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THE TONGUE

Tongue comprises skeletal muscle which is voluntary.


Introduction :
The Tongue is a muscular organ situated in the floor of the mouth. It is associated with the
functions of taste, speech, mastication and deglutition. It has an oral part that lies in the
mouth, and a pharungeal parts are separately by a V-shaped sulcus, the sulcus terminals.

Fig. 17.1 : The dorsum of the tongue, epiglottis and palatine tonsil
DISSECTION
In the sagittal section, identify fan-shaped genioglossus muscle. Cut the attachments of
buccinator, superior constrictor muscles and the intervening pterygomandibular raphe and
reflect these downwards exposing the lateral surface of the tongue. Look at the superior,
inferior surfaces of your own tongue with the help of hand lens.
External Features :
The Tongue has :
1. A root,
2. A tip and
3. A body, which has(a) a curved upper surface or dorsum, and (b) an inferior surface.
The dorsum is divided into oral and pharyngeal parts. The inferior surface is
confined to the oral part only.

The root is attached to the mandible and soft palate above, and to the hyoid bone
below.

The dorsum of the tongue is convex in all directions. It is divided into : (a) An oral part or
anterior two-thirds, and (b) a pharyngeal part or posterior one-third by a faint V-shaped
groove, the sulcus terminalis. The two limbs of the V meet at a median pit, named the
foramen caecum. They run laterally and forwards up to the palatoglossal arches. The
foramen caecum represents the site from which the thyroid diverticulum grows down in the
embryo. The oral and pharyngeal parts of the tongue differ in their development, topography,
structure , and function.
The oral or papillary part of the tongue is placed on the floor of the mouth. Its margins are
free and in contact with the gums abd teeth. Junt in front of the palatoglossal arch each
margin shows 4 to 5 vertical folds, named the foliate pappillae. The superior surface of the
oral part shows a median furrow and is covered with papillae which make it rough. The
inferior surface is covered with a smooth mucous membrane, which shows a median fold
called the frenulum linguae. On either side of the frenulum there is a prominence produced
by the deep lingual veins. More laterally there is a fold called the plica fimbriata that is
directed forwards and medially towards the tip of the tongue.
The pharyngeal or lymphoid part of the tongue lies behind the palatoglossal arches and the
sulcus terminalis. Its posterior surface, sometimes called the base of the tongue, forms the
anterior wall of the orpharynx. The mucous membrane has no papillae, but has many
lymphoid follicles that collectively constitute the lingual tonsil. Mucous glands are also
presents.
The posteriormost part of the tongue is connected to the epiglottis by three folds of mucous
membrane. There are the median glossoepiglottic fold and the right and the left lateral
glossoepiglottic folds. On either side of the median fold there is a depression called the
vallecula. The lateral folds separate the valeculla from the piriform fossa.
PAPILLAE OF THE TONGUE
There are projections of mucous membrane or corium which give the anterior two-thirds of
the tongue its characterstic roughness. These are of the following three types.
1. Vallate or circumvallate papillae. They are large in size 1-2 mm in diameter and are 812 in number. They are situated immidiately in fornt of the sulcus terminals. Each
papilla is a cylindrical projection surrounded by a circular sulcus. The walls of the
papilla are raised above the surface.

2. The fungiform papillae are numerous near the tip and margins of the tongue, but some
of them are also scattered over the dorsum. These are smaller than the vallate papillae
but larger than the filiform papillae. Each papillae consists of a narrow pedicle and a
large rounded head. They are distinguished by their bright red colour.
3. The filiform papillae of conical papillae cover the presulcal area of the dorsum of the
tongue, and give it a characteristic velvety appearance. They are the smallest and most
numerous of the lingual papillae. Each is pointed and covered with keratin; the apex is
often split into filamentous processes.

Muscles of the Tongue :


A middle fibrous septum divides the tongue into right and left halves. Each half contains
four intrinsic and four extrinsic muscles.
Intrinsic Muscles :
1.
2.
3.
4.

Superior longitudinal
Inferior longitudinal
Transverse
Vertical

Extrinsic muscles
1.
2.
3.
4.

Genioglossus
Hyoglossus
Styloglossus
Palatoglossus

The intrinsic muscles occupy the upper part of the tongue, and are attached to the
submucous fibrous layer and to the median fibrous septum. They alter the shape of the
tongue. The superior longitudinal muscle lies beneath the mucous membrane. It
shortens the tongue and makes its dorsum concave. The inferior longitudinal muscle is
a narrow band lying close to the inferior surface of the tongue between the
genioglossus and the hyoglossus. It shortens the tongue and makes its dorsum convex.
The transverse muscle extends from the median septum to the margins. It makes the
tongue narrow and elongated. The vertical muscle is found at the borders of the
anterior part of the tongue. It make the tongue broad and flattened.
The extrinsic muscles connect the tongue to the mandible via genioglossus; to the
hyoid bone through hyoglossus; to the styloid process via styloglossus, and the palate
via palatoglossus. The genioglossus is described here. The hyoglossus has been

described in chapter 11; the styloglossus in chapter 12 and the palatoglossus in chapter
14.
The genioglossus is a fan-shaped muscle which forms the main bulk of the tongue. It
arises from the upper genial tubercle of the mandible. From here the fibers fan out and
run backwards. The upper fibers are inserted into the tip, the middle fibers into the
dorsum, and the lower fibers into the hyoid bone. The upper fibers retract the tip, the
middle fibres depress the tongue, and the lower fibers pull the posterior part of the
tongue forwards and thus protrude the tongue from the mouth.
This muscle if paralysed will fall back on the oropharynx and block the air passage.
During anaesthesia, the tongue is pulled forwards to clear the air passage.

Arterial Supply of Tongue


It is chiefly derived from the lingual artery, a branch of the external carotid artery. The
root of the tongue is also supplied by the tonsillar and ascending pharyngeal arteries.

Venous Drainage
The arrangement of the vena comitantes/veins of the tongue is vaiable. Two venae
comitantes accompany the lingual artery, and one vena comitantes accompanies the
hypoglossal nerve. The deep lingual vein is the largest and principal vein of the
tongue. It runs backwards and crosses the genioglossus and the hyoglossus below the
hypoglossal nerve.
These veins unite at the posterior border of the hyoglossus to form lingual vein which
ends either in the common facial vein or in the internal jugular vein.

Lymphatic Drainage
1. The tip of the tongue drains bilaterally to tge submental nodes.
2. The right and left halves of the remaining part of the anterior two-thirds of the
tongue drain unilaterally to the submandibular nodes. A few central lymphatics
drain bilaterally to the same nodes.
3. The posterior one-third of the tongue drains bilaterally to the jugulo-omohyoid
nodes, these are known as the lymph nodes of the tongue.

Nerve Supply :

Motor nerves. All the intrinsic and extrinsic muscles, except the palatoglossus, are
supplied by the hypoglossal nerve. The palatoglossus is supplied by the crainal root of
the accessory nerve through the pharyngeal plexus.
Sensary nerves. The lingual nerve is the nerve of general sensation and the chroda
tympani is the nerve of taste for the anterior two-thirds of the tongue except vallate
papillae.
The glossopharyngeal nerve is the nerve for both general sensation and taste for the
posterior one-third of the tongue including the circumvallate papelae. The
posteriormost part fo the tongue is supplied by the vagus nerve through the internal
laryngeal branch.

TABLE 17.1

Histology :
1. The bulk of the tongue is made of striated muscles.
2. The mucous membrane consists of a layer of connective tissue (corium), lined by
stratified squamous epithelium. On the oral part of the dorsum, it is thin, forms
papillae, and is adherent to the muscles. On the pharyngeal part of the dorsum, it is
very rich in lymphoid follicles. On the inferior surface, it is thin and smooth.
Numerous glands, both mucous and serous lie deep to the mucous membrane.
3. Taste buds are most numerous on the sides of the vallate papillae, and on the walls
of the surrounding sulci. Taste buds are numerous over the foliate papillae and over
the posterior one-third of the tongue; and sparsely distributed on the fungiform
papillae, the soft palate, the epiglottis and the pharynx. There are no taste buds on
the middorsal region of the oral part of the tongue.

Development of Tongue
1. Epithelium
(a) Anterior two-thirds ; from two lingual swellings and one tuberculum impar, which
arise from the first branchial arch. The tuberculum impar soon disappears.
Therefore, it is supplied by lingual nerve (post-trematic) and chorda tympani
(pretrematic).
(b) Posterior one-third : from cranial large part of the hypobranchial eminence, i.e.
from the third arch. Therefore, it is supplied by the glossopharyngeal nerve.

(Table 17.1)
(c) Posteriormost part from the fourth arch. This is therefore supplied by the vagus
nerve.
II

Muscles :

The muscles develop from the occipital myotomes which are supplied by the
hypoglossal nerve.

III

Connective Tissue :
The connective tissue develops from the local mesenchyme.

Table 17.1 : Parts of the tongue


Nerve Supply Anterior two-thirds
Sensary
Taste

Development
of epithelium

Posterior one-third

Posterior most part or


Vallevula
Lingual
Glossopharyngeal
Internal
laryngeal
branch of vagus
Chorda tympani except Glossopharyngeal
Internal
laryngeal
vallate papillae
including the vallate branch of vagus
papillae
Lingual swellings of 1 Third arch which forms Fourth arch which
arch. Soon disappears
large ventral part of the forms small dorsal
bypobranchial eminence part of hypobranchial
eminence

Muscles develop from occipital myotomes, so the cranial nerve XII (hypoglossal nerve) supplies all intrinsic and three
extrinsic muscles. Only palatoglossus in supplied by cranial root of accessory through pharyngeal plexus and is
developed from mesoderm of sixth arch.

CLINICAL ANOTOMY
1. Injury to the hypoglossal nerve produces paralysis of the muscles of the tongue on the
side of lesion. If the lesion is infranuclear, there is gradual atrophy of the affected half
of the tongue or hemiatrophy. Muscular twitchings are also observed. Infranuclear
lesions of the hypoglossal nerve are seen typically in motor neuron disease and in
syringomyelia. Supranuclear lesions of the hypoglossal nerve produce paralysis
without wasting. This is best seen in pseudobulbar palsy where the tongue in stiff,
small and moves very sluggishly resulting in defective articulation.

2. Glossitis is usually a part of generalized unceration of the mouth cavity or stomatits.


In certain anaemias, the tongue becomes smooth due to atrophy of the filiform
papillae.
3. The presence of a rich network of lymphatics and of loose areolar tissue in the
substance of the tongue is responsible for enormous swelling of the tongue acute
glossitis. The tongue fills up the mouth cavity and then protrudes out of it.
4. The undersurface of the tongue is a good site along with the bulbar conjuctiva for
observation of jaundice.
5. In unconscious patients, the tongue may fall back and obstruct the air passage. This
can be prevented either by lying the patient on one side with head down (the tonsil
position) or by keeping the tongue out mechanically.
6. In patients with grand mal epilepsy, the tongue is commonly bitten between the teeth
during the attack. This can be prevented by hurriedly putting in a mouth gag at the
onset of the seizure.
7. Carcinoma of the tongue is quite common. The affected side of the tongue is removed
surgically. All the deep cervical lymph nodes are also removed, i.e. block dissection of
neck because recurrence of malignant disease occures in lymph nodes. Carcinoma of
the posterior one-third of the tongue is more dangerous due to bilateral lymphatic
spread.