DEVELOPMENT OF

TONGUE AND PALATE

K.SANTOSHI
I MDS
CONTENTS:
• Introduction
• Development of tongue
• Anatomy of tongue
• Muscles of tongue
• Vascular supply of tongue
• Lymphatic drainage of tongue
• Nerve supply
• Anomalies of tongue and
clinical considerations
• conclusion
• References
INTRODUCTION:
The word “Tongue“derived from the Latin word ‘lingua’and Greek word
‘glossa’.
 Tongue is a mobile muscular organ of oral cavity in vertebrates. It is
associated with the following functions:
.
DEVELOPMENT OF TONGUE
Anterior 2/3rd of the tongue

 the medial most portions of mandibular arches proliferate to form

two lingual swellings
 The lingual swellings are partly separated from one another by
another swelling that appears in the midline. This median swelling
is called Tuberculum impar
 Immediately behind the tuberculum impar the epithelium proliferates to
form down-growth from which thyroid gland develops.

 The site of this down growth is subsequently marked by a depression called

foramen caecum
 Swellings merges with each other and form ant2/3rd of the tongue
 Nerve supplied by trigeminal nerve
Posterior 1/3rd of the tongue:
 At end of 2nd and 4th week of IUL,midline swelling develop from
mesenchyme of 2nd ,3rd and 4th `arches, this swelling is called hypobrachial
eminence

 Hypobrachial eminence divided into

 Cranial part(copula)-2nd and 3rd arch

Caudal part-4th arch (forms epiglottis)
 The posterior one third of the tongue is formed from the cranial part of
hypobranchial eminence. i.e. copula
 In this situation the second arch mesoderm becomes buried below the
surface. The third arch mesoderm grows over it to fuse with mesoderm of
the first arch
 The posterior one third is thus formed by third pharyngeal arch mesoderm
 Nerve supplied by glossopharyngeal nerve.
Tongue musculature
 During the 5th to 7th week of IUL ,3-4 occipital myotomes, migrate
anterirorly to form the musculature of the tongue
Anatomy of tongue
Parts and surface of the tongue
 It has an oral part that lies in mouth and pharyngeal part that lies in
pharynx. The oral and pharyngeal parts are separated by a V-shaped sulcus-
sulcus terminalis

pharyngeal part

Sulcus terminalis

oral part
 The tongue has
A Root
A Tip
A Body
 The body has
a) superior surface or dorsum surface
b) inferior surface or ventral surface
• Superior surface devided in to three parts
a) anterior 2/3rd part called as oral part
b)posterior 1/3rd part called as pharygeal part
c)base (root) of tongue

•The two limbs of V-meet at a median pit,

named the foramen caecum.

• They run laterally and forwards upto

palatoglossal arches.
Superior surface
Oral part pharyngeal part

•The oral part of the tongue is •No papillae, shows nodular

placed on the floor of the surface,
mouth presence of lymphatic
•Just in front of palatoglossal nodules
arch each margin shows 4-5 and lingual tonsills.
vertical folds named, foliate •Contribute anterior
papillae. wall of oropharynx

Base part
•Base of tongue is far back and
Is bottom of tongue
•Contribute to the front wall
Of pharynx
•Movement can effect
the diameter of pharynx
Papillae of the tongue
 Indentation of any structure in the overlying epithelium
 Superior surface of tongue covered by numerous papillae
 Have taste buds on their surface
 Types of papillae
a) Circumvallate
b) Fungiform
c) Filliform
d) Foliate
 Filliform Foliate papilla Fungiform Circumvallate
papilla papilla papilla
•cover the dorsum •They are large in size
of tongue and give •They are numerous about 1-2mm in
it a characteristic These are present as near the tip and diameter and are 8-12
3 or 4vertically margins of the tongue, in number
velvety appearance
arranged mucus but some of them are
scattered over the • They are situated in a
• They are the folds on the lateral
dorsum. single row adjacent to
smallest and most margin of the and in front of the
numerous of the tongue ,in front of • They are sulcus terminalis
lingual papillae sulcus terminalis distinguished by their
bright red colour. • Each papillae is seen
.Each is pointed and as a truncated conical
covered with projection surrounded
by a circular sulcus at
keratin
its base
Inferior surface
 It does not contain papillae
 The inferior surface is covered with a smooth mucous membrane which
shows a median fold called frenulum linguae
 Lateral to frenulum, deep lingual vein can be seen through the mucosa
 lateral to the lingual vein, mucosal fold called as plica fimbriata

Deep lingual vein

Pilica fimbriata

Lingual frenum
 Tongue masculature
A middle fibrous septum divides tongue in
right and left halves. Each of the half contains
four intrinsic and four extrinsic muscles
Intrinsic muscles
a) Superior longitudinal
b)Inferior longitudinal
c)Transverse
d)Vertical
Extrinsic muscle
a)Genioglossus
b)Hyoglossus
c)Styloglossus
d)Palatoglossus
 Muscle Origin Insertion Action

Superior It lies beneath the mucous These fibres extend forward Turns the apex and sides
longitudinal membrane of the dorsum of tongue from near the epiglottis and the of the tongue upward to
and consist of longitudinally and median lingual septum to the make the dorsum
obliquely running fibres side of tongue concave

Inferior It lies near the ventral surface of The muscle fibres extend
longitudinal tongue interposed between the between the root and apex of curl the tip inferiorly
hyoglossus laterally and tongue. Some of the posterior and shortens the tongue
genioglossus medially fibres are connected to the body
of hyoid bone

The muscle fibres run

inferolaterally from the dorsum of ventral surface of the borders of Flattens and broadens
tongue. They are confined to the the tongue the tongue
Verticalis
anterior part of tongue extending
from the dorsal to the ventral
lingual surface

The muscle fibres run from each fibrous tissue at the margins of Narrow and elongates
side of the median fibrous septum tongue the tongue
Transverse to the right and left margins of the
tongue
Extrinsic muscles
These muscles take origin from parts outside the tongue,
therefore move the tongue as well as alter the shape
Divide into four types
1) Genioglossus
2) Hyoglossus
3) Styloglossus
4) Palatoglossus
 fibres radiate and insert protrude the tip of
origin: inner surface of throughout the tongue tongue and makes the
symphysis menti from from apex to root of dorsum concave,
Genioglossus the superior genial
tongue. lowest fibres are prevents the tongue from
tubercles or spines of
mandible attached to superior falling back and
border of body of hyoid obstructing the
bone orophrynx.

The fibers run upward and It depresses the

From the whole length of slightly forward to be tongue,makes dorsum
Hyoglossus inserted in to the side of convex and helps in
greater cornu and the the tongue between retraction of protruded
front of the lateral part of styloglossus and inferior tongue
the body of hyoid bone longitudinal muscle of the
tongue.

Descends in palatoglossal Elevates the posterior part

Palatogloss Oral surface of palatine arch to the side of the of tongue. Approx imates
us muscle aponeurosis tongue at the junction of the palatoglossal arches
its oral and pharyngeal bilaterally and thus closes
parts oro pharyngeal isthumus

From tip and adjacent part Fibers run down wards and Draws the tongue upward
Styloglossu of anterior surface of insert along the entire and back wards,is
s muscle styloid process as well as length of side of tongue antagonist to genioglossus..
from upper end of styloid
ligament
VASCULAR SUPPLY
Arterial supply
 Lingual artery supplies tongue and floor of the mouth
 Originate from external carotid artey
 Passes between hyoglossus and genio glossus muscles of tongue.
 Lingual artery mainly gives three branches with in the tongue namely:
 A) Dorsal lingual artery
 B) Deep lingual artery
 C)Sub lingual artery
Venous drainage
 Drained by Dorsal lingual vein and Deep lingual vein.
 Deep lingual vein
 Begins near tip of tongue and run beneath the mucous membrane
 Visible on inferior surface of tongue
 Anterior to lingual artery
 Ultimately drains in to internl jugular vein
 Dorsal lingual vein
 Drains the dorsum and sides of tongue
 Runs along the lingual artery
 Drains into internal jugular vein
Lymphatic drainage
 Apical vessels
 Drains into submental nodes
and deep cervical nodes

Marginal vessels
Drains into submandibular and
Deep cervical nodes.

Basal vessels
 Drains into deep cervical nodes.
Nerve supply
Motor supply:
 All extrinsic and intrinsic muscles are supplied by Hypoglossal nerve except
palatoglossus which is supplied by vagus nerve.
Sensory supply:
General sensation is by 3 nerves
Lingual nerve- ant 2/3 of tongue
Glossopharyngeal nerve-podt 1/3
Vagus nerve: post most part of tongue
 Special sensory:

 Chorda tympanal: Taste sensation of anterior 2/3 of tongue

 Glossopharyngeal : Taste sensation from psterior 1/3

 Vagus nerve: Taste sensation of posterior most part.

Anomalies of Tongue
Aglossia and microglossia
Macroglossia
Ankyloglossia
Cleft tongue
Fissured tongue
Median rhomboid glossitis
Benign migratory glossitis
Hairy tongue
Lingual varies
 Aglossia
complete absence of tongue at birth- very rare
Etiology:It is caused by failure of the tongue embyogenesis
process .
4th to 8th week of gestation.

Treatment: The treatment

is to prevent complications
like collapsed bite ,
orthodontic treatment should
be done if there is severe
malocclusion.
Microglossia
A rare congenital anomaly –presence of samll or rudimentary tongue
Aglossia –microglossia extreme glossoptosis
Etiology – thought to be due to foetal cell traumatism in the 1st few
weeks of gestation
As a consequence of lack of muscular stimulus between the
alveolar arches

 these do not develop transversely and mandible does not grow

in an anterior direction , produced as a result severe dental
malocclusion

Treatment: There is no treatment for this condition , and the

Affected person will have to train their tongue to the best of
their abilities.
Macroglossia
It is the development of abnormally large
tongue
Cause – may be due to dilation of lymphatics,
muscle hypertrophy or inflammation.
Types –
a)true macroglossia
b) pseudo macroglossia

Physical examination of the oral cavity and

head morphology is helpful to deduce true
from pseudomacroglossia
Pseudomacroglossia – severe maxillary or
mandibular retrognathia may indicate this
condition
C/F-
Displacement of teeth/malocclusion
Crenation and scalloping of the lateral border of tongue
Tips of the crenation fitting into the interproximal spaces
between the teeth

Associated syndromes
Beckwith’s Wiedmann syndrome and Down syndrome

Treatment
surgical reduction or trimming may be required when it
disturbs the oropharyngeal function
 Ankyloglossia( Tongue tie)
It is a developmental condition characterized
by fixation of tongue to the floor of the mouth

Types:
A) Complete ankyloglossia - occurs a result of
complete fusion between the ventral surface of
the tongue and floor of mouth
B)Partial ankyloglossia is much more
common condition, occurs as result of short
lingual frenum.
Clinical features
 Restriction of free movement of tongue
In infancy tongue tie cause feeding difficulties
Some cases causes speech defects
Contributes to persistent gap between the mandibular incisors

Treatment
Partial ankyloglossia is sometimes self corrective
Complete ankyloglossia can be surgically treated by
frenulectomy
Cleft tongue

Complete cleft/ Bifid tongue-

a rare condition
is due to lack of merging of the lateral lingual swelling of the organ

Partial cleft tongue

Common condition
 Manifested as groove in the midline of the dorsal surface
Cause
 incomplete merging and failure of groove obliteration by
underlying mesenchymal proliferation
Associated syndrome
oral-facial-digital syndrome
thick fibrous bands in lower anterior mucobuccal fold eliminating
the sulcus and with clefting of hypoplastic mandible.

C/F
Food debris and microorganisms may collect in the base of the
cleft and cause irritation
Fissured tongue
(scrotal tongue/lingua pilcata )
manifested clinically by numerous small furrows or grooves 2-
6mm in depth on the dorsal surface, often radiating from the
central groove along the midline of the tongue

etiology
chronic trauma
 vitamin deficiencies
 autosomal dominant mode of inheritance
Painless except in cases when food debris tends to collect
in the grooves and produce irritation

Associated syndrome
Melkersson-Rosenthal syndrome

Treatment
Material is removed by stretching and flattening the fissures
and using tooth brush or gauze sponge to cleanse the
surface
Median rhomboid glossitis
 Congenital anomaly which is due to failure of tuberculum impar to
retract or withdraw before fusion of lateral halves of the tongue
 Candida albicans
C/F
Its appears as an ovoid, diamond,
Rhomboid shaped reddish patch
or plaque on the dorsal surface of
Tongue , immediately anterior to
circumvallate papillae
Lesions are typically less than 2cms in diameter
Histological examination
 absence of fungiform and filiform papilla, chronic
inflammatory cell infiltrate.

Treatment
Antifungal therapy for erythema and inflammation due to
candida infection
Nodular cases must be intervened surgically.
 Benign migratory glossitis
Areas of desquamation of the filiform papillae in an irregular
circinate pattern
Central portion
-Inflamed white with borders may be outlined by a thin,
yellowish white line or band
-Fungiform papillae persist and appear as elevated dots
Its dominant characteristic is a constantly changing pattern of
serpinginous white lines surrounding areas of smooth,
depapillated mucosa

Cause – sometimes genetic, aggrevated by stress

Histopathologic examination
A thickened layer of keratin is infiltrated with neutrophils, as are
lower portions of the epithelium to a lesser extent. These
inflammatory cells often produce small microabscesses called
Monro’s abscesses in the keratin and spinous layers

Treatment
Symptomatic lesions can be treated with topical prednisolone
and a topical or systemic antifungal medication can be tried if a
secondary candidiasis is suspected
Hairy tongue/lingue nigra
Characterized by hypertrophy of filiform papillae with lack of
normal desquamation
C/F
Normal filiform papillae – 1mm in length
 Hairy tongue – 15mm in length
Greater frequency in HIV patients
Rarely symptomatic, although overgrowth of candida albicans may
result in glossopyrosis ( burning tongue).

Tickling sensation in the soft palate and oropharynx during swallowing.

Retention of debris between the elongated papilla result in halitosis

Etiology
Candida albicans

Treatment
Mild cases- thorough brushing of the tongue is sufficient to remove
elongated filliform papilla
Severe cases – surgical removal
Lingual varices
A varix is a dilated, tortuous vein, most commonly a vein
which is subjected to increased hydrostatic pressure but poorly
supported by surrounding tissue.
Lingual varice appear as red or purple shotlike clusters of
vessels on the ventral and lateral borders of tongue and floor of
mouth.
It represents an aging process
DEVELOPMENT OF PALATE
 CONTENTS
 Introduction
 Features And Parts Of Palate
 Blood Supply
 Nerve Supply
 Lymphatic Drainage
 Muscualature Of The Soft Palate
 Development Of Palate
 A. Development Of Primary Palate
 B. Development Of Secondary Palate
 Anomalies and Clinical Considerations
 Conclusion
 References
INTRODUCTION
Palate forms the roof of the mouth.  It separates the
oral cavity from nasal cavity.
 
Has two parts
 Hard palate Bony( anteriorly)
   Soft palate Muscular(posteriorly)
HARD PALATE
 SOFT PALATE
Seperates oral cavity from naso pharynx.

Margins:

Anteriorly : It continous with the hard palate

Posterio laterally: Forms the superior

portion of the palatoglossal and palato
pharyngeal folds

Posteriorly: The uvula hangs in the center of

posterior free margin.
Blood supply
Arteries
Veins:
Generally follow the arteries
Ultimately drains in to the pterygoid plexus of veins in
infra temporal fossa.

Lymphatic drainage : drains in to deep cervical nodes.

Nerve supply
Muscles of soft palate
Palatine aponeurosis
Fibrous sheath
Attached to posterior border of
hard is flattend tendon of tensor veli palatini.
splits to enclose musculus uvulae
Gives origin and insertion
 to palatine muscles.
 DEVELOPMENT OF PALATE
 During the 4th week of development, after the formation of the
head fold, two prominent bulgings appear on the ventral aspect of
the developing embryo, separated by the stomatodeum.
They are: –
 Developing brain cranially
 Pericardium caudally

 The floor of the stomatodeum is formed by the buccopharyngeal

membrane, which separates it from the foregut. On each side, the
stomatodeum is bounded by first arch.

 Soon, mesoderm covering the developing forebrain proliferates and

forms a downward projection that overlaps the upper part of the
stomatodeum. This downward projection is called the frontonasal
process.

 The pharyngeal arches are laid down in the lateral and ventral
walls of the most cranial part of the foregut. These are also,
therefore, in very close relationship to the stomatodeum.
INTERMAXILLARY SEGMENT
 As a result of medial growth of the maxillary prominences, the two medial nasal
prominences merge not only at the surface but also at a deeper level. The structure
formed by the two merged prominences is the intermaxillary segment. It is composed of
( 1) a labial component, which forms the philtrum of the upper lip; (2) an upper jaw
component, which carries the four incisor teeth; and (3) a palatal component,
which forms the triangular primary palate. The intermaxillary segment is continuous
with the rostral portion of the nasal septum, which is formed by the frontal
prominence.
SECONDARY PALATE

 Although the primary palate is derived

from the intermaxillary segment, the
main part of the definitive palate is
formed by two shelf-like outgrowths
from the maxillary prominences.
 These outgrowths, the palatine
shelves, appear in the sixth week of
development and are directed obliquely
downward on each side of the tongue.
In the seventh week, however, the
palatine shelves ascend to attain a
horizontal position above the tongue
and fuse, forming the secondary
palate.
 Anteriorly, the shelves fuse with the
triangular primary palate, and the
incisive foramen is the midline
landmark between the primary and
secondary palates. At the same time
as the palatine shelves fuse, the nasal
septum grows down and joins with
the cephalic aspect of the newly
formed palate .
THANK YOU
Anomalies
CLEFT PALATE:

Clefts of the primary palate

 Result from a failure of mesoderm to penetrate into the grooves
between the medial nasal and maxillary processes. Which prohibits
their fusion from each other.

Clefts of the secondary palate

 Result from a failure of the palatine shelves to fuse with one another.
The cause for this is failure of the tongue to descend in to the oral
cavity.
Normal cleft palate
classification
PROBLEMS ASSOCIATED WITH CLEFT PALATE:
Feeding problems are often associated with infants affected with cleft
lip and palate, making it difficult to maintain adequate nutrition. These
problems include:
Insufficient suction to pull milk from the nipple
Excessive air intake during feeding
Choking
Nasal regurgitation
Excessive time required for nourishment
Speech problems
Respiratory tract infections
Ear infection
Associated cardiac anomalies
Associated syndromes; Van-der Woude syndrome
Dental problems commonly associated with cleft lip
and palate:

Natal and neo-natal teeth

Congenitally absent teeth
Supernumerary teeth
Ectopic eruption of teeth
Various anomalies of tooth morphology
Premature loss of teeth adjacent to cleft
Rotated teeth adjacent to cleft
Cross-bite due to medial collapse of maxilla, etc.
Management
Ideally, treatment involves a multidisciplinary approach.

Maxillo facial
surgeon
Social
Social Worker
Worker

Pediatrician
Pediatrician

Nurse
Nurse Team
Team

Pedodontist/Orthod
Pedodontist/Orthod
ontist
ontist
CLEFT PALATE

Genetic
Genetic Counsellor
Counsellor

Speech
Speech Therapist
Therapist

Audiologist
Audiologist
Oto
Oto Laryngologist
Laryngologist
BIFID UVULA
A bifid uvula is an uvula that is split, or
forked. It’s also called a cleft uvula.
The uvula serves several purposes, from
lubricating the back of the mouth to
directing nasal secretions to throat. Its
primary function is two fold:
•It helps the soft palate close when eating
and drinking, preventing food and liquid
from entering your nose.
•It helps move the soft palate to the back
of your throat so words and sounds are
properly enunciated.
 :
COMPLICATIONS:
. • Trouble moving their soft palate during times of eating,
drinking, and speaking.
• Improper ingestion of food, re.
• Distorted speech. This is especially true when the uvula
is deeply split

MANAGEMENT:
In most cases, a bifid uvula needs no treatment.
If symptomatic, speech and feeding therapies may be
recommended.
When speech is extremely nasal or feeding problems are
significant, surgery to repair the uvula and any underlying factors,
like a submucous cleft palate, may be advised.
NASOPALATINE DUCT CYST (INCISIVE CANAL CYST)

Clinical and Radiographic Features:

 the anterior palate and labial alveolar mucosa .
 Most common in the fourth to sixth decades of life. In spite of its
being a "developmental" cyst, the nasopalatine duct cyst is rarely
seen during the first decade.
 Male predilection present
 Swelling of the anterior palate. drainage. and pain.
 Many lesions are asymptomatic and are discovered on routine
radiographs.
 Rarely a large cyst may produce a "through- and-through"
fluctuant expansion involving
Treatment and Prognosis:
Surgical enucleation. Biopsy is
recommended because the lesion
is not diagnostic
radiographically; other benign
and malignant lesions have been
known to mimic the nasopalatine
duct cyst
 MEDIAN PALATAL (PALATINE) CYST:
 A rare fissural cyst

 Develops from epithelium entrapped along the embryonic line of fusion

of the lateral palatal shelves of the maxilla.

 Difficult to distinguish from a nasopalatine duct cyst. In fact most

"median palatal cysts" may represent posteriorly positioned nasopalatine
duct cysts.
 Clinical and Radiographic Features:
 A firm or fluctuant swelling of the midline of the hard palate posterior to the palatine
papilla.
 The lesion appears most frequently in young adults.
 Often asymptomatic but some patients complain of pain or expansion. The average size
is 2 X 2 cm, but sometimes it can become quite large.
 Occlusal radiographs demonstrate a well circumscribed radiolucency in the midline of
the hard palate.

Treatment and Prognosis: The median palatal cyst is treated by surgical removal.
Recurrence should not be expected.
 TORUS PALATINUS:

Common exostosis that occurs in the midline of the vault of

the hard palate.

The pathogenesis of these tori has long been debated with

arguments centering on genetic versus environmental
factors such as masticatory stress. Some authorities have
suggested that the torus palatinus is inherited as an
autosomal dominant trait. However, others believe that the
development of this lesion is multifactorial, including both
genetic and environmental influences.
 Clinical and Radiographic Features: The torus palatinus presents as a bony hard mass that
arises along the midline suture of the hard palate. Tori sometimes are classified according to
their morphology:
 • The flat torus has a broad base and a slightly convex, smooth surface.
 • The spindle torus has a midline ridge along the palatal raphe.
 • The nodular torus arises as multiple protuberances, each with an individual base.
 • The lobular torus is also a lobulated mass, but it rises from a single base. Can be either
sessile or pedunculated.
CONCLUSION

It is important for the clinician to know the normal and the
abnormal ranges in growth for proper diagnosis, treatment
planning and selecting appropriate clinical procedures.
Orthodontic treatment, irrespective of appliance depends
to a great extent on the adaptive capacity of the alveolar
process, growth and remodeling.
 
 
REFERENCES:

I.B.Singh, Human Embryology, 4TH Edition

The Developing Human, Moore
Oral Pathology, Neville
Human Anatomy, B.D. Chaurasia, Vol III
Langman’s Medical Embryology