Dysphagia causes: Difference between revisions

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(/* Causes in Alphabetical OrderSailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016 Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachuset...)
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* [[Tongue cancer]]
* [[Tongue cancer]]
* [[Tongue disease|Tongue conditions]]
* [[Tongue disease|Tongue conditions]]
* [[Tonsil disorders ]]
* [[The '''tongue''' is a [[muscular hydrostat]] on the floor of the mouth of most [[vertebrate]]s that manipulates food for [[mastication]]. It is the primary [[organ (anatomy)|organ]] of [[taste]] (gustation), as much of its upper surface is covered in [[taste buds]]. The tongue's upper surface is also covered in numerous [[lingual papilla]]e. It is sensitive and kept moist by [[saliva]], and is richly supplied with nerves and blood vessels. In humans a secondary function of the tongue is [[Articulatory phonetics|phonetic articulation]]. The tongue also serves as a natural means of [[oral hygiene|cleaning]] the teeth.<ref>{{cite book |last1=Maton |first1=Anthea |last2=Hopkins |first2=Jean |last3=McLaughlin |first3=Charles William |last4=Johnson |first4=Susan |last5=Warner |first5=Maryanna Quon |last6=LaHart |first6=David |last7=Wright |first7=Jill D. |title=Human Biology and Health |publisher=Prentice Hall |year=1993 |location=Englewood Cliffs, New Jersey, USA |isbn=0-13-981176-1}}</ref> The ability to perceive different tastes is not localised in different parts of the tongue, as is widely believed.<ref>[http://www.scientificamerican.com/article.cfm?id=the-taste-map-all-wrong The Taste Map: All Wrong], ''[[Scientific American]], March 18, 2001.</ref> This error arose because of misinterpretation of some 19th-century research (see [[tongue map]]).
 
==Structure==
[[File:Facies inferior linguae.JPG|right|thumb|175px|The underside of a human tongue]]
The tongue is a muscular structure that forms part of the floor of the [[oral cavity]]. The left and right sides of the tongue are separated by the [[lingual septum]]. The human tongue is divided into [[Anatomical terms of location#Anterior and posterior|anterior and posterior]] parts. The anterior part is the visible part situated at the front and makes up roughly two-thirds the length of the tongue. The posterior part is the part closest to the throat,  roughly one-third of its length. These parts differ in terms of their embryological development and nerve supply. The two parts of the tongue are divided by the [[Terminal sulcus (tongue)|terminal sulcus]].<ref name=GRAYS2005>{{cite book|last=Drake|first=Richard L.|title=Gray's anatomy for students|year=2005|publisher=Elsevier/Churchill Livingstone|location=Philadelphia|isbn=978-0-8089-2306-0|author2=Vogl, Wayne |author3=Tibbitts, Adam W.M. Mitchell  |author4=illustrations by Richard |author5= Richardson, Paul }}</ref>{{rp|989–990}}
 
The anterior tongue is, at its apex, thin and narrow, it is directed forward against the lingual surfaces of the lower [[incisor]] teeth. The posterior part is, at its root, directed backward, and connected with the [[hyoid bone]] by the [[hyoglossi]] and [[genioglossi]] muscles and the [[hyoglossal membrane]], with the [[epiglottis]] by three folds (glossoepiglottic) of mucous membrane, with the [[soft palate]] by the [[glossopalatine arches]], and with the [[pharynx]] by the [[superior pharyngeal constrictor muscle]] and the [[mucous membrane]]. It also forms the anterior wall of the [[oropharynx]].
 
In [[phonetics]] and [[phonology]], a distinction is made between the '''tip''' of the tongue and the '''blade''' (the portion just behind the tip).  Sounds made with the tongue tip are said to be [[apical consonant|apical]], while those made with the tongue blade are said to be [[laminal consonant|laminal]].
 
===Muscles===
The eight muscles of the human tongue are classified as either ''intrinsic'' or ''extrinsic''. The four intrinsic muscles act to change the shape of the tongue, and are not attached to any bone. The four extrinsic muscles act to change the position of the tongue, and are anchored to bone.
 
<gallery>
File:Gray1020.png |Coronal section of tongue, showing intrinsic muscles
File:Gray1019.png |Lateral view of the tongue, with extrinsic muscles highlighted.
</gallery>
 
====Extrinsic====
The extrinsic muscles originate from bone and extend to the tongue. Their main functions are altering the tongue's position allowing for protrusion, retraction, and side-to-side movement.<ref name=GRAYS2005 />{{rp|991}}
# [[Genioglossus]], which arises from the [[mandible]] and protrudes the tongue. It is also known as the "safety muscle" of the tongue since it is the only muscle having the forward action.
# [[Hyoglossus]], which arises from the [[hyoid bone]] and depresses the tongue
# [[Styloglossus]], which arises from the [[styloid process]] of the temporal bone and elevates and retracts the tongue
# [[Palatoglossus]], which arises from the [[palatine aponeurosis]], and depresses the [[soft palate]], moves the ''palatoglossal fold'' towards the midline, and elevates the back of the tongue.
 
====Intrinsic====
Four paired intrinsic muscles of the tongue originate and insert within the tongue, running along its length. These muscles alter the shape of the tongue by: lengthening and shortening it, curling and uncurling its apex and edges, and flattening and rounding its surface. This provides shape, and helps facilitate speech, swallowing, and eating.<ref name=GRAYS2005 />{{rp|991}}
# The [[superior longitudinal muscle of tongue|superior longitudinal muscle]] runs along the superior surface of the tongue under the mucous membrane, and elevates, assists in retraction of, or deviates the tip of the tongue. It originates near the [[epiglottis]], the [[hyoid bone]], from the median fibrous septum.
# The [[inferior longitudinal muscle of tongue|inferior longitudinal muscle]] lines the sides of the tongue, and is joined to the styloglossus muscle.
# The [[vertical muscle of tongue|vertical muscle]] is located in the middle of the tongue, and joins the superior and inferior longitudinal muscles.
# The [[transverse muscle of tongue|transverse muscle]] divides the tongue at the middle, and is attached to the [[mucous membrane]]s that run along the sides.
 
===Blood supply===
The tongue receives its [[blood]] supply primarily from the [[lingual artery]], a branch of the [[external carotid artery]]. The [[lingual veins]], drain into the [[internal jugular vein]]. The floor of the mouth also receives its blood supply from the lingual artery.<ref name=GRAYS2005 />{{rp|993–994}} There is also a secondary blood supply to the tongue from the [[tonsillar branch of the facial artery]] and the [[ascending pharyngeal artery]].
 
An area in the neck sometimes called [[Pirogov Triangle|Pirogov's triangle]] is formed by the intermediate tendon of the [[digastric muscle]], the posterior border of the [[mylohyoid muscle]], and the [[hypoglossal]] nerve.<ref>[http://www.whonamedit.com/synd.cfm/3186.html Pirogov's triangle]</ref><ref>{{cite journal |title=Topographic anatomy of lingual arterial anastomoses; Pirogov-Belclard's triangle |last1=Jamrozik |first1=T. |last2=Wender |first2=W. |journal=Folia Morphologica |volume=3 |issue=1 |pages=51–62 |date=January 1952 |pmid=13010300}}</ref> The lingual artery is a good place to stop severe [[hemorrage]] from the tongue.
 
===Innervation===
Innervation of the tongue consists of motor fibers, [[special visceral afferent|special sensory]] fibers for taste, and [[general visceral afferent|general sensory]] fibers for sensation.<ref name=GRAYS2005 />{{rp|994–5}}
 
*Motor supply for all intrinsic and extrinsic muscles of the tongue is supplied by [[efferent nerve fiber|efferent motor nerve fibers]] from the [[hypoglossal nerve]] (CN XII), with the exception of the [[palatoglossus]]. The palatoglossus is innervated by the [[vagus nerve]] (CN X).<ref name=GRAYS2005 />{{rp|995}}
 
Innervation of taste and sensation is different for the anterior and posterior part of the tongue because they are derived from different embryological structures ([[pharyngeal arch]] 1 and pharyngeal arch 3 and 4, respectively).<ref>{{Cite book | edition = Sixth
| publisher = LWW | isbn = 9781451190380 | last = PhD | first = Dr Ronald W. Dudek | title = BRS Embryology | date = 2014}}</ref>
 
*Anterior two thirds of tongue (anterior to the [[Lingual papilla#Circumvallate papillae|vallate papillae]]):
**Taste: chorda tympani branch of the [[facial nerve]] (CN VII) via [[special visceral afferent]] fibers
**Sensation: lingual branch of the mandibular division (V3) of the [[trigeminal nerve]] (CN V) via [[general somatic afferent]] fibers
 
*Posterior one third of tongue:
**Taste and sensation: [[glossopharyngeal nerve]] (CN IX) via a mixture of special and general visceral afferent fibers
 
===Histology===
[[File:Human tongue (251 09) Section.jpg|thumb|Section through the human tongue; stained [[Hematoxylin and eosin stain|H&E]]]]
The tongue is covered with numerous [[taste bud]]s, and [[filiform papillae|filiform]], [[fungiform papillae|fungiform]], [[vallate papillae|vallate]] and [[foliate papillae|foliate]], [[lingual papilla]]e.<ref name=GRAYS2005 />{{rp|990}}
 
===Length===
The average length of the human tongue from the [[oropharynx]] to the tip is 10cms in length.<ref>{{cite book |year=1997 |last=Kerrod |first=Robin |title=MacMillan's Encyclopedia of Science |publisher=Macmillan Publishing Company, Inc. |volume=6 |isbn=0-02-864558-8}}</ref>
 
===Development===
The anterior tongue is derived primarily from the [[first pharyngeal arch]]. The posterior tongue is derived primarily from the third [[pharyngeal arch]]. The second arch however has a substantial contribution during fetal development, but this later atrophies. The fourth arch may also contribute, depending upon how the boundaries of the tongue are defined.
 
The terminal sulcus, which separates the anterior and posterior tongue, is shaped like a V, with the tip of the V situated posteriorly. At the apex is the [[foramen caecum]], which is the point where the embryological [[thyroid]] begins to descend.<ref name=GRAYS2005 />{{rp|990}}
 
==Function==
{{multiple image
| align    = right
| direction = horizontal
| width    = 250
| image1    = Tongue_and_taste_buds.jpg
| width1    = 250
| alt1      = Human tongue and taste buds
| image2    = 1402 The Tongue.jpg
| width2    = 240
| alt2      = Taste receptors in papillae
| footer    = Taste receptors are present on the human tongue in papillae
| footer_align      = center
}}
 
===Taste===
{{main|Taste|Taste receptor|Supertaster}}
Chemicals that stimulate [[taste receptor]] cells are known as tastants. Once a tastant is dissolved in [[saliva]], it can make contact with the [[plasma membrane]] of the gustatory hairs, which are the sites of taste [[transduction (physiology)|transduction]].<ref>Tortora. ''Principles of Anatomy and Physiology'' 12th edition, chapter 17, p.602.</ref>
 
The tongue is equipped with many [[taste buds]] on its [[Anatomical terms of location|dorsal]] surface, and each taste bud is equipped with taste receptor cells that can sense particular classes of tastes. Distinct types of taste receptor cells respectively detect substances that are sweet, bitter, salty, sour, spicy, or taste of [[umami]].<ref>Silverhorn. ''Human Physiology: An integrated approach'' 5th edition, chapter 10, p.352.</ref> Umami receptor cells are the least understood and accordingly are the type most intensively under research.<ref>Schacter, Daniel L., Daniel Todd. Gilbert, and Daniel M. Wegner. "Sensation and Perception." Psychology. 2nd ed. New York: Worth, 2009. 166. Print.</ref>
 
===Mastication===
The tongue is also used for crushing food against the hard palate, during mastication. The [[epithelium]] on the tongue’s upper, or dorsal surface is [[keratin]]ised. Consequently, the tongue can grind against the hard palate without being itself damaged or irritated.<ref>Atkinson. "Anatomy for dental students'' 4th edition.</ref>
 
===Swallowing===
 
===Speech===
 
==Clinical relevance==
 
===Disease===
{{Main|Tongue disease}}
 
After the [[Gingiva|gum]]s, the tongue is the second most common [[soft tissue]] site for various [[pathology|pathologies]] in the [[oral cavity]].{{medical citation needed|date=July 2013}} Examples of pathological conditions of the tongue include [[glossitis]] (e.g. [[geographic tongue]], [[median rhomboid glossitis]]), [[burning mouth syndrome]], [[oral hairy leukoplakia]], [[oral candidiasis]] and [[squamous cell carcinoma]].<ref name="SCC">{{cite journal |last1=Lam |first1=L. |last2=Logan |first2=R. M. |last3=Luke |first3=C. |title=Epidemiological analysis of tongue cancer in South Australia for the 24-year period, 1977-2001 |journal=Aust Dent J |volume=51 |issue=1 |pages=16–22 |date=March 2006 |pmid=16669472 |doi=10.1111/j.1834-7819.2006.tb00395.x}}</ref> Food debris, desquamated epithelial cells and bacteria often form a visible tongue coating.<ref name=Newman2012>{{cite book|last=(editors) Newman MG, Takei HH, Klokkevold PR, Carranza FA|title=Carranza's clinical periodontology|year=2012|publisher=Elsevier/Saunders|location=St. Louis, Mo.|isbn=978-1-4377-0416-7|pages=84–96|edition=11th}}</ref> This coating has been identified as a major contributing factor in bad breath ([[halitosis]]),<ref name=Newman2012 /> which can be managed by brushing the tongue gently with a toothbrush or using special oral hygiene instruments such as tongue scrapers or mouth brushes.<ref name=Outhouse2006>{{cite journal|last=Outhouse|first=TL|author2=Al-Alawi, R |author3=Fedorowicz, Z |author4= Keenan, JV |title=Tongue scraping for treating halitosis.|journal=The Cochrane database of systematic reviews|date=Apr 19, 2006|issue=2|pages=CD005519|pmid=16625641 |doi=10.1002/14651858.CD005519.pub2}}</ref>
 
===Medical delivery===
The [[sublingual]] region underneath the front of the tongue is a location where the [[oral mucosa]] is very thin, and underlain by a plexus of veins. This is an ideal location for introducing certain medications to the body. The sublingual route takes advantage of the highly [[Blood vessel|vascular]] quality of the oral cavity, and allows for the speedy application of medication into the cardiovascular system, bypassing the gastrointestinal tract. This is the only convenient and efficacious route of administration (apart from [[Intravenous therapy|I.V.]] administration) of [[Glyceryl trinitrate (pharmacology)|nitroglycerin]] to a patient suffering chest pain from [[angina pectoris]].
 
==Society and culture==
 
===Figures of speech===
The tongue can be used as a [[metonymy|metonym]] for ''language'', as in the phrase ''[[mother tongue]]''. Many languages<ref>[[Afrikaans language|Afrikaans]] ''tong''; [[Danish language|Danish]] ''tunge''; [[Albanian language|Albanian]] ''gjuha''; [[Armenian language|Armenian]] ''lezu'' (լեզու); [[Greek language|Greek]] ''glóssa'' (γλώσσα); [[Irish language|Irish]] ''teanga''; [[Manx language|Manx]] ''çhengey''; [[Latin]] and [[Italian language|Italian]] ''lingua''; [[Catalan language|Catalan]] ''llengua''; [[French language|French]] ''langue''; [[Portuguese language|Portuguese]] ''língua''; [[Spanish language|Spanish]] ''lengua''; [[Romanian language|Romanian]] ''limba''; [[Bulgarian language|Bulgarian]] ''ezik'' (език); [[Polish language|Polish]] ''język''; [[Russian language|Russian]] ''yazyk'' (язык); [[Czech language|Czech]] and [[Slovak language|Slovak]] ''jazyk''; [[Slovene language|Slovene]], [[Bosnian language|Bosnian]], [[Croatian language|Croatian]], and [[Serbian language|Serbian]] ''jezik''; [[Kurdish language|Kurdish]] ''ziman'' (زمان); [[Persian language|Persian]] and [[Urdu]] ''zabān'' (زبان); [[Arabic]] ''lisān'' (لسان); [[Aramaic language|Aramaic]] ''liššānā'' (ܠܫܢܐ/לשנא); [[Hebrew language|Hebrew]] ''lāšon'' (לָשׁוֹן); [[Maltese language|Maltese]] ''ilsien''; [[Estonian language|Estonian]] ''keel''; [[Finnish language|Finnish]] ''kieli''; [[Hungarian language|Hungarian]] ''nyelv''; [[Azerbaijani language|Azerbaijani]] and [[Turkish language|Turkish]] ''dil''; [[Kazakh language|Kazakh]] and [[Khakas language|Khakas]] ''til'' (тіл)</ref> have the same word for "tongue" and "[[language]]".
 
A common temporary failure in word [[Recollection|retrieval]] from [[memory]] is referred to as the ''[[Tip of the tongue|tip-of-the-tongue]]'' [[phenomenon]]. The expression ''[[Tongue-in-cheek|tongue in cheek]]'' refers to a statement that is not to be taken entirely seriously – something said or done with subtle ironic or sarcastic humour. A ''[[tongue twister]]'' is a phrase made specifically to be very difficult to pronounce. Aside from being a [[Ankyloglossia|medical condition]], "tongue-tied" means being unable to say what you want to due to confusion or restriction. The phrase "cat got your tongue" refers to when a person is speechless. To "bite one's tongue" is a phrase which describes holding back an opinion to avoid causing offence. A "slip of the tongue" refers to an unintentional utterance, such as a [[Freudian slip]]. [[Speaking in tongues]] is a common phrase used to describe ''glossolalia'', which is to make smooth, language-resembling sounds that is no true spoken language itself. A deceptive person is said to have a [[forked tongue]], and a smooth-talking person said to have a {{Linktext|silver tongue}}.
 
===Gestures===
Sticking one's tongue out at someone is considered a childish gesture of [[rudeness]] and/or defiance in many countries; the act may also have  sexual connotations, depending on the way in which it is done. However, in [[Tibet]] it is considered a greeting.<ref>{{cite web |url=http://www.tibetwrites.org/?Tibetan-Culture-in-the-21st |title=Tibetan culture in the 21st century |author=Bhuchung K Tsering |date=27 December 2007 |accessdate=13 February 2012}}</ref> In 2009, a farmer from [[Fabriano]], Italy was convicted and fined by [[Court of Cassation (Italy)|the country's highest court]] for sticking his tongue out at a neighbor with whom he had been arguing. Proof of the affront had been captured with a cell phone camera.<ref name="UPI">[http://www.upi.com/Odd_News/2009/12/19/Sticking-out-your-tongue-ruled-illegal/UPI-71761261272837/ Sticking out your tongue ruled illegal]</ref> [[Blowing a raspberry]] can also be meant as a gesture of derision.{{cn|date=September 2015}}
 
===Body art===
Being a cultural custom for long time, [[tongue piercing]] and [[tongue splitting|splitting]] has become quite common in western countries in recent decades, with up to one-fifth of young adults having at least one piece of body art in the tongue.<ref name="DTLEVIN">{{cite journal |last1=Liran |first1=Levin |last2=Yehuda |first2=Zadik |last3=Tal |first3=Becker |title=Oral and dental complications of intra-oral piercing |journal=Dent Traumatol |volume=21 |issue=6 |pages=341–3 |date=December 2005 |pmid=16262620 |doi= 10.1111/j.1600-9657.2005.00395.x |accessdate=2008-07-16}}</ref>
 
===As food===
{{See also|Beef tongue}}
 
The tongues of some animals are consumed and sometimes considered delicacies. Hot tongue sandwiches are frequently found on menus in [[Kosher]] [[delicatessen]]s in America. [[Taco|Taco de lengua]] (''lengua'' being Spanish for tongue) is a taco filled with [[beef tongue]], and is especially popular in Mexican cuisine. As part of Colombian gastronomy, Tongue in Sauce (Lengua en Salsa), is a dish prepared by frying the tongue, adding tomato sauce, onions and salt.  Tongue can also be prepared as [[birria]]. Pig and beef tongue are consumed in Chinese cuisine. [[Duck]] tongues are sometimes employed in [[Szechuan cuisine|Szechuan]] dishes, while [[Lamb (food)|lamb]]'s tongue is occasionally employed in Continental and contemporary American cooking. Fried [[cod]] "tongue" is a relatively common part of fish meals in [[Norway]] and [[Newfoundland and Labrador|Newfoundland]]. In [[Argentina]] and [[Uruguay]] cow tongue is cooked and served in vinegar (''lengua a la vinagreta'').  In the Czech Republic and Poland, a pork tongue is considered a delicacy, and there are many ways of preparing it. In Eastern Slavic countries, pork and beef tongues are commonly consumed, boiled and garnished with horseradish or jelled; beef tongues fetch a significantly higher price and are considered more of a delicacy.  In Alaska, cow tongues are among the more common.
 
Tongues of seals and whales have been eaten, sometimes in large quantities, by sealers and whalers, and in various times and places have been sold for food on shore.<ref>CHARLES BOARDMAN HAWES. Whaling. Doubleday, 1924</ref>
 
==History==
 
===Etymology===
The word '''tongue''' derives from the [[Old English]] ''tunge'', which comes from [[Proto-Germanic]] *''tungōn''.<ref name="OED">[http://www.etymonline.com/index.php?term=tongue Online Etymology Dictionary]</ref> It has [[cognates]] in other [[Germanic languages]] — for example ''tonge'' in [[West Frisian language|West Frisian]], ''tong'' in [[Dutch language|Dutch]]/[[Afrikaans]], ''Zunge'' in [[German language|German]], ''tunge'' in [[Danish language|Danish]]/[[Norwegian language|Norwegian]] and ''tunga'' in [[Icelandic language|Icelandic]]/[[Faroese language|Faroese]]/[[Swedish language|Swedish]]. The ''ue'' ending of the word seems to be a fourteenth-century attempt to show "proper pronunciation", but it is "neither etymological nor phonetic".<ref name="OED"/> Some used the spelling ''tunge'' and ''tonge'' as late as the sixteenth century.
 
==Other animals==
[[File:Giraffe's tongue.jpg|thumb|Giraffe's tongue]]
[[File:Okapitongue.jpg|thumb|right|An [[okapi]] cleaning its [[snout|muzzle]] with its tongue]]
Most [[vertebrate]] animals have tongues. In mammals such as [[dog]]s and [[cat]]s, the tongue is often used to clean the fur and body. The tongues of these species have a very rough texture which allows them to remove oils and parasites. A dog's tongue also acts as a heat regulator. As a dog increases its exercise the tongue will increase in size due to greater blood flow. The tongue hangs out of the dog's mouth and the moisture on the tongue will work to cool the bloodflow.<ref>[http://www.doctordog.com/drdognewsletter/tongue.html A dog's tongue]</ref><ref>{{cite journal |title=Lingual blood flow and its hypothalamic control in the dog during panting |journal=[[Pflügers Archiv European Journal of Physiology]] |date=January 1976 |issn=0031-6768 |doi=10.1007/BF00583652 |pages=25–31 |volume=367 |issue=1 |last1=Krönert |first1=H. |last2=Pleschka |first2=K. |accessdate=June 24, 2011}}</ref>
 
Some animals have tongues that are specially adapted for catching prey. For example, [[chameleon]]s, [[frog]]s, and [[anteater]]s have [[prehensility|prehensile]] tongues.
 
Many species of fish have small folds at the base of their mouths that might informally be called tongues, but they lack a muscular structure like the true tongues found in most [[tetrapod]]s.<ref name=VB>{{cite book |last1=Romer |first1=Alfred Sherwood |last2=Parsons |first2=Thomas S. |year=1977 |title=The Vertebrate Body |publisher=Holt-Saunders International |location= Philadelphia, PA |pages=298–299 |isbn= 0-03-910284-X}}</ref><ref>{{cite book |last=Kingsley |first=John Sterling |year=1912 |title=Comparative anatomy of vertebrates |publisher=P. Blackiston's Son & Co. |pages=217–220 |isbn= 1-112-23645-7}}</ref>
 
Other animals may have organs that are [[analogy (biology)|analogous]] to tongues, such as a [[butterfly]]'s [[proboscis]] or a [[radula]] on a [[mollusca|mollusc]], but these are not [[Homology (biology)|homologous]] with the tongues found in vertebrates, and often have little resemblance in function, for example, butterflies do not lick with their proboscides; they suck through them, and the proboscis is not a single organ, but two jaws held together to form a tube.<ref name= "isbn0-412-61390-5">{{cite book |last1=Richards |first1=O. W. |last2=Davies |first2=R. G. |title=Imms' General Textbook of Entomology: Volume 1: Structure, Physiology and Development Volume 2: Classification and Biology |publisher=Springer |location=Berlin |year=1977 |isbn=0-412-61390-5}}</ref>
[[File:Macroglossum stellatarum anatomy - MHNT.jpg|thumb|''[[Macroglossum]]'': View of the extended proboscis, which inspired the name of the animal, literally "long-tongue"]]
 
==Additional Images==
<gallery>
File:Tongue.agr.jpg|The human tongue
</gallery>
 
==See also==
{{Anatomy-terms}}
{{col-begin}}{{col-break}}
* [[Ankyloglossia]]
* [[Electronic tongue]]
* [[Language]]
* [[Licking]]
* [[List of Mendelian traits in humans]] {{nb10}}
* [[Oral cancer]]
* [[Taste bud]]
* [[Tip of the tongue]]
{{col-break}}
* [[Tongue splitting]]
* [[Tongue cleaner]]
* [[Tongue disease]]
* [[Tongue piercing]]
* [[Tongue rolling]]
* [[Tongue-twister]]
* [[Vocal tract]]
{{col-end}}
 
==References==
{{Gray's}}
{{Reflist|2}}
 
==External links==
{{Commons category|tongue}}
{{wikiquote}}
{{Wiktionary}}
*[http://www.umanitoba.ca/faculties/arts/linguistics/russell/138/sec1/anatomy.htm University of Manitoba, Anatomy of the Vocal Tract]
 
{{Mouth anatomy}}
{{Gustatory system}}
{{Taste}}
 
{{Authority control}}
 
[[Category:Sensory organs]]
[[Category:Gustatory system]]
[[Category:Tongue|*]]
[[Category:Digestive system]]
[[Category:Human mouth anatomy]]  
* [[Tonsil cancer|Tonsillar cancer]]
* [[Tonsil cancer|Tonsillar cancer]]
* [[Tonsillar abscess]]
* [[Tonsillar abscess]]

Revision as of 19:16, 23 December 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farman Khan, MD, MRCP [2] Kiran Singh, M.D. [3]

Overview

Life threatening causes of dysphagia include lead poisoning, rabies, and stroke. Other common causes of dysphagia include food impaction, gastroesophageal reflux, and pharyngitis.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Aberrant subclavian artery, amyloidosis, anomalous left pulmonary artery,aortic aneurysm, aortic arch anomalies, charge syndrome, double aortic arch, enlarged aorta, enlarged left atrium, hypokalemia, mitral valve stenosis, pericarditis, superior vena cava syndrome
Chemical / poisoning Arizona bark scorpion poisoning, arsenic poisoning, botulism, cobra poisoning, fluoride poisoning, lead poisoning
Dermatologic Behcet's syndrome, dermatomyositis, polymyositis, Stevens-Johnson syndrome, systemic lupus erythematosus
Drug Side Effect Antipsychotic medications, artemether and lumefantrin, atropine, botulinum toxin, bicalutamidechemotherapy, cyclosporine toxicity, cytarabine, dactinomycin, doxycycline, eletriptan, hydroxocobalaminhyoscyamine, ibandronate, ioxilan, ixabepilone, minocycline hydrochloride, nabumetone, neuroleptics, oxcarbazepine, pergolide, rimabotulinumtoxinb, riociguat, ropinirole, sargramostim, sertraline, scarlet fever, tiagabine
Ear Nose Throat Carcinoma of the vocal tract, cricopharyngeal spasm, eagle syndrome, epiglottitis, Impaired sensitivity in the larynx, laryngeal cancer, nasopharyngeal carcinoma, oral pharyngeal disorders, palatine tonsil, pharyngeal pouch, pharyngitis, pharynx cancer, quinsy, retropharyngeal abscess, tonsillar cancer
Endocrine Cushing's syndrome, diabetic neuropathy, goiter, hyperthyroidism, hypokalemia, hypothyroidism, paraganglioma, Riedel thyroiditis, subacute granulomatous thyroiditis, thymoma, thyroglossal cyst, thyroid cancer, anaplastic,thyrotoxicosis, vagal paraganglioma, De Quervain's thyroiditis, solitary thyroid nodule
Environmental No underlying causes
Gastroenterologic Achalasia, adjustable gastric band, aerophagia, aspiration of foreign body, Barret's syndrome,candida esophagitis, cascade stomach, caustic esophagitis, Crohn's disease of the esophagus, diffuse esophageal spasm, diverticulum, eosinophilic esophagitis, eosinophilic gastroenteritis, esophageal atresia, esophageal cancer, esophageal cyst, esophageal diverticulum, esophageal leiomyoma, esophageal obstruction by a foreign body, esophageal pouch, esophageal spasm, esophageal stricture, esophageal web, esophageal moniliasis, esophageal sarcoidosis, esophageal trauma, esophagitis, esophagotracheal fistula, external esophageal compression, gastric cancer, gastric volvulus, gastritis, gastroesophageal reflux, gastrointestinal stromal tumor, gastroparesis, Gaucher disease, globus pharyngis, globus syndrome, hiatal hernia, hypertensive lower esophageal sphincter, infectious esophagitis, intramural pseudodiverticulosis, lymphocytic esophagitis, mitochondrial neurogastrointestinal encephalopathy syndrome, mucositis, myoneurogastrointestinal encephalopathy syndrome, nutcracker esophagus, odynophagia, peptic esophagitis, post surgery, peptic stricture, pharyngeal pouch, pill esophagitis, Plummer-Vinson syndrome, presbyphagia, pseudoachalasia, pyloric stenosis, radiation esophagitis, Schatzki ring, stomach cancer, upper oesophageal sphincter dysfunction, Wilson disease, zenker's diverticulum
Genetic Aberrant subclavian artery, achalasia-addisonian syndrome, achromatopsia, adrenoleukodystrophy, Behcet's syndrome, chromosome 1p36 deletion syndrome, chromosome 22 ring, chromosome 22 trisomy mosaic, connective tissue disease, Emanuel syndrome , extreme spinal curvature, Gaucher disease,Huntington disease, lissencephaly, type 1, x-linked , muscular dystrophy, Duchenne and Becker type ,myotonic dystrophy, nemaline myopathy1, oculopharyngeal muscular dystrophy, pseudoadrenoleukodystrophy , spinal muscular atrophy type I, spinocerebellar ataxia 17 , spinocerebellar ataxia 22, spinocerebellar ataxia, autosomal recessive 1 Stuve-wiedemann dysplasia , vascular ring with right aortic arch, Wiedemann–Rautenstrauch syndrome, Wilson disease
Hematologic Agranulocytosis, mononucleosis, Plummer-Vinson syndrome
Iatrogenic No underlying causes
Infectious Disease Abscess, angina tonsillaris, botulism, candida esophagitis, Chagas disease, cytomegalovirus, diphtheria, epiglottitis, gastritis, herpangina, herpes simplex virus, infectious esophagitis,laryngeal papillomatosis, lassa fever, Ludwig's angina, lyme disease, lymph granulomatosis, Lymphadenopathy,Medication-induced esophagitis, mumps, neonatal tetanus , oral candidiasis, paracoccidioidomycosis, Pharyngitis, polio, poliomyelitis, postpolio syndrome, quinsy, rabies, retropharyngeal abscess, snakebites, syphilis, tetanus, tetrodotoxin, tonsillar abscess, ulcer
Musculoskeletal / Ortho Diffuse idiopathic skeletal hyperostosis, distal myopathy 2, elongated styloid process, extreme spinal curvature, inclusion body myositis, muscular dystrophy, Duchenne and Becker type, osteophytes, Pierre Robin's sequence 
Neurologic 10th cranial nerve disorder, amyotrophic lateral sclerosis, Arnold–Chiari malformation, ataxia neuropathy spectrum, autonomic nerve disorders, autonomic neuropathy, autosomal recessive spastic paraplegia, type 11, Avellis syndrome, Babinski–Nageotte syndrome, basal ganglia disease, basilar artery insufficiency syndrome, brain stem gliomas, brainstem stroke, brainstem tumors, pseudobulbar palsy, bulbar palsy, carotid paraganglioma, central pontine myelinosis, central vagal nucleus lesion, central hypoglossal nerve paralysis, cerebellar Infarction, cerebellar stroke, cerebral palsy, cerebrovascular accident, congenital myasthenic syndrome, cervical osteophytes, dementia, diabetic neuropathy, dystonia, epileptic encephalopathy, early infantile, 1, fosmn syndrome, Guillain-Barre Syndrome, head trauma, Huntington disease, infantile striato-thalamic degeneration, lateral funiculus angina, lateral medullary syndrome, lissencephaly, type 1, x-linked, mass brain lesion, metabolic encephalopathies, microcephaly brain defect spasticity hypernatremia, mitochondrial neurogastrointestinal encephalopathy syndrome, motor neuron disease, multiple sclerosis, multiple system atrophy, muscular dystrophy, Duchenne and Becker type, myasthenia gravis, myoneurogastrointestinal encephalopathy syndrome, myopathy, myotonic dystrophy, neuroferritinopathy, neurosarcoidosis, osmotic demyelination syndrome,paraganglioma, paraneoplastic limbic encephalitis, Parkinson disease, peripheral neuropathy, peripheral tongue paralysis, polyradiculitis, pontocerebellar hypoplasia type 2a, primary lateral sclerosis, adult, primary motility disorders, Pseudobulbar paralysis,pseudodysphagia, secondary motility disorders, Shy-Drager syndrome, spastic paraplegia 11, autosomal recessive, spinal muscular atrophy type I, spinocerebellar ataxia 17 , spinocerebellar ataxia 22 , spinocerebellar ataxia, autosomal recessive 1, striatonigral degeneration infantile, stroke, syringobulbia, tardive dyskinesia, vagus nerve palsy, Wallenberg's syndrome
Nutritional / Metabolic Adrenoleukodystrophy, amyloidosis, Gaucher disease, hydroxocobalamin, hypokalemia, Plummer-Vinson syndrome, Wilson disease
Obstetric/Gynecologic Leiomyoma
Oncologic Acoustic neuroma, brain stem gliomas, brain stem tumors, bronchial carcinoma, carcinoma of the vocal tract, carotid body tumor, chordoma, esophageal cancer, gastric cancer, laryngeal cancer, laryngeal carcinoma, leiomyoma, lymphadenopathy, malignant lung cancer, malignant mesothelioma, nasopharyngeal carcinoma, neck cancer, odontoma, Oral cavity tumor, oropharyngeal cancer, palate cancer, paraganglioma, paraneoplastic limbic encephalitis, paraneoplastic syndrome, pharynx cancer, small cell lung cancer, stomach cancer, supraglottic laryngeal cancer, throat cancer, thyroid cancer, anaplastic, tongue cancer, tonsillar cancer, vagal paraganglioma
Opthalmologic Achromatopsia, oculopharyngeal muscular dystrophy
Overdose / Toxicity Alcoholism
Psychiatric Anxiety disorders, dementia, frontotemporal dementia, functional disorders, global hystericus, rumination disorder, tardive dyskinesia
Pulmonary Bronchial carcinoma, congenital bronchogenic cyst, epiglottitis, malignant lung cancer, malignant mesotheliomamediastinal mass, mediastinitis, Ondine's curse, pharyngitis, pleuritis, sarcoidosis
Renal / Electrolyte Hypomagnesemia primary, hypophosphatemia, systemic lupus erythematosus
Rheum / Immune / Allergy Allergic swelling, amyloidosis, Behcet's syndrome, cervical osteophytes, CREST syndrome, dermatomyositis, diffuse systemic sclerosi, fibrosis, graft-versus-host disease, inclusion body myositis, muscular dystrophy, oculopharyngeal muscular dystrophy, osteophytes, paraneoplastic syndrome, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, sarcoidosis, scleroderma, systemic lupus erythematosus, systemic sclerosis, trismus
Sexual No underlying causes
Trauma Head trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Canomad syndrome, crisponi syndrome, cytoplasmic body myopathy, Franek-bocker-kahlen syndrome, Lhermitte-cornil-quesnel syndrome, Opitz-frias syndrome, oral submucous fibrosis, palatoplegia, Pallidopyramidal syndrome, stomatitis, tongue conditions, vascular abnormality, Vincent's angina

Causes in Alphabetical Order[1] [2]

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Structure

File:Facies inferior linguae.JPG
The underside of a human tongue

The tongue is a muscular structure that forms part of the floor of the oral cavity. The left and right sides of the tongue are separated by the lingual septum. The human tongue is divided into anterior and posterior parts. The anterior part is the visible part situated at the front and makes up roughly two-thirds the length of the tongue. The posterior part is the part closest to the throat, roughly one-third of its length. These parts differ in terms of their embryological development and nerve supply. The two parts of the tongue are divided by the terminal sulcus.[5]:989–990

The anterior tongue is, at its apex, thin and narrow, it is directed forward against the lingual surfaces of the lower incisor teeth. The posterior part is, at its root, directed backward, and connected with the hyoid bone by the hyoglossi and genioglossi muscles and the hyoglossal membrane, with the epiglottis by three folds (glossoepiglottic) of mucous membrane, with the soft palate by the glossopalatine arches, and with the pharynx by the superior pharyngeal constrictor muscle and the mucous membrane. It also forms the anterior wall of the oropharynx.

In phonetics and phonology, a distinction is made between the tip of the tongue and the blade (the portion just behind the tip). Sounds made with the tongue tip are said to be apical, while those made with the tongue blade are said to be laminal.

Muscles

The eight muscles of the human tongue are classified as either intrinsic or extrinsic. The four intrinsic muscles act to change the shape of the tongue, and are not attached to any bone. The four extrinsic muscles act to change the position of the tongue, and are anchored to bone.

  • Coronal section of tongue, showing intrinsic muscles

    Coronal section of tongue, showing intrinsic muscles

  • Lateral view of the tongue, with extrinsic muscles highlighted.

    Lateral view of the tongue, with extrinsic muscles highlighted.

Extrinsic

The extrinsic muscles originate from bone and extend to the tongue. Their main functions are altering the tongue's position allowing for protrusion, retraction, and side-to-side movement.[5]:991

  1. Genioglossus, which arises from the mandible and protrudes the tongue. It is also known as the "safety muscle" of the tongue since it is the only muscle having the forward action.
  2. Hyoglossus, which arises from the hyoid bone and depresses the tongue
  3. Styloglossus, which arises from the styloid process of the temporal bone and elevates and retracts the tongue
  4. Palatoglossus, which arises from the palatine aponeurosis, and depresses the soft palate, moves the palatoglossal fold towards the midline, and elevates the back of the tongue.

Intrinsic

Four paired intrinsic muscles of the tongue originate and insert within the tongue, running along its length. These muscles alter the shape of the tongue by: lengthening and shortening it, curling and uncurling its apex and edges, and flattening and rounding its surface. This provides shape, and helps facilitate speech, swallowing, and eating.[5]:991

  1. The superior longitudinal muscle runs along the superior surface of the tongue under the mucous membrane, and elevates, assists in retraction of, or deviates the tip of the tongue. It originates near the epiglottis, the hyoid bone, from the median fibrous septum.
  2. The inferior longitudinal muscle lines the sides of the tongue, and is joined to the styloglossus muscle.
  3. The vertical muscle is located in the middle of the tongue, and joins the superior and inferior longitudinal muscles.
  4. The transverse muscle divides the tongue at the middle, and is attached to the mucous membranes that run along the sides.

Blood supply

The tongue receives its blood supply primarily from the lingual artery, a branch of the external carotid artery. The lingual veins, drain into the internal jugular vein. The floor of the mouth also receives its blood supply from the lingual artery.[5]:993–994 There is also a secondary blood supply to the tongue from the tonsillar branch of the facial artery and the ascending pharyngeal artery.

An area in the neck sometimes called Pirogov's triangle is formed by the intermediate tendon of the digastric muscle, the posterior border of the mylohyoid muscle, and the hypoglossal nerve.[6][7] The lingual artery is a good place to stop severe hemorrage from the tongue.

Innervation

Innervation of the tongue consists of motor fibers, special sensory fibers for taste, and general sensory fibers for sensation.[5]:994–5

Innervation of taste and sensation is different for the anterior and posterior part of the tongue because they are derived from different embryological structures (pharyngeal arch 1 and pharyngeal arch 3 and 4, respectively).[8]

  • Posterior one third of tongue:
    • Taste and sensation: glossopharyngeal nerve (CN IX) via a mixture of special and general visceral afferent fibers

Histology

File:Human tongue (251 09) Section.jpg
Section through the human tongue; stained H&E

The tongue is covered with numerous taste buds, and filiform, fungiform, vallate and foliate, lingual papillae.[5]:990

Length

The average length of the human tongue from the oropharynx to the tip is 10cms in length.[9]

Development

The anterior tongue is derived primarily from the first pharyngeal arch. The posterior tongue is derived primarily from the third pharyngeal arch. The second arch however has a substantial contribution during fetal development, but this later atrophies. The fourth arch may also contribute, depending upon how the boundaries of the tongue are defined.

The terminal sulcus, which separates the anterior and posterior tongue, is shaped like a V, with the tip of the V situated posteriorly. At the apex is the foramen caecum, which is the point where the embryological thyroid begins to descend.[5]:990

Function

Human tongue and taste buds
Taste receptors in papillae
Taste receptors are present on the human tongue in papillae

Taste

Main articles: Taste, Taste receptor, and Supertaster

Chemicals that stimulate taste receptor cells are known as tastants. Once a tastant is dissolved in saliva, it can make contact with the plasma membrane of the gustatory hairs, which are the sites of taste transduction.[10]

The tongue is equipped with many taste buds on its dorsal surface, and each taste bud is equipped with taste receptor cells that can sense particular classes of tastes. Distinct types of taste receptor cells respectively detect substances that are sweet, bitter, salty, sour, spicy, or taste of umami.[11] Umami receptor cells are the least understood and accordingly are the type most intensively under research.[12]

Mastication

The tongue is also used for crushing food against the hard palate, during mastication. The epithelium on the tongue’s upper, or dorsal surface is keratinised. Consequently, the tongue can grind against the hard palate without being itself damaged or irritated.[13]

Swallowing

Speech

Clinical relevance

Disease

Main article: Tongue disease

After the gums, the tongue is the second most common soft tissue site for various pathologies in the oral cavity.[medical citation needed] Examples of pathological conditions of the tongue include glossitis (e.g. geographic tongue, median rhomboid glossitis), burning mouth syndrome, oral hairy leukoplakia, oral candidiasis and squamous cell carcinoma.[14] Food debris, desquamated epithelial cells and bacteria often form a visible tongue coating.[15] This coating has been identified as a major contributing factor in bad breath (halitosis),[15] which can be managed by brushing the tongue gently with a toothbrush or using special oral hygiene instruments such as tongue scrapers or mouth brushes.[16]

Medical delivery

The sublingual region underneath the front of the tongue is a location where the oral mucosa is very thin, and underlain by a plexus of veins. This is an ideal location for introducing certain medications to the body. The sublingual route takes advantage of the highly vascular quality of the oral cavity, and allows for the speedy application of medication into the cardiovascular system, bypassing the gastrointestinal tract. This is the only convenient and efficacious route of administration (apart from I.V. administration) of nitroglycerin to a patient suffering chest pain from angina pectoris.

Society and culture

Figures of speech

The tongue can be used as a metonym for language, as in the phrase mother tongue. Many languages[17] have the same word for "tongue" and "language".

A common temporary failure in word retrieval from memory is referred to as the tip-of-the-tongue phenomenon. The expression tongue in cheek refers to a statement that is not to be taken entirely seriously – something said or done with subtle ironic or sarcastic humour. A tongue twister is a phrase made specifically to be very difficult to pronounce. Aside from being a medical condition, "tongue-tied" means being unable to say what you want to due to confusion or restriction. The phrase "cat got your tongue" refers to when a person is speechless. To "bite one's tongue" is a phrase which describes holding back an opinion to avoid causing offence. A "slip of the tongue" refers to an unintentional utterance, such as a Freudian slip. Speaking in tongues is a common phrase used to describe glossolalia, which is to make smooth, language-resembling sounds that is no true spoken language itself. A deceptive person is said to have a forked tongue, and a smooth-talking person said to have a silver tongue.

Gestures

Sticking one's tongue out at someone is considered a childish gesture of rudeness and/or defiance in many countries; the act may also have sexual connotations, depending on the way in which it is done. However, in Tibet it is considered a greeting.[18] In 2009, a farmer from Fabriano, Italy was convicted and fined by the country's highest court for sticking his tongue out at a neighbor with whom he had been arguing. Proof of the affront had been captured with a cell phone camera.[19] Blowing a raspberry can also be meant as a gesture of derision.[citation needed]

Body art

Being a cultural custom for long time, tongue piercing and splitting has become quite common in western countries in recent decades, with up to one-fifth of young adults having at least one piece of body art in the tongue.[20]

As food

See also: Beef tongue

The tongues of some animals are consumed and sometimes considered delicacies. Hot tongue sandwiches are frequently found on menus in Kosher delicatessens in America. Taco de lengua (lengua being Spanish for tongue) is a taco filled with beef tongue, and is especially popular in Mexican cuisine. As part of Colombian gastronomy, Tongue in Sauce (Lengua en Salsa), is a dish prepared by frying the tongue, adding tomato sauce, onions and salt. Tongue can also be prepared as birria. Pig and beef tongue are consumed in Chinese cuisine. Duck tongues are sometimes employed in Szechuan dishes, while lamb's tongue is occasionally employed in Continental and contemporary American cooking. Fried cod "tongue" is a relatively common part of fish meals in Norway and Newfoundland. In Argentina and Uruguay cow tongue is cooked and served in vinegar (lengua a la vinagreta). In the Czech Republic and Poland, a pork tongue is considered a delicacy, and there are many ways of preparing it. In Eastern Slavic countries, pork and beef tongues are commonly consumed, boiled and garnished with horseradish or jelled; beef tongues fetch a significantly higher price and are considered more of a delicacy. In Alaska, cow tongues are among the more common.

Tongues of seals and whales have been eaten, sometimes in large quantities, by sealers and whalers, and in various times and places have been sold for food on shore.[21]

History

Etymology

The word tongue derives from the Old English tunge, which comes from Proto-Germanic *tungōn.[22] It has cognates in other Germanic languages — for example tonge in West Frisian, tong in Dutch/Afrikaans, Zunge in German, tunge in Danish/Norwegian and tunga in Icelandic/Faroese/Swedish. The ue ending of the word seems to be a fourteenth-century attempt to show "proper pronunciation", but it is "neither etymological nor phonetic".[22] Some used the spelling tunge and tonge as late as the sixteenth century.

Other animals

File:Giraffe's tongue.jpg
Giraffe's tongue
An okapi cleaning its muzzle with its tongue

Most vertebrate animals have tongues. In mammals such as dogs and cats, the tongue is often used to clean the fur and body. The tongues of these species have a very rough texture which allows them to remove oils and parasites. A dog's tongue also acts as a heat regulator. As a dog increases its exercise the tongue will increase in size due to greater blood flow. The tongue hangs out of the dog's mouth and the moisture on the tongue will work to cool the bloodflow.[23][24]

Some animals have tongues that are specially adapted for catching prey. For example, chameleons, frogs, and anteaters have prehensile tongues.

Many species of fish have small folds at the base of their mouths that might informally be called tongues, but they lack a muscular structure like the true tongues found in most tetrapods.[25][26]

Other animals may have organs that are analogous to tongues, such as a butterfly's proboscis or a radula on a mollusc, but these are not homologous with the tongues found in vertebrates, and often have little resemblance in function, for example, butterflies do not lick with their proboscides; they suck through them, and the proboscis is not a single organ, but two jaws held together to form a tube.[27]

File:Macroglossum stellatarum anatomy - MHNT.jpg
Macroglossum: View of the extended proboscis, which inspired the name of the animal, literally "long-tongue"

Additional Images

  • The human tongue

    The human tongue

See also

Template:Anatomy-terms

References

Template:Gray's

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. ↑ Maton, Anthea; Hopkins, Jean; McLaughlin, Charles William; Johnson, Susan; Warner, Maryanna Quon; LaHart, David; Wright, Jill D. (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1.
  4. ↑ The Taste Map: All Wrong, Scientific American, March 18, 2001.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-8089-2306-0.
  6. ↑ Pirogov's triangle
  7. ↑ Jamrozik, T.; Wender, W. (January 1952). "Topographic anatomy of lingual arterial anastomoses; Pirogov-Belclard's triangle". Folia Morphologica. 3 (1): 51–62. PMID 13010300.
  8. ↑ PhD, Dr Ronald W. Dudek (2014). BRS Embryology (Sixth ed.). LWW. ISBN 9781451190380.
  9. ↑ Kerrod, Robin (1997). MacMillan's Encyclopedia of Science. 6. Macmillan Publishing Company, Inc. ISBN 0-02-864558-8.
  10. ↑ Tortora. Principles of Anatomy and Physiology 12th edition, chapter 17, p.602.
  11. ↑ Silverhorn. Human Physiology: An integrated approach 5th edition, chapter 10, p.352.
  12. ↑ Schacter, Daniel L., Daniel Todd. Gilbert, and Daniel M. Wegner. "Sensation and Perception." Psychology. 2nd ed. New York: Worth, 2009. 166. Print.
  13. ↑ Atkinson. "Anatomy for dental students 4th edition.
  14. ↑ Lam, L.; Logan, R. M.; Luke, C. (March 2006). "Epidemiological analysis of tongue cancer in South Australia for the 24-year period, 1977-2001". Aust Dent J. 51 (1): 16–22. doi:10.1111/j.1834-7819.2006.tb00395.x. PMID 16669472.
  15. ↑ 15.0 15.1 (editors) Newman MG, Takei HH, Klokkevold PR, Carranza FA (2012). Carranza's clinical periodontology (11th ed.). St. Louis, Mo.: Elsevier/Saunders. pp. 84–96. ISBN 978-1-4377-0416-7.
  16. ↑ Outhouse, TL; Al-Alawi, R; Fedorowicz, Z; Keenan, JV (Apr 19, 2006). "Tongue scraping for treating halitosis". The Cochrane database of systematic reviews (2): CD005519. doi:10.1002/14651858.CD005519.pub2. PMID 16625641.
  17. ↑ Afrikaans tong; Danish tunge; Albanian gjuha; Armenian lezu (լեզու); Greek glóssa (γλώσσα); Irish teanga; Manx çhengey; Latin and Italian lingua; Catalan llengua; French langue; Portuguese língua; Spanish lengua; Romanian limba; Bulgarian ezik (език); Polish język; Russian yazyk (язык); Czech and Slovak jazyk; Slovene, Bosnian, Croatian, and Serbian jezik; Kurdish ziman (زمان); Persian and Urdu zabān (زبان); Arabic lisān (لسان); Aramaic liššānā (ܠܫܢܐ/לשנא); Hebrew lāšon (לָשׁוֹן); Maltese ilsien; Estonian keel; Finnish kieli; Hungarian nyelv; Azerbaijani and Turkish dil; Kazakh and Khakas til (тіл)
  18. ↑ Bhuchung K Tsering (27 December 2007). "Tibetan culture in the 21st century". Retrieved 13 February 2012.
  19. ↑ Sticking out your tongue ruled illegal
  20. ↑ Liran, Levin; Yehuda, Zadik; Tal, Becker (December 2005). "Oral and dental complications of intra-oral piercing". Dent Traumatol. 21 (6): 341–3. doi:10.1111/j.1600-9657.2005.00395.x. PMID 16262620. |access-date= requires |url= (help)
  21. ↑ CHARLES BOARDMAN HAWES. Whaling. Doubleday, 1924
  22. ↑ 22.0 22.1 Online Etymology Dictionary
  23. ↑ A dog's tongue
  24. ↑ Krönert, H.; Pleschka, K. (January 1976). "Lingual blood flow and its hypothalamic control in the dog during panting". Pflügers Archiv European Journal of Physiology. 367 (1): 25–31. doi:10.1007/BF00583652. ISSN 0031-6768. |access-date= requires |url= (help)
  25. ↑ Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. pp. 298–299. ISBN 0-03-910284-X.
  26. ↑ Kingsley, John Sterling (1912). Comparative anatomy of vertebrates. P. Blackiston's Son & Co. pp. 217–220. ISBN 1-112-23645-7.
  27. ↑ Richards, O. W.; Davies, R. G. (1977). Imms' General Textbook of Entomology: Volume 1: Structure, Physiology and Development Volume 2: Classification and Biology. Berlin: Springer. ISBN 0-412-61390-5.

External links

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Common Causes of Oropharyngeal Dysphagia

Common Causes of Esophageal Dysphagia

  • Peptic stricture, or narrowing of the esophagus, is usually a complication of acid reflux, most commonly due to gastroesophageal reflux (GERD). These patients are usually older and have had GERD for a long time. Acid reflux can also be due to other causes, such as Zollinger-Ellison syndrome, NG tube placement, and scleroderma. Other non-acid related causes of peptic strictures include infectious esophagitis, ingestion of chemical irritant, pill irritation, and radiation. Peptic stricture is a progressive mechanical dysphagia, meaning patients will complain of initial intolerance to solids followed by inability to tolerate liquids. Usually the threshold to solid intolerance is 13 mm of the esophageal lumen. Symptoms relating to the underlying cause of the stricture usually will also be present.
  • Esophageal cancer also presents with progressive mechanical dysphagia. Patients usually come with rapidly progressive dysphagia first with solids then with liquids, weight loss (> 10 kg), and anorexia (loss of appetite). Esophageal cancer usually affects the elderly. Esophageal cancers can be either squamous cell carcinoma or adenocarcinoma. Adenocarcinoma is the most prevalent in the US and is associated with patients with chronic GERD who has developed Barrett's esophagus (intestinal metaplasia of esophageal mucosa). Squamous cell carcinoma is more prevalent in Asia and is associated with tobacco smoking and alcohol use.
Main article: esophageal cancer
  • Esophageal rings and webs, are actual rings and webs of tissue that may occlude the esophageal lumen.
    • Rings --- Also known as Schatzki rings from the discoverer, these rings are usually mucosal rings rather than muscular rings, and are located near the gastroesophageal junction at the squamo-columnar junction. Presence of multiple rings may suggest eosinophilic esophagitis. Rings cause intermittent mechanical dysphagia, meaning patients will usually present with transient discomfort and regurgitation while swallowing solids and then liquids, depending on the constriction of the ring.
    • Webs --- Usually squamous mucosal protrusion into the esophageal lumen, especially anterior cervical esophagus behind the cricoid area. Patients are usually asymptomatic or have intermittent dysphagia. An important association of esophageal webs is to the Plummer-Vinson syndrome in iron deficiency, in which case patients will also have anemia, koilonychia, fatigue, and other symptoms of anemia.
Main article: esophageal web
  • Achalasia is an idiopathic motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation as well as loss of peristalsis in the distal esophagus, which is mostly smooth muscle. Both of these features impair the ability of the esophagus to empty contents into the stomach. Patients usually complain of dysphagia to both solids and liquids. Dysphagia to liquids, in particular, is a characteristic of achalasia. Other symptoms of achalasia include regurgitation, night coughing, chest pain, weight loss, and heartburn. The combination of achalasia, adrenal insufficiency, and alacrima (lack of tear production) in children is known as the triple A (Allgrove) syndrome. In most cases the cause is unknown (idiopathic), but in some regions of the world, achalasia can also be caused by Chagas disease due to infection by Trypanosoma cruzi.
Main article: achalasia
  • Scleroderma is a disease characterized by atrophy and sclerosis of the gut wall, most commonly of the distal esophagus (~90%). Consequently, the lower esophageal sphincter cannot close and this can lead to severe gastroesophageal reflux disease (GERD). Patients typically present with progressive dysphagia to both solids and liquids secondary to motility problems or peptic stricture from acid reflux.
Main article: scleroderma
    • DES can be caused by many factors that affect muscular or neural functions, including acid reflux, stress, hot or cold food, or carbonated drinks. Patients present with intermittent dysphagia, chest pain, or heartburn.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Murray, J. (1999). Manual of Dysphagia Assessment in Adults. San Diego: Singular Publishing.

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