TONGUE

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TONGUE
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INTRODUCTION

• The tongue is a mobile muscular organ can assume
  a variety of shapes and positions. The tongue
  is partly in the oral cavity and partly in the
  pharynx.
• At rest it occupies essentially all the oral
  cavity proper.

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• Introduction
• Anatomy
• Physiology
• Diseases of the tongue
• Making diagnosis
• History
• Clinical Examination
• Investigations
• Neoplasms of the tongue

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SURGICAL ANATOMY
The tongue is divided into two part, an anterior
buccal portion and posterior pharyngeal
portion. These are separated by V-shaped sulcus
on its superior surface at the apex is formen
caecum from which thyroid gland developed.
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(Functions)
PHYSIOLOGY

• The main functions-
• Forming words during speaking
• Squeezing food into the pharynx when
  swallowing
• Other functions
• Taste
• Mastications
• deglutition
• articulation
• oral cleaning

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Conditions of the TONGUE
Congenital abnormities Glossitis Ulceration
of the tongue Neoplasms of the tongue
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Congenital abnormalities
Aglossia Bifid tongue Ankyloglossia (tongue
tie) Congenital furrowing Macroglossia
(e.g., idiots, cretins and lymphangiomas)
Lingual thyroid
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(Tongue tie)
ANKYLOGLOSSIA
Commonly Congenital in origin and due to short
frenulum linguae. It is not common cause of
speech defect. The tongue is bent down to the
floor of the mouth and its movements are
impaired. TR should be divided transversely and
then closed vertically.
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Neoplasms of the
TONGUE
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Benign Tumors
Benign are uncommon compared with malignant sq.
cell carcinoma. Haemangioma Papilloma
Lymphangioma Lipoma Neurofibroma
Osteoma Juvenile fibrous
Carcinoma (sq.cell carcinoma) of the tongue
(malignant)
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Aetiology
Cancer of the tongue uncommon below the age of 50
years (50-70 years) used to be common In men than
women (the sex incidence is now approaching
parity).
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The importance predisposing causes
Chronic irritation by smoking, sepsis, spices and
spirits (alcohol). Pre-cancerous lesions which
include syphilis, ch. superficial glossitis,
dental ulcers and papilloma. Poor oral hygiene
and mal nutrition. Betel chewing.
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Pathology
Two-thirds of the tongue cancer arise in the ant.
2/3rd and 1/3rd in the posterior part. The
commonest sites are the sides of the ant. 2/3rd
of the tongue. Posterior tumors are much more
to be in the midline.
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Gross appearance
The tumor usually occurs as malignant
ulcer. Less often it take, the form of hard
submucous nodule or deep fissure. Rarely it
occurs as diffuse hard infiltration of whole
tongue. (wooden tongue)
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Histology
The tumor is usually poorly diff. Squamous cell
carcinoma. Posterior tumors are less well diff.
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Spread of carcinoma of the TONGUE
Local (direct to the floor of the mouth, gums and
pharynx). Lymphatic spread. Blood spread (very
rare)
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The patient may seek advice because of mass or
ulcer in the tongue. But more often he present
with other symptoms which includes

• Pain
• Profuse salvation and fowl breathing
• Severe haemorrhage
• Fixation of the tongue (ankyloglossia)
• Alteration of the voice
• Lump of glands in the neck
• dysphagia

clinical features
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TERMINAL EVENTS
Death from an uncontrolled primary tumors occurs
as result of Inhalation bronchopneumonia. Hae
morrhage from erosion of the lingual
artery. Combined cancerous cachexia and
starvation. Asphyxia.
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T R E A T M E N T
Biopsy confirms the diagnosis the treatment by
SURGERY or RADIOTHERAPY or Combination of two.

• RADIOTHERAPY
• Usually reserved for tumors of the posterior
  third and for inoperable cases or as combination.

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II. SURGERY Local excision by partial or
hemiglossectomy in case a lesion at the tip of
the tongue or small lesion in the ant. 2/3rd with
2 cm of healthy tissue at all sides. Radical
block dissection, if the lymph nodes
enlarged. The commando operations combined
mandibulectomy and neck dissection.
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PROGNOSIS
For patient with LN negative with tumors in the
ant. 2/3rd there is 50, 5 years survival. For
patient with posterior 1/3rd of the tongue with
negative LN 20-25, 5 years survival.
a.
b.