Epithelioid sarcoma of the tongue.

A case of epithelioid sarcoma in the tongue is reported. The patient, a 35 year old woman, presented with a non-ulcerated painful lesion of the tongue. Microscopically, the tumour was characterised by multiple coalescent nodules with central geographic necrosis infiltrating the lingual muscle. The tumour cells were epithelioid with abundant eosinophilic cytoplasm and atypical nuclei. Immunohistochemically, the tumour cells stained for vimentin, keratin, and epithelial membrane antigen. These morphological and immunohistochemical appearances led to the diagnosis of epithelioid sarcoma of the tongue. Seven years later, the patient died with metastatic dissemination to the scalp, lungs, and brain. No case of epithelioid sarcoma arising in the tongue has been described previously.     

Primary colonic-type adenocarcinoma of the base of the tongue: a previously unreported phenotype

Primary lingual adenocarcinomas are rare and typically of salivary or seromucinous glands origin. Similarly, metastatic adenocarcinoma from distant primary sites to the tongue is an uncommon event, with only 3 cases from a colonic primary site reported. We present, for the first time, 2 primary colonic-type adenocarcinomas of the base of the tongue and discuss their putative origin and the clinicopathologic characteristics.     

Defining the anatomy of the neonatal lingual frenulum

The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered “normal” lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal “band” or “string” and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824–835, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.     

Analysis of the dynamic relationships between the lingual artery and lingual markers in patients with obstructive sleep apnea

Purpose

To determine the relationships between the lingual artery and the lingual markers in tongue resting and extended positions in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) for the clinical application of functional tongue surgery.

Method

Computed tomography angiography (CTA) of the lingual artery was performed on 30 OSAHS patients using a 16-slice spiral CT scanner. The anatomical relationships between the lingual artery and the lingual markers were analyzed with the tongue in resting and extended positions using the CTA images.

Results

The course of the lingual artery resembled the configuration of the Big Dipper constellation when the tongue was in a resting position. When the tongue was in a full-extended position, the majority of the lingual artery moved forward and upward with the hyoid and formed a “√” fashion. The positions of the tip of the greater horn of the hyoid changed with the tongue positions. While the relationship between the main lingual artery and the tip of the greater horn of the hyoid, as well as the distances between bilateral lingual arteries, remained constant in both tongue positions.

Conclusions

In conditions of dynamic tongue movement, the tip of the great horn of the hyoid and the lingual midline are constant anatomical markers to indicate the course of the lingual artery.     

舌神经至不同下颌磨牙牙龈缘距离的关系分析

目的探讨舌神经至不同下颌磨牙牙龈缘的距离,为患者进行相关手术治疗提供可靠临床依据,尽量避免患者术后发生舌神经损伤情况,提高患者生活质量。方法在本院2000年至2012年之间所收集的成人头部标本中随机选取20例进行解剖,所有标本均已进行防腐固定措施,使用专用测量工具对标本左侧舌神经、右侧舌神经与下颌第1、2、3磨牙牙龈缘距离分别进行测量,记录测量结果并进行统计学分析,得出结论。结果左侧舌神经与右侧舌神经相距下颌第1、2、3磨牙牙龈缘水平距离、垂直距离以及45度角距离相近,且P>0.05,左侧舌神经与右侧舌神经相距下颌第1磨牙牙龈缘距离无统计学意义。结论在对患者进行下颌磨牙舌侧骨嵴修整术或阻生智齿拔除术治疗时,应根据人体舌神经解剖学知识,以及舌神经至不同下颌磨牙的牙龈缘距离范围,尽量避免对患者舌神经造成伤害,从而有效预防患者术后发生暂时性或永久性舍感觉丧失并发症,提高患者生活质量。     

Miliary pulmonary metastases from a clinically occult pleural mesothelioma

Mesothelioma is a rare neoplasm of the serosal membranes. Signs and symptoms of a pleural effusion typically herald discovery of the tumor. We report a case of miliary metastatic mesothelioma involving both lungs in a 54-year-old man who presented with right-sided chest discomfort, numerous pulmonary nodules detected by computed tomography of the chest, and absent pleural effusion. Immunohistochemical and electron microscopy studies performed on wedge biopsies of parenchymal pulmonary nodules led to the diagnosis of metastatic mesothelioma. Subsequent pleural evaluation and biopsy of pleural thickening noted at a site of prior chest wall trauma identified the primary neoplasm and confirmed the diagnosis as malignant epithelioid mesothelioma. The histologic appearance of discohesive epithelioid cells in a distinctly myxoid background was the clue in this case leading to the consideration of metastatic mesothelioma and a thorough immunohistochemical evaluation of the tumor. This case shows that mesothelioma may metastasize throughout the lungs in a miliary pattern and the metastases may be clinically detected before the primary pleural tumor. Metastatic mesothelioma is a consideration for metastatic pulmonary tumors of unknown origin.     

Synaptic efficacy of inhibitory synapses in hypoglossal motoneurons after transection of the hypoglossal nerves

In cat hypoglossal motoneurons after axotomy the synaptic efficacy of inhibitory synapses made by the lingual nerve afferent fibers was studied. The amplitude of the short- and the long-lasting inhibitory postsynaptic potential produced in tongue protruder motoneurons 24 days after axotomy by stimulation of the lingual nerve was significantly reduced in size as compared with the control on the unoperated side. In most protruder motoneurons 40 days after axotomy a large excitatory postsynaptic potential and a spike was produced by stimulation of either the ipsilateral or the contralateral lingual nerve. We have demonstrated that the decline of synaptic efficacy of inhibitory synapses for the short-lasting inhibitory postsynaptic potential was more prominent than that for the long-lasting inhibitory potential in the motoneuron 24 days after axotomy. After the cut axons of protruder motoneurons were re-united to tongue muscles, we have demonstrated that the decline of synaptic efficacy of inhibitory synapses for the short-lasting inhibitory postsynaptic potential was less prominent than that in axotomized protruder motoneurons.     

Distribution pattern of the human lingual nerve

The tongue is an intricate organ with many functions. Despite the knowledge of the presence of muscular and neural connections in the tongue, a detailed neuroanatomical depiction of the nerves' topography in the tongue has not been demonstrated. The topography, branching patterns and neuronal interconnections of the lingual nerve were studied in five postmortem human tongues. They were stained with Sihler's stain, a technique that renders most of the tongue tissue translucent while counterstaining nerves. The lingual nerve reaches the tongue posterolaterally. There are two main branches off of the main trunk: the medial branch sends 2-4 small branches to the medial part of the ventrolateral tongue and the lateral branch runs along the lateral tongue border and sends 3-4 large branches to the anterior tip of tongue. Each subdivision gives off 2-5 distal branches. Both medial and lateral branches have interconnections with the proximal part of the hypoglossal nerve. One of the unexpected discoveries in this study was the high density of nervous fibers in the lateral aspect of the tongue as compared to the midline region. The average diameter of the main trunk of the lingual nerve is 3.5 mm. The medial and lateral branches average 1 mm in diameter, the more distal subdivisions measure 0.5-0.75 mm, and the lingual-hypoglossal interconnections measure 0.125-0.250 mm. In summary, this study provides the first detailed depiction of the topography of the human lingual nerve and its branches in situ, confirmation of lingual-hypoglossal nerve connection, and the first depiction of the high density of lingual nerve innervation in the lateral tongue.     

Light and scanning electron microscopic study of the tongue in the white tailed eagle (Haliaeetus albicilla, Accipitridae, Aves).

The tongue of the white tailed eagle is elongated with a sharp-ended apex. The length of the tongue is 6 cm. The characteristic morphological features observed on the body of the tongue include a distinct median groove dividing the mucosa into two symmetrical, convex lateral parts and a single crest of large conical papillae in the posterior part of the lingual body, extending over the surface of the flat root of the tongue. The mucosa of the lingual body and root is covered by the parakeratinized multilayered epithelium. The horny layer in the mucosal epithelium was observed in the median groove, on the conical papillae and on the ventral surface of the tongue. The observations of the three dimensional structure of the subepithetial connective tissue revealed the presence of a system of laminae or smaller interconnected ridges, depending on the area of the tongue. In the white tailed eagles the anterior and posterior lingual glands were distinguished. The glands consist of several alveolar-tubular secretory units and a subepithelial chamber collecting the mucous secretion. The orifices of the anterior glands are situated on the lateral surfaces of the posterior part of the lingual body, whereas the posterior lingual glands open on the entire surface of the lingual root.     

The origins of the afferent fibers to the lingual muscles of the dog, a retrograde labelling study with horseradish peroxidase

The origin of the afferent fibers to the lingual muscles of the dog was investigated by means of retrograde transport of horseradish peroxidase (HRP) from injection sites in the tongue and the extrinsic lingual muscles. Intralingual injections were not satisfactory because the enzyme diffused beyond the intrinsic lingual muscles to include virtually all tissues within the tongue. Thus, the resultant retrograde labeling of cell bodies of the trigeminal, geniculate, glossopharyngeal, vagal, and first cervical (C1) spinal ganglia represented a composite of lingual sensory innervation. In order to confine HRP uptake to intramuscular nerve endings, injections were limited to surgically isolated extrinsic lingual muscles, i.e., the genioglossus, hyoglossus, and styloglossus. After these intramuscular injections, labeled neurons appeared ipsilaterally in the C1 spinal ganglion, the proximal vagal (jugular) ganglion, and trigeminal ganglion. Earlier suggestions that the lingual proprioceptive neurons of the dog reside in the distal vagal (nodose) ganglion and hypoglossal ganglia were not confirmed. The mesencephalic nucleus of the trigeminal nerve failed to label after enzyme injections into the tongue or the extrinsic lingual muscles. The retrograde labeling of cell bodies in the C1 spinal ganglion was abolished when HRP injections into the extrinsic lingual muscles were preceded by surgical interruption of the ansa cervicalis or distal section of the hypoglossal nerve. Retrograde labeling of neurons in the proximal vagal ganglion persisted after hypoglossal nerve transections.     

Functional Morphology of the Tongue in the Domestic Goose (Anser Anser f. Domestica)

Using LM and SEM methods, the study describes microstructures in particular areas of the tongue of the goose. A thick multilayered keratinized epithelium forms the “lingual nail” and covers small and giant conical papillae, whereby the first functions as an exoskeleton of the tongue apex, and the latter are arranged along the lingual and well‐developed connective tissue cores, and together with the bill lamellae are involved in cutting. The row of conical papillae on the lingual prominence prevents regurgitation of transported food. In the area of the “lingual nail” and in the anterior part of the lingual prominence, Herbst corpuscles are accumulated, which allow to recognize food position. Filiform papillae, as widely distributed between the conical papillae of the body, are responsible for filtering. They can be explained as long keratinized processes of the epithelium and are devoid of connective tissue cores. During food transport, the flattened areas of the lingual body and the lingual prominence are protected by a parakeratinized epithelium, but the root is covered by a nonkeratinized epithelium. The presence of adipose tissue in the tongue probably reduces pressure during food passage, but also promotes mucus evacuation from the lingual glands, thus facilitating food transport. An entoglossal bone with a continuation as cartilage is the stable structural basis of the tongue system. Anat Rec, 2011. © 2011 Wiley‐Liss, Inc.     

Morphology of the dorsal lingual papillae in the barbary sheep, Ammotragus lervia

The dorsal lingual surface of a barbary sheep (Ammotragus lervia) was examined by scanning electron microscopy (SEM). The tongue was about 20 cm in length. There were about 30 vallate papillae on both sides. Filiform, conical, fungiform and vallate papillae were found. The filiform papillae were distributed over the entire dorsal surface of the tongue, excepted for the lingual torus where conical papillae were present. The fungiform papillae were present rounded bodies, and more densely distributed as compared to that of the lingual body on the tip and ventral surface of lingual apex. No foliate papillae were seen on the dorsal surface. The vallate papillae were located on both sides of the midline in the caudal part. Each papilla was surrounded by a groove. These findings indicate that the tongue of the barbary sheep is similar to that of the formosan serow, japanese serow and blackbuck.     

Ultrastructural study of the relationship between the morphogenesis of filiform papillae and the keratinisation of the lingual epithelium in the rat

Tongues were removed from rat fetuses on d 16 of gestation (E16) and from newborn (P0) and juvenile rats on d 7 (P7) and d 21 (P21) postnatally for examination by light and transmission electron microscopy. In the fetuses at E16, no rudiments of filiform papillae were visible on the dorsal surface of the tongue. No evidence of keratinisation could be recognised over the entire dorsal lingual epithelium. At P0, rudiments of filiform papillae showed a similar distribution to that seen in the adult, but had a more rounded appearance. The columnar structure of cells in the epithelium, with the different degrees of keratinisation as observed in the mature adult, was indistinct, but a keratinised layer was clearly located at the tip of each filiform papilla. In juveniles at P7, the filiform papillae on the anterior part of the tongue were long and slender, and the anterior and posterior cell columns of the filiform papillae and the interpapillary cell columns were clearly distinguishable. In juveniles at P21, the structure of filiform papillae was identical to that in the adult. These results indicate that, in rats, the morphogenesis of filiform papillae advances in parallel with keratinisation of the lingual epithelium from just before birth to a few weeks after birth.     

Morphological studies for retrusive movement of the human adult tongue

This study identified the anatomical and close functional relationship between the transverse lingual and superior pharyngeal constrictor muscle. Two en bloc samples (including the tongue and mid-pharyngeal wall) and four whole tongues were obtained from adult human cadavers. We found that fibers of the superior pharyngeal constrictor muscle connected with fibers of the transverse lingual muscle, forming a ring of muscle at the base of the tongue. The average diameters of the transverse muscle fibers increased in size gradually as they approached the base of the tongue. Distribution of the muscle spindles in the transverse lingual muscle and the genioglossus muscle also increased as they reached posteriorly near the base of the tongue. These findings suggest that a ring of muscle formed by the postero-inferior portion of the transverse lingual muscle and the superior pharyngeal constrictor may be largely responsible for the retrusive movement of the tongue and the constrictive movement of the pharyngeal cavity as an antagonist of the genioglossus muscle.     

Lingual cysticercosis--a case report

Cysticercosis is unlikely to be the first diagnosis for a swelling over the tongue. In this report we document an unusual case of lingual cysticercosis presenting as an isolated lesion.     

Peripheral lymphadenopathy as the initial manifestation of pericardial mesothelioma: a case report

Lymphadenopathy is an unusual initial presentation of malignant mesothelioma. We describe a case of extrathoracic lymphadenopathy as the only initial manifestation of primary pericardial malignant mesothelioma. The diagnosis of metastatic malignant mesothelioma was made by excisional biopsy of the supraclavicular lymph node and later confirmed by cytologic examination of pericardial fluid. The clinical and pathological features of this case, including positron-emission tomography (PET), immunohistochemistry, and electron microscopy, are discussed.     

The origins of the afferent fibers to the lingual muscles of the dog,a retrograde labeling study with horseradish peroxidase

The origin of the afferent fibers to the lingual muscles of the dog was investigated by means of retrograde transport of horseradish peroxidase (HRP) from injection sites in the tongue and the extrinsic lingual muscles. Intralingual injections were not satisfactory because the enzyme diffused beyond the intrinsic lingual muscles to include virtually all tissues within the tongue. Thus, the resultant retrograde labeling of cell bodies of the trigeminal, geniculate, glossopharyngeal, vagal, and first cervical (C₁) spinal ganglia represented a composite of lingual sensory innervation. In order to confine HRP uptake to intramuscular nerve endings, injections were limited to surgically isolated extrinsic lingual muscles, i.e., the genioglossus, hyoglossus, and styloglossus. After these intramuscular injections, labeled neurons appeared ipsilaterally in the C₁ spinal ganglion, the proximal vagal (jugular) ganglion, and trigeminal ganglion. Earlier suggestions that the lingual proprioceptive neurons of the dog reside in the distal vagal (nodose) ganglion and hypoglossal ganglia were not confirmed. The mesencephalic nucleus of the trigeminal nerve failed to label after enzyme injections into the tongue or the extrinsic lingual muscles. The retrograde labeling of cell bodies in the C₁ spinal ganglion was abolished when HRP injections into the extrinsic lingual muscles were preceded by surgical interruption of the ansa cervicalis or distal section of the hypoglossal nerve. Retrograde labeling of neurons in the proximal vagal ganglion persisted after hypoglossal nerve transections.     

Instrument measurement of lingual force variability reflects tardive tongue dyskinesia

Tardive tongue dyskinesia is often under-diagnosed or misdiagnosed. Instrument measurement of lingual force variability may be a valid and reliable method for assessing tardive tongue dyskinesia. Instrument measurement of lingual force variability was compared to the clinical level of tardive tongue dyskinesia and total body dyskinesia as measured by the Abnormal Involuntary Movement Scale (AIMS) in 35 subjects: 23 patients with a psychiatric disorder using antipsychotics, of which 11 were with and 12 were without tardive tongue dyskinesia, and 12 age- and gender-matched healthy controls. Lingual force variability correlated with tardive tongue dyskinesia (Spearman r?=?0.56; p?<?0.01) and with total dyskinesia (r?=?0.47; p?=?0.02); there was no association with age, antipsychotic dose, or psychiatric diagnosis. Instrument test-retest reliability corresponded with an ICC of 0.85 p?<?0.0001. Instrument measurement of lingual force variability is a valid and reliable method for assessing tardive tongue dyskinesia.     

Morphological characteristics of the tongue and lingual papillae of the large bamboo rat (<Emphasis Type="Italic">Rhizomys sumatrensis</Emphasis>)

The large bamboo rat (Rhizomys sumatrensis) is a fossorial rodent found throughout Indochina that has a distinct habitat dominated by bamboo thickets. In the study reported here, the lingual biology of this rodent is described in detail, based on characteristic features of the tongue and lingual papillae as determined by light and scanning electron microscopy studies. The tongue was found to be elongated with a rounded apex and possessed a median groove and a well-developed intermolar prominence. Three types of the papillae were found on the dorsal lingual surface: filiform, fungiform and vallate papillae. The most abundant papillae were the filiform papillae, the majority of which had a wide base and fork-like processes. Rounded fungiform papillae with one to four taste buds were randomly distributed among the filiform papillae, with a high density found at the anterior tongue, particularly the apex. Two oval vallate papillae were observed on the posterior part of the tongue, surrounded by a circumferential groove into which their numerous gustatory pores opened. The lingual radix had no papillae but contained mucus-secreting Weber’s salivary glands. Structural adaptations of the tongue to meet the functional demands of food ingestion and food manipulation in the oral cavity are also discussed.     

Evolution of the structure and function of the vertebrate tongue

Studies of the comparative morphology of the tongues of living vertebrates have revealed how variations in the morphology and function of the organ might be related to evolutional events. The tongue, which plays a very important role in food intake by vertebrates, exhibits significant morphological variations that appear to represent adaptation to the current environmental conditions of each respective habitat. This review examines the fundamental importance of morphology in the evolution of the vertebrate tongue, focusing on the origin of the tongue and on the relationship between morphology and environmental conditions. Tongues of various extant vertebrates, including those of amphibians, reptiles, birds and mammals, were analysed in terms of gross anatomy and microanatomy by light microscopy and by scanning and transmission electron microscopy. Comparisons of tongue morphology revealed a relationship between changes in the appearance of the tongue and changes in habitat, from a freshwater environment to a terrestrial environment, as well as a relationship between the extent of keratinization of the lingual epithelium and the transition from a moist or wet environment to a dry environment. The lingual epithelium of amphibians is devoid of keratinization while that of reptilians is keratinized to different extents. Reptiles live in a variety of habitats, from seawater to regions of high temperature and very high or very low humidity. Keratinization of the lingual epithelium is considered to have been acquired concomitantly with the evolution of amniotes. The variations in the extent of keratinization of the lingual epithelium, which is observed between various amniotes, appear to be secondary, reflecting the environmental conditions of different species.