Tongue, salivary glands (for ED I.) additional images for the lecture Dr. Ágota Ádám February 22, 2018. Part I. - Tongue Dorsum of the tongue Ventral surface of the tongue Ant. lingual glands fimbriated fold (plica fimbriata) Developmental disorder: ‘tongue-tied’ baby frenulum (ankyloglossia) Sublingual caruncle! Deep lingual a. and v.; (opening of lingual n. submandibular and sublingual ducts!) Sublingual fold Muscles of the tongue Motor innervation: hypoglossal nerve (CN XII.)! (palatoglossus) (soft palate muscles!) styloglossus genioglossus The ONLY muscle that hyoglossus protrudes the tongue! Innervation of the tongue SPECIAL (TASTE) SENSATION GENERAL (SOMATIC) SENSATION Motor innervation: hypoglossal n. (CN. XII.) N. X. N. X. a, normal situation N. IX. N. IX. b, unilateral hypoglossal nerve palsy (paralysed genioglossus on affected side) a, b, chorda tympani lingual n. (from CN V/3) (from CN VII.) Vessels and nerves of the tongue lingual n. (from CN V/3) glossopharyngeal n. submandibular ganglion lingual a. (from ECA) and lingual v. hypoglossal n. Lateral lingual sulcus (groove) Borders: Medial: hyoglossus m. lateral and inferior: mylohyoid m. superior: mucosa of oral cavity Contents: •N. XII. •n. lingualis (from V/3) •submandibular duct •sublingual gland lingual nerve sublingual gland sublingual caruncle medial pterygoid submandibular gland submandibular duct The lymphatic drainage of the tongue Anterior 2/3: to central and marginal lymph vessels; post. 1/3: to dorsal lymph vessels. The lymph nodes receive drainage from both ipsilateral and contralateral sides!!! UPPER DEEP CERVICAL LYMPH NODES: (around the int. jugular v.) submandibular jugulo-gastric node lymph nodes jugulo-omohyoid node submental lymph nodes LOWER DEEP CERVICAL LYMPH NODES Papillae of the tongue filiform fungiform foliate circumvallate taste buds Taste bud von Ebner’s glands (serous) Examples of diseases showing clinical signs on the tongue median rhomboid glossitis ‘strawberry tongue’ ‘geographic glossitis’ (Candida infection) (scarlet fever) (cause unknown) leukoplakia oral cancer on pre-cancerous the side of the lesion, due to tongue or permanent irritation (smoking (!) ) Part II. - Salivary glands 3 major salivary glands: parotid duct (Stensen) parotid gland sublingual gland buccinator m. submandibular gland Parotid nest (drawing!!!) posterior border: SCM, post. belly of digastric medial border: ‘stylo-muscles’ anterior border: masseter, ramus of mandible, med. pterygoid lateral border: parotideomasseteric fascia Openings of salivary glands to the oral cavity (!) Submandibular duct (of Wharton) (1/side): to proper oral cavity, sublingual caruncula Sublingual ducts (8-20): to proper oral cavity, the largest duct (of Bartholin) joins the submandibular duct and opens into the sublingual caruncula, the smaller ones (of Rivinius) open at the sublingual fold/plica Parotid duct (of Stensen) (1/side): to oral vestibule, on the buccal mucosa, opposite to the upper 2nd molar tooth RELATIVE ISOLATION of the teeth from saliva ABSOLUTE ISOLATION upper posterior teeth – isolation from the opening of Stensen’s duct lower posterior teeth rubber dental dam isolation of lower front teeth from the sublingual caruncle Minor salivary glands Bimanual examination of the salivary glands In addition to the 3 major paired glands, 500-1000 minor glands also secrete saliva (5-8% of total) into the oral cavity Labial glands submandibular (mixed) gland Palatine glands (mucous) lymph node Pharyngeal glands (mucous) Sublingual gland Histology of salivary glands acinus (with myoepithelial cells around) – intercalated duct – striated duct – interlobular duct - excretory duct submandibular gland sublingual gland parotid gland (mixed; serous > mucous) mixed; mucous > serous) (pure serous) serous acini mucous acinus striated duct mucous acinus striated duct serous acini Submandibular gland – more serous acini! adipocytes striated duct Sublingual gland – more mucous acini! striated duct Salivary stones (sialolithiasis) sialendoscopy Thank you for your attention! .