Anatomy of the Tongue

Extrinsic Muscles
• Genioglossus
• Hyoglossus
• Styloglossus
• Palatoglossus
Intrinsic Muscles
• Longitudinal
• Transverse
• Vertical
Innervation
• Motor: Hypoglossal Nerve
• Sensory: Lingual Nerve, Chorda Tympani, Glossopharyngeal Nerve
• Blood supply: Lingual Artery
• Drainage: Lingual Vein
Lymphatic Drainage
Squamous Cell Carcinoma
• More than 90% of cancers in the oral cavity and oropharynx are squamous
cell carcinomas
• Ratio of Scc in Ant 2/3 to Post 1/3 is 4:1
• In the earliest recognizable stage, squamous cell carcinoma appears as
firm, pearly plaques or as irregular, roughened, or verrucous areas of
mucosal thickening.
• Scc of the tongue: 2nd most common
• 66% of lingual carcinomas appear as painless, indurated masses or ulcers of
the posterior lateral border of the tongue
• Age of Presentation: 60 years old
• Men>Women
Incidence according to site
• - MIDDLE 1/3 OF LATERAL BORDER OF TONGUE - 47%
• POST 1/3 -20%
• TIP - 15%
• VENTRAL SURFACE & FRENULUM - 9%
• DORSUM - 6.5%
• FACIO - LINGUAL - 6%
 Etiology
• No single causative agent(Extrinsic and Intrinsic Factors)
• Risk Factors:
• Tobacco Smoking , Alcohol, Phenols, Radiation, Iron Deficiency, Vit A
deficiency, Candidal Infection, Oncogenic viruses. Immunosuppression,
Plummer Vinson syndrome
• Risk of carcinoma Increases with amount of tobacco used and
duration
• Exposure to tobacco causes Progressive sequential morphologic
changes of mucosa leading to neoplastic transformation
Premalignant Conditions
Definite Risk of Malignant changes:
• Leucoplakia
• Erythroplakia
• Chronic Hyperplastic Candidiasis
Leukoplakia
• White or grayish in patches
that can't be wiped away
• Irregular or flat-textured
• Thickened or hardened in
areas
• Along with raised, red lesions
(speckled leukoplakia or
erythroplakia), which are
more likely to show
precancerous changes
Erythroplakia
• Any lesion of Oral mucosa that
present with bright red velvety
plaque that cannot be
characterized clinically or
pathologically with any other
disease
• erythroplakia has a much
greater probability (91%) of
showing signs of dysplasia or
malignancy at the time of
diagnosis
Other Lesions
• ORAL SUBMUCOUS FIBROSIS
• SYPHILITIC GLOSSITIS
• SIDEROPENIC DYSPLASIA
• ORAL LICHEN PLANUS
Clinical Features
• Common presentation is painless lump or ulcer at the surface of the tongue
• Excessive salivation
• Pain- late sign
• Due to involvement of nerves
• Localized or referred to ear
• On swallowing- Post 1/3 Ca
• Dysarthria
• Fetor oris
• Bleeding
• Trismus
• Mandibular Anesthesia
Macroscopic Features
• Grossly, squamous cell carcinoma of oral cavity may have the
following types:
• Ulcerative type
• Papillary or verrucous type
• Nodular type
• Scirrhous type
• All these types appear on a background of leukoplakia or
erythroplasia of the oral mucosa
• Enlarged cervical lymph nodes may be present.
Pathogenesis
• NEOPLASIA:The process of transformation from a normal cell to a
cancerous one.
• An abnormality of cell growth and multiplication characterised by:
At cellular level :
• Excessive cellular proliferation
• Uncoordinated growth
• Tissue infiltration
At molecular level :
Disorder of growth regulatory genes
Histopathological
• Increased mitotic activity
• Well differentiated Keratin pearls (abnormal keratinization)
• Hyperchromatic nuclei
• Pleomorphism
• Epithelium islands
• Connective tissue stroma with chronic inflammation (histiocytes,
lymphocytes, etc.)