Tongue cancer is a relatively stra...

Tongue cancer is a relatively strange cancer in the general population, nevertheless can result in major disruptions in patients' lives. tongue and swallowing comprise two of the greatest in number important activities we have forward a daily basis, and the tongue is the primary ingredient in both. Tongue cancer method of treatment rates vary with tumor stage. A number of treatment protocols have been used with various combinations of radiation, chemotherapy, and surgery When the decision is made to treat a patient with tongue cancer surgically, all team members must be be of importance toed immediately about the patient's reconstruction and rehabilitation. Surgical management of these patients requires intimate knowledge of the embryology anatomy, and physiology of the oral cavity and of the of the present day physiology created by surgery and reconstruction.

EMBRYOLOGY OF THE TONGUE

The embryologic formation of the tongue, oral cavity, and arises from the evolution of the bronchial arch apparatus (ie, individual of the mesodermal ridges that confines the lateral wall of the oral and regions), which contributes to the formation of the face and neck The cranial force (CAN) innervation and of these edifices follow an organized pattern, in such a manner that the regional spread of malignancies in the upper tract (ie, oral cavity, larynx, pharynx) can be predicted to any degree by knowledge of the embryology of the bronchial arch apparatuses (Figure 1)

[Figure 1 ILLUSTRATION OMITTED]

ANATOMY AND PHYSIOLOGY OF THE TONGUE

The tongue has a certain special considerations because of its multiple functions.(1)

Anterior portion. The anterior sum of two units thirds of the tongue arise as couple separate swellings from bilateral first (ie, mandibular) branchial arches, which fuse in the midline, accounting for the avascular anterior lingual septum The lingual might a branch of trigeminal CN V supplies sensation to the anterior third of the tongue while the chorda tympani (ie, branch of CN VII [facial]) supplies taste.

Posterior portion. The posterior third of the tongue (ie, tongue base) derives from the hypobranchial eminence (ie, furcula) and the third branchial arch. The hypobranchial eminence is a midline pile and the tongue base is therefore a midline conformation with bilateral lymphatic drainage. Sensation is derived from the superior laryngeal power (ie, branch of CN X [vague]) and the glossopharyngeal courage (ie, CN IX). The vallecula, a depression between the tongue base and the epiglottis, portrays a groove between the anterior and posterior parts of the embryologic hypobranchial eminence.

The posterior constituent of the hypobranchial eminence forms the epiglottis, which also is a midline mode of building The pharyngoepiglottic fold (ie, the same of the paired folds of mucous membranes passing from the pharynx to the epiglottis) originates from the fourth branchial arch. These distinctions are important in understanding the divisions between the various makes and in knowing why they can be preserv or must be resect For example, laryngeal cancer has specific patterns of bourgeoning and metastases consistent with embryologic divisions.(2) Likewise, tumors in the base of the tongue ofttimes do not involve the epiglottis until highly late in the disease proces greatest in number likely because of the embryologic division in the hypobranchial eminence.

ANATOMY AND PHYSIOLOGY OF SWALLOWING

Several factors have an impact onward speech and swallowing. The mostly obvious is tongue bulk, which can have a significant impact in succession swallowing, especially if the base of tongue is ablated. Tongue coordination is important in articulate utterance swallowing, and oral hygiene. Sensory feedback also may help in the rapid recruiting of oropharyngeal defects. Tongue mobility, which is distinct from coordination, is essential in the one and the other speech and swallowing. The propulsive force and ability to generate a posterior push of a bolus (ie, a rotunded mass of food) also assists in swallowing.

Coordination and mobility of the tongue are related yet are not the same. It is important to note that flaps (ie, parts of skin and subcutaneous tissues that are mov from single part of the body to another) can copy bulk and can sometimes improve mobility of the residual tongue by the agency of preventing scarring to adjacent buildings Flaps, however, do not give aid in tongue coordination and sometimes actually may decrease tongue coordination because of the adynamic size of the flap. Flaps also are incapable of creating propulsive force if it be not that may sometimes be made sensate. Mobility and coordination are retained by way of preserving the suprahyoid muscles and the hypoglossal steadiness (ie, CN XII) when possible. Suspension of the larynx and mass of the flap also are helpful in preventing aspiration during swallowing. The tongue also has taste receptors and originates saliva from minor salivary glands, although these are relatively unimportant in reconstructive procedures

Swallowing comprises undivided of the most complicated reflexe requiring five cranial mights for the optimal transport of provender from the mouth to the stomach and bypassing the airway. It hangs on movements of the orifice pharynx, larynx, and neck working in rapid succession. Swallowing may be initiated voluntarily, although it progresse reflexively without further voluntary direct It may be elicited in anesthetized or decerebrate animals on way of the superior laryngeal strengthen or glossopharyugeal nerve, by mucosal or direct strength stimulation, or by stimulating electrode implanted in the dorsal reticular formation of the medulla, ventral to the nucleus tractus solitarius (ie, rounded pillar of cells in the medulla oblongata) and the floor of the fourth ventricle.(3)