TONGUE

DEVELOPMENT, ANATOMY, HISTOLOGY,

NEUROVASCULAR SUPPLY, & GUSTATION
- Dr. Aparna Aarathi Sreekumar
I MDS

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CONTENTS
■ INTRODUCTION

■ DEFINITION

■ DEVELOPMENT

■ EXTERNAL FEATURES

■ MUSCLES OF TONGUE

■ VASCULAR SUPPLY
■ NERVE SUPPLY
■ LINGUAL SALIVARY GLANDS 2
■ HISTOLOGY
■ FUNCTIONS
■ CONDITIONS ASSOCIATED WITH TONGUE
■ DEVELOPMENTAL ANOMALIES
■ OTHER TONGUE PATHOLOGIES
■ CLINICAL SIGNIFICANCES
■ CONCLUSION
■ REFERENCES

3
INTRODUCTION
■ The word ‘tongue’ is derived from the Latin word ‘lingua’ &

Greek word ‘glossa’

■ Tongue is a muscular organ situated in the floor of the

mouth.

4
■ It is associated with the functions of taste, speech,
mastication, deglutition

■ It is essentially a mass of skeletal muscle covered by

mucous membrane

■ The tongue is sometimes pathologically affected as a part of

some oral disease or as signs of some systemic diseases

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DEFINITION
■ “A fleshy movable muscular organ in the mouth of a
mammal, used for tasting, licking, swallowing, & (in
humans) articulating speech”
- English Oxford Dictionary
■ “A mobile organ which bulges upwards from the floor of the
mouth, & its posterior part forms the anterior wall of the
oral part of the pharynx”
- Cunningham’s Manual of Practical Anatomy
(Vol. 3) – 15th Edition

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DEVELOPMENT OF TONGUE

■ Begins at 4 weeks of IUL

■ Pharyngeal arches arises as a mesodermal thickening in the
lateral wall of the foregut & that it grows ventrally to become
continuous with corresponding arch of opposite side
■ Phayngeal arches meet in midline beneath primitive mouth
■ Local proliferation of mesenchyme gives rise to many
swellings in floor of mouth
Human Embryology – 8th Ed – Inderbir Singh & G P Pal
Ten Cate’s Oral Histology – 6th Ed – Antonio Nanci
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Tuberculum impar arises in the midline in mandibular process, flanked
by lingual swellings

They enlarge & merge with each other, from which the mucous
membrane of anterior 2/3 arises

Epithelium proliferates just behind the tuberculum impar,

forming thyroglossal duct

This downgrowth marks a depression – Foramen caecum

Medial swelling in relation to medial ends of 2nd, 3rd, & 4th arches
– hypo-branchial eminence - 5th week of IUL

2 parts – cranial & caudal – cranial part relates with 2nd, 3rd arches –
copula, caudal part forms epiglottis
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 •From 2 lingual swellings and one
Anterior 2/3 tuberculum impar, i.e., from first
branchial arch

•From the cranial half of the

Posterior 1/3 hypobranchial eminence, i.e., from
the third arch

Posterior-most part •From the fourth arch

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10
 Root •From the hypobranchial eminence

Musculature •From the occipital myotomes

•1st made up of a single layer of cells

Epithelium •Later becomes stratified & papilla
becomes evident

•Formed in relation to terminal

Taste Buds branches of innervating nerve fibres

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EXTERNAL FEATURES

■ PARTS
Tip

Body

Root
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TIP/APEX
• Anterior free end
• At rest – lies behind upper incisor
teeth

BODY
• Has 2 parts:
1.Curved upper surface – Dorsum
2.Inferior surface

ROOT
• Attached to mandible & soft
palate above & to hyoid below
• In between the 2 bones, it is
related to geniohyoid &
mylohyoid
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DORSUM OF TONGUE
■ Tip to anterior surface of epiglottis
■ Convex in all directions
■ Divided by sulcus terminalis (faint V-shaped groove) into:
– Oral part / Anterior 2/3
– Pharyngeal part/ Posterior 1/3
■ Apex of ‘V’ – points posteriorly – marked by a pit – foramen
ceacum
■ 2 limbs of ‘V’ – run laterally & forwards up to palatoglossal arches

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Oral Part ■ Superior surface shows a
median furrow
■ Thick mucous membrane is
roughened by presence of
papillae – foliate papillae

■ Inferior surface covered with a

smooth mucous membrane, a
median fold – frenulum linguae
■ Another fold – plica fimbriata –
directed forwards & medially
towards tip of tongue

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Pharyngeal ■ Forms the anterior wall of
Part oropharynx

■ Mucous membrane has no

papillae

■ Rich in lymphoid follicles –

lingual tonsil

■ Mucous glands are also present

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Posteriormost ■ Connected to epiglottis by 3 folds

Part of mucous membrane:

– R & L lateral glossoepiglottic
folds
– Median glossoepiglottic folds

■ On either side of median fold – a

depression – vallecula

■ Lateral folds separate vallecula

from piriform fossa
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Lingual Papillae
■ Projections of mucous membrane or corium which gives
anterior 2/3 of the tongue, its characteristic roughness
1.Vallate/ circumvallate papillae
• Largest in size
• 1-2mm diameter
• 7-12 in number
• Anterior to sulcus terminalis
• Shape of a short cylinder sunk into tongue
surface, with a deep trench around it
• Opposite walls of trench – studded with taste
buds
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2.Fungiform papillae
•Smaller
•Numerous
•Near tip & margins, some are scattered over dorsum
•As bright red spots
•Each is attached by a narrow base(pedicle), expands
into a rounded knob-like free extremity(head)

3.Filiform papillae
•Minute
•Most numerous
•Cover all over presulcal part of dorsum & margins in rows
•Velvety appearance
•Each is pointed & covered with keratin
•Cornified apices may be broken up into thread-like
processes during inflammation 21
4.Foliate papillae
•Minute
•Very rare
•Lateral margins of posterior part
•Pink in colour
•Consists of 4-11 parallel ridges that alternate with deep
groves in mucosa
•Few taste buds are present in epithelium of lateral walls
of these ridges

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Inferior Surface & Sides
■ Covered with smooth, thin mucous membrane
■ Anteriorly – in midline – mucosa is raised into a sharp fold
which joins the inferior surface to floor of the mouth –
frenulum linguae
■ Each side of frenulum:
1. Deep lingual vein – seen through mucous membrane
2. A fringed fimbriated fold of mucous membrane –
inferolaterally
3. Opening of Wharton’s duct on sublingual papilla – on
floor of mouth
4. Sublingual fold
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■ On the sides of tongue, anterior to lingual attachment of the
palatoglossal arch – 5 short, vertical folds of mucous
membrane – folia linguae
■ These carry taste buds

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 MUSCLES OF TONGUE
❖ A middle fibrous septum divides tongue into right & left halves

INTRINSIC Superior Longitudinal

FIBRES Inferior Longitudinal
Transverse
Vertical
EXTRINSIC Genioglossus
FIBRES Hyoglossus
Styloglossus
Palatoglossus
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Intrinsic Muscles
■ Occupy upper part of tongue
■ Attached to submucous fibrous layer & to median fibrous
septum
■ They alter the shape of tongue

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 • Lies beneath mucous membrane
Superior
• Shortens tongue
Longitudinal
• Makes dorsum concave
• A narrow band lying close to inferior
surface of tongue between genioglossus
Inferior & hyoglossus
longitudinal
• Shortens tongue
• Makes dorsum convex
• Extends from median septum to
Transverse margins
• Makes tongue narrow & elongated
• At borders of anterior part of tongue
Vertical
• Makes tongue broad & flattened 27
 Fan-shaped – main bulk of tongue
Origin:
Extrinsic •Arises from superior genial tubercle
Muscles above the origin of geniohyoid

1.Genioglossus Insertion:
•Upper fibres – into the tip
•Middle fibres – into the dorsum
•Lower fibres – into the hyoid bone
Action:
•Protrusion
•Bilaterally – Central part depression
•Unilaterally – Diverges to the opposite
side
•Upper fibres – retract tip
•Middle fibres - depress the tongue
•Lower fibres – pull posterior part of
tongue forwards & protrusion of tongue28
 Quadrilateral muscle

Extrinsic
Muscles Origin:

2.Hyoglossus •Greater cornua & lateral part of body of

hyoid bone

Insertion:

•Side of the tongue between styloglossus

& inferior longitudinal

Action:

•Depresses the tongue 29

 Origin:
Extrinsic
•Styloid process near its apex
Muscles
3.Styloglossus
Insertion:

•Longitudinal part into the inferior

longitudinal muscles
•Oblique part into hyoglossus

Action:

•Draws the tongue upwards & backwards

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 Origin:
Extrinsic •Palatine aponeurosis of soft palate
Muscles
4.Palatoglossus Insertion:

•Side of the tongue

Action:

•Elevates the posterior part of the tongue

•Bilaterally - approximates the
palatoglossal folds to constrict the
isthmus of the fauces
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VASCULAR SUPPLY
• Chief supply – Lingual Artery
• A branch of external carotid
artery(after passing deep to the
hyoglossus muscles)
• Divides into :
• Dorsal lingual arteries: supplies
ARTERIAL posterior part
SUPPLY • Deep lingual artery: supplies the
anterior part
• Sublingual artery: supplies the
sublingual gland and floor of
the mouth
• Root – supplied by Tonsillar &
Ascending pharyngeal Arteries
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34
■ VENOUS DRAINAGE
– “Vena comitantes”
– 2 of them – accompany lingual artery & 1- accompanies
hypoglossal nerve
– Deep Lingual Vein /Ranine Veins– largest & principal vein of
tongue – visible on the inferior surface of tongue
■ Joins with sublingual veins from sublingual salivary
gland
■ It runs backwards & crosses genioglossus & hyoglossus
below hypoglossal nerve
– Dorsal Lingual Vein drains the dorsum and sides of the
tongue
■ They unite – Lingual Vein –at posterior border of
hyoglossus
■ Drains into Common Facial Vein or in Internal Jugular Vein

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36
Lymphatic Drainage
• Drain to bilateral submental nodes or directly
Tip to deep cervical nodes
• Marginal lymphatics from the anterior part -
Both halves of Drain to ipsilateral submandibular nodes or
remaining part directly to inferior deep cervical nodes
of anterior 2/3 • Central lymphatics - Drain to deep cervical
nodes of either side
• Drains directly and bilaterally to deep cervical
Posterior 1/3 nodes (Jugulodigastric and Jugulo-omohyoid
nodes)
• Eventually drain through the jugulo-omohyoid
All lymph from
nodes, before reaching the thoracic duct or
the tongue
right lymphatic duct
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38
NERVE SUPPLY
Nerve Supply

Sensory
Motor Nerves
Nerves

General
sensation

Special
sensation
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Motor Supply Sensory Supply
NERVE ANTERIOR POSTERIOR POSTERIOR
■ All intrinsic & extrinsic SUPPLY 2/3 1/3 MOST PART/
muscles – Hypoglossal VALLECULA

Nerve Sensory Lingual Glossoph Internal

■ Exception – aryngeal Laryngeal
Palatoglossus – cranial Branch of
Vagus
part of Accessory Nerve
through Pharyngeal Taste Chorda Glossoph Internal
Plexus Tympani, aryngeal Laryngeal
except including Branch of
Vallate Vallate Vagus
Papillae Papillae

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LINGUAL SALIVARY GLANDS
■ GLANDS OF VON EBNER
– On posterior aspect of tongue
– Exclusively serous
– Secrete lingual lipase
– Innervated by cranial nerve glossopharyngeal nerve
– Functions:
1. Washout of trough papillae
2. Enables the taste buds to respond rapidly to changing
stimuli
3. Antibacterial activity – lysozyme & peroxidase
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■ GLANDS OF BLANDIN & NUHN
– Anterior lingual glands (also called apical glands) -
deeply placed seromucous glands
– Located near the tip of the tongue on each side of the
frenulum linguae
– Found on the inferior surface of the apex of the tongue
– Covered by a muscular fibers derived from the
Styloglossus & Longitudinalis inferior
– 12 to 25 mm. in length, & approximately 8 mm. wide
– Each opens by three or four ducts on the inferior surface
of the tongue's apex

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■ GLAND OF WEBER
– Lie along the lateral border of the tongue
– Pure mucous secreting glands.
– Opens into the crypts of the lingual tonsils on the
posterior tongue dorsum.
– Abscess formed due to accumulation of pus and fluids
in this gland - Peritonsillar Abscess

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HISTOLOGY
■ Substance of tongue – chiefly made up of skeletal muscle,
supported by connective tissue
■ The muscle – arranged in bundles that run in vertical,
transverse, longitudinal directions
■ Connective tissue septum – divides tongue into right & left
halves
■ Surface – covered by mucous membrane, lined by stratified
squamous epithelium
■ Epithelium is supported on a layer of connective tissue
■ Epithelium – non-keratinised in inferior surface
■ Collections of lymphoid tissue – posterior part of dorsum of
tongue
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 ■ Papillae:-
– Filiform, foliate, fungiform, circumvallate papillae
– new variety discovered- papilla simplex
– Cant seen by naked eye
– They are projections of connective tissue
■ Mucous & serous glands:-
– Present in connective tissue
– Mucous glands – mostly in pharyngeal part
– Open into recesses of mucosa that dip into masses of
lymphoid tissue
– Serous glands – present in relation to circumvallate
papillae, opening into furrows surrounding them
Ablation of NTPDase2+ Cells Inhibits The Formation Of Filiform Papillae In Tongue Tip, Feng Li et.al,
Animal Model Exp. Med. 2018;1:143-151 47
48
Taste Buds

■ Present in relation to circumvallate, fungiform papillae, &

leaf-like folds of mucosa (folia linguae)
■ Mainly present on postero-lateral part of the tongue, also on
soft palate, epiglottis, palatoglossal arches, posterior wall of
oropharynx
■ Each taste bud is a piriform structure, made up of modified
epithelial cells
■ Extends through entire thickness of epithelium

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■ Each bud has a small cavity –
opens to surface through –
gustatory pore; cavity – filled with
polysaccharides
■ Cells present – elongated &
vertically oriented
■ Those towards periphery – curved
like crescents
■ Each cell has a central broader
part containing nucleus & tapering
ends
■ 2 types:
– Receptor cells/gustatory cells
– related to afferent nerve
endings
– Supporting cells 50
FUNCTIONS
Taste Speech Mastication

Barrier Jaw
Deglutition
function development

Defence Maintenance
Secretion
mechanism of oral hygiene

General
sensitivity

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Taste Discrimination/ Gustation
Gustatory
receptors detect
four main types
of taste
sensation: Umami/ savoury
taste – identified
• Sweet : tip by Kikunae
• Sour : middle Ikeda(1908) –
• Salty : 5th basic taste
anterolateral
• Bitter : base

Umami The 5th Basic Taste: History Of Studies On Receptor Mechanisms & Role As A Food Flavour,
Kenzo Kurihara; BioMed Research International, 2015:Article ID-189402,10 pages
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 Anterior 2/3 – facial, Posterior 1/3 –
Gustatory glossopharyngeal, Posteriormost - vagus

pathway Ganglia 0f 7th, 9th, & 10th cranial nerves (1st

order)
Gustatory portion of Nucleus tractus solitarius
in Medulla oblongata + 2nd order neurons

Ipsilateral Medial lemniscus

Ventral Posteromedial nucleus of Thalamus

3rd order neurons(axons) – through Thalamic

Radiation

Face area of Somatosensory cortex in

Ipsilateral Post central gyrus (GUSTATORY
CORTEX)
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 ■ Chemoreceptors respond to
Mechanism of substances dissolved in oral
fluids
taste ■ Substance forms a weak bond to
perception receptor protein
■ Receptor- inside - -vely charged,
TASTE RECEPTOR outside - +vely charged
SOUR ENaC, HCN ■ Chemical stimuli – partial loss of
–ve potential
SALT ENaC
■ Microvilli – more permeable to
SWEET G – PROTEIN COUPLED Na+ ions, Na+ enters cell,
RECEPTOR causing depolarisation
BITTER G – PROTEIN COUPLED ■ This change in receptor potential
GUSTDUCIN – action potential in sensory
UMAMI GLUTAMATE RECEPTOR fibres innervating the gustatory
cell receptor 54
Factors affecting taste sensation

1. Area of stimulation 7. Taste preference & control

2. Duration of diet

3. Temp. of substance 8. Affective nature of taste

4. Olfaction 9. Sex

5. Adaptation 10. Individual variations

6. Interaction between taste-

producing substances

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Speech

An “overlaid process” secondary to vegetative

functions

Processes of respiration, phonation, resonances

& articulation are co-ordinated & integrated by
nervous system to produce complex & dynamic
behaviour, known as speech production

Tongue plays role in phonation & articulation of

speech

56
Mastication

■ Closing phase:
– Initiates the breaking up process by pressing food
against hard palate
– Pushes food onto occlusal surfaces of teeth for crushing
■ Opening phase of next chewing cycle: tongue repositions the
partially crushed food onto the teeth for further break down
■ Helps in collecting & sorting food suitable for swallowing

57
Deglutition

■ Upper surface of tongue helps to manipulate food for chewing &

swallowing
■ Preparatory phase – tongue acts like a spoon in preparing &
positioning the bolus
■ Oral phase – elevation of anterior 2/3 of tongue propels the
bolus from oral cavity to pharynx
■ Pharyngeal phase - Tongue is pressed against palate & blocks
off oral cavity during swallowing to prevent bolus from shooting
back out the mouth

58
59
 Barrier Function Jaw Development
Acts as a barrier in
blocking food entering Tongue & mandible have
into respiratory system common origins
while swallowing

Done by increasing They arise simultaneously

intraoral pressure by from mandibular arch &
pressing against the are co-ordinated in their
hard palate development & growth

Mandible & Tongue Development, Carolina Parada, Yang Chai; Current Topics in Developmental Biology
60
 Maintenance
Defence General
Secretion of Oral
Mechanism Sensation
Hygiene
• Mucous & • Lysozymes • Tongue • Tongue
serous present in flushes also helps
glands of secretions saliva all in general
tongue of glands over the sensation
gives its are oral cavity of oral
secretory antimicrobi & bathes cavity to
function al the teeth, stimuli like
• Lymphoid preventing pain,
tissue in food touch,
posterior accumulati heat,
1/3 acts as on & itching etc.
a barriers lodgement
of infection in between
the teeth
61
 CONDITIONS ASSOCIATED WITH
TONGUE
GLOSSALGIA Pain in the tongue
GLOSSITIS Inflammatory condition of tongue
GLOSSODYNIA/
GLOSSOPYROSIS Burning sensation of tongue
GLOSSOPLEGIA Paralysis of tongue
GLOSSOPTOSIS Abnormal downward displacement of tongue
GLOSSOTOMY Dissection of tongue
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DEVELOPMENTAL ANOMALIES

■ Aglossia & Microglossia ■ Fissured Tongue

Syndrome ■ Hairy Tongue
■ Macroglossia ■ Lingual Thyroid
■ Ankyloglossia ■ Varicosities
■ Cleft Tongue

63
Aglossia & Microglossia
Syndrome

Very rare
Associated with malformities in extremities, cleft palate & dental
agenesis
Extreme glossoptosis with a rudimentary, small tongue
Severe dentoskeletal malformations
No gender predilections & no genetic implications
Etiology: fetal cell traumatism in 1st few weeks of gestation

64
Macroglossia
■ Tongue hypertrophy, prolapses of tongue, enlarged tongue,
pseudomacroglossia
■ Etiology of pseudomacroglossia:
1. Habitual posturing
2. Enlarged tonsils &/ or adenoids
3. Decreased oral cavity volume
4. Hypotonia of tongue
5. Neoplasms
6. Retrognathism

65
■ Etiology of true macroglossia:
1. Congenital causes
Idiopathic muscle hypertrophy
Lymphangioma
Hemangioma
Beckwith- Wiedman Syndrome
Trisomy 22
Gargoylism
Mucopolysacharoidosis
66
2. Acquired Causes
– Metabolic / Endocrine – hypothyroidism, diabetes,
cretinism
– Inflammatory / Infectious – syphilis, scurvy, pellagra,
small pox, typhoid, Ludwig’s angina, candidiasis, giant
cell arteritis, etc
– Systemic/ medical conditions – uremia, myxedema,
acromegaly, neurofibromatosis
– Traumatic – surgery, haemorrhage, RT, intubation injury
– Neoplastic – carcinoma, plasmacytoma
– Infiltrative – amyloidosis, sarcoidosis

67
Treatment – surgery – reduce tongue size & improve function
68
Ankyloglossia/ tongue-tie
More common in boys

Inferior frenulum attaches to bottom of

tongue, restricting the movements

Clinical features:
• Mild, moderate, & severe cases
• Speech defects
• Displacement of epiglottis & larynx – rare
• Various degrees of dyspnoea
Treatment - frenulectomy
69
Cleft tongue

Completely clefted/ bifid tongue – rare

Partially clefted tongue – common, manifests as a deep grove

in midline of dorsal surface
Etiology: lack of fusion of lateral lingual swellings
• Partial clefts – due to incomplete merging & failure of groove
obliteration by underlying mesenchymal proliferation

May associated with oro-facial-digital syndrome

70
Fissured tongue/ Scrotal tongue/
Lingua plicata
Very common

Dorsum & lateral surfaces

Grooves vary in depth

Etiology: polygenic mode of inheritance

Seen in Melkerson-Rosenthal Syndrome, Down’s Syndrome & benign

migratory glossitis
H/f: thickening of lamina propria,loss of filiform papillae, hyperplasia
of rete pegs
Treatment: no definite treatment/ medication
71
Hairy tongue
Lingua nigra/lingua villosa/lingua villosa nigra/black hairy tongue

Etiology:defective desquamation of filiform papillae - hypertrophy

May appear in different colours – specific etiology & secondary
factors
Associated with poor oral hygiene, tobacco use, coffee/ tea
drinking
Males>females

HIV infection, IV drugs, Candidal overgrowth

Asymptomatic, rarely glossopyrosis, gagging – severe cases

72
DD: candidiasis, leukoplakia, OLP,
oral hairy leukoplakia

H/f:elongated filiform papillae,mild

hyperkeratosis, presence of
inflammatory cells

Treatment:

• Oral hygiene practices

• Surgical removal of papillae –
CO2 laser, electrodesication

Excellent prognosis
73
Lingual thyroid

■ Etiology: Follicles of thyroid tissue are found in the substance of

tongue that failed to migrate to its predestined position
■ C/f: a nodular mass in/ near base of tongue – around foramen
ceacum, 2-3cm
■ Dysphagia, dyspnea, haemorrhage, pain or discomfort
■ H/f: resembles normal thyroid tissue
■ DD: median rhomboid glossitis
■ Treatment: surgical excision
74
Lingual varices/ varicosities

■ Dilated, tortuous vein with raised hydrostatic pressure &

poorly supporting surrounding tissue
■ Ranine veins – commonly involved
■ Red / purple clusters of vessels on ventral & lateral
surfaces, floor of the mouth
■ After 50yrs
■ Thrombosis - common

75
OTHER TONGUE PATHOLOGIES
RED LESIONS

KERATOTIC LESIONS

NEOPLASMS

OTHER COMMON LESIONS

ABNORMALITIES OF TASTE SENSATION

76
 ■ Geographic tongue/ Erythema
migrans/glossitis areata
Red Lesions migrans/glossitis areata
Beningn exfoliativa/annulus migrans/ wandering
rash
Migratory ■ Etiology: unknown,associated with stress
Glossitis ■ C/f: burning sensation, depapillation,
■ Females, 5-84yrs, diabetes, psoriasis
■ H/f:loss of filiform papillae,thinning of
mucosa,Monro’s abscess,thin rete pegs
■ DD: Reiter’s syndrome, psoriasis
■ Treatment:no treatment, prednisolone -
symptomatic
77
Red Lesions
Median Rhomboid Glossitis
Etiology: earlier, considered as a developmental defect due to non-fusion of
tuberculum impar & lateral lingual swellings
Now considered as candida infection – POSTERIOR MIDLINE ATROPHIC
CANDIDIASIS
C/f: Smooth, flat rhomboid/oval shaped area of depapillation on dorsum,
concomitant erythrematous area in midline of soft palate (KISSING
LESION)
Middle aged males, diabetes
H/f:atrophic epithelium, pseudoepitheliomatous hyperplasia,dilated
capillaries, candida & inflammatory cell infiltration
DD: Lingual thyroid

Treatment: no treatment, prednisolone - symptomatic 78

79
Nutritional Deficiency Vit.B2/
Riboflavin
- MAGENTA
TONGUE

Vit. B6/
Chronic Niacin
glossitis - SCARLET
TONGUE

Vit.B12/
Cyanocobalamine
- BEEFY RED
TONGUE

80
81
Red Tongue of Xerostomia

■ Deep red colour with burning sensation

82
Syphilis

1⸰ 2⸰ 3⸰

83
 ■ White patch/plaque that can’t be
characterised clinically or
Keratotic pathologically as any other
disease
Lesions ■ Etiology: TOBACCO, spicy foods,
Leukoplakia trauma, virus, Candida
■ Homogeneous, speckled,
combination, Verrucous
■ Males>females
■ H/f: dysplastic changes in
epithelium
■ DD: candidiasis, OHL, OLP
■ Malignant potential – field
cancerisation
■ Treatment:habit cessation
84
 ■ Oral hairy leukoplakia(OHL)/HIV-
associated hairy leukoplakia
Keratotic ■ White patch on the side of the
Lesions tongue with a corrugated or hairy
appearance.
OHL ■ Etiology: EBV infection
■ H/f: no dysplasia, hyperplastic
and parakeratinized epithelium,
with "balloon cells" (lightly
staining cells) in the upper
stratum spinosum and "nuclear
beading" in the superficial layers
■ No malignant transformation
■ DD: leukoplakia, OLP, candidiasis
■ Treatment: the lesion itself is
benign and does not require any
treatment 85
 ■ Mucocutaneous white lesion
Keratotic ■ Etiology: autoimmune reaction
Lesions ■ Reticular, erosive
Lichen Planus ■ Wickham’s striae
■ Males<females
■ Premalignant condition
■ DD: leukoplakia, OHL,
candidiasis

■Lichenoid reaction –
drugs, restorative materials,
dentrifices, etc
86
WHITE SPONGE NEVUS

PEMPHIGUS

CANDIDIASIS
87
Neoplasms

SCC

MALIGNANT MELANOMA

FIBROMA
88
Other Lesions

APHTHOUS ULCER

HERPETIC TONGUE

SCARLET FEVER
89
Abnormalities of Taste Sensation
Ageusia – absence of taste
• Lesions of facial, glossopharyngeal nerve or congenital
Hypogeusia – diminished taste sensitivity
Dysgeusia – altered taste sensation
• Temporal lobe lesion
Familial dysautonomia
Selective taste blindness/non-tasters
• Mendelian recessive trait
• Very high increase in threshold to bitter taste of phenyl
thiourea
• All other taste sensations are normal to them
90
CLINICAL SIGNIFICANCES
1. GAG REFLEX 2. PARALYSIS OF
■ Posterior part – on GENIOGLOSSUS
palpation causes gag ■ Tongue tends to fall
■ Glossopharyngeal & posteriorly
vagus –muscular ■ Airway obstruction,
contraction of each side suffocation
of pharynx ■ In GA, an airway is
■ Glossopharyngeal inserted – to prevent
branches – afferent limb tongue from relapsing
of gag reflex

91
3. INJURY TO 4. SUBLINGUAL
HYPOGLOSSAL NERVE ABSORPTION OF DRUGS
■ Trauma injuring ■ Pills / spray – put under
hypoglossal nerve – the tongue, where it
unilateral paralysis – dissolves & enters into
atrophy deep lingual vein
■ Deviates to affected side ■ Quick absorption (<1min)
on protrusion ■ Eg: nitroglycerin – angina
■ Due to unaffected action pectoris
of genioglossus on
opposite side

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5. THYROGLOSSAL DUCT 6. FLAPS FROM TONGUE
CYST ■ Used for reconstruction of
■ Cystic remnant of defects in palate, lip
thyroglossal duct – found ■ Rich vascular supply
in root of the tongue
■ May connected to
foramen ceacum

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7. MALLAMPATTI SCORE
■ Seshagiri Mallampatti
■ To predict the ease of
endotracheal intubation
■ Visual assessment of
distance from tongue base to
roof of the mouth
■ 1 & 2 – easy intubation
■ 3 & 4 – difficult intubation &
higher incidence of sleep
apnea

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8.TASTE MODALITIES

■ IV inj. of histamine – metallic taste

■ Patients with jaundice – bitter taste Protective
■ Deadly plant toxins – alkaloids –bitter taste Action
■ Saccharin – 600 times sweeter than sucrose
■ P-4000 – very toxic – 5000 times sweeter than sucrose
■ Miraculin – taste modifying protein from miracle fruit in Africa –
sour substances taste sweet

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CONCLUSION
■ Tongue is a mass of striated muscle, covered with a specialised
mucosa textured with lingual papillae

■ Occupies most of the oral cavity when mouth is closed

■ Its extrinsic muscles control its placement, while intrinsic

muscles control its shape, for chewing, swallowing & speech

■ Highly sensitive with 4 cranial nerves contributing fibres to it

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REFERENCES
1. Gray’s Anatomy for Students – Richard L.Drake,Wayne Vogl, Adam
W.M. Mitchell(989-996)
2. Cunningham’s Manual of Practical Anatomy, Vol.3, 15th Ed –
G.J.Romanes(166-171)
3. B.D. Chaurasia’s Human Anatomy – Vol.3, 4th Ed –
B.D.Chaurasia(249-254)
4. Clinically Oriented Anatomy – 5th Ed – Keith L.Moore, Arthur
F.Dalley(1002-1008)
5. Human Embryology – 8th Ed – Inderbir Singh & G P Pal (143-146)
6. Ten Cate’s Oral Histology – 6th Ed – Antonio Nanci (44-45,364-
367)
97
 REFERENCES
6. Orban’s Oral Histology & Embryology – 12th Ed – G.S.Kumar(10-
14,237-239)
7. Essentials of Oral Biology – Maji Jose (289-298)
8. Textbook of Human Histology – 4th Ed – Inderbir Singh(222-225)
9. Oral & Maxillofacial Pathology- 3rd Ed – Neville, Damm, Allen,
Bouquot(9-16,362-433,741-752)
10.Shafer’s Textbook of Oral Pathology – 6th Ed – Shafer,
Hine,Levy(22-33)
11.Differential Diagnosis of Oral and Maxillofacial Lesions, 5th Ed -
Norman K. Wood, Paul W. Goaz (90-95)

98
12.Textbook of Medical Physiology – 2nd Ed – N. Geetha(650-652)
13.Ablation of NTPDase2+ Cells Inhibits The Formation Of Filiform
Papillae In Tongue Tip, Feng Li et.al, Animal Model Exp. Med.
2018;1:143-151
14.Airway Management, An Issue of Anaesthesiology, DCNA, June
2015 – Lynette Mark(283-284)
15.Umami The 5th Basic Taste: History Of Studies On Receptor
Mechanisms & Role As A Food Flavour,Kenzo Kurihara; BioMed
Research International, 2015:Article ID-189402,10 pages
16.Mandible & Tongue Development, Carolina Parada, Yang Chai;
Current Topics in Developmental Biology

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