The tongue

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The tongue Powered By Docstoc
					               The tongue
The tongue is able to move in nearly every •
 direction, expand, compress and display a
 fine degree of articulation. Such muscular
    control allows us to manipulate our food
and speak. The organ's ability to transform
     into a variety of shapes comes from its
              composition of skeletal muscle
                         interspersed with fat.
     The tongue and its muscles are laterally symmetrical: a median •
septum divides the organ into two halves. The tongue is made up of
      two types of muscles: extrinsic and intrinsic. Extrinsic muscles
 originate from elsewhere in the body and attach to the tongue. They
    connect with surrounding bones and help the organ move up and
        down, from side to side and in and out. The tongue's extrinsic
muscles all end in "glossus," which, unsurprisingly, means "tongue."
      The genioglossus depresses the tongue and thrusts it out. The
styloglossus raises and withdraws the tongue. The palatoglossus
     raises its back. And, the hyoglossus lowers the tongue's sides..
The muscles connect to the mandible, or jawbone, the hyoid bone,
       a U-shaped structure that supports the tongue, and the styloid
  processes of the temporal lobes. The styloid processes suspend
 the hyoid bone with muscles and ligaments, making it the only bone
                           that doesn't come into contact with another.
         Unlike extrinsic muscles, intrinsic •
muscles originate within the tongue. They
allow it to expand and contract, altering its
     shape and size. The tongue's intrinsic
muscles, which include the longitudinalis
          superior, longitudinalis inferior,
      transversus linguae and verticalis
      linguae, are especially important for
    speech and deglutition, or swallowing
  Mucous membrane covers the tongue's •
    mass of muscles and fat. The double-
 layered membrane helps block microbes
and pathogens from entering the digestive
system. The epithelial layer of the mucous
    membrane secretes mucus that helps
             moisten the mouth and food
The tongue (L. lingua; G. glossa) functions •
     as a digestive organ by facilitating the
 movement of food during mastication and
     assisting swallowing. Other important
       functions include speech and taste
.so The tongue consists of striated muscle •
   and occupies the floor of the mouth. The
        dorsal mucosal surface consists of
       stratified squamous epithelium, with
     numerous papillae and taste buds. The
  tongue, a voluntary muscular structure, is
  attached by a fold, called the frenulum, to
                      the floor of the mouth
      The tongue's surface is made up of •
 numerous small projections that give it a
  somewhat velvety feel. (In the cat family
   tongue projections are big enough and
 hard enough to be obvious) These small
projections (called "papillae") can be seen
     easily by protruding your tongue and
     drying a small area with a soft, clean
   If one does this, one will note that there are different •
                                       types of elevations.
          The most numerous ones are the pink, slender,
 threadlike structures that are uniformly distributed over
 the surface of the tongue. These are usually the first to
   disappear in some diseased states, including certain
 nutritional disorders and don’t have taste buds,they are
                                   called filliform papillae.
Another kind of small projection on the tongue's surface.
There are fewer of these mushroom-shaped elevations,
   and they are generally a little redder than the others.
They also disappear at times ,they are called fungiforme
    - circumvallate papillae: located at the •
junction of posterior third and anterior two
            third of the dorsal surface of the
     tongue,arranged in an inverted V ,and
                           contain taste buds
  -foliate papillae: on the lateral margin of •
 posterior third of the tongue ,and contain
                                  taste buds.
                                        What is geographic tongue?
     Geographic tongue (also known as benign migratory glossitis or
  erythema migrans) is a harmless condition that affects about 2% of
 the population. Geographic tongue is typically seen as well-defined,
   reddened areas on and around the sides of the tongue. These red
        areas usually have a slightly white or yellow-white, raised line
       around their edges. The condition usually waxes and wanes in
 severity, with the red patches appearing in one area during a period
  of several hours to a few days, persisting for a period of time (days
  to weeks to months, depending on the individual), and clearing up;
      however, the process usually repeats itself in a different area or
  areas after a few more days, weeks or months. When the condition
is "active", the tongue is often sensitive to hot, spicy or acidic foods.
                   Will it turn into cancer? •
   No. Geographic tongue has never been
demonstrated to undergo transformation to
          cancer. Of course, if any oral sore
develops which doesn’t behave like typical
geographic tongue, the prudent thing to do
  would be to have it evaluated by the oral
            pathologist or other health care
 practitioner with experience in diagnosing
                                 oral disease.
                       What causes geographic tongue?
   We don’t really knows what causes this condition -- all
      we know is that it is not a serious problem. It is not
 caused by an infection, and it is not related to any other
disease. If a biopsy were to be taken from your tongue, it
would look a little like psoriasis of the skin ("psoriasiform
    mucositis"). Geographic tongue patients usually don’t
    have psoriasis; however, psoriasis is a common skin
          condition that also has an unknown cause, and
  occasionally we see a patient with both problems. This
          may be nothing more than coincidence in many
Geographic tongue, localized lesion.
    Or ankyloglossia: refers to congenital •
   shortness of lingual frenom or a frenum
attachment extends nearly to the tip of the
      tongue, it may lead to impairment of
                                                   Tongue-tie •
  Dear Dr Bowen, We have a seven (7) year old son with
       tongue tie. He was speech delayed but was able to
            leave speech therapy at age 5 and now has no
   articulation problems and does very well in school. His
        pediatrician told us he doesn't need surgery but the
     dentist says he does. He has some drooling and is a
picky eater. My questions for you are: 1. Do you know of
  any experts in the United States, particularly in Texas if
         possible, in the tongue-tie area (i.e. surgeons and
     speech pathologists)? 2. What are the chances that
 having this surgery could actually cause our son to have
  some speech problems, given that he does not seem to
  have any at present? Thank you so much for your help
                                             and God Bless!
Increased tongue size which can be seen •
        in: lymphangioma,heamangioma,
 amyloidosis, mongolism and acromegally
  Congenital anomally characterized by •
    decreased size of the tongue,usually
associated with severe deformity of limbs
                               and digits
      burning mouth or Glossodynia •
  characterized by a burning or tingling
   sensation of the tongue or the entire
Typically, there are no visual signs like •
   discoloration that help the diagnosis
It may represent •
 1-a manifestation of systemic disease •
2- local causation •
3- psychogenic in origin •
And can be devided into 2 groups: •
a- glossodynia associated with observable •
clinical changes (25%)
B- without observable clinical changes(75%) •
 Glossodynia with clinical changes
May be local , systemic or both: systemic like B •
       complex deficiency anemia( concerning the
    whole tongue which looks raw red with some
 ulcerations) ,pernicious anemia( concerning the
   tip and lateral borders which have a bright red
  color) iron deficiency anemia ( tongue pale and
atrophied), diabetes(tongue looks beefy red) and
     sjogren syndrome or local factors like tongue
      habits, irregular or crowded lower teeth with
        calculas deposits, prosthetic or orthodontic
         appliances, medicaments and dentifrices.
    Possible causes include nutritional •
          or anxiety deficiencies, chronic
menopause ,type 2 diabetes ,depression
 chronic oral disorders such as thrush or
          dry mouth, or damaged nerves
            Other causes : smoking, alclhol, spicy food, drug
                                   eruption,allergy contact.
                 Complete investigations are recommended
                                      Treatment is etiologic
One cause of burning mouth pain, which may be •
       often misdiagnosed as burning mouth s.,
        in the oral tissues is a contact senstivity
to common substances such as sodium lauryl s.
        a commonly used in household products,
   cinnamon aldehyde or dental materials. There
  are now several toothpastes on the market free
  sodium lauryl sulfate and specifically without
      preservatives which have been found to be
                       associated with sensitivities
     Glossodynia without clinical
During fourth to seventh decade,patients complain from •
  insomnia, anxiety, and fear of cancer . The burning
  tongue is a symptome of depression or psychologic
  stress following a death or bad news.This condition
appears more often in women, specifically women after
     menopause, than men. Pain typically is low or
nonexistent in the morning builds up over the course of
 the day treatment and doesn’t follow any recognised
    anatomic pattern ,taste abnormality are common
      anticonvulsants antidepressants ,benzodiazepines •
       median rhomboid glossitis
    The embryonic tongue is formed by two lateral processes (lingual          •
           tubercles) meeting in the midline and fusing above a central
 structure from the first and second branchial arches, the tuberculum
  impar. The posterior dorsal point of fusion is occasionally defective,
 leaving a rhomboid-shaped, smooth erythematous mucosa lacking.
median rhomboid glossitis (central papillary atrophy) is a focal area
              .of susceptibility to recurring chronic atrophic candidiasis,
      The latter term has certain difficulties, however, because not all      •
     cases improve with antifungal therapy or show initial evidence of
fungal infection. The erythematous clinical appearance, moreover, is
   due primarily to the absence of filiform papillae, rather than to local
       inflammatory changes, as first suggested in 1914 by Brocq and
         Pautrier. The lesion is found in one of every 300-2,000 adults,
                     depending on the rigor of the clinical examinations
median rhomboid glossitis.
So it is a developmental anomaly,diamond •
      in shape, located in the medline of the
 tongue anterior to the V , it is smooth and
     sometimes lobulated ,red,more in men
                                       over 40
             It should be differenciated from •
     thyroglossal duct and abberant thyroid
                       No need for treatment •
          Black hairy tongue
Hairy tongue may occasionally appear •
black as a result of the growth of pigment-
producing bacteria that colonize the
elongated filiformpapillae .In addition, the
black color may also be due to staining
from food and tobacco or may follow a
course of antibiotics. The diagnosis is
made on the basis of clinical criteria.
              Fissured tongue
    Fissured tongue is a condition frequently seen in the •
         general population (10%) that is characterized by
       grooves that vary in depth and are noted along the
      dorsal and lateral aspects of the tongue. Although a
       definitive etiology is unknown, a polygenic mode of
  inheritance is suspected because the condition is seen
       clustering in families who are affected. Patients are
usually asymptomatic, and the condition is initially noted
on routine intraoral examination as an incidental finding.
   Fissured tongue is also seen in Melkersson-Rosenthal
            and in frequent downsyndrome syndrome and
 geographic ) association with benign migratory glossitis
                                 Mortality/Morbidity •
Fissured tongue is a totally benign condition and •
  is considered by most to be a variant of normal
   tongue architecture. When seen in association
        with Melkersson-Rosenthal syndrome, the
 morbidity is due not to the fissured tongue but is
secondary to the granulomatous inflammation of
     the lips/facial soft tissues and facial paralysis
     B- complex deficient diet may cause •
     fissures on the surface of the tongue
    These fissures may become inflamed •
   because of bacterial growth where food
  debris accumulate and cause discomfort
                            and even pain
Treatment if needed is hydrogen peroxide •
 solution to remove food debris and warm
                              mouth wash
Atrophy of the tongue coating
         Concerne filliform and fingiform •
      They can regenerate if not severly •
Etiology may be iron deficiency ,vitamin •
deficiency, pernicious anemia, riboflavin
       deficiency and chronic alcoholism

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