01 Tongue and Oropharynx

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Tongue and OropharynxTong

ue and OropharynxBy:-Dr. Kamlesh B.By:-Dr. Kamlesh B.

M.D.S. (I) PeriodonticsM.D.S. (I) Periodontics


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Contents:-Contents:- Tongueongue IntroductionIntroduction Development of tongueDevelopment of tongue Parts and surfacesParts and surfaces

HistologyHistology

Taste sensationTaste sensation Muscles of tongueMuscles of tongue MovementsMovements Nerve supply, Blood supply,Nerve supply, Blood supply,

venous and lymphaticvenous and lymphaticdrainage.drainage.

Applied anatomy Applied anatomy

OropharynxOropharynx IntroductionIntroduction Interior and parts of PharynxInterior and parts of Pharynx OropharynxOropharynx

Palatine TonsilsPalatine Tonsils

Muscles related to Oropharynx.Muscles related to Oropharynx. Nerve supply, Blood supply,Nerve supply, Blood supply,

venous and lymphaticvenous and lymphaticdrainage.drainage.


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Introduction:-Introduction:-

Tongue is essentially a mass of skeletal muscles coveredTongue is essentially a mass of skeletal muscles coveredby mucous membrane, with a midline fibrous septumby mucous membrane, with a midline fibrous septumseparating the two muscular halves.separating the two muscular halves.

It has an oral part and a pharyngeal partIt has an oral part and a pharyngeal part

Oral part lies in the mouth and pharyngeal part inOral part lies in the mouth and pharyngeal part inpharynx.pharynx.


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Functions of tongueFunctions of tongue

The tongue had evolved as primarily a general sensoryThe tongue had evolved as primarily a general sensoryorgan ( to detect touch, pain, temperature ) of food goingorgan ( to detect touch, pain, temperature ) of food goinginto the oropharynx.into the oropharynx.

Secondly it squeezes food into the oropharynx duringSecondly it squeezes food into the oropharynx during

swallowing.swallowing. Others functions are,Others functions are,- Forming words during speaking- Forming words during speaking- to assist in mastication- to assist in mastication

- Taste- Taste- Deglutition- Deglutition- Oral cleansing.- Oral cleansing.


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Development of tongue:Development of tongue:


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Endodermal lining of pharyngeal pouch

ARCH I

II

Pharyngeal grooveI

III

IV

Endodermal lining of pharyngeal pouch

Ectodermalcovering

Mesenchymal core


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Sources of Tongue development I

ARCH

I

II

III

IV

ARCH I

ARCH III

Terminalsulcus

II


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Mesenchymal core

ARCH

I

II

III

IV

TUBERCULUM IMPAR

LATERAL LINGUAL SWELLINGS

MIDLINE HYPOBRANCHIALEMINENCE

OCCIPITAL MYOTOMES

muscle core

Sources of Tongue Development

Forms the connectivetissue.


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Mesenchymal core

ARCH

I

II

III

IV

TUBERCULUM IMPAR

LATERAL LINGUAL SWELLINGS

MIDLINE HYPOBRANCHIALEMINENCE

OCCIPITAL MYOTOMES

muscle core

Sources of Tongue Development

Forms the connectivetissue.

(Lingual and Chorda tympani nerves)

(Glossopharyngeal nerve)

(Hypoglossal nerve)


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Parts and Surfaces of tongueParts and Surfaces of tongue


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Parts of tongueParts of tongue

It has following parts,It has following parts,- Body- Body

- a curved dorsum- a curved dorsum- an inferior surface- an inferior surface

- Apex- Apex

- Root- Root


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DorsumDorsum

Dorsum of tongue is convexDorsum of tongue is convexin all directions .in all directions .

At rest it occupies almost all At rest it occupies almost allspace of oral cavity proper.space of oral cavity proper.

It gets divided into oral partIt gets divided into oral partand pharyngeal part by aand pharyngeal part by afaint V- shaped groove,faint V- shaped groove,sulcus terminalis.sulcus terminalis.


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Sulcus terminalis: V shaped grooveSulcus terminalis: V shaped grooveTwo limbs of the V meet at a medianTwo limbs of the V meet at a median

pit called foramen caecum. It representspit called foramen caecum. It representsthe site from which the thyroidthe site from which the thyroiddiverticulum grows down in embryo.diverticulum grows down in embryo.


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Inferior SurfaceInferior Surface

When tip of tongue is raised to theWhen tip of tongue is raised to theroof of the mouth, inferior surfaceroof of the mouth, inferior surfaceof tongue can be inspected.of tongue can be inspected.

A small midline septum of mucous A small midline septum of mucousmembrane called the lingualmembrane called the lingualfrenulum unites tongue to floor of frenulum unites tongue to floor of mouth.mouth.

Laterally are the deep lingual veinsLaterally are the deep lingual veinswhich can be usually seen throughwhich can be usually seen throughthe mucosa.the mucosa.

Farther laterally, there is anotherFarther laterally, there is anotherfold of mucosa, the fimbriated fold.fold of mucosa, the fimbriated fold.


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RootRoot

Root of tongue is attachedRoot of tongue is attachedto mandible and soft palateto mandible and soft palateabove and to hyoid boneabove and to hyoid bonebelow.below.

It is the attachment of theIt is the attachment of themobile tongue to the relatedmobile tongue to the relatedstructures.structures.


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Apex (tip) Apex (tip)

Tip of tongue forms theTip of tongue forms theanterior free end which liesanterior free end which liesbehind the upper incisorbehind the upper incisorteeth.teeth.

It is the most mobile part of It is the most mobile part of tongue.tongue.


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Posterior one third of tonguePosterior one third of tongue

It slopes downwards fromIt slopes downwards fromthe sulcus terminalis as thethe sulcus terminalis as theanterior wall of oropharynx.anterior wall of oropharynx.

No papllae.No papllae.

Nodular appearance by theNodular appearance by thepresence of underlyingpresence of underlyingmasses of glands andmasses of glands andlymphoid follicles.lymphoid follicles.

Lymphoid follicles constituteLymphoid follicles constitutethe lingual tonsils.the lingual tonsils.


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Posterior one third of tonguePosterior one third of tongue

Between tongue andBetween tongue andepiglottis there is midlineepiglottis there is midlineflange of mucousflange of mucousmembrane, the medianmembrane, the medianglosso-epiglottic fold.glosso-epiglottic fold.

On both sides of this foldOn both sides of this foldthere is a depression, thethere is a depression, the

vallecula bounded blaterallyvallecula bounded blaterallyby similar fold called lateralby similar fold called lateralglosso-epiglottic fold.glosso-epiglottic fold.


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Papillae of tonguePapillae of tongue

Surface of tongue is roughened by theSurface of tongue is roughened by thepresence of projections called papillae.presence of projections called papillae. There are 4 types of papillae,There are 4 types of papillae,

- Filiform papillae- Filiform papillae- Fungiform papillae- Fungiform papillae

- Vallate papillae- Vallate papillae- Foliate papillae- Foliate papillae


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Filiform papillaeFiliform papillae

These are minute conicalThese are minute conicalprojections on mucousprojections on mucousmembrane.membrane.

They give rise to velvetyThey give rise to velvetyappearance of the tongue.appearance of the tongue.

They are long and numerous,They are long and numerous,contain afferent nerve endingscontain afferent nerve endingsthat are sensitive to touch.that are sensitive to touch.

TheyThey do notdo not bear any tastebear any tastebuds.buds.


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Fungiform PapillaeFungiform Papillae

These are visible as discreteThese are visible as discretepinheads.pinheads.

They are more numerousThey are more numeroustowards edges of tongue.towards edges of tongue.

Somewhat larger than theSomewhat larger than thefiliform papillae.filiform papillae.

Each of them bears a few tasteEach of them bears a few tastebuds.buds.

They are bright red in colour.They are bright red in colour.


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Vallate papillae Vallate papillae

These are about a dozen inThese are about a dozen innumber.number.

Arranged in form of V, just in Arranged in form of V, just infront of the sulcus terminalis.front of the sulcus terminalis.

Each is a cylindrical projectionEach is a cylindrical projectionsurrounded by a circular sulcussurrounded by a circular sulcusand a raised outer wall.and a raised outer wall.

There are many taste budsThere are many taste buds

and serous glands in theand serous glands in thesulcus.sulcus.


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Foliate papillaeFoliate papillae

Small lateral folds on theSmall lateral folds on thelingual mucosa.lingual mucosa.

Poorly developed in humans.Poorly developed in humans.


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Histology of tongueHistology of tongue

Bulk is made of striatedBulk is made of striatedmuscles.muscles.

Mucous membrane is lined byMucous membrane is lined bystratified squamousstratified squamousepithelium.epithelium.

On oral part, it is thin, formsOn oral part, it is thin, formspapillae and adherent topapillae and adherent tomuscles.muscles.

On pharyngeal part- rich inOn pharyngeal part- rich inlymphoid follicles.lymphoid follicles.

On inferior surface- thin andOn inferior surface- thin andsmooth.smooth. Numerous glands, bothNumerous glands, both

mucous and serous lie deep tomucous and serous lie deep tomucous membrane.mucous membrane.


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Taste sensationTaste sensation


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Chemoreceptors, -stimulatedChemoreceptors, -stimulatedby substances dissolved inby substances dissolved inmouth by saliva.mouth by saliva.

These dissolved substances actThese dissolved substances acton microvilli of taste receptorson microvilli of taste receptorsin taste pores.in taste pores.

This causes development of This causes development of receptor potential in receptorreceptor potential in receptorcells.cells.

This leads to generation of This leads to generation of action potential in sensoryaction potential in sensoryneurons which is carried toneurons which is carried tobrain for taste perception.brain for taste perception.


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Sweetweet : cyclic AMP causes depolarization.: cyclic AMP causes depolarization. Saltalt : Salt stimulus causes depolarization by: Salt stimulus causes depolarization by

increasing passive transport of sodium ionsincreasing passive transport of sodium ionsthrough ungated channels.through ungated channels. Sourour : Acid depolarizes receptors by blocking: Acid depolarizes receptors by blockingpotassium channels with Hydrogen ions.potassium channels with Hydrogen ions.

Bitteritter : Stimulating agents activate: Stimulating agents activatephospholipase C through G-proteins. This causesphospholipase C through G-proteins. This causesproduction of Inositol triphosphate which releaseproduction of Inositol triphosphate which releaseCa ions to develop depolarization.Ca ions to develop depolarization.



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Muscles of tongueMuscles of tongue

A middle fibrous septum divides the A middle fibrous septum divides thetongue into right and left halves. Each half tongue into right and left halves. Each half

contains four intrinsic and four extrinsiccontains four intrinsic and four extrinsicmuscles.muscles.


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Intrinsic musclesIntrinsic muscles

1.1. Superior longitudinalSuperior longitudinal2.2. Inferior longitudinalInferior longitudinal3.3. TransverseTransverse4.4. Vertical Vertical


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Extrinsic musclesExtrinsic muscles

1.1. GenioglossusGenioglossus2.2. HyoglossusHyoglossus3.3. StyloglossusStyloglossus4.4. PalatoglossusPalatoglossus


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These occupy the upper part of theThese occupy the upper part of thetongue and are attached to thetongue and are attached to the

submucous fibrous layer and to thesubmucous fibrous layer and to themedian fibrous septum.median fibrous septum. They alter the shape of the tongueThey alter the shape of the tongue


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Superior longitudinal:-Superior longitudinal:-- Lies beneath- Lies beneath

mucous membranemucous membrane- Shortens the- Shortens thetongue and makes thetongue and makes thedorsum concavedorsum concave


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Inferior Longitudinal:-Inferior Longitudinal:--It is a narrow band-It is a narrow bandlying close to inferiorlying close to inferiorsurface of tongue.surface of tongue.

-It lies between-It lies betweengenioglossus andgenioglossus andhyoglossus.hyoglossus.

-Shortens the tongue-Shortens the tongueand makes it convexand makes it convex


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Transverse:-Transverse:--Extends from the-Extends from the

median septum to themedian septum to themargins.margins.- It makes the- It makes the

tongue narrow andtongue narrow andelongated.elongated.


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Vertical:- Vertical:-- Found at the- Found at the

borders of theborders of theanterior part of anterior part of tongue.tongue.- It makes the tongue- It makes the tonguebroad and flat.broad and flat.


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Genioglossus:-Genioglossus:-- Arises from the superior- Arises from the superiormental spine of mandible.mental spine of mandible.

- Fans out and runs- Fans out and runsbackwards to be insertedbackwards to be insertedinto the mucousinto the mucousmembrane.membrane.- Lowest fibers pass down- Lowest fibers pass downthe hyoid body.the hyoid body.- Main bulk.- Main bulk.- Safety muscle of tongue.- Safety muscle of tongue.


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Hyoglossus:-Hyoglossus:-- arises from- greater horn- arises from- greater hornof hyoid bone and fromof hyoid bone and fromlateral part of the body.lateral part of the body.- extends upwards,- extends upwards,interdigitating with fibresinterdigitating with fibresof styloglossus andof styloglossus and

attaches to sides.attaches to sides.


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Styloglossus:-Styloglossus:-- Arises from the front of - Arises from the front of the lower part of styloidthe lower part of styloidprocess and the upperprocess and the upperpart of styloid ligament.part of styloid ligament.- Passes forwards below- Passes forwards belowthe superior constrictor tothe superior constrictor to

get inserted into sides of get inserted into sides of tongue.tongue.


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Palatoglossus:-Palatoglossus:-- Descends from the- Descends from theundersurface of theundersurface of thepalatine aponeurosis topalatine aponeurosis tosides of the tongue.sides of the tongue.- Pairing with muscle on- Pairing with muscle onopp. side formsopp. side forms

palatoglossal arch.palatoglossal arch.


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Movements : Extrinsic musclesMovements : Extrinsic muscles

GenioglossusGenioglossus

-Bilaterally depresses-Bilaterally depresses

-Posterior part pulls tongue anteriorly for protrusion-Posterior part pulls tongue anteriorly for protrusion-Anterior part retracts apex of protruded tongue-Anterior part retracts apex of protruded tongue-Unilateral contraction leads to deviation-Unilateral contraction leads to deviation

HyoglossusHyoglossus

--Depresses tongue, pulling its sidesDepresses tongue, pulling its sides-Shortens (retrudes) tongue-Shortens (retrudes) tongue

StyloglossusStyloglossus -Retrudes tongue and curls (elevates) its sides-Retrudes tongue and curls (elevates) its sides

PalatoglossusPalatoglossus -Elevates posterior tongue or depresses soft palate.-Elevates posterior tongue or depresses soft palate.


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Nerve supplyNerve supplySupplySupply Anterior Anterior

two-thirdtwo-thirdPosterior one-Posterior one-thirdthird

PosteriorPosteriormost part ormost p art orvalleculavallecula

SensorySensoryLingual nerveLingual nerve Glosso-Glosso-

pharyngeal nervepharyngeal nerveInternalInternallaryngeallaryngealbranch of branch of vagusvagus

TasteTasteChordaChordatympani excepttympani exceptvallate papillaevallate papillae

Glosso-Glosso-pharyngealpharyngealincluding theincluding thevallate papillaevallate papillae

InternalInternallaryngeallaryngealbranch of branch of vagusvagus


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All the muscles of All the muscles of tongue, intrinsic andtongue, intrinsic andextrinsic, are suppliedextrinsic, are suppliedby the hypoglossalby the hypoglossalnerve (exceptnerve (exceptpalatoglossus which ispalatoglossus which is

supplied by thesupplied by thepharyngeal plexus)pharyngeal plexus)


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Blood SupplyBlood Supply

Tongue is supplied by theTongue is supplied by thelingual artery runslingual artery runsabove the greater horn of above the greater horn of

hyoid deep to hyoglossushyoid deep to hyoglossusand passes forward toand passes forward tothe tip.the tip.

Dorsal lingual branches.Dorsal lingual branches.

Tonsillar branch of facialTonsillar branch of facialartery and ascendingartery and ascendingpharyngeal artery.pharyngeal artery.


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Venous Drainage of tongue Venous Drainage of tongueDeep Lingual Vein

Runs back super ficial to hyoglossus

Sublin gual Vein

Forms Vena comitan s of hypoglossal nerve

Facial Vei n Lingual Vein

Internal Jugular V ein


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Lymphatic DrainageLymphatic Drainage

Tip of tongue drains bilaterally to theTip of tongue drains bilaterally to thesubmental nodes.submental nodes.

Right and left halves of remaining part of Right and left halves of remaining part of anterior two-thirds of tongue drainsanterior two-thirds of tongue drainsunilaterally.unilaterally.

Posterior one third of the tongue drainsPosterior one third of the tongue drainsbilaterally to jugulo-omohyoid nodes.bilaterally to jugulo-omohyoid nodes.


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Applied anatomy of tongue: Applied anatomy of tongue:

Paralysis of Genioglossus.Paralysis of Genioglossus. Lingual carcinoma:Lingual carcinoma:

Posterior part- metastasizes to deepPosterior part- metastasizes to deepcervical lymph nodes bilaterallycervical lymph nodes bilaterally Thyroglossal Duct cyst:Thyroglossal Duct cyst:

Cystic remnant of thyroglossal duct,Cystic remnant of thyroglossal duct,associated with development of thyroidassociated with development of thyroidgland.gland.


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Congenital and developmental disorders.Congenital and developmental disorders.-Aglossia and microglossia-Aglossia and microglossia-Macroglossia-Macroglossia

-Ankyloglossia-Ankyloglossia-Cleft tongue-Cleft tongue-Lingual thyroid nodule-Lingual thyroid nodule-Lingual polyp-Lingual polyp

-Varices of tongue-Varices of tongue-Geographic tongue.-Geographic tongue.-Fissured tongue-Fissured tongue


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Ankyloglossia (tongue-tie) Ankyloglossia (tongue-tie)-A short lingual frenulum-A short lingual frenuluminterferes with tongueinterferes with tongue

movements.movements.-Speech problems.-Speech problems.-Periodontal problems.-Periodontal problems.-Diastema-Diastema


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FrenectomyFrenectomy


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OropharynxOropharynx


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PharynxPharynx

Pharynx is a wide muscular tube, situatedPharynx is a wide muscular tube, situatedbehind the nose, the mouth and thebehind the nose, the mouth and the

larynx.larynx. Upper part of the pharynx transmits onlyUpper part of the pharynx transmits only

air, lower- only food but middle isair, lower- only food but middle is

common passage for both.common passage for both.


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Dimensions:Dimensions:Length about 12 cmLength about 12 cm

Width: upper widest (3.5 cm)Width: upper widest (3.5 cm)middle narrowmiddle narrowlower narrowestlower narrowest


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Parts of PharynxParts of Pharynx

Nasal partNasal part Oral partOral part

Laryngeal partLaryngeal part


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OropharynxOropharynx

Middle part of the pharynx situated behindMiddle part of the pharynx situated behindthe oral cavity.the oral cavity.

Extends from: lower surface of the softExtends from: lower surface of the softpalate to the upper border of epiglottis.palate to the upper border of epiglottis.


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RelationsRelations

Above: communicates with nasopharynx Above: communicates with nasopharynx Infront: communicates with theInfront: communicates with the

oropharynxoropharynx Below: opens into laryngopharynx at levelBelow: opens into laryngopharynx at level

of upper border of epiglottisof upper border of epiglottis

Posteriorly: Supported by cervical vertebraPosteriorly: Supported by cervical vertebra Laterally: palatine tonsils in tonsillar fossa.Laterally: palatine tonsils in tonsillar fossa.


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Palatine tonsils are the large collection of Palatine tonsils are the large collection of lymphoid tissue which project into thelymphoid tissue which project into theoropharynx from the tonsillar fossa.oropharynx from the tonsillar fossa.

They are the part of Waldeyers ring whichThey are the part of Waldeyers ring whichalso consists of also consists of -Pharyngeal tonsils-Pharyngeal tonsils-Tubal tonsils-Tubal tonsils-Lingual tonsils-Lingual tonsils


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Waldeyers ringWaldeyers ring

Definition: Ring of Lymphoid tissue guarding entrance to the

digestive & respiratory tracts.

It plays an important role in early recognition of pathogenic micro-organisms.


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Muscles related to oropharynxMuscles related to oropharynx

Superior constrictorSuperior constrictor Middle constrictorMiddle constrictor

Inferior constrictorInferior constrictor-Thyropharyngeus-Thyropharyngeus-Cricopharyngeus-Cricopharyngeus

StylopharyngeusStylopharyngeus PalatopharyngeusPalatopharyngeus SalpingopharyngeusSalpingopharyngeus } Longitudinal coatLongitudinal coatof the pharynxof the pharynx


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Blood Supply and Lymphatic drainageBlood Supply and Lymphatic drainage

Arteries of pharynx are, Arteries of pharynx are, Ascending pharyngeal branch. Ascending pharyngeal branch. Ascending palatine and tonsillar branches. Ascending palatine and tonsillar branches. Dorsal lingualDorsal lingual G. palatine, pharyngeal and pterygoid branchesG. palatine, pharyngeal and pterygoid branches

Veins form a plexus on the posterolateral aspect of Veins form a plexus on the posterolateral aspect of

pharynx. It drains into int. jugular and facial veins.pharynx. It drains into int. jugular and facial veins.Lymph drains into the retropharyngeal and deepLymph drains into the retropharyngeal and deepcervical lymph nodes.cervical lymph nodes.


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Nerve supplyNerve supply

Motor : Cranial accessory nerve exceptMotor : Cranial accessory nerve exceptstylopharyngeus (lXstylopharyngeus (lX thth nerve)nerve)

Sensory : Glossopharyngeal and vagusSensory : Glossopharyngeal and vagus Taste sensation from vallecula : InternalTaste sensation from vallecula : Internal

laryngeal branch of vagus.laryngeal branch of vagus.


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Functions of the Oropharynx:

1. Common pathway for food & air. 2. Respiratory function (Patent pathway between

nose & larynx). 3. Reflex actions (sneezing, coughing &

vomiting). 4. Speech resonance (articulation of vowels).

5. Deglutition (2nd pharyngeal phase of swallowing). 6. Drainage of mucus from nasopharynx.


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References:References:

Textbook of Anatomy, LastsTextbook of Anatomy, Lasts Grays Anatomy, 39Grays Anatomy, 39 thth editionedition

Textbook of Human Anatomy, ChaurasiaTextbook of Human Anatomy, Chaurasia Clinically oriented Anatomy, Keith L. Moore andClinically oriented Anatomy, Keith L. Moore and Arthur F. Dalley 5 Arthur F. Dalley 5 thth Ed.Ed.

Txt bk. of Medical Physiology, Guyton/HallTxt bk. of Medical Physiology, Guyton/Hall Txt bk. of Oral Pathology and Med., Anil GhomTxt bk. of Oral Pathology and Med., Anil Ghom InternetInternet


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Recent advances !Recent advances !

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01 Tongue and Oropharynx