The Tongue. Everything about it.
69
ONGUE A Dr. Amit T. Suryawanshi Presentation
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Transcript of The Tongue. Everything about it.
TONGUE A
Dr. Amit T. Suryawanshi Presentation
Created & Presented byDr. Amit T. Suryawanshi (MDS)
Facial Cosmetic SurgeonOral & Maxillofacial Surgeon
Dental Surgeon & ImplantologistHair Transplant Surgeon (Germany)
Consulting Surgeon in Kolhapur, Sangli, Pune & Mumbai (India)
& founder of
Face Art International Super specialityat Kolhapur
Cell Phone no. +91 9405622455Clinic Landline - +91 7758976097
Email– [email protected]
INTRODUCTION
DEVELOPMENT
ANATOMY
TASTEBUDS
MUSCLES
ARTERIAL SUPPLY OF TONGUE
VENOUS DRAINAGE OF TONGUE
LYMPHATIC DRAINAGE OF TONGUE
NERVE SUPPLY OF TONGUE
STRUCTURE OF TONGUE
FUNCTION OF TONGUE
SPECIALISED EXAMINATION OF TONGUE
DEVELOPMENTAL DISTURBANCES OF TONGUE
TONGUE BIOPSY
TONGUE FLAPS
DEVELOPMENT OF TONGUETONGUE DEVELOPS DURING 4TH – 8TH WEEK
OF PRENATAL DEVELOPMENT.
IT DEVELOPS FROM INDEPENDENT SWELLINGS FORMED BY THE FIRST FOUR BRANCHIAL ARCHES.
BODY OF THE TONGUE : 1ST ARCH
BASE OF THE TONGUE : 3RD & 4TH ARCH
Some Recent FindingsYamane A. Embryonic and postnatal
development of masticatory and tongue muscles.
"Tongue myogenesis follows a similar regulatory program to that for limb myogenesis. Myogenesis and synaptogenesis in the masticatory muscles are delayed in comparison with other muscles and are not complete even at birth,
whereas the development of tongue muscles proceeds faster than those of other muscles and ends at around birth.
The regulatory programs for masticatory and tongue myogenesis seem to depend on the developmental origins of the muscles, i.e., the origin being either a somite or somitomere, whereas myogenesis and synaptogenesis seem to progress to serve the functional requirements of the masticatory and tongue muscles."
The tongue has contributions from all pharyngeal arches which changes with time. The tongue initially begins as swelling rostral to foramen cecum, the median tongue bud.
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ANATOMY OF TONGUE
INFERIOR SURFACE OF TONGUE
DORSUM OF THE TONGUE
PAPILLAE OF TONGUE
MUSCLES-INTRINSIC
MUSCLES-EXTRINSIC
ARTERIAL SUPPLY OF TONGUE
VENOUS DRAINAGE
LYMPHATIC DRAINAGE
NERVE SUPPLY
STRUCTURE OF THE TONGUEMUCOUS MEMBRANETASTEBUDS
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FUNCTIONS OF THE TONGUESpeechMasticationDeglutitionDigestionTasteBarrier functionJaw developmentSecretionDefence mechanismMaintainance of oral hygieneSuckingGeneral sensitivity
SPECIALIZED EXAMINATIONS OF TONGUECINERADIOGRAHYCOMPUTER ASSISTED TOMOGRAPHYPULSED(DOPPLER) ULTRASOUNDREAL TIME ULTRASOUND ISOTOPIC SCANNING TECHNIQUEELECTROMYOGRAPHYSCANNING ELECTRON MICROSCOPETRANSMISSION ELECTRON MICROSCOPY
MICROGLOSSIA
ANKYLOGLOSSIACLEFT-TONGUE
FISSURED TONGUE
GEOGRAPHIC TONGUE
MEDIAN RHOMBOID GLOSSITIS
LINGUAL THYROID NODULE
LINGUAL VARICOSITIES
HAIRY TONGUE
MACROGLOSSIA
DEVELOPMENTAL DISORDERS OF TONGUE
MICROGLOSSIA
MACROGLOSSIA
• The terms 'ankyloglossia', 'short fraenum', 'short fraenulum', or 'tongue tie’, refer to a restricted lingual fraenum due to consolidation of tissue. Leading to reduced mobility of the tongue.
• Ankyloglossia occurs as a result of the fusion of the lingual frenum to the floor of the mouth.
• Partial ankyloglossia or "tongue-tie" is a much more common condition, because complete fusion rarely occurs.
• This leads to a myriad of speech problems such as lisping and stuttering , periodontal and swallowing problems.
ANKYLOGLOSSIA
• This is the gross appearance of the tongue when the patient was asked to Stick out tongue.
• Note the classic symptom of a bifid or bilobed lingual apex with a corresponding midline "cleft" or septal limitation.
Clinical features
This photograph shows the tongue's anatomy as the patient is asked to pull tongue back into mouth as far as possible.
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• Manual elevation of the lingual apex by the examiner.
• The treatment is to surgically sever the connection between the frenum and the floor of the mouth.
• In young children treatment is postponed until 4 – 5 years since it is difficult to access severity of disorder in early life.
Frenectomy
Photographs are added in the presentation with patient’s permission.
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CLEFT-TONGUE
• Cleft tongue is a condition where the tongue has a cleft running right across it horizontally.
• Complete clefting (Diglossia) is extremely rare and occurs as a result of lack of developmental forces to push both halves of the tongue towards each other.
• Partial clefting presents as a deep groove in the middle of the tongue and is a common feature in the oro-facial-digital syndrome (thick fibrous bands in lower anterior mucobuccal fold and clefting of hypoplastic mandibular alveolar process).
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FISSURED TONGUE
SCROTAL TONGUE
FURROWED TONGUE
LINGUA FISSURATA
LINGUA PLICATA
LINGUA SCROTALIS
PLICATED TONGUE
CEREBRIFORM TONGUE
GROOVED TONGUE
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Benign migratory glossitis or Erythema migrans or Psoriasiform mucositis is a benign condition that occurs in about 3% of the general population.
GEOGRAPHIC TONGUE
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CLINICAL FEATURES
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TREATMENTNo medical intervention is required because the
lesion is benign and most often asymptomatic.
In severe cases topical corticosteroids in the form of fluocinonide & beta methasone gel with zinc suppliments can be prescribed.
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MEDIAN RHOMBOID GLOSSITISMedian rhomboid glossitis or central papillary atrophy or
posterior lingual papillary atrophy is a focal area of susceptibility to recurring or chronic atrophic candidiasis.
Prompting a recent movement toward the use of posterior midline atrophic candidiasis as a more appropriate diagnostic term.
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CLINICAL FEATURES
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TREATMENT
No treatment is necessary for median rhomboid glossitis, but nodular cases are often removed for microscopic evaluation.
Recurrence after removal is not expected, although those cases with pseudoepitheliomatous hyperplasia should be followed closely for at least a year after biopsy to be certain of the benign diagnosis.
Antifungal therapy (topical troches or systemic medication) will reduce clinical erythema and inflammation due to candida infection.
Some lesions will disappear entirely with antifungal therapy. 05/01/2023
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LINGUAL THYROID NODULE
Accessory accumulation of thyroid tissue that is usually functional within the body of the posterior tongue.
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CLINICAL FEATURESThe lingual thyroid is four times more common in females than
in males. 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, but most patients are unaware of the mass at the time of diagnosis, which is usually in the teenage or young adult years.
Up to 70% of patients with lingual thyroid have hypothyroidism and 10% suffer from cretinism.
Other sites of ectopic thyroid deposition include the cervical lymph nodes, submandibular glands and the trachea. Rarely, parathyroid glands are associated with the ectopic thyroid tissue.
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TREATMENTSurgical excision or radioiodine therapy are
effective treatments for lingual thyroid, but no treatment should be attempted until an 131iodine radioisotope scan has determined that there is adequate thyroid tissue in the neck.
Endocrine evaluation for hypothyroidism should, therefore, be done in such cases. In this light, it is important to know that three of every four patients with infantile hypothyroidism have ectopic thyroid tissue
Occasional patients with parathyroid tissue associated with their lingual thyroid have developed tetany after their inadvertent removal.
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In those patients lacking thyroid tissue in the neck, the lingual thyroid can be excised and autotransplanted to the muscles of the neck.
However, Most cases require no treatment and in cases where biopsy is necessary it should be considered with caution because of the potential for hemorrhage, infection or release of large amounts of hormone into the vascular system (thyroid storm).
Rare examples of thyroid carcinoma arising in the mass have been reported, almost always in males.
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LINGUAL VARICOSITIES Prominent lingual veins, usually observed on the
ventral and lateral surface of the tongue are called lingual varicosities.
These are hemmorhoid (dialated veins) caused by the decrease in the amount of surrounding connective tissue.
A normal variant in adults over 60 years of age believed to be related to the aging process.
It's occurance increases with age or increased blood pressure
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• Enlarged veins usually purple or red or clusters on ventral and lateral surface of the tongue.
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HAIRY TONGUECommonly observed condition of defective
desquamation of the filiform papillae that results from a variety of precipitating factors.
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CLINICAL FEATURES
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TREATMENT
Treatment of hairy tongue is variable.
In many cases, simply brushing the tongue with a toothbrush or using a commercially available tongue scraper is sufficient to remove elongated filiform papillae and retard the growth of additional ones.
Surgical removal of the papillae by using electrodesiccation, carbon dioxide laser or even scissors is the treatment of last resort when less complicated therapies prove ineffective.
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APPLIED ANATOMY OF TONGUE:INJURY TO HYPOGLOSSAL NERVE PRODUCES
PARALYSIS OF THE MUSCLES OF THE TONGUE.
GLOSSITIS : USUALLY A PART OF GENERALIZED ULCERATION. IN CERTAIN ANAEMIAS TONGUE BECOMES BALD DUE TO ATROPY OF THE FILLIFORM PAPILLAE.
DUE TO PRESENCE OF RICH NETWORK OF LYMPHATICS & OF LOOSE AREOLAR TISSUE IN THE SUBSTANCE OF TONGUE IS RESPONSIBLE FOR ENORMOUS SWELLING OF THE TONGUE IN ACUTE GLOSSITIS.
UNDERSURFACE OF TONGUE IS A GOOD SITE FOR OBSERVATION OF JAUNDICE.
IN UNCONSCIOUS PATIENT THE TONGUE MAY FALL BACK & OBSTUCT THE AIR PASSAGES.
IN PATIENT WITH GRAND MAL EPILEPSY THE TONGUE IS COMMONLY BITTEN DURING ATTACK.
CARCINOMA OF THE TONGUE IS QUITE COMMON . IT IS BETTER TREATED WITH RADIOTHERAY THAN SURGERY .BUT SINCE FACILITIES FOR IRRADIATION ARE NOT ALWAYS AVAILABLE THE AFFECTED PART IS REMOVED SURGICALLY. ALL THE DEEP CERVICAL LYMPH NODES ARE ALSO REMOVED BECAUSE OF RECURANCE OF MALIGNANT DISEASE OCCURS IN LYMPH NODES.
CARCINOMA OF POSTERIOR 1/3RD OF THE IS MORE DANGEROUS DUE TO BILATERAL LYMPHATIC SPREAD.
Applied anatomy
•Carcinoma of the lat. part of ant 2\3rd of tongue spreads unilaterally. Thus a hemiglossectomy with unilateral lymph node dissection can be done.
•Gag reflex occurs on touching the post. 1\3rd of the tongue. IX n.provides the afferent limb of the reflex.
•Injury to hypoglossal n. due to fracture mandible leads to unilateral paralysis of tongue. Tongue deviates to the paralysed side on protrusion.•Paralysis of genioglossus occurs when the patient is unconscious. The tongue falls back & the patient may suffocate to death. Tongue is pulled forward in an unconscios patient. Genioglossus is called a safety muscle•Sublingual absorption of drugs – for fast absorption of drugs they are placed sublingually because of the thin mucosa which allows quick absorption
THYROGLOSSAL DUCT CYST
ABERRANT THYROID GLAND
TONGUE BIOPSY
INTRAORAL RECONSTRUCTION WITH TONGUE FLAPS-FOR THE CLOSURE OF PERFORATIONS IN
HARD PALATE
-PALATAL ALVEOLAR FISTULA AFTER NOMA
DEFECT ON THE LOWER ASPECT OF TONGUE AND FLOOR OF THE MOUTH
CHEEK AREA RECONSTRUCTION
MIDLINE GLOSSOTOMY
RECONSTRUCTION OF PARTIAL GLOSSECTOMY DEFECTS
RECONSTRUCTION OF THE BASE OF TONGUE AND TOTAL GLOSSECTOMY DEFECTS
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