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 food

Mucous membrane covers the tongue's mass of muscles and fat. The doublelayered 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 cloth..

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 dont 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 papillae

- 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 doesnt 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 dont 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 dont 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 instances

Geographic tongue, localized lesion.

Tongue-tie
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 speech.

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!

macroglossia
Increased tongue size which can be seen in: lymphangioma,heamangioma, amyloidosis, mongolism and acromegally

microglossia
Congenital anomally characterized by decreased size of the tongue,usually associated with severe deformity of limbs and digits

Glossodynia
burning mouth or Glossodynia characterized by a burning or tingling sensation of the tongue or the entire .mouth 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 changes

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 doesnt 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 glang No need for treatment

Black hairy tongue

Hairy tongue may occasionally appear black as a result of the growth of pigmentproducing 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 .)tongue

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 damaged Etiology may be iron deficiency ,vitamin deficiency, pernicious anemia, riboflavin deficiency and chronic alcoholism