Tongue

The tongue (Latin lingua; Greek glossa) is a mobile muscular organ covered with mucous membrane. It can assume a variety of shapes and positions. It is partly in the oral cavity and partly in the oropharynx. The tongue's main functions are articulation (forming words during speaking) and squeezing food into the oropharynx as part of deglutition (swallowing). The tongue is also involved with mastication, taste, and oral cleansing.

Parts and Surfaces of Tongue

The tongue has a root, body, and apex. The root of the tongue is the attached posterior portion, extending between the mandible, hyoid, and the nearly vertical posterior surface of the tongue. The body of the tongue is the anterior, approximately two thirds of the tongue between root and apex. The apex (tip) of the tongue is the anterior end of the body, which rests against the incisor teeth. The body and apex of the tongue are extremely mobile.

The tongue features two surfaces. The more extensive, superior and posterior surface is the dorsum of the tongue (commonly referred to as the "top" of the tongue). The inferior surface of the tongue (commonly referred to as its "underside") usually rests against the floor of the mouth. The margin of the tongue separating the two surfaces is related on each side to the lingual gingivae and lateral teeth. The dorsum of the tongue is characterized by a V-shaped groove, the terminal sulcus of the tongue, the angle of which points posteriorly to the foramen cecum. This small pit, frequently absent, is the non-functional remnant of the proximal part of the embryonic thyroglossal duct from which the thyroid gland developed. The terminal sulcus divides the dorsum of the tongue transversely into a presulcal anterior part in the oral cavity proper and a postsulcal posterior part in the oropharynx.

A midline groove divides the anterior part of the tongue into right and left parts. The mucosa of the anterior part of the tongue is relatively thin and closely attached to the underlying muscle. It has a rough texture because of numerous small lingual papillae:

• Vallate papillae: large and flat topped, lie directly anterior to the terminal sulcus and are arranged in a V-shaped row. They are surrounded by deep circular trenches, the walls of which are studded with taste buds. The ducts of the serous glands of the tongue open into the trenches.

• Foliate papillae: small lateral folds of the lingual mucosa. They are poorly developed in humans.

• Filiform papillae: long and numerous, contain afferent nerve endings that are sensitive to touch. These scaly, conical projections are pinkish gray and are arranged in V-shaped rows that are parallel to the terminal sulcus, except at the apex, where they tend to be arranged transversely.

• Fungiform papillae: mushroom shaped pink or red spots scattered among the filiform papillae but most numerous at the apex and margins of the tongue.

The vallate, foliate, and most of the fungiform papillae contain taste receptors in the taste buds.

The mucosa of the posterior part of the tongue is thick and freely movable. It has no lingual papillae, but the underlying lymphoid nodules give this part of the tongue an irregular, cobblestone appearance. The lymphoid nodules are known collectively as the lingual tonsil. The pharyngeal part of the tongue constitutes the anterior wall of the oropharynx and can be inspected only with a mirror or downward pressure on the tongue with a tongue depressor.

The inferior surface of the tongue is covered with a thin, transparent mucous membrane. This surface is connected to the floor of the mouth by a midline fold called the frenulum of the tongue. The frenulum allows the anterior part of the tongue to move freely. On each side of the frenulum, a deep lingual vein is visible through the thin mucous membrane. A sublingual caruncle (papilla) is present on each side of the base of the lingual frenulum that includes the opening of the submandibular duct from the submandibular salivary gland.

Muscles of Tongue

The tongue is essentially a mass of muscles that is mostly covered by mucosa (mucous membrane). As in the orbit, it is traditional to provide descriptions of the actions of tongue muscles ascribing (1) a single action to a specific muscle, or (2) implying that a particular movement is the consequence of a single muscle acting. This approach facilitates learning, but greatly oversimplifies the actions of the tongue. The muscles of the tongue do not act in isolation, and some muscles perform multiple actions. Parts of a single muscle are capable of acting independently, producing different, even antagonistic actions. In general, extrinsic muscles alter the position of the tongue, and intrinsic muscles alter its shape. The four intrinsic and four extrinsic muscles in each half of the tongue are separated by a median fibrous lingual septum, which merges posteriorly with the lingual aponeurosis.

Extrinsic Muscles of Tongue

The extrinsic muscles of the tongue (genioglossus, hyoglossus, styloglossus, and palatoglossus) originate outside the tongue and attach to it. They mainly move the tongue but they can alter its shape as well.

Intrinsic Muscles of Tongue

The superior and inferior longitudinal, transverse, and vertical muscles are confined to the tongue. They have their attachments entirely within the tongue and are not attached to bone. The superior and inferior longitudinal muscles act together to make the tongue short and thick and to retract the protruded tongue. The transverse and vertical muscles act simultaneously to make the tongue long and narrow, which may push the tongue against the incisor teeth or protrude the tongue from the open mouth (especially when acting with the posterior inferior part of the genioglossus).

Innervation of Tongue

All muscles of the tongue, except the palatoglossus, receive motor innervation from CN XII, the hypoglossal nerve. Palatoglossus is a palatine muscle supplied by the pharyngeal plexus. For general sensation (touch and temperature), the mucosa of the anterior two thirds of the tongue is supplied by the lingual nerve, a branch of CN V₃. For special sensation (taste), this part of the tongue, except for the vallate papillae, is supplied the chorda tympani nerve, a branch of CN VII. The chorda tympani joins the lingual nerve in the infratemporal fossa and runs anteriorly in its sheath. The mucosa of the posterior third of the tongue and the vallate papillae are supplied by the lingual branch of the glossopharyngeal nerve (CN IX) for both general and special sensation. Twigs of the internal laryngeal nerve, a branch of the vagus nerve (CN X), supply mostly general but some special sensation to a small area of the tongue just anterior to the epiglottis. These mostly sensory nerves also carry parasympathetic secretomotor fibers to serous glands in the tongue.

There are four basic taste sensations: sweet, salty, sour, and bitter. Sweetness is detected at the apex, saltiness at the lateral margins, and sourness and bitterness at the posterior part of the tongue. All other "tastes" expressed by gourmets are olfactory (smell and aroma).

Vasculature of Tongue

The arteries of the tongue are derived from the lingual artery, which arises from the external carotid artery. On entering the tongue, the lingual artery passes deep to the hyoglossus muscle. The dorsal lingual arteries supply the root of the tongue; the deep lingual arteries supply the lingual body. The deep lingual arteries communicate with each other near the apex of the tongue. The dorsal lingual arteries are prevented from communicating by the lingual septum.

The veins of the tongue are the dorsal lingual veins, which accompany the lingual artery; the deep lingual veins, which begin at the apex of the tongue, run posteriorly beside the lingual frenulum to join the sublingual vein. The sublingual veins in elderly people are often varicose (enlarged and tortuous). Some or all of them may drain into the IJV, or they may do so indirectly, joining first to form a lingual vein that accompanies the initial part of the lingual artery.

The lymphatic drainage of the tongue is exceptional. Most of the lymphatic drainage converges toward and follows the venous drainage; however, lymph from the tip of the tongue, frenulum, and central lower lip runs an independent course. Lymph from the tongue takes four routes:

1. Lymph from the root drains bilaterally into the superior deep cervical lymph nodes.

2. Lymph from the medial part of the body drains bilaterally and directly to the inferior deep cervical lymph nodes.

3. Lymph from the right and left lateral parts of body drains to the submandibular lymph nodes on the ipsilateral side.

4. The apex and frenulum drain to the submental lymph nodes, the medial portion draining bilaterally.

All lymph from the tongue ultimately drains to the deep cervical nodes, and passes via the jugular venous trunks into the venous system at the right and left venous angles.