Tongue examination

Surface

• Sulcus terminalis: It lies partly in the mouth (oral part), which comprises the anterior ⅔rd and in the pharynx (pharyngeal part), which comprises the posterior ⅓rd. Both the parts are separated by the inverted ‘V’-shaped sulcus called the sulcus terminalis. At the apex of sulcus terminalis, there is a depression, called the foramen cecum • Anterior part: In the anterior part of the tongue, the mucous membrane is thin with reduced lamina propria and is closely attached to the underlying muscular tissue. The color of the anterior part of the mucous membrane is pink and is marked by a variety of papillae that gives the tongue a characteristic roughness. The anterior part of the tongue is divided in half by the median lingual sulcus • Posterior part: The posterior part also called as pharyngeal part or base of the tongue is located posterior to the palatoglossal arch • Lingual tonsil: The surface without papillae shows a slightly corrugated appearance, due to the underlying lymphoid tissue called the lingual tonsil • Root of tongue: The root of the tongue is attached to the epiglottis by a medial fold (the glossoepiglottic fold). Laterally, pharyngoepiglottic (glossopharyngeal) folds pass from the sides of the tongue and pharyngeal wall to the epiglottis. The root of tongue is attached to the hyoid bone, below and the mandible above • Ventral surface: The ventral surface is smooth and purplish with no papillae. On the ventral surface, lingual veins are often visible as bluish streaks • Lingual frenulum: The tongue is connected to the floor of the mouth by a sickle-shaped fold of mucous membrane called as lingual frenulum. Anteriorly, on either side of the frenulum, the caruncles opening for the submandibular ducts are visible

• Ankyloglossia

• Plica fimbriata: At the lateral side of the vein, a fringed fold of mucous membrane called as the plica fimbriata or fimbriated fold • Taste buds: These are peripheral gustatory organs which are composed of modified epithelial cells. They are most numerous on the sides of circumvallate papillae and less on the walls surrounding the foliate papillae. They are more numerous in infants than in adults. With age, they undergo atrophy.

Muscle(movement)

Functions

Developmental • Aglossia or hypoglossia • Ankyloglossia • Bifid tongue • Lingual polyp • Macroglossia • Midline fistula • Teratoma • Median rhomboid glossitis Infectious • Bacterial • Fungal and saprophytic • Parasitic • Viral Cystic • Epidermoid • Dermoid • Lymphoepithelial • Mucus • Anterior median lingual cyst • Gastric mucosal cyst • Parasitic cyst • Bronchogenic cyst Neoplastic Benign • Fibroma • Granular cell myoblastoma • Glomus tumor • Leiomyoma • Rhabdomyoma • Rhabdomyosarcoma • Neurofibroma • Keratoacanthoma • Traumatic neuroma • Papilloma • Adenoma – Hemangioma – Lymphangioma Malignant – Squamous cell carcinoma – Adenocarcinoma – Transitional cell carcinoma – Verrucous carcinoma – Mucoepidermoid carcinoma – Reticular cell carcinoma Metastatic lesions from – Kidney – Liver – Stomach – Lung Fissured tongue – Congenital – Syphilis – Amyloidosis – Melkersson-Rosenthal syndrome – Papillon-Lefevre syndrome – Traumatic bite – Lymphosarcoma – Angiosarcoma – Kaposi’s sarcoma – Melanoma Red and white lesions – Leukoplakia – Erythroplakia – Lichen planus – OSMF – Candidiasis – Psoriasis – Focal epithelial hyperplasia – White sponge nevus – Pemphigus • Syphilitic mucus patches – Verruca vulgaris Neurologic – Dyskinesia—involuntary movements – Glossodynia – Trigeminal neuralgia – Glossopharyngeal neuralgia – Polyneuritis – Neurofibromatosis – Tongue thrusting – Dysgeusia Papillary changes in tongue Atrophic – Median rhomboid glossitis – Geographic tongue – Pernicious anemia – Protein deficiency – Lichen planus – OSMF – Scleroderma Hypertrophic – White and black hairy tongue – After antibiotic therapy – After steroid therapy – Hydrogen peroxide mouth wash – Immunosuppressive drugs – Smoking – High fever – Constipation – Hyperacidity Systemic diseases manifested in tongue – Infections—bacterial, viral and fungal – Blood disorders – Metabolic disorders – Dermatological disorders – Collagen and autoimmune disorders