Tongue patwal

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Presented by ,HARSHAVARDHAN PATWAL

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Contents

• Introduction• Development• Functions• External Features • Papilla of Tongue• Taste buds• Intrinsic Muscles• Extrinsic Muscles

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Contents

• Blood Supply• Nerve Supply• Lymphatic Drainage• Clinical/applied anatomy• Evaluation of swallowing• Normal and abnormal deglutition• Clinical examination• Disorders Of tongue• Treatment • References

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Tongue

• INTRODUCTION :• The tongue is a muscular structure that forms

part of the floor of the oral cavity and part of the anterior wall of the oropharynx. Its anterior part is in the oral cavity and is somewhat triangular in shape with a blunt apex of tongue. The apex is directed anteriorly and sits immediately behind the incisor teeth .

Continued…• The root of the tongue is attached to the

mandible and the hyoid bone .• The superior surface of the oral or anterior two-

thirds of the tongue is orianted in the horizontal plane.

• The pharyngeal surface or the posterior one-thirds of the tongue curves inferioroly and becomes orianted more in the vertical plane.

• The oral and pharyngeal surfaces are seperated by a v-shaped terminal sulculas of tongue .

Continued …• This terminal sulcus forms the inferior margin of the

oropharyngeal isthemus between the oral and the pharyngeal cavities .

• At the apex of the v-shaped sulcus is a small depression (the foramen cecum of the tongue) which marks the site in the embryo where the epithelium invaginated to form the thyroid gland.

• In some people a throglossal duct persists and connects the foramen cecum on the tongue with the thyroid gland in the neck.

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Functions

• speaking.• Squeezing food into the pharynx

while swallowing.Other functions:TasteMasticationDeglutitionArticulationOral cleansing

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Embryological Development

• Starts in the 4th month of IU life.• Develops in relation to the pharyngeal

arches in the floor of the developing mouth.• Proliferation of medial-most parts of

mandibular arches Lingual swellings.• Separated by another swelling that appears

in the midline.• Median swelling Tuberculum impar.

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• Immediately behind the tuberculum impar,

the epithelium proliferates to form a

downgrowth (thyroglossal duct ) this site

is marked by foramen caecum.

• Another midline swelling in relation to the

medial ends of the 2nd, 3rd & 4th arches

hypobranchial eminence.

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• Subdivisions:

CRANIAL PART related to the 2nd & 3rd arches

Copula.

CAUDAL PART related to the 4th arch ( forms

the epiglottis ).

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Development

•2 lingual swellings•1 tuberculum impar

Ant.2/3rd

•Hypobrachial Eminence Post.1/3rd

•4th brachial archPost. most part

•Occipital myotomesMuscles

•Local mesenchymeConnective Tissue

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External Features Mandible and

Soft palate• Root Hyoid Bone • Tip Behind Incisors

Dorsal Surface

• Body

Ventral Surface

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Dorsal surface

• Convex in all directions.

• Divided into 2 parts by a faint V-

shaped groove (sulcus terminalis):

1. An oral /papillary part (antr. 2/3rds).

2. A pharyngeal part (postr. 1/3rd).

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ANTERIOR 2/3rd :-

Dorsal Surface

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Foramen Caecum

• A median pit at which the two limbs of the V meet.

• Site from which the thyroid diverticulum grows down in the embryo.

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Oral/ Papillary Part

• Floor of the mouth.

• Free margins.

• Each margin shows 4 to 5 vertical folds –

foliate papillae – located just in front of

the palatoglossal arch.

• Superior surface shows a median furrow.

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ventral Surface

• Covered with a smooth mucous membrane.

• Median fold – frenulum linguae.

• Either side – prominence produced by the

deep lingual veins.

• Laterally – folds called the plica fimbriata.

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Ventral Surface

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Ventral surface of tongue: anatomy

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Pharyngeal/ Lymphoid Part

• Lies behind the palatoglossal arches & the sulcus

terminalis.

• Postr. surface – forms the antr. part of the oropharynx.

• Mucous membrane – no papillae but many lymphoid

follicles – lingual tonsil.

• Mucous glands.

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Posterior 1/3rd

Lies behind the palatoglossal arches and sulcus terminalis. Anterior wall of pharynx. It is devoid of papillae, but has many lymphoid follicles It is connected to the palate by a fold of mucous membrane called the

palatoglossal fold.

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Posterior most part

It is connected to the epiglottis by 3 folds of mucous membrane – Median glossoepiglottic fold and right and left lateral glossoepiglottic folds.

On either side of the median fold there is a depression called the Vallecula.

The lateral folds separate the vallecula from the piriform fossa.

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Histology of tongue

The mucous membrane of the tongue is formed by stratified squamous epithelium resting on a lamina propria of connective tissue.

Dorsum surface of the tongue

Anterior 2/3rd-

The epithelium is thick and keratinized.

Freely attached to the connective tissue.

Has a velvety or rough appearance due to the

presence of papillae.

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Posterior 1/3rd

Covered by lymphoid tubercles.

It is smooth and glistening.

Inferior surface of the tongue Mucous membrane is smooth, thin and loosely attached.

Made of non-keratinized epithelium.

Contains adipose tissue.

Sub lingual glands lie close to the sublingual fold.

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Papilla Of Tongue

1. Circumvallate papillae Situated in front of the sulcus terminalis Cylindrical projection surrounded by a

circular sulcus. Large in size 1-2mm in diameter. 8-12 in number. Taste buds are present on the

surrounding wall and trough like depression.

Concerned with bitter taste

They are projections of mucous

membrane which gives the

anterior 2/3rd its

characteristic roughness

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2. Fungiform papillae- Numerous near the tip and margins

of the tongue.

Mushroom like.

Distinguished by their bright red

colour.

Contains taste buds.

Concerned with Salty taste at the

margins and Sweet taste at the tip.

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3. Filliform papillae- Conical, pointed hair like structures

covered with keratin, 2-3mm in length, on

dorsum of tongue.

Gives the tongue, its velvety appearance.

Apex is split into filamentous processes,

that gives it a rough appearance and helps

to masticate the food.

They have no taste buds.

They contain receptors for pain, touch,

temperature and pressure.

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4. Foliate papillae-

Leaf like present on the lateral margins of the posterior part of tongue. Concerned with sour taste. They are rudimentary in man.

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PAPILLAE OF THE TONGUE

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Specialized receptors that occur in the oral cavity and pharynx, 30-80 in number.

50-80micron in length, 30-50micron in diameter. Flask shaped, Barrel shaped or Spindle shaped. Numerous on Vallate and Foliate papillae. Also present on epiglottis, pharynx and palate. Apically they have a taste pit or taste pore of 2-

3micron. They are maximum in children and decreases with

age. Life span of taste buds is 10-14 days. They are the Receptors for taste stimuli.

Taste buds

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There are four types of cells-

1. Type I cells or dark cells or Neuroepithelial cells

Form 50-60%

Slender and irregularly shaped.

Apex of the cells ends in microvilli in the taste pore.

2. Type II cells or light cells or Sustenticular cells.

Regularly shaped oval cells, forms 30-40% of

cells.

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3. Type III cells

Oval cells, that end in narrow club shaped organ or projection in the

taste pore

Forms 5-15% of cells.

It has vesicles that resembles synaptic vesicles.

It forms the taste receptor.

4. Type IV cells-

Basal cells or undifferentiated precursors of above cells.

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Taste buds

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Taste sensation

The word Taste comes from the

Latin Taxare, meaning “to

touch”, or estimate or judge.

The receptors for taste are

chemoreceptors. Activated

when in contact with acqueous

solution.

Taste buds are the sensory

receptor organ for taste.

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Basic taste sensations-1. Sweet

Filliform

2. Salty

3. Bitter- Circumvallate papillae

4. Sour – Foliate papillae

5. Umami – Recently identified, elicited by glutamate.

All the papilla except Filliform Papilla contain taste buds.

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Transmission of taste sensation to CNS-

From ant 2/3rd – lingual nerve and chorda tympani nerve.

Post 1/3rd- glossopharyngeal nerve.

Base of the tongue- vagus nerve.

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Taste Pathway

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Muscles of tongue

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Intrinsic Muscles

• Shortens tongue•Makes dorsum concave

Sup. Longitudinal

• Shortens tongue• Makes dorsum convexInf.

Longitudinal

• Makes the tongue narrow and elongated.

Transverse

• Makes the tongue broad and flattened

Vertical

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Extrinsic Muscles

• Attaches - MandibleGenioglossus

• Attaches - Hyoid BoneHyoglossus

•Attaches - Styloid Process

Styloglossus

•Attaches - Palate

Palatoglossus

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1. Genioglossus muscle :-

Main bulk of the tongue, fan shaped.

Origin :- Upper genial tubercles.

Insertion :- Upper fibres - Tip of tongue

Middle fibres - Dorsum

Lowers fibres - hyoid bone

Actions :-

Upper fibres - Retract the tip

Middle fibres – Depresses

Lowers fibres - Protrudes

Nerve supply :- Hypoglossal nerve

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2. Hyoglossus muscle :-

Quadrilateral muscle, connects the tongue to

the hyoid bone.

Origin- Greater cornu and body of hyoid bone.

Insertion- Side of the tongue, between

styloglossus and inferior longitudinal muscle.

Actions - Depresses the tongue

Makes it dorsum convex

Retracts the protruded tongue.

Nerve supply- Hypoglossal nerve

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3. Styloglossus muscle :- Connects the tongue to styloid process. Origin - Styloid process and stylomandibular ligament. Insertion - Side of the tongue. Actions - Retracts and elevates the tongue. Nerve supply - Hypoglossal nerve.

4. Palatoglossus muscle :- Origin - Palatine aponeurosis Insertion - Side of the tongue Actions - Approximates the palatoglosaal arches, thus helps in closing the

oropharyngeal isthmus. Nerve supply - Cranial part of the accessory nerve

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Blood Supply

• Arterial Supply : Lingual artery – branch of External Carotid Artery Root of the tongue : Tonsillar branch of Facial artery Ascending Pharyngeal branch of External Carotid Artery

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• Venous Drainage : Vena comitanes – veins of the tongue.

Variable arrangement.

2 vena comitanes accompany the lingual artery.

1 vena comitanes accompanies the hypoglossal nerve. Deep Lingual Vein – the largest and principal vein of

tongue. All unite at the postr. border of the hyoglossus to form

the lingual vein, which ends either in the common facial vein or the internal jugular vein.

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Motor : 1. All the Intrinsic and Extrinsic muscles except Palatoglossus – Hypoglossal

nerve 2. Palatoglossus – Cranial root of

accessory

Nerve Supply

Sensory

Taste

Ant 2/3rd

Lingual

Chorda Tympani

Post 1/3rdGlosso

pharyngeal

Glossopharyngeal

Post Most

Vagus

Vagus

Nerve Supply

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Lingual & Glossopharyngeal Nerves

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Motor Nerve supply

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Sensory nerve supply

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Lymphatic drainage

Tip Submental Nodes

Ant 2/3rd (except tip)

Submandibular Nodes

Post 1/3rd Jugulo -omohyoid

Post most part Upper deep cervical Nodes

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Lymphatic Drainage

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Clinical Anatomy

• Injury to any part of the taste pathway – abnormality in appreciation of taste.

• Glossitis : As part of generalized ulceration of the oral cavity or stomatitis. Atrophy of filliform papilla.

• Anemias : In certain anemias, tongue becomes smooth due to atrophy of filliform papillae.

• The under surface of the tongue is a good site along with bulbar conjunctiva for observation of jaundice

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• In Unconscious Patient – tongue may fall back – obstruct the air passage.

• In diseases of the post. part of tongue- Pain is Referred - to the ear, glossopharyngeal nerve is a common supply for both regions.

• Sorbitate – taken sublingually – for immediate relief of angina pectoris- absorbed fast because of rich blood supply of tongue.

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Tongue lacerations

Cause serious bleeding due to rich vascularity. In grand mal epilepsy- tongue is bitten, can be

prevented by putting a mouth gag.

Foliate papillae

Common area where cancerous lesions are likely to occur.

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• Genioglossus - ‘safety muscle of the tongue’ because if it is paralysed – tongue will fall back in oropharynx .

• During Anesthesia, tongue is pulled forwards to clear the air passage.

In unconscious patient Prevented either by making the patient lie down on one side with the head down (the ‘tonsil position’) or by keeping the tongue out mechanically.

• In patients with grand mal epilepsy Mouth gag should be used to prevent the tongue from being bitten during the attack.

Paralysis of the genioglossus muscle

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Injury to hypoglossal nerve- Paralysis of the muscles on the affected

side - Tongue is pulled to the opposite side

and protruded to the paralysed side. Infranuclear lesions (Motor neuron

disease and Syringomyelia)– Hemiatrophy

of the affected half. Supranuclear lesions( pseudobulbar

palsy)- Paralysis of the muscles without

wasting.

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Ca tongue Affected side removed surgically.

Block dissection of neck (removal of all the deep

cervical nodes) to prevent recurrence.

Ca of postr. 1/3rd of the tongue

More dangerous due to bilateral lymphatic

spread.

Removal of trigeminal ganglion –

Causes temporary loss of taste sensation.

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Evaluation of Swallowing

• Study of deglutitional cycle

1st step in functional assessment.

• INFANTILE/ VISCERAL SWALLOW:

Relatively large tongue in neonates.

Located in the fwd. position for suckling.

Tip inserts through the gum pads.

Helps in the antr. lip seal.

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Evaluation of Swallowing

• Eruption of incisors at 6 months

Tongue position starts to retract.

• TRANSITIONAL PERIOD:

Over a period of 12 to 18 months.

Proprioception causes postural &

functional changes in the tongue.

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Evaluation of Swallowing

• SOMATIC/ MATURE SWALLOW:

Also called functionally balanced swallow.

Develops b/w 2-4 yrs normally.

• Persistence of visceral swallow after the 4th yr

Dysfunctional or abnormal because of its

association with certain malocclusive

characteristics.

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Infantile Swallow

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Somatic Swallow

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Normal Deglutition

• No tongue thrust or constant fwd. posture.

• Tip of the tongue supported on the lingual of

dentoalveolar area.

• Slight contraction of peri-oral muscles.

• Teeth in momentary contact.

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Normal Deglutition

• 4 STAGES :

[Based on original work by Gwynne-Evans (1954),

Ballard (1956) & Björk (1972)]

STAGE 1:

Antr. third of dorsum flat or contracted.

Food bolus collected on the flat antr. part of the

tongue or in the sublingual area in front of the

retracted tongue.

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Normal Deglutition

Postr. arched part of dorsum in contact with the soft palate.

Closed postr. seal – swallowing cannot take place yet.

Teeth & lips not in contact.

STAGE 2:Soft palate moves in a cranial & postr. direction.

Palatolingual & palatopharyngeal seals open up.

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Normal Deglutition

Tip of the tongue moves up as the dorsum drops

Creates a groove or depression in the mid. third.

Permits postr. transport of the bolus.Simultaneously a slight contraction of the lip muscles while the lips are in contact.

Approximation of anterior teeth at the end of this stage.

Symptoms of tongue thrust syndrome observable.

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Normal Deglutition

STAGE 3:Superior constrictor muscle ring in epipharyngeal wall (Passavant’s pad ) starts to constrict.

Seen as a bulge in the postr. wall on lateral cephs or in cinefluorography.

Soft palate assumes a triangular form

Both tissues form the palatopharyngeal/

velopharyngeal seal.

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Normal Deglutition

Nasopharynx closes

Posterior part of dorsum drops more.

Allows the bolus to pass through the isthmus

faucium.Simultaneously, the antr. part of the tongue is pressed against the hard palate.

Helps to manipulate the bolus in a posterior

direction.

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Normal Deglutition

Tongue pushes agst. the tensed soft palate Squeezes the residual food out of the oropharyngeal area.The terminal action can be likened to squeezing a tube of toothpaste.

• Seen only in normal functional patterns with normal occlusions.

• Many variations have been observed during cinefluorographic examinations.

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Normal Deglutition

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Abnormal Deglutition

Associated with a Class II, Division 1 malocclusion:

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Clinical Examination

• Amazingly versatile functional possibilities

Because it is anchored only at one end.

• This very freedom permits it to deform dental

arches when function is abnormal.

• Aspects deserving attention:

1. Size.

2. Posture.

3. Function.

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Clinical ExaminationTrue macroglossia is rare What appears to be a clinically large tongue may be a result of fwd. tongue posture.Both macroglossia & microglossia correlate with certain symptoms in the dentoalveolar area & the skeletal pattern considered in the evaluation. Skeletal open bite with tongue thrust can be mistaken clinically for a case of macroglossia.

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Clinical Examination

Protruded tongue reaches the lower incisors at best

& the floor of the mouth is elevated & visible on

each side of the diminutive tongue

Microglossia/hypoglossia.

Severe Class II relationship is usually evident.

Lower dental arch collapsed & reduced.

Extreme crowding in the premolar area.

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Clinical Examination

Aglossia – severe functional disturbances are present.Excellent examples of the dynamics of muscle balance & imbalance. Aglossia Macroglossia

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Clinical Examination

• POSTURE:Some investigators hold that tongue posture is more important than tongue function (Mason, Proffit, 1974).

Flat or arched.Protracted or retracted.Narrowed & long or spread laterally & shortened.Examined clinically with the mandible in the

postural rest position.Can be evaluated cephalometrically.

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Clinical Examination

Root :Usually flat in cases of mouth breathing & deep

overbite caused by a small tongue.In all other cases, slight contact of the tongue usually

occurs with the soft palate.

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Dorsum:Arched & high in Class II, division 1 malocclusions & deep

overbite.In all other malocclusions, a tendency exists for the tongue

to flatten in accordance with the length of the

interocclusal space.

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Clinical Examination

Tip:

Usually retracted in Class II, division 1 malocclusions.

But in other malocclusion categories, a slight antr.

gliding of the tongue tip occurs as the mandible

moves into postural rest position.

• Changes in the position of the tongue tip relate

directly

to mandibular malformations.

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Clinical Examination

• FUNCTION:Consequence of retained infantile deglutitional patterns or other abnormal oral habits Abnormal function.Primary etiologic factor Functional appliance therapy.Adaptive to morphologic aberrations Correction of the basal dysplasia of skeletal parts will restore normalcy.

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Disorders of tongue

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Congenital Anomalies

Microglossia : As a consequence of the less muscular

stimulus between the alveolar arches- tongue do not develop transversely – so mandible do not grow in anterior

direction resulting in Dentoskeletal

Malocclusion.

Aglossia – Absence of tongue.

Can cause difficulty in eating and talking.

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Congenital Anomalies

Microglossia : As a consequence of the less muscular

stimulus between the alveolar arches- tongue do not develop transversely – so mandible do not grow in anterior

direction resulting in Dentoskeletal

Malocclusion.

Aglossia – Absence of tongue.

Can cause difficulty in eating and talking.

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Macroglossia (Enlarged tongue)

Clinical features-

Malocclusion

Scalloping of lateral borders.

Displacement of teeth.

Associated with Beckwith’s Hypoglycemic syndrome.

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Etiology-

Congenital or hereditary Lymphangioma Hemangioma Cretinism Downs syndrome

Acquired

Edentulous patients Amyloidosis Acromegaly Angioedema Carcinoma or tumor

Treatment- No specific treatment.

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Ankyloglossia / Tongue tie : Etiology –

Genetic in origin.

Commonly associated with Pierre robin syndrome.

Two types- Complete and Partial

Complete – fusion of the tongue to the floor. Partial – short lingual frenum attached to the tip of the tongue.Causes speech difficulties Treatment - Lingual frenectomy

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Cleft tongue or bifid tongue-

• Caused due to the lack of merging of the lateral swellings.

• Food debris may collect in the base of the cleft and cause irritation.

• Associated with oro-facial-digital syndrome.

Fissured tongue (Scrotal tongue)-

• Small furrows or grooves, radiating from central groove along the midline.

• Usually painless except in which food debris collects and causes irritation.

• Associated with Geographic tongue.

• Etiology- Extrinsic factors such as chronic trauma or vitamin deficiency.

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Cleft tongue or bifid tongue-

Fissured tongue (Scrotal tongue)-

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Median rhomboid glossitis – Depapillated ovoid or diamond or rhomboid area anterior to

vallate papillae.

Etiology- Failure of tuberculum impar to retract.

Cooke suggested relationship between median rhomboid glossitis and localized chronic fungal infections

Clinical features-

The structure is devoid of filliform papillae. Appears as a flat or slightly raised reddish patch or plaque anterior to the circumvallate papillae.

Treatment – Antifungal drugs

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Benign migratory glossitis Also called as Geographic tongue, Wandering rash, Erythema migrans.

Etiology – Unknown, but may be associated with emotional stress.

Clinical features-

• Areas desquamation of filliform papillae.

• These areas remain for some time in one location and then heal and appear in another location.

• Persists for week or months and

then regresses spontaneously.

Treatment - No specific treatment.

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Black hairy tongue Unusual condition.• Etiology – Unknown , but can be micro organisms (candida),

systemic disturbances (anaemia), Drugs (penicillin), smokers, x

ray radiation, change in local oral environment.

• CLINICAL FEATURES-

Hypertrophy of filliform papillae. Lack of normal desquamation Papillae may vary in colour depending

on staining with extrinsic factors.

Treatment – No specific treatment.

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Lingual varices

(lingual varicosities)

Red or purple shot like clusters of

vessels on the ventral surface, lateral

borders of the tongue and floor of the

mouth. It represents aging process.

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Lingual thyroid nodule

• Follicles of thyroid nodule are found in the

substance of tongue.

Clinical features- • Nodular mass 2-3cm in diameter, present in

or near the base of the tongue.

• Symptoms – Dysphagia, Dysphonia,

hemorrhage with pain or a feeling of

tightness or fullness.

Treatment – Surgical excision

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Disease Of Microbial Origin

Oral manifestations Strawberry tongue- fungiform papillae- edematous and hyperemic.

The coating is lost and the tongue becomes smooth- Raspberry tongue.

Scarlet fever : – Beta Haemolytic Streptococci

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Recurrent Apthous Stomatitis

Clinical features – • Recurrent Apthous minor - edema of tongue. • Ulcers are painful , interfere with eating.

Ulcers persists for 7-14 days and gradually heal without scarring.

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Syphilis - Spirochete treponema pallidum. Primary syphillis – Chancre Intraoral chancre is an ulcerated lesion covered by

grayish white membrane on tongue. Secondary Syphilis – Syphilitic Glossitis Tertiary syphilis – Gumma Intraoral gumma commonly involves the tongue and

palate. It consists of focal granulomatous inflammatory

process with central necrosis.

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Candidasis

Etiology – Candida albicans

.Clinical features – Appears as soft, white,

slightly elevated plaques. Resembles milk

curds. The plaque is wiped away leaving a

normal mucosa or an erythematous area.

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Tongue Disorder Due to Physical Injury

Traumatic ulcer• Etiology - Caused by some trauma. • Commonly seen on the lateral border of tongue. • They may persists for a longer time and may bear

resemblance to carcinoma.

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Vitamin Deficiency

Vit B2 ( riboflavin ) Glossitis, Filliform papillae are atrophic, Fungiform papillae become engorged Giving the tongue reddened, coarsely

granular appearance – Magenta coloured tongue

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Niacin deficiency Burning sensation - fiery red and painful tongue. Desquamation of the epithelium – Bald tongue of

sandwich.

Folic acid deficiency Swelling and redness of the tip and lateral

margins. Smooth and fiery red.

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Vit B12 deficiency• Triad of symptoms- Generalized weakness,

painful tongue, numbness and tingling of the extremities.

• Glossitis, Glossodynia, Glossopyrosis• Loss of taste.• Gradual atrophy of the papillae leads to

smooth and bald tongue- Hunter’s glossitis or Moeller’s glossitis.

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Immunological Disorder

Lichen Planus Characterized by radiating, white or gray velvety

thread like papules on the dorsum of the tongue.

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Premalignant Lesions

Leukoplakia White patch or plaque occurring on the surface of

mucous membrane which cannot be rubbed or stripped off

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Erythroplakia – Leukoerthroplakia commonly seen on the

tongue. There is erythroplakia that is bright red,

soft velvety lesions with scalloped margins interspersed with patches of leukoplakia.

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Benign Tumours And

Malignant Tumours

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Fibroma

Appears as a well defined elevated

lesion of normal colour and

smooth surface. It may sometimes

become irritated and inflammed

Hemangioma

Benign tumor of connective tissue. Characterized by proliferation of blood vessels. Lesions appear as flat or raised, and are usually deep red or bluish red in colour.

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Granular cell myoblastoma- Benign tumor of muscles. Lesions appear as single nodules

within the substance of the tongue itself.

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Squamous cell carcinoma

• Carcinima of the tongue – 25% to 50% of all intra oral carcinomas.

• Commonly Develops on the lateral border or ventral surface of the tongue, in rare cases it occurs on the dorsum.

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The Important Predisposing Causes

• Chronic irritation by smoking, sepsis, spices and spirits (alcohol).

• Pre-cancerous lesions which include syphilis, leukoplakia.

• Betel chewing• Dental ulcers, Carious or broken tooth or an ill

fitting denture. • Poor oral hygiene and mal nutrition.

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Clinical features

• Painless mass or ulcer which may begin as a superficially indurated ulcer with slightly raised borders and may develop as a exophytic growth or to infilterate the deep layers of tongue.

• Oral Manifestations: sore throat and Dysphagia

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Clinical Features

• Tumours occur on the post 1/3rd – Higher grade for malignency, metastatize earlier, and offer a poor prognosis because it is inaccessible for treatment.

• If, Involvement of Lingual Nerve , Pain that may be referred to the ear through Auriculotemporal Nerve.

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Treatment

Ca Tongue

Growth <1cm

Surgery

Growth >1cm

Radiothrapy

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Treatment

• Early Stage 1 & stage 2 – Surgery or Radiotherapy.

• Advanced Stage 3 & stage 4 – Combination of Surgery and Radiotherapy.

• The role of Chemotherapy has not clearly defined in Ca-Tongue

Robert A. ORD. Currnet management of Oral Cancer. The Journal of the American Dental Association, November 2001 ; vol. 132no. suppl 1 19S

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Surgery

If growth is <1 mm – Surgical Excision When growth is too large involving the jaw -

Radiotherapy may causes Necrosis

• hemimandibulactomy

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Radiotherapy

• Ant 2/3 rd : Interstitial therapy with Radium Needles-

Radioactive Titanium Wire or Indium wire.• When growth is deep - Teletherapy – with

Cobalt 60 units

Usually on Post 1/3 rd where interstitial therapy is difficult

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• IMRT (Intensity Modulated Radiation Therapy) technique- delivers a homogenous dose of radiation focused on the target site and minimize radiation exposure to healthy tissue.

• Recent reports- The ability to reduce parotid gland exposure to radiation, significantly reduces subsequent xerostomia.

Robert A. ORD. Currnet management of Oral Cancer. The Journal of the American Dental Association, November 2001 ; vol. 132no. suppl 1 19S

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References

Gray’s Anatomy- The Anatomical Bases Of Clinical Preactice, 39th Edition, Elsevier, 2005, pages 584-590

Margaret J. Fehrenbach, Anatomy Of The Head And Neck, 3rd Edition, Elsevier, 2007, Pages 170-173

The Encyclopedic Atlas Of The Human Body, Gordon Cheers, 2004, pages 182-185 Frank H. Netter, Altas Of Human Anatomy, 3rd Edition, Icon, 2003, Pages 47,48,54,58,69 R. Rajendran, Shafer’s Textbook of Oral Pathology, 5th Edition, Elsevier, 2007, pages 35-44 Neville, Oral And Maxillofacial Pathology, 3rd Edition, Elsevier, 2009, pages 10-13 Lasts anatomy The developming human , keeth moore. Mcminn anatomy Usmle videos