TONGUE

• The dorsum (posterosuperior surface) of tongue is divided by a V-shaped sulcus terminalis (Fig. 1.1B) into an anterior, oral
(presulcal) part that faces upwards, and a posterior, pharyngeal (postsulcal) part that faces posteriorly.
• Foramen cecum is located at the apex of the V and indicates the site of origin of the embryonic thyroglossal duct.
• Lingual Papillae are of four types (Fig. 1.2): Circumvallate papillae are arranged in the form of a V in front of the sulcus
terminalis; fungiform papillae on the sides and the apex of the tongue; filiform papillae are most numerous on the dorsum
and foliate papillae are rudimentary.
DEVELOPMENT OF TONGUE AND NERVE SUPPLY
• Tongue develops in ventral portion of pharyngeal arches and have three components:
• Connective tissue: Contributed by pharyngeal arch mesoderm
• Epithelium on the anterior 2/3 of tongue is derived from surface ectoderm and posterior 1/3 from endoderm.
• The ectoderm-endoderm junction marked by sulcus terminalis.
• Muscles of tongue develop from the occipital myotomes (somites). Palatoglossus muscle is an exception, as it
develops in pharyngeal arches.
• Note: Tongue has contribution from all the three germ layers.
• Oral part of the tongue develops from the lingual swellings and tuberculum impar whereas, pharyngeal part develops from
the hypobranchial eminence (Table 1.1 and Fig. 1.1).
• The embryological derivation explains its nerve supply (Table 1.1 and Fig. 1.2).

Fig. 1.1 Development of tongue

Table 1.1 Development of tongue and nerve supply
Embryonic precursor Intermediate structure Adult structure Innervation
Pharyngeal arch 1 • Tuberculum impar Overgrown by lateral • General sensations1: Mandibular nerve
(median tongue bud) lingual swellings (Nerve of arch 1)
• Lateral lingual swellings Mucosa (Anterior 2/3 of • Taste sensations2: Chorda tympani
tongue) (facial nerve)
Pharyngeal arch 2 Copula Overgrown by other
(minimal contribution) structures
Pharyngeal arch 3 Large, ventral part of Mucosa (posterior 1/3 of Glossopharyngeal nerve3
hypopharyngeal eminence tongue) (Nerve of arch 3)
Pharyngeal arch 4 Small, dorsal part of Mucosa of posteriormost Superior laryngeal nerve4
hypopharyngeal eminence tongue (root of tongue) (Nerve of arch 4)
Occipital somites Myoblasts Muscles of tongue Hypoglossal nerve5
(except palatoglossus)
Pharyngeal arch Myoblasts Palatoglossus muscle Cranial accessory nerve6
mesoderm
1: General sensations of anterior 2/3 of tongue are carried by the Lingual nerve →Mandibular nerve → Trigeminal nerve.
2: Taste sensations of anterior two third of tongue (except the circumvallate papillae) are carried by the Chorda tympani nerve
→ Facial nerve.
3: General and taste sensations from the posterior 1/3 of tongue are carried by a branch of Glossopharyngeal nerve. (Contd.)
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4: General and taste sensations from the posterior-most tongue are carried by Internal laryngeal nerve → Superior laryngeal
nerve → Vagus nerve.
5: Hypoglossal nerve supplies motor fibers to all of the intrinsic and extrinsic muscles of the tongue except the palatoglossus.
6: Palatoglossus muscle is supplied by the cranial part of accessory nerve (via vagus accessory complex in pharyngeal plexus).

Fig. 1.2 Nerve supply of tongue and types of papillae.

1 – Circumvallate; 2 – Foliate; 3 – Filiform and 4 – Fungiform papillae.
TASTE PATHWAY

Fig. 1.3: Taste (gustatory) pathways: a - geniculate ganglion of facial nerve, b - superior ganglion of glossopharyngeal nerve, c -
inferior ganglion (ganglion nodosum) of vagus nerve.
Pathway: Cranial nerves (taste) → Nucleus tractus solitarius (rostral portion) → Medial lemniscus → Ventero-Postero-Medial
(VPM) thalamus → Genu of internal capsule →Parietal lobe (gustatory cortex - area 43).
• According to Barr and Kiernann the taste area is located in the inferior part of the parietal lobe posterior to the general
sensory area for the mouth in the post-central gyrus.
• Taste pathway comes under SVA (Special Visceral afferent) category, embryologically. (Mnemonic: SVA – T – NTS)
MUSCLES OF TONGUE
• Tongue has intrinsic and extrinsic musculature.
• Intrinsic muscles—Superior and inferior longitudinal, vertical, and transverse.
• Extrinsic muscles: Genioglossus, hyoglossus, styloglossus, palatoglossus, and geniohyoid.
• Genioglossus muscle pull the tongue anterior, medial and inferior (AIM). It is the chief muscle of tongue protrusion.
• Clinical correlations: Bilateral loss of genioglossus function, for example during deep general anaesthesia or as a
consequence of a central neurologic lesion, results in the tongue falling against the posterior wall, with the attendant risk
of upper airway obstruction and suffocation.
• Thus, the normally functioning genioglossi can be considered as 'safety muscles' that aid in the patency of the upper
airway.
• Genioglossus muscles are innervated with each inspiration and this important muscle activity can become defunct in
certain patients with sleep apnea syndrome – one of the culprit muscle. (Contd.)

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 • In this case as the patient goes into sleep, genioglossus muscle relaxes and is unable to prevent the tongue from falling
backward into the respiratory tube, leading to difficulty in breathing and the patient is forced to wake up momentarily,
again to fall asleep.
• This cycle of fall asleep→ wake-up→ fall asleep continues throughout the sleep period.
HYPOGLOSSAL NERVE

Fig 1.4: Hypoglossal nerve – Origin

(A) Base of brain, showing the nerve arising from the medulla oblongata ventrally in the preolivary sulcus (lying between
pyramids anterior and olives posterior).
(B) Transverse section of upper medulla showing hypoglossal nucleus on dorsal aspect, giving fibres of the nerve, which passes
ventrally and exits medulla lying between pyramid and olive.

Fig 1.5 : Hypoglossal nerve – Course and branches.

The nerve leaves the cranium through the hypoglossal canal, passes through the carotid triangle and enter the digastric
triangle. It goes deep to the mandible to enter the tongue, where it supplies where it supplies the intrinsic and extrinsic
lingual muscles.
The nerve is joined immediately distal to the hypoglossal canal by a branch conveying fibers from the C1 (and C2) loop of the
cervical plexus. These fibers hitch a ride with CN XII and have three destinations: (Contd.)

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 1. A meningeal branch returns to the cranium through the hypoglossal canal and innervates the dura mater on the floor and
posterior wall of the posterior cranial fossa.
2. Some fibres leave the CN XII and continue as superior root of ansa cervicalis (descending hypoglossi), contains C1 fibres to
supply infrahyoid muscles.
3. Few fibres continue further alongwith hypoglossal nerve to supply thyrohyoid and geniohyoid muscles.

LYMPHATIC DRAINAGE OF TONGUE

Fig 1.6 : Lymphatic drainage of the tongue. (A) Course and direction of apical, marginal, and basal lymph vessels; (B) Course
and direction of central lymph vessels and (C) Areas (in dark red) have bilateral lymphatic drainage.
Lymphatics are in four groups:
1. Apical vessels drain the tip and inferior surface of the tongue into submental lymph nodes. Their efferents go to the
submandibular nodes mainly, some cross the hyoid bone to reach the jugulo-omohyoid nodes.
2. Marginal vessels drain the marginal portions of the anterior two-third of the tongue unilaterally into submandibular lymph
nodes and then to the lower deep cervical lymph nodes, including jugulo-omohyoid.
3. Central vessels drain the central portion of the anterior two-third of the tongue (i.e., area within 0.5 inch on either side of
midline). They pass vertically downwards in the midline of the tongue between the genioglossus muscles and then drain
bilaterally into the deep cervical lymph nodes (Fig. 1.6 B).
4. Basal vessels drain the root of the tongue and posterior one-third of the tongue bilaterally into upper deep cervical lymph
nodes, including jugulodigastric.

MULTIPLE CHOICE QUESTIONS

2

1. Anterior 2/3rd of the tongue is demarcated by (AIIMS 2. Tongue develops from all EXCEPT
2016) a. Tuberculum impar
a. Passavant ridge b. Hypobranchial eminence
b. Circumvallate papillae c. Second arch
c. Sulcus terminalis d. Lingual swellings
d. Filiform papillae
3. Posterior one-third of the tongue develops from (NEET 4. Tongue muscles develops from (NEET Pattern 2012)
pattern 2012) a. Occipital somites
a. Lingual swellings b. Hypobranchial eminence
b. Tuberculum impar c. Neural crest cells
c. Hypobranchial eminence d. Pharyngeal pouches
d. Tongue bud
5. Tongue muscle which is NOT developed from occipital 6. The taste pathway from circumvallate papillae of the
myotome (NEET pattern 2015) tongue goes through
a. Styloglossus a. Chorda tympani branch of Facial nerve
b. Hyoglossus b. Greater petrosal nerve branch of Facial nerve
c. Genioglossus c. Superior laryngeal branch of Vagus nerve
d. Palatoglossus d. Lingual branch of Glossopharyngeal nerve

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7. Protrusion of tongue NOT possible in damage of (NEET 8. Palsy of left genioglossus causes
Pattern 2015) a. Deviation of tongue to right
a. Styloglossus b. Deviation of tongue to left
b. Hyoglossus c. Deviation of soft palate to right
c. Palatoglossus d. Deviation of soft palate to left
d. Genioglossus
9. All of the following about hypoglossal nerve are true 10. In complete unilateral damage to hypoglossal nerve, all are
EXCEPT true EXCEPT (AIIMS 2012)
a. C1 fibres enter cranial cavity along with it a. Tongue atrophy on affected side
b. Passes through carotid triangle and enter digastric b. Deviation of tongue towards the site of lesion
triangle c. Deviation of Larynx to the contralateral side during
c. Send C1 fibres into inferior root of ansa cervicalis swallowing
d. Carry C1 fibres to supply thyrohyoid and geniohyoid d. Loss of tactile sensation on affected side
11. All are supplied by ansa cervicalis EXCEPT (AIIMS) 12. Nucleus tractus solitarius receive fibers from all of the
a. Thyrohyoid following cranial nerves EXCEPT
b. Sternothyroid a. Facial
c. Sternohyoid b. Glossopharyngeal
d. Inferior belly of omohyoid c. Vagus
d. Accessory
13. Taste pathway comes under the neural column 14. UNTRUE about lymphatics of tongue is
a. SSA (Special Somatic Afferent) a. Apical vessels drain into submental lymph nodes
b. GSA (General Somatic Afferent) b. Marginal vessels drain into submandibular lymph
c. SVA (Special Visceral Afferent) nodes
d. GVA (General Visceral Afferent) c. Basal vessels drain into jugulo-omo-hyoid lymph
nodes
d. Central vessels have bilateral lymphatic drainage
ANSWERS WITH EXPLANATIONS
1. c. Sulcus terminalis
• Sulcus terminalis V shape structure which divides the tongue into anterior two-thirds (oral part) and posterior one-third
(pharyngeal part).
• The two parts differ in their developmental origin and accordingly mucosa, innervation and lymphatic drainage as well.
2. c. Second arch
• Second arch has minimal contribution in the adult tongue.
3. c. Hypobranchial eminence
• Posterior one-third of the tongue develops from the cranial (ventral) part of hypobranchial eminence (copula of His).
4. a. Occipital somites
• Tongue muscles develop from occipital myotomes (somites) and are innervated by the hypoglossal nerve.
• One tongue muscle (palatoglossus) develops in pharyngeal arch mesoderm.
5. d. Palatoglossus
• Tongue muscles develop from occipital myotomes except palatoglossus, which develop in pharyngeal arches.
• All tongue muscles are supplied by hypoglossal nerve except palatoglossus (supplied by cranial accessory nerve via the
vagus accessory complex in the pharyngeal plexus).
6. d. Lingual branch of Glossopharyngeal nerve
• SVA (special visceral afferent) fibers for taste sensation from
• Anterior two-thirds of the tongue run in the chorda tympani of the facial nerve
• Posterior one-third of the tongue run in the glossopharyngeal nerve
• Root of tongue and epiglottis is carried by the internal laryngeal branch of the superior laryngeal nerve (branch of the
vagus).
• Palate are carried by the facial nerve through its greater petrosal branch which sends fibers into the palatine nerves.
7. d. Genioglossus
• Posterior part of genioglossus pulls tongue anteriorly for protrusion.
8. b. Deviation of tongue to left
• Genioglossus muscle moves the tongue anterior, inferior and medial (AIM).
• Bilateral contraction of genioglossus help in protrusion and depression of tongue in midline, since the vector of medial
pull is balanced and cancelled.
• Palsy of left genioglossus muscle deviates the tongue to the left side, due to unopposed medial pull of the right
genioglossus (as shown in the following fig.).

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9. c. Send C1 fibres into inferior root of ansa cervicalis
• Hypoglossal nerve sends C1 fibres into superior (not inferior) root of ansa cervicalis.
10. d. Loss of tactile sensation on affected side
• Tactile sensation of tongue is not carried by the hypoglossal nerve, hence there will be no loss of tactile sensation on the
tongue.
• Hypoglossal nerve is a pure motor nerve and there is no loss of taste sensation or general sensation of tongue in its
lesion.
• Hypoglossal nerve supplies the tongue muscles. It also carries the C-1 fibres to supply the two muscles of hyoid bone:
Geniohyoid and thyrohyoid.
• Lesion of the hypoglossal nerve causes unilateral tongue paralysis and eventual hemiatrophy.
• Since muscle on the affected side is paralyzed, the normal (unaffected) muscle becomes unopposed and pulls the
tongue further across the midline, and tongue deviates to the side of the lesion.
• The larynx may deviate towards the active side in swallowing due to unilateral paralysis of the hyoid depressors
associated with loss of the first cervical (C1) spinal nerve, which runs with the hypoglossal nerve. (Gray’s anatomy).
11. a. Thyrohyoid
• Ansa cervicalis supplies numerous neck muscles but thyrohyoid and geniohyoid are supplied by C1 fibres of spinal cord
carried by the hypoglossal nerve.
12. d. Accessory
• Nucleus tractus solitarius is present in the medulla oblongata and through it run the solitary tract axons from the facial,
glossopharyngeal and vagus nerves.
• Accessory nerve is a pure motor nerve, its cranial part is included under special visceral efferent (SVE) neural column, as
it supplies the pharyngeal arch muscles of palate, pharynx and larynx.
13. c. SVA
• Special Visceral Afferent (SVA) fibers transmit taste sensations to the CNS.
• SSA (Special Somatic Afferent) carry special somatic sensations of smell (CN I), vision (CN II) and hearing & balance (CN
VIII).
• GSA (General Somatic Afferent) carry general somatic sensations like touch, pain, temperature etc.
• GVA (General Visceral Afferent) carry general visceral sensations like angina pain, colicky pain etc.
14. c. Basal vessels drain into the jugulo-omo-hyoid lymph nodes
• Basal vessels drain the root of the tongue and posterior one-third of the tongue bilaterally into upper deep cervical
lymph nodes, including jugulodigastric (and not jugulo-omo-hyoid).

HIGH YIELD FACTS

• Taste sensation from anterior 2/3rd of tongue is carried by chorda tympani (branch of facial nerve), towards the facial nerve
and geniculate ganglion (NEET Pattern 2012).
• C1 fibres of spinal cord, doesn’t have cutaneous supply. C1 dermatome is absent in the body.
• Epiglottis develops in fourth pharyngeal arch.
• Lemniscus: A bundle of fibres for e.g., Lemnisci are the collections of nerve fibres passing through the brainstem. Medial
lemniscus carries taste and lateral lemniscus carry auditory fibres in the brainstem.

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