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TONGUE, PALATE, PALATINE TONSILS AND PHARYNX

Tongue
The tongue is located in the oral cavity proper.

The lower surface of the tongue is connected to the floor of the mouth by a median fold of the
mucus membrane called frenulum linguae.

It is a mass of skeletal muscle covered by mucus membrane. The roof of the tongue is attached
to the mandible and hyoid bone via muscles. This makes it impossible to swallow the tongue
during deglutition.

The body of the tongue is divided into two on the dorsal surface be the sulcus terminalis:

 Oral part……Anterior 2/3

 Pharyngeal part….posterior 1/3

The oral tongue has a larger number of the following papillae while the pharyngeal tongue has
a larger number of lymphoid vesicles (lingual tonsils), mucus and serous glands.

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The ventral surface of the tongue has the deep lingual veins and the frenulum linguae.

Clinical relevance

 Tongue tie
 Tongue carcinoma

Muscles of the tongue

They are divided into two groups:

 Intrinsic muscles
 Extrinsic muscles

The intrinsic muscles are within the tongue and have no attachment outside the tongue
whereas extrinsic muscles take origin from structures outside the tongue and enter the tongue
to be inserted in it.

Intrinsic muscles

 Superior longitudinal
 Inferior Longitudinal
 Vertical
 Transverse

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The above muscles are paired.

Confined to the tongue and have no bony attachment. They affect the shape and size of the
tongue

Their motor innervation is via the hypoglossal nerve.

Extrinsic muscles

 Genioglossus
 Hyloglossus
 Styloglossus
 Palatoglossus

They are all supplied by the hypoglossal nerve except the palatoglossus that is supplied by the
vagus nerve (motor innervation)

Function of the muscles include :

Genioglossus Inferior fibres protrude the tongue, middle

fibres depress the tongue, superior fibres
draw the tip of the tongue back and down.
Hyloglossus Depress and retractthe tongue
Styloglossus Retracts and elevates the tongue
Palatoglossus Elevates the posterior aspect of the tongue

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The tongue is supplied by the following arteries:

 Lingular artery (branch of the external carotid)

 Tonsilar branch of the facial artery
 Ascending pharyngeal artery

The tongue is drained by the lingual vein located in the ventral part of the tongue.

Lymphatic drainage
Anterior 2/3--- Submental and submandibular lymph nodes >>>> deep cervical lymph nodes

Posterior1/3----Directly into the deep cervical lymph nodes

Clinical relevance

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Hypoglossal nerve palsy/ paralysis –Patients with this condition present with deviation of
the tongue towards the damaged side on protrusion

PALATE
This refers to the roof of the mouth. It forms division between the nasal and the oral
cavities.

It is divided into two parts

 Hard palate—forms anterior 4/5 of the palate. It is immobile. Comprised of bone.

 Soft palate---forms anterior 1/5 of the palate. Comprises of muscle fibres covered by
mucus membrane. It can be elevated to close the pharyngeal isthmus during
swallowing—This prevents the food bolus from entering the nasopharynx

Hard palate

Forms the anterior aspect of the palate .

It has the following foramina:

 Incisive fossa(incisive canals/foramina)—Nasopalatine nerve and greater palatine

vessels
 Greater palatine foramen---greater palatine nerve and vessels.
 Lesser palatine Foramen---lesser palatine nerve and vessels

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The hard palate is lined by keratinized squamous epithelium.

It is supplied by the palatine arteries that originate from the third part of maxillary artery.

Veins of the hard palate drain into the pterygoid venous plexus (mainly) and the pharyngeal
venous plexus.

The hard palate is supplied by greater palatine and nasopalatine nerves derived from
pterygopalatine ganglion.

Lympatics from this region mainly drain into the upper deep cervical lymph nodes and a few
into the retropharyngeal lymph nodes.

Soft palate

It is located posteriorly. It is mobile and comprised of muscle fibres covered by mucus

membrane.

It separates the nasopharynx from the oropharynx

Inferior border is free and forms the anterior boundary of the pharyngeal isthmus. A conical,
small, tongue-like projection hanging down from its middle is called uvula

Two arches bind the palate to the tongue and pharynx i.e. palotoglossal and palatopharyngeal
arches

Between these two arches lie the palatine tonsils, which reside in the tonsillar fossa of the
oropharynx.

It has folds of mucus membrane enclosing 5 muscles

In the sub mucosa of both the surfaces there are mucus glands especially around the uvula and
the oral part of the soft palate.

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The mucosa on the oral surface may also contain taste buds (especially in children) and
lymphoid follicles.

It contains 5 pair of muscles:

 Tensor veli palatini

 Levator veli palatini
 Palatoglossus
 Palatopharyngeus
 Musculus Uvulae

*functions of each muscle

Functions

1. Separates the oropharynx from nasopharynx during swallowing so that food does not enter
the nose. 2. Isolates the oral cavity from oropharynx during chewing so that breathing is not
affected.

3. Helps to modify the quality of voice, by varying the degree of closure of the pharyngeal
isthmus.

4. Protects the damage of nasal mucosa during sneezing, by appropriately dividing and directing
the blast of air through both nasal and oral cavities.

5. Prevents the entry of sputum into nose during coughing by directing it into the oral cavity

It is supplied by the following arteries:

 Lesser palatine branch of maxillary artery

 Ascending palatine branch of facial artery
 Palatine branch of ascending pharyngeal artery

Venous drainage is into the pharyngeal and pterygoid venous plexuses

Lymph from the soft palate is drained into the retropharyngeal and upper deep cervical lymph
nodes.

Motor supply—all by accessory nerve except the tensor palatini—mandibular nerve

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Sensory supply—lesser palatine nerve and glossopharyngeal nerve

Clinical relevance

Cleft lip and cleft palate

Cleft lip occurs when the medial nasal prominence and the maxillary prominence fail to fuse.

Cleft palate can occur in the isolation when the palatal shelves fail to fuse in the midline. Or in
combination with cleft lip.

Palatine Tonsils (Waldeyer’s ring)

located in the tonsillar fossa. They are two in number. Located between the palatoglossus and
the palatopharyngeal arch. Each tonsil is an almond-shaped mass of lymphoid tissue.

Also called faucial tonsils. Located on the

right and left side side of the throat. Can
be seen as flesh coloured, pinkish lumps

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The tonsillar bed is made up of the following:

 Pharingiobasilar fascia
 Superior constrictor muscle
 Buccopharyngeal fascia

Supplied by the following arteries:

 Tonsillar branch of facial artery

 Dorsalis linguae branches of lingual artery.
 Ascending palatine
 Ascending pharyngeal
 Greater palatine (descending palatine)

Venous drainage

Paratonsillar vein>>>pharyngeal venous plexus

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Lymph draine into the deep group of cervical lymph nodes (jugulogastric lymph node)

Supplied by glossopharyngeal l nerve and the lesser palatine branches of the sphenopalatine
ganglion.

Clinical relevance
Tonsillitis—this the inflammation of the tonsils. Acute tonsillitis is the most common
manifestation of tonsillar disease. Associated with sore throat, fever and difficulty in
swallowing

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