ÎeÉuWûÉaÉiÉ

urÉÉkÉÏ
(DISEASES OF TONGUE)
• The tongue is a muscular organ situated
in floor of mouth

Functions
• Taste
• Speech
• Mastication
• Deglutination
External Features
1) Root
2) Tip
3) Body

a) curved upper surface – Dorsum

Dorsum - Divided in 2 parts
i) Oral
ii) Pharyngeal Part
b) Inferior Surface
1) Root is attached to mandible above and
to the hyoid bone below
2) The Tip of Tongue forms the anterior
free and which at rest lies behind upper
Incisior teeth
Papillae of Tongue
• These are projections of mucous
Membrane (corium) which give anterior
two third of the tongue its
characteristic roughness

• Vallate Papillae
• Fungiform Papillae
• Filliform Papillae
• Muscles of Tongue
A Middle fibrous septum divides tongue
into right and left Halves for Intrinsic and
extrinsic muscles

Intrinsic Muscles
1. Superior Longitudinal
2. Inferior Longitudinal
3. Transverse
4. Vertical
Extrinsic Muscles
1. Genoglossus
2. Hyoglossus
3. Styloglossus
4. Palatoglossus

Arterial Supply
• Lingual Artery a branch of external
carotid Artery
• Root is also supplied by Tonsilar and
Ascending Pharyngeal Arteries
Venous Drainage
Deep Lingual Vein

Lymphatic Drainage
• Tip – Submental Nodes
• Right and Left Halves – Submandibular
Nodes
• Posterior one third – Jugulo omohyoid
nodes
A Nerve Supply
A. Motor Nerves
Hypoglossal Nerve
B. Sensory Nerves Lingual Nerve
Chroda Tympani

Glossopharyngeal Nerve
A
A) According to Sushrutacharya –
5 Jivha roga

1) Vataja Jivha Kantaka (Chronic Glossitis)

2) Pittaja Jivha Kantaka (Acute Glossitis)
3) Kaphaja Jivha Kantaka(Chronic Glossitis)
4) Alasa (Sublingual cyst or abscess)
5) Upjivhaka (Ranula or Cystic swelling)
B) According to Vagbhatacharya

1) Vataja Jivha Kantaka (Chronic Glossitis)

2) Pittaja Jivha Kantaka (Acute Glossitis)
3) Kaphaja Jivha Kantaka(Chronic Glossitis)
4) Alasa (Sublingual cyst or abscess)
5) Upjivhaka (Ranula or Cystic swelling)
6) Adhijivhaka
 1) Vataja Jivha Kantaka
( Chronic Glossitis)

ÎeÉuWûÉöÌlÉsÉålÉ xTÑüÌOûiÉÉ
mÉëxÉÑmiÉÉ pÉuÉåccÉ
vÉÉMücNûSlÉmÉëMüÉvÉÉ |
(xÉÑ.ÌlÉ.A.16/37)

vÉÉMümɧÉZÉUÉ xÉÑmiÉÉ
xTÑüÌOûiÉÉ uÉÉiÉSÕÌwÉiÉÉ ||
(A.WØû.E.A.21)
• The Vata vitiation changes smooth
regular surface of tongue into,
- xTÑüÌOûiÉÉ - cracked
- mÉëxÉÑmiÉÉ - loss of sensation
- vÉÉMücNûSlÉmÉëMüÉvÉÉ -
thorny
- ZÉUÉ- rough, dry
- with loss of taste perception
- discomfort,
- pain
 Treatment

• Like Vataja Osta Prakopa

- Abhyanga with Chatur Snehas

- Nadi or Upanaha Sweda
- Sneha Pratisarana
- Snehana Nasya
- Vatahara, Vranaropaka, Shothahara,
• Glossitis can mean soreness of the
tongue, or more usually inflammation with
depapillation of the dorsal surface of the
tongue (loss of the lingual papillae), leaving
a smooth and erythematous (reddened)
surface, (sometimes specifically termed 
atrophic glossitis).

• In a wider sense, glossitis can mean

inflammation of the tongue generally.
• Glossitis is often caused by nutritional
deficiencies and may be painless or cause
discomfort.
•Tongue soreness caused by glossitis is
differentiated from burning mouth
syndrome, where there is no identifiable
change in the appearance of the tongue,
and there are no identifiable causes.
Causes
1. Anaemia
2. Vitamin B Deficiency
3. Infections
4. Other Causes Alcoholism
5. Chrons Disease
6. Whipples Disease
Classification
1. Atrophic glossitis
2. Median rhomboid glossitis
3. Benign migratory glossitis
4. Geometric glossitis
5. Strawberry tongue
1. Atrophic glossitis
• Atrophic glossitis, also known as bald
tongue, smooth tongue, Hunter glossitis,
Moeller glossitis, or Möller-Hunter
glossitis, 
• condition characterized by a smooth
glossy tongue that is often Tender /
painful,caused by complete atrophy of the
lingual papillae (depapillation)
• Risk Factors of Glossitis
•have a mouth injury
• eat spicy foods
• wear braces or dentures that irritate your
tongue
• have herpes
• have low iron levels
• have food allergies
• have an immune system disorder
• SIGNS AND SYMPTOMS
•pain or tenderness in the tongue
• swelling of the tongue
• change in the color of your tongue
• an inability to speak, eat, or swallow
• loss of papillae on the surface of your
tongue
Medications
Antibiotics and Antibacterial other
medications that get rid of infections may
be prescribed if bacteria are present in
your body.
• topical corticosteroids to reduce the
redness and soreness.
Home care
• Brushing and flossing your teeth several
times a day may improve the health of your
tongue, gums, and teeth.
• This can help relieve the symptoms
associated with glossitis and prevent the
condition from happening again.
A
A
2) ÌmÉiiÉeÉ ÎeÉuWûÉMüÇOûMü
(Acute Glossitis)

• ÌmÉiiÉålÉ mÉÏiÉÉ mÉËUS½ÉiÉå cÉ

ÍcÉiÉÉ xÉUYiÉæUÌmÉ
MühOûMæü¶É || (xÉÑ.ÌlÉ.A.16/37)

• ÎeÉuWûÉ ÌmÉiiÉÉiÉ
xÉSÉWûÉåwÉÉ
UYiÉæqÉÉïÇxÉÉMÑüUæͶÉiÉÉ||
 Vitiated Pitta dosha causes
- ÍcÉiÉÉ / mÉËUS½ÉiÉå/ AÉãwÉÉ –
burning sensation
- mÉÏiÉÉ / xÉUYiÉæUÌmÉ –
- the tongue appears red, yellow
- MühOûMæü¶É /
UYiÉæqÉÉïÇxÉÉMÑüUæͶÉiÉÉ –
- red thorny buds
- inflammatory changes in tongue,
- Pain
- discomfort
 Treatment
1) Raktamokshana
By rubbing the the surfaces of tongue with
the leaves of Gojivha or Shephalika
2) Siravyadha
3) Pratisarana with Kakolyadi Madhura
sneha dravyas
4) Kakolyadi dravya kwatha Gandoosha
5) Kakolyadi dravya + Milk + Sneha siddha –
Sneha Nasya
6) Pittahara Aahara Vihara
 3) MüTüeÉ ÎeÉuWûÉ MüÇOûMü
(Chronic Glossitis Leukoplakla)

• MüTïülÉ aÉÑuÉÏï oÉWûsÉÉ ÍcÉiÉÉ

cÉ qÉÉÇxÉÉåªqÉæ:
vÉÉsqÉÍsÉMühOûMüÉpÉæ: |
(xÉÑ.ÌlÉ.A.16/37)

• vÉÉsqÉsÉÏMühOûMüÉpÉæxiÉÑ
A Vitiated Kapha dosha causes the jivhaa as
- aÉÑuÉÏï - heavy
- oÉWûsÉÉ - thick wide
- vÉÉsqÉÍsÉMühOûMüÉpÉæ:
qÉÉÇxÉÉåªqÉæ: - scattered with thorny
buds resembling Shalmali Kantaka
And is associated with
- Pain
- Discomfort
- itching sensation
- sticky salivation
 Treatment
1) Lekhana or Gharshana with the leaves
of Gojivha or Shephalika to remove
impure blood
2) Raktamokshana
3) Pratisarana – Trikatu, Sarshapa,
Saindhava Lavana and Madhu
4) Kavala Graha – Shweta Sarshapa,
Saindhava Lavana,
5) Yusha Sevana – Yusha prepared from
Patola, Nimba Twaka, Varthaka, Yava K
 4) AsÉÉxÉ
(Sublingual Cyst or Abscess)
ÎeÉuWûÉiÉsÉå rÉ: µÉrÉjÉÑ:
mÉëaÉÉRû: xÉÉåsÉÉxÉxÉÇ¥É:
MüTüUYiÉqÉÔÌiÉï: |
ÎeÉuWûÉÇ xÉ iÉÑ xiÉqpÉrÉÌiÉ
mÉëuÉëÑ®Éå qÉÔsÉå iÉÑ ÎeÉuWûÉ
pÉëÑvÉqÉåÌiÉ mÉÉMüqÉç ||
(xÉÑ.ÌlÉ.A.16/38)
MüTüÌmÉiiÉÉkÉ: vÉÉåTüÉå
- MüTüUYiÉqÉÔÌiÉï: - Tridoshas
(Kapha, Rakta, Pitta mainly) vitiate and
causes
- mÉëaÉÉRû: ÎeÉuWûÉiÉsÉå rÉ:
µÉrÉjÉÑ:- dredful swelling underneth
the tongue
- ÎeÉuWûÉÇ xÉ iÉÑ xiÉqpÉrÉÌiÉ -
which immobilises tongue
- mÉëuÉëÑ®Éå qÉÔsÉå iÉÑ
ÎeÉuWûÉ pÉëÑvÉqÉåÌiÉ mÉÉMüqÉç
- mÉYuÉ: xÉÉåsÉxÉÉå
qÉÉÇxÉvÉÉiÉlÉ
after suppuration it causes destruction
of muscles of tongue
- qÉixrÉaÉÎlkÉpÉïuÉåiÉç - expels
matsya gandha
 Treatment
• Disease with short duration – Sadhya
• Disease with chronicity - Asadhya
• Asadhya but can try with the following
treatment principles
- Virechana
- Raktamokshana
- Kawala
- Shirovirechana
- Dhooma, Vamana, Nasya
 5) EmÉÎeÉuWûÉ / AÍkÉÎeÉuWûÉ
(Ranula or Cystic Swelling of tongue)

ÎeÉuWûÉaÉëÂmÉ: µÉrÉjÉÑÎWïû
ÎeɽqÉѳÉxrÉ eÉÉiÉ:
MüTüU£ürÉÉåÌlÉ: |

mÉëxÉåMüMühQÕûmÉËUSÉWûrÉÑYiÉ
É mÉëMüjrÉiÉåxÉÉuÉÑÎeÉÎuWûMåüÌiÉ||
(xÉÑ.ÌlÉ.A.16/39)
• MüTüU£ürÉÉåÌlÉ - Vitiated Kapha
Rakta Dosha causes
• ÎeÉuWûÉaÉëÂmÉ: µÉrÉjÉÑ - cystic
swelling resembling tip of tongue
• ÎeɽqÉѳÉxrÉ eÉÉiÉ:- And pushes
tongue upwards
Associated with
• mÉëxÉåMü - itching sensation
• MühQÕû - Salivation
• mÉËUSÉWû - Burning sensation
 Treatment
1) Raktamokshana
2) Lekhana
3) Pratisarana
4) Nasya
5) Gandoosha
6) Dhooma pana
7) Chedana
8) Teekshna Dravya Pratisarana (Vagbhata)
9) Pratisarana Dravyas Kutaki, Pippali,
Nimba
A
 6) AÍkÉÎeÉuWûÉ
mÉëoÉlkÉlÉåkÉÉå ÎeÉuWûÉrÉÉ:
vÉÉåTüÉå ÎeÉuWûÉaÉëxÉ̳ÉpÉ: |
xÉÉXMÑüU
MüTüÌmÉiiÉÉx§ÉæsÉÉïsÉÉåwÉÉxiÉ
qpÉuÉÉlÉç ZÉU|
AÍkÉÎeÉuWû:
xÉÂYMühQÕûuÉïYrÉÉWûÉUÉÌuÉkÉ
ÉiÉ¢ÑüiÉç |
iÉÉSØaÉåuÉÉåmÉÎeÉuWûxiÉÑ
• Sushruta explained it in Kantha Roga
• The description of Adhijivha is equal to
the Sushrutas Upajivhika
• Vagbhata Said the Cyst arises below the
tongue and pushes it Upwards
• According to Vagbhata Upajivhika arises
above the tongue and Adhijivhika arises
below the Tongue

• Upajivhika - Arise above the Tongue

• Adhijivhika - Arise below the Tongue
• mÉëoÉlkÉlÉåkÉÉå ÎeÉuWûÉrÉÉ: -
•vÉÉåTüÉå ÎeÉuWûÉaÉëxÉ̳ÉpÉ:
xÉÉXMÑüU -
•MüTüÌmÉiiÉÉx§É -
•sÉÉsÉÉå -
•AÉåwÉÉ
•xiÉqpÉuÉÉlÉç
•ZÉU
•xÉÂMçü
•MühQÕûuÉïYrÉÉWûÉUÉÌuÉkÉÉiÉ
¢ÑüiÉç
 Treatment
• Chedana
• Lekhana
• Pratisarana

• Sadhyasadhyata
Among Jivha Roga Alasa is Asadhya
• Glossitis refers to inflammation of the
tongue.
• The condition causes the tongue to swell
in size, change in color, and develop a
different appearance on the surface.
• Glossitis may cause the small bumps on
the surface of the tongue (papillae) to
disappear.
• The papillae contain thousands of tiny
sensors called taste buds and play a role in
how you eat.
• Severe tongue inflammation that results
in swelling and redness can cause pain and
may change the way you eat or speak.
Types
• Acute glossitis
• Acute glossitis is an inflammation of the
tongue that appears suddenly and often
has severe symptoms.
• This type of glossitis typically develops
during an allergic reaction.
• Chronic glossitis
• Chronic glossitis is an inflammation of the
tongue that continues to recur.
• This type may begin as a symptom of
another health condition.
• Atrophic glossitis
• Atrophic glossitis, also known as Hunter
glossitis, occurs when many papillae are
lost.
• This results in changes in the tongue’s
color and texture.
• This type of glossitis typically gives the
tongue a glossy appearance.

• Causes
1. Allergic reactions
- Allergic reactions to medications, food,
and other potential irritants may aggravate
the papillae and the muscle tissues of the
tongue.
- Irritants include toothpaste and certain
types of medications that treat high B.P.
2) Diseases
-Certain diseases that affect your immune
system may attack the tongue’s muscles
and papillae. 
- Herpes simplex, a virus that causes cold
sores and blisters around the mouth, may
contribute to swelling and pain in the
tongue.
3) Low iron levels
-Not enough iron in the blood can trigger
glossitis.
- Iron regulates cell growth by helping your
body make red blood cells, which carry
oxygen to your organs, tissues, and
muscles. 
- Low levels of iron in the blood may result
in low levels of myoglobin.
- Myoglobin is a protein in red blood cells
that’s important for muscle health,
- including the tongue’s muscle tissue.
4) Mouth trauma
- Trauma caused by injuries to the mouth
can affect the condition of your tongue.
- Inflammation may occur because of cuts
and burns on the tongue or dental
appliances like braces placed on your
teeth.
• Symptoms
- pain or tenderness in the tongue
- swelling of the tongue
- change in the color of your tongue
- an inability to speak, eat, or swallow
- loss of papillae on the surface of your
tongue
• Diagnosis
-You may see your dentist or doctor for an
assessment of your condition.
- They’ll examine your mouth to check for
abnormal bumps and blisters on your
tongue, gums, and soft tissues of your
mouth.
- Samples of your saliva and blood may also
be taken and sent to a laboratory for
further examination.
A
 RANULA
• A Ranula is extravasation cyst
•A ranula is a mucus extravasation cyst
involving a sublingual gland and is a type
of mucocele found on the floor of the
mouth.
• Ranulae present as swelling of connective
tissue consisting of collected mucin from a
ruptured salivary gland caused by local
trauma.
• Arises from damaged sublingual gland
• A ranula is a fluid collection or cyst that
forms in the mouth under the tongue.
• It is mucous or salivary fluid bounded by
fibrous tissue capsule
• It may rupture and discharge
• but sometime it may recur

• Treatment
• Excision of damaged sublingual gland
CARCINOMA OF TONGUE
 AETIOLOGY
Factors
1.Smoking , Tobacco
2.Syphilis
3.Sepsis
4.Spices
5. Spirit
6.Sharp edge of tooth
7.Candidiasis
Carcinoma of tongue may present as

1.An oval, raised, papillated plaque with

white keratin flecks on the surface
2. An ulcer with sloughing from an
indurated baseand with everted margins
3. A deep, often infected fissure with
indurated surroundings
4. A lobulated and indurated mass
 Clinical Features
• In early stage – no symptom
• in advanced stage
• Pain in tongue (lingual nerve)
• Salivation
• Ankyloglossia (fixed tongue)
• Dysphagia
• Inability to articulate clearly
• foetor oris
• a lump in the neck
• alteration in the voice (posterior 1/3)
• SPREAD OF CA TONGUE
• Local spread –
Upto Tonsils, Pharynx, Spine, Mandible
• Lymphatic spread (to neck)
• Blood Spread
• Diagnosis Tongue - Biopsy
•
• Death
- May occur in carcinoma of the tongue
due to bronchopneumonia
- Haemorrhage
- Starvation
-Asphyxia
• Treatment
• Surgery
• Radiotherapy
• Combination of both
 Classification
Tumours of oral cavity can be classified as
1.Benign tumours
a) Solid
b) Cystic
2. Premalignant lesions

3.Malignant lesions
a) Carcinoma
b) Non squmous malignant lesions
Macroglossia – Meaning large tongue
 Ankyloglossia or Tongue – tie

• When inferior frenulum attaches to the

bottom of the tongue and subsequently
restricts free movement of tongue
• Cause speech problems
• Occurs in 1.7% of neonates
• Treatment Simple incision
• Fissured tongue/Scrotal tongue/Lingua
Plicata

• Characterised by grooves that vary in

depth and are noted along the dorsal and
lateral aspect of tongue

• Usually patient asymptomatic

 MEDIAN Rhomboid Glossitis
Central papillary atrophy
Posterior lingual papillary atrophy
•Embrylogically the tongue is formed by
two lateral processes (lingual turbecles)
meeting in the midline and fusing above a
central structure from the first and second
brachial arches the tuberculum impar

• The posterior dorsal point of fusion is

occasionally defective leaving a rhomboid
shaped, smooth erythematous mucosa
lacking in papillae or taste buds
A Presents in posterior midline of the
dorsum of the tongue just anterior to the V
shaped grouping of the circumvallate
papillae
Those lesions presents with atrophic
candidiasis are usually erythmatous but
some responds with excess keratin
production therefore show white surface
change
Kissing lesion
Infected cases may also demonstrate
midline soft palate erythema in the area of
routine contact with the underlying tongue
involvement this is commonly referred as
kissing lesion
A
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