INTRODUCTION

The tongue is a mobile muscular organ can assume a variety of shapes and positions. The tongue is partly in the oral cavity and partly in the pharynx.
At rest it occupies essentially all the oral cavity proper.

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Introduction Anatomy

Physiology
Diseases of the tongue Making diagnosis History Clinical Examination

Investigations
Neoplasms of the tongue
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The tongue is divided into two part, an anterior buccal portion and posterior pharyngeal portion.
These are separated by V-shaped sulcus on its superior surface at the apex is formen caecum from which thyroid gland developed.

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The main functions:-

(Function s)

Forming words during speaking

Squeezing food into the pharynx when swallowing Other functions:
Taste Mastications deglutition articulation oral cleaning

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Conditions of the TONGUE

Congenital abnormities Glossitis Ulceration of the tongue Neoplasms of the tongue

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Congenital abnormalities
Aglossia Bifid tongue

Ankyloglossia (tongue tie)

Congenital furrowing

Macroglossia (e.g., idiots, cretins and lymphangiomas)

Lingual thyroid
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(Tongue tie)
Commonly Congenital in origin and due to short frenulum linguae. It is not common cause of speech defect. The tongue is bent down to the floor of the mouth and its movements are impaired.
TR should be divided transversely and then closed vertically.
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Benign Tumors:
Benign are uncommon compared with malignant sq. cell carcinoma.
Haemangioma Papilloma Lymphangioma

Lipoma
Neurofibroma Osteoma Juvenile fibrous
Carcinoma (sq.cell carcinoma) of the tongue (malignant) Saleh M. Al Salamah
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Aetiolog y
Cancer of the tongue uncommon below the age of 50 years (50-70 years) used to be common In men than women (the sex incidence is now approaching parity).

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The importance predisposing c

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

Pre-cancerous lesions which include syphilis, ch. superficial glossitis, dental ulcers and papilloma.
Poor oral hygiene and mal nutrition.

Betel chewing.
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Pathology
Two-thirds of the tongue cancer arise in the ant. 2/3rd and 1/3rd in the posterior part. The commonest sites are the sides of the ant. 2/3rd of the tongue. Posterior tumors are much more to be in the midline.

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Gross appearance
The tumor usually occurs as malignant ulcer. Less often it take, the form of hard submucous nodule or deep fissure. Rarely it occurs as diffuse hard infiltration of whole tongue. (wooden tongue)

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Histology
The tumor is usually poorly diff. Squamous cell carcinoma. Posterior tumors are less well diff.

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Spread of carcinoma of the TONGUE

Local (direct to the floor of the mouth, gums and pharynx). Lymphatic spread.
Blood spread (very rare)

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The patient may seek advice because of mass or ulcer in the tongue. But more often he present with other symptoms which includes:
1. Pain 2. Profuse salvation and fowl breathing 3. Severe haemorrhage 4. Fixation of the tongue (ankyloglossia) 5. Alteration of the voice

6. Lump of glands in the neck

7. dysphagia
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TERMINAL EVENTS:
Death from an uncontrolled primary tumors occurs as result of: Inhalation bronchopneumonia.

Haemorrhage from erosion of the lingual artery.

Combined cancerous cachexia and starvation. Asphyxia.
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TREATMENT
Biopsy confirms the diagnosis the treatment by SURGERY or RADIOTHERAPY or Combination of

two.
I. RADIOTHERAPY

Usually reserved for tumors of the posterior third and for inoperable cases or as combination.

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II.

SURGERY Local excision by partial or hemiglossectomy in case a lesion at the tip of the tongue or small lesion in the ant. 2/3rd with 2 cm of healthy tissue at all sides. Radical block dissection, if the lymph nodes enlarged. The commando operations combined mandibulectomy and neck dissection.
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PROGNOSIS
a.

For patient with LN negative with tumors in the ant. 2/3rd there is 50%, 5 years survival.

For patient with posterior 1/3rd of the tongue with b. negative LN 20-25%, 5 years survival.

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