterior 1/3rd)
posteriormost part.
The oral & pharyngeal parts are divided by a V-shaped, the
sulcus terminalis.
The two lines of ‘V’ meet at a median pit, known as foramen
caecum.

The inferior surface is confined to the oral part only.

• Root- is attached to the styloid process & soft palate
above & to mandible & the hyoid bone below.

• Tip- forms the anterior free end which, at rest, lies

behind the incisor teeth.
 PAPILLAE
• These are the projections of mucous membrane or
cornium which give the anterior two-thirds of the
tongue its characteristic roughness.

• Types of of papillae-
-Vallate/circumvallate
- Filiform
- Fungiform
- Foliate
 Vallate Papillae

Largest among papillae

SHAPE: Blunt-ended cylindrical
NUMBER: 8 to 12
LOCATION: infront of sulcus terminalis
 Filiform Papillae
• SHAPE: Thin, long papillae having pointed ends ‘V’
shaped cones
• Only papillae having no taste buds
• NUMBER: numerous
• These papillae are mechanical and not involved in
gustation
• Identified by increased keratinization
• LOCATION: Present at pre-sulcal area
of the tongue
 Fungiform Pappilae
• SHAPE: slightly mushroom-shaped if looked at in
longitudinal section
• Taste buds on their surfaces
• LOCATION: apex of the tongue as well as the margins
• Larger than filiform papillae
 Foliate Pappilae

• SHAPE: Short vertical folds

• LOCATION: Present lateral to terminal sulcus and at
margins
 MUSCLES OF TONGUE
A middle fibrous septum divides the tongue into right & Left halves
Each half of tongue contains four intrinsic and four extrinsic muscles.
Intrinsic muscles :- Superior longitudinal,
inferior longitudinal,
transverse
vertical.
Extrinsic muscles – Genioglussus
hyoglossus
styloglossus
palatoglossus.
 INTRINSIC MUSCLES

• These muscles are confined to the tongue.

• They originate and inserts within the tongue.
• No bony attachments.
• Function: They alter the shape of tongue
MUSCLES ACTIONS
Superior longitudinal Shortens the tongue makes dorsum
concave
Inferior longitudinal Shortens the tongue makes dorsum
convex
Transverse Makes tongue narrow and elongated
Vertical Makes tongue broad and flattened
 EXTRINSIC MUSCLES
• These muscles take origin from parts outside the
tongue, therefore move the tongue as well as alter
the shape.
 ARTERIAL SUPPLY OF TONGUE
• Lingual artery
A branch of external carotid
artery(after passing deep to the
hyoglossus muscles)
Divides into :
Dorsal lingual arteries: supply
posterior part
Deep lingual artery : supplies the
anterior part
Sublingual artery : supplies the
sublingual gland and floor of the
mouth
 VENOUS DRAINAGE
The arrangement of the veins of the tongue is
variable.
Two veins accompany the lingual artery
& one vein accompaines the hypoglossal nerve.
The deep lingual vein is the largest and principal
vein of the tongue. It is visible on the inferior
surface of the tongue.
Dorsal lingual vein- drains the dorsum and sides of the
tongue
Deep lingual veins - drains the tip of the tongue and
join sublingual veins from sublingual salivary gland
These veins unite at the posterior border of the
hyoglossus to form the lingual vein which ends in the
internal jugular vein.
 LYMPHATIC DRAINAGE
Tip – drain bilaterally to submental nodes.
Right & Left Half of Anterior 2/3rd of tongue- drains into
submandibular nodes.
Posterior 1/3rd & posteriormost part- drain bilaterally
into upper deep cervical lymph nodes including
jugulodigastric 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
 NERVE SUPPLY
PART GENERAL SENSATION TASTE SENSATION
ANTERIOR 2/3RD (except Lingual branch of mandibular Chorda Tympani
circumvallate papillae) division of trigeminal nerve

POSTERIOR 1/3rd (including Glossopharyngeal Glossopharyngeal

circumvallate papillae)

POSTERIOR MOST PART Internal laryngeal branch of Internal laryngeal branch of

vagus vagus
All the muscles of the tongue are developed from the
occipital myotomes – are supplied by hypoglossal
nerve.

Except Palatoglossus, which is developed from the 6th

arch mesoderm, is supplied by cranial part of accessory
nerve through pharyngeal plexus i.e. vagoaccessory
complex.
 HISTOLOGY
The bulk of the tongue is made up of striated muscles.
The mucous membrane consists of layer of connective
tissue (corium), lined by stratified squamous
epithelium.

On the oral part of the dorsum, it is thin, forms papillae,

and is adherent to the muscles.
On the pharyngeal part of the dorsum, it is very rich in
lymphoid follicles.

On the inferior surface, it is thin and smooth.

• Taste buds are most numerous on the sides of the
circumvallate papillae, and on the walls of the
surrounding sulci.
• STRUCTURE OF TASTE BUD
Taste bud is a bundle of taste receptor cells, with
supporting cells embedded in the epithelial covering
of the papillae.
• Each taste bud contains about 40cells, which are the
modified epithelial cells.
• Cells of taste bud are divided into four groups:
• 1. Type I cells or sustentacular cells
• 2. Type II cells
• 3. Type III cells
• 4. Type IV cells or basal cells.
 Type I cells and type IV cells are
supporting cells.
Type III cells are the taste receptor cells.
Function of type II cell is unknown.
• Type I, II and III cells have microvilli, which project into
an opening in epithelium covering the tongue.
• This opening is called taste pore or gustatory pore.
• Neck of each cell is attached to the neck of other. All
the cells of taste bud are surrounded by epithelial
cells.
• There are tight junctions between epithelial cells and
the neck portion of the type I, II and ill cells, so that
only the tip of these cells are exposed to fluid in oral
cavity.
 TASTE DISCRIMINATION
• All taste sensations result from various combinations
of the following taste sensations:
Sour taste
Salty taste
Sweet taste
Bitter taste
Umami taste
• 1) Sour taste : The sour taste is caused by acids, i.e.,
hydrogen ions. The edges of tongue are more
sensitive to sour.
• 2) Salty taste : • The salty taste is elicited by ionized
salts mainly by sodium ion concentration. The cation
of the Salt (Na) is mainly responsible.
Anterior half of the tongue is more sensitive to salty
taste.
• 3) Sweet taste : It is produced by various classes of
organic molecules. The tip of the tongue is most
sensitive to sweet.
• 4) Bitter taste : Bitter taste is produced by long-chain
organic substances containing nitrogen and by
alkaloids such as quinine and caffine.
The back of the tongue is particularly sensitive to
bitter.

• 5) Umami taste : proposed machanism of this taste is

through glutamate taste sensors (glutamate
receptors) with the release of neuronal glutamic acid.
 TASTE PATHWAY
TASTE BUDS IN THE
TASTE BUDS IN THE TASTE BUDS IN
POSTERIOR MOST
ANTERIOR 2/3 RD POSTERIOR 1/3 RD
PART AND
OF THE TONGUE OF THE TONGUE
EPIGLOTTIS

INNERVATED INNERVATED
INNERVATED
BY LINGUAL BY
BY THE FIBERS
BANCH OF GLOSSOPHAR
OF VAGUS
THE FACIAL YNGEAL
NERVE
NERVE NERVE

GUSTATORY FIBRES OF THESE NERVES TERMINATE

IN THE NUCLEUS OF TRACTUS SOLITARIUS (NTS)
 2ND ORDER NEURONS ORIGINATING IN THE NTS
CROSSES THE MIDLINE & ASCEND IN THE MEDIAL
LEMINSCUS TO TERMINATE IN THE THALAMUS

3RD ORDER NEURONS ORIGINATE FROM THE

THALAMUS & TERMINATE IN THE CEREBRAL
CORTEX

TASTE AREA 1- located in the postcentral

gyrus close to the somesthetic
representation of the tongue

TASTE AREA 2- lies burried in the insular

cortex.
 ABNORMALITIES OF TASTE SENSATIONS
AGEUSIA
• Loss of taste sensation
• Lesion in facial nerve, chorda tympani or
mandibular division of trigeminal nerve causes
loss of taste sensation in the anterior two third of
the tongue.
• Lesion in glossopharyngeal nerve leads to loss of
taste in the posterior one third of the tongue
HYPOGEUSIA
• Hypoguesia is the decrease in taste sensation. It is due
to increase in threshold for different taste sensations.
However, the taste sensation is not completely lost.

TASTE BLINDNESS
• Taste blindness is a rare genetic disorder in which the
ability to recognize substances by taste is lost.
 DYSGEUSIA
• Disturbance in the taste sensation is called
dysgeusia.
• It is found in temporal lobe syndrome,
particularly when the anterior region of
temporal lobe is affected.
• In this condition, the paroxysmal
hallucinations of taste and smell occur, which
are usually unpleasant.
 DEVELOPMENTAL DISTURBANCES OF
TONGUE

• AGLOSSIA

• Complete absence
of the tongue.
• Rare condition.
• Difficulty in eating &
talking.
• High arched palate,
narrow mandible
 MICROGLOSSIA

Presence of small or rudimentory

tongue.

Often results in severe

dentoskeletal maloclussion
as there is lack of muscular
stimulas between the
alveolar arches.

Syndrome associated-
-Pierre Robin Syndrome
-Oromandibular limb hypogenesis
syndrome
 MACROGLOSSIA
Meaning large tongue
2 types- true macroglossia
- pseudomacroglossia

May cause displacement of teeth

& maloclussion

Sydromes associated-
Down syndrome
Beckwith- wiedemann syndrome

Management- Surgical therapy if needed.

 ANKYLOGLOSSIA
Also known as tongue-tie.

The lingual frenum attaches to the bottom of the tongue &

restricts free movement of the tongue.
Can be complete or partial.

Can lead to feeding problems,

speech defect.

Treatment-
Counselling of the patient.
If needed, Frenectomy
is recommended.
 CLEFT TONGUE
• Complete cleft/ Bifid tongue-
Rare
Occurs due to lack of merging of the lateral lingual
swelling.

• Partial cleft tongue-

More common
Results because of incomplete
merging & failure of groove
obliteration by underlying
mesenchymal proliferation

Food debris & microbes may collectin the cleft & cause
irritation.

Management- regular tongue cleaning.

 FISSURED TONGUE
Also known as scrotal tongue/
lingua plicata.

Characterized by grooves that vary

in depth along the dorsal & lateral
aspects of the tongue.

It is seen in Melkersson-Rosenthal
syndrome.

Management- maintenance of
tongue hygiene.
 MEDIAN RHOMBOID GLOSSITIS
Also known as Central papillary atrophy
of tongue.

The posterior dorsal point of fusion is

occasionally defective, leaving a rhomboid
shaped, smooth erythematous mucosa
lacking in papilla or taste buds.

This lesion is a focal area of susceptibility to candidiasis.

Management - Antifungal agents

Cryosurgery or excisional biopsy in long
standing cases.
 BENIGN MIGRATORY GLOSSITIS
Also known as Geographic tongue/
wandering rash of tongue.

Characterized my changing pattern

of white lines surrounding areas of
smooth, depapillated mucosa.

Lesion confines to the dorsal surface & lateral border

of tongue, but may also occur on the ventral surface.

Patient is usually asymptomatic, but may experience

burning sensation.
 HAIRY TONGUE
Also known as Lingua nigra/ Lingual villosa.

Characterized by hypertrophy/overgrowth of filiform

papillae on the dorsal surface of the tongue.
Normal length of papillae is 1mm.
Here, they may grow upto 15mm.

Etiology-
Fungal & bacterial overgrowth.
Use of certain drugs
Poor oral hygiene
Intake of tea/coffee.

Treatment- includes brushing of tongue with a

toothbrush or tongue scrappers & elimination of
predisposing factor.
 LINGUAL VARICES
A varix is a dilated, tortous vein,
most commonly a vein which is
subjected to increased hydrostatic
pressure but poorly supported by
surrounding tissue.

Varices involving the lingual veins

are relatively common, appearing
red or purple clusters of vessels on
the ventral surface & lateral
borders of tongue as well as floor
of the mouth
 LINGUAL THYROID NODULE
Anomalous condition in which follicles of thyroid
tissue are found in the substance of the tongue,
possibly arising from the thyroid cells that failed to
migrate to its predestined position from
the remnants that became detached &
were left behind.

Clinically appears as nodular mass in or

near the base of the tongue.

May cause dysphagia, dysphonia or dyspnea.

Management- Suppressive thyroxine for 6 months.
- Surgical excision.
 NEUROLOGICAL DISORDERS

• GLOSSODYNIA -Painful tongue.

• GLOSSOPYROSIS- Burning sensation of tongue.
• LINGUAL PARASTHESIA- Just discomfort is felt.
• GLOSSOPLEGIA- Paralysis of the tongue.
 Variations in Tongue Movement
Curling of tongue: Ability to
curl up the lateral borders
of the tongue into a tube

Folding back tip of tongue:

Ability to fold back the tip
of the extended tongue,
without the aid of the
teeth.
Trefoil tongue: Clover leaf pattern

Gorlin sign: Extensibility of the

tongue, both forward to touch tip
of nose and backwards into the
pharynx.
 SYSTEMIC DISEASES
Iron deficiency anemia: Atrophic changes are seen on the dorsum of the tongue. It
first appears at the tip and lateral borders with loss of filiform papilla & later
fungiform papillae.
In extreme cases, the entire dorsum
becomes smooth and glazed. The tongue
may be very painful and is either pale or
fiery red.

Niacin deficiency/ Pellagra-

The tongue become fiery red and devoid of papillae.
The filiform papillae are the most sensitive and dissapear first.
The fungiform papilla may become enlarged.
In advanced cases, all the papillae are lost and reddening become intense.

.
Pernicious anemia:
The patient suffer from general weakness, burning or itching
sensation from the oral mucous membrane with disturbance of
taste and occasional dryness of mouth.
There may be paresthesia & atrophy of filiform
and fungiform papillae.
The tongue is often beefy red in colour.
In advanced cases, dorsum of the tongue
becomes completely atrophic that eventuate
in smooth or bald tongue, which is often referred
to as Hunter’s glossitis or Moeller’s glossitis.
Folic acid deficiency-
There is marked glossitis.
The tongue is fiery red and atrophy of filiform and fungiform papillae
is seen.
The tongue is often swollen and small cracks may appear on the
dorsum of the tongue

Scleroderma:
Fibrosis of submucosal tissue secondary to
the obliteration of small vessels by an autoimmune process is
responsible for a scarred, shrunken and atrophic appearance of the
tongue in scleroderma.
Here, he tongue shrinks, losing its mobility and papillary pattern.
The color of tongue changes to a vivid appearance due to circulatory
disturbances. In the end stages, the tongue lies as a stiff, reduced
body in the floor of mouth
Zoster infection:
It is a viral infection caused by herpes zoster
virus.
Numerous vesicles occur on the surface of
the tongue.

Tuberculosis: The most frequent involved

area is dorsum of the tongue.
There is ulceration with irregular outline
and undermined borders, covered by
yellowish gray fibrinous layer.
Pain is often associated with ulceration.
Syphilis:
Depapillation of the tongue usually occurs
in secondary and tertiary syphilis.
In secondary syphilis, mucus patch occur,
which may be single or multiple on the
tongue.
Tongue in tertiary syphilis may show
gumma formation.
A more diffuse, chronic, non-ulcerating,
irregular induration, with an asymmetrical
pattern of grooves and smooth atrophic
field covering the entire dorsum is seen.
SCARLET FEVER-
Early in the course of the disease, the tongue exhibits a
white coating & the fungiform papillae are edematous
& hyperemic, projecting above the surface as small red
knobs- this is descibed as ‘Strawberry Tongue.’
Later, the coating of tongue is lost & it becomes deep
red, glistening & smooth- described as ‘Raspberry
tongue.’
MALIGNANT TUMORS OF TONGUE
CARCINOMA OF TONGUE
Carcinoma of tongue comprises between 25-
50 % of all intraoral cancer.

Etiology- Chronic trauma/ irritation

Consumption of alcohol & tobacco
Poor oral hygiene
• It typically occurs on the lateral border or
ventral surface of the tongue.
• Rarely it may develop on the dorsum of the
tongue.
• Usually appears as painless mass/ulcer. Becomes painful if
secondarily infected.
• There is excessive salivation, fetor oris, immobility of
tongue, hoarseness of voice & dysphagia.

• Treatment- Surgical excision

Radiation therapy
Chemotherapy.
 SUMMARY
• Tongue is an important organ which helps in
speech, mastication & is the primary organ of taste.
• The dorsum of the tongue is covered by taste buds.
• It is richly supplied with nerves & blood vessels.
• We have also seen various anomalies like
abnormalities of taste sensation, developmental
disturbances of tongue, variations in tongue
movements, appearance of tongue in various
systemic diseases & malignant tumors of tongue.
 REFERENCES
1. B.D. Chaurasia’s Human Anatomy (2013), Volume 3-
Head-Neck Brain, 6th edition.
2. Inderbir Singh’s Human Embryology(2012), 9th
edition.
3. Inderbir Singh’s Textbook of Human
Histology(2011), 6th edition.
4. Sembulingam’s Essential of Medical Physiology, 6th
edition.
5. Shaffer’s Textbook of Oral Pathology(2014), 7th
edition.
6. Ghom’s Textbook of Oral Medicine (2014), 3rd
edition.
 Thank You..
And Have A Nice Day!