GOOD MORNING

DEVELOPMENT OF
TONGUE AND SALIVARY
GLANDS

PRESENTED BY: DR. ABHIMANYU ROHMETRA

PG IST YEAR,
DEPTT OF ORTHODONTICS
 CONTENTS
• INTRODUCTION
• ANATOMY OF TONGUE
• EMBRYOLOGY Of TONGUE
• DEVELOPMENT OF THE TONGUE
• FUNCTIONS OF NORMAL TONGUE
• ANOMALIES OF THE TONGUE
• RELATION OF NORMAL TONGUE AND
DENTAL FUNCTION
• SWALLOWING
• CLASSIFICATION OF SWALLOWING
• EXAMINATION OF THE TONGUE
• ROLE OF TONGUE IN MALOCCLUSION
• TONGUE THRUST
• TREATMENT OF TONGUE THRUSTING HABITS
• DEVELOPMENT OF SALIVARY GLANDS
• STAGES OF DEVELOPMENT (6 STAGES)
• POSTNATAL DEVELOPMENT
• CLASSIFICATION
• HISTOLOGICAL CHARACTERISTICS OF
SALIVARY GLANDS
• CLINICAL APPLICATIONS
• CONCLUSION
• REFERENCES
INTRODUCTION
ANATOMY OF TONGUE
• The tongue is a highly muscular organ of
deglutition, taste and speech; it is partly oral and
partly pharyngeal in position. The tongue is
located in the floor of the mouth. It is a muscular
organ with a mucous membrane covering. It has a
 root
 an apex
 a curved dorsum and
 an inferior surface
 It is divided by V - shaped sulcus terminalis into an
anterior , oral or presulcular part facing upwards
• Muscles of the tongue
 Its mucosa is normally pink and moist. The root of
the tongue is attached to the hyoid bone and
mandible. The dorsum is generally convex in all
directions.
• There are two groups of muscles associated with
the tongue; the extrinsic and the intrinsic.
• Intrinsic muscles : Extrinsic muscles :
1. Superior longitudinal 1. Genioglossus
2. Inferior longitudinal 2. Hyoglossus
3. Transverse 3. Styloglossus
4. Vertical 4. Palatoglossus
SUPERIOR LONGITIDINAL MUSCLE

Shortens the tongue & makes the dorsum

concave

INFERIOR LONGITIDINAL MUSCLE

Shortens the tongue & makes the dorsum

convex
TRANSVERSE MUSCLE

Makes the tongue narrow & elongated

VERTICAL MUSCLES

Makes the tongue broad & flattened

Hyoglossus – depresses the tongue
Styloglossus - pulls it upward & backward
Genioglossus – Protrudes the tongue out of the
mouth by pulling the posterior
part forwards
Palatoglossus – brings the palatoglossal
arches together, thus shutting
the oral cavity from the
oropharynx
 Blood Supply
• The blood is supplied to the tongue by right and
left lingual arteries which are branches of the
external carotid arteries; lingual veins carry the
blood to the internal jugular vein.
 Nerve Supply
• The motor nerve supply is the hypoglossal nerve,
which supplies both the intrinsic muscles and all
but not one of the extrinsic muscles. That one is
the palatoglossus muscle, which is innervated
from the vagus through the pharyngel plexus.
EMBRYOLOGY OF TONGUE
The tongue arises in the ventral wall of
the primitive oropharynx from the inner
lining of the first four branchial arches.
During the 4th week i.u., paired lateral
thickening of mesenchyme appear on the
internal aspect of the first branchial arches
to form the lingual swellings.
• Between and behind these swellings a median
eminence appears, the tuberculum impar
(unpaired tubercle), whose caudal border is
marked by a blind pit.
• This pit, the foramen caecum marks the site of
origin of the thyroid diverticulum, an
endodermal duct that appears during the somite
period. the diverticulum migrates caudally
ventral to the pharynx as the thyroglossal duct,
which bifurcates and subdivides to form the
thyroid gland.
• The lingual swelling grow and fuse with each other,
encompassing the tuberculum impar, to provide the
ectodermal derived mucosa of the body (anterior two
thirds) of the tongue.

ANTERIOR TWO THIRDS :

From two lingual swellings and one tuberculum impar,
which arise from the first branchial arch. The tuberculum
impar soon disappears.
•POSTERIOR ONE THIRD:
From the cranial large part of the hypobranchial
eminence, ie from the third arch.
•POSTERIOR MOST PART:
From the fourth arch.
POSTNATAL DEVELOPMENT OF THE
TONGUE
• The entire tongue is within the mouth at birth; its
posterior third descends into the pharynx by the
age of 4 years.

• The tongue normally doubles in length, breadth,

and thickness between birth and adolescence,
reaching nearly maximal size by about 8 years of
age but continuing to grow in some individuals
during adulthood. Its early growth tends to be
prematurely relative to the size of the mouth,
reflecting its early role in suckling.
• Also, the large tongue in a small mouth partly
accounts for the peculiar tongue-thrusting
character of the infant’s early swallowing pattern,
in which the tongue fills the space between the
separated jaws during swallowing.

• The later enlargement of the mouth facilitates the

conversion to the adult pattern of swallowing, in
which the tip of the tongue lies against the palate
behind the maxillary incisor teeth
• Until the primary first molars erupt, the infant
swallows with jaws separated and tongue thrust
forward, predominantly using the facial muscles
(orbicularis oris and buccinators) innervated by
the facial nerve.

• This pattern, known as the infantile swallow, is

an unconditioned congenital reflex.
• Contrary to the action in adults, the infant’s lips
suck during swallowing and make stronger
movements than the tongue.

• After the eruption of the posterior primary teeth

at 18 months of age onward, the child tends to
swallow with the teeth brought together by
masticatory muscle action, without a tongue
thrust.
• This mature swallow is an acquired conditioned
reflex.

• As the child grows older, variation in the pattern

decreases as the adult swallowing pattern is
increasingly adopted.
• The movements of the mature swallow are
primarily of those muscles innervated by the
trigeminal nerve (ie, the muscles of mastication
and the mylohyoid).

• Once the facial-nerve musculature has been

relieved of its swallowing duties, it is better able
to perform the delicate mimetic activities of facial
expression and speech that are acquired from 18
months onward
FUNCTIONS OF NORMAL TONGUE
• The normal tongue has several very important
normal functions of interest to the orthodontist.

• In mastication, it does so by placing the food in

position, chiefly by the anterior and lateral
portions of the body of the tongue pushing the
food buccally when mastication begins.
• In deglutition the tongue is essential, first of all, in
forming the bolus, and then in propelling the bolus
into the pharynx in the first stage of swallowing.
Immediately after swallowing, the position of the
tongue is found to be contacting the hard palate
while the soft palate is pulled away downward
against the posterior portion of the tongue
• The formations of sounds in speech are another
function of the tongue. The tongue is in perpetual
motion during speech and takes a very necessary
part in forming the sounds for “s”, “z”. “t”, “d”,
“sh”, “e”, “g”, “l”, and “r”. Some of the necessary
movements are protrusion between the anterior
teeth, as in “b”, and elevation of the tip alone
directly behind the maxillary incisor teeth, as in
the sound “s”.
• In normal breathing using the nasal air passages,
the tongue is found to be in a rest position. In
normal forced breathing through the mouth, such
as an athlete may do upon exertion, the mandible
is depressed, the lips are opened, and the tongue
laterally remains in contact with the lingual
surfaces of the mandibular teeth dropping away
from the maxilla; the anterior part of the tongue,
including the tip, is lowered to contact the lingual
surfaces of the mandibular anterior teeth.
ANOMALIES OF THE TONGUE
• Developmental disturbances of tongue:
Microglossia
Macroglossia
Ankyloglossia
Cleft tongue
Fissured tongue
Median rhomboid glossitis
Benign migratory glossitis
Hairy tongue
Lingual thyroid nodules
 MICROGLOSSIA & MACROGLOSSIA

• The tongue may fail to achieve a normal growth

rate, resulting in an abnormally small tongue
(microglossia) or in over development
(macroglossia).
MICROGLOSSIA
MACROGLOSSIA
 Aglossia & Bifid Tongue

• Rarely, the tongue fails to develop (aglossia), or

it becomes forked, bifid, or trifid as a result of the
failure of its components to fuse.
AGLOSSIA
BIFID TONGUE
 TONGUE TIE

•The retention of an abnormally short

lingual frenum results in Ankyloglossia
(tongue-tie), a fairly common
developmental anomaly
FISSURED TONGUE

• Also termed as scrotal tongue

• Manifests as numerous small firrows or grooves
on the dorsal surface,often radiating out from a
central groove along the midline of the tongue.
 MEDIAN RHOMBOID GLOSSITIS

• Cause due to failure of the tuberculum impar to

retract or withdraw before fusion of lingual
swelling
• Appears as a diamond shaped reddish patch or
plaque on the dorsal surface of the tongue
immediately anterior to circumvalate pappilae.
 BENIGN MIGRATORY GLOSSITIS

• Presents as multiple areas of desquamation in an

irregular pattern.
 CARCINOMAS OF TONGUE
1. Squamous cell carcinoma with
varying degree of anaplasia
(commonest).
2. Basal cell carcinoma.
3. Adenocarcinoma (minor salivary
tumors).
4. Anaplastic carcinoma
(carcinosarcoma) in posterior 1/3.
5. Pure sarcoma.
 Melkerson- Rosenthal syndrome

• Characterized by triad
1. Chelitis granulamatosa
2. Facial Paralysis
3. Scrotal tongue
RELATION OF NORMAL TONGUE
AND
DENTAL FUNCTION
• The normal growth, development, and function
of the tongue integrated with the normal growth,
development, and function of all other related oral
and dental structures will inevitably lead to what
is considered to be normal jaw relationships and
normal dental function.
SWALLOWING
•

• Normal mature swallowing takes place without

contracting the muscles of facial expression. The
teeth are momentarily in contact and the tongue
remains inside the mouth.
• Abnormal swallowing is caused by tongue-
thrust, either as a simple thrusting action or as
“tongue-thrust syndrome”.
 The following symptoms distinguish this
syndrome.
• Protrusion of the tip of the tongue.
• No tooth contact of the molars.
• Contraction of peri-oral muscles during the
deglutition cycle. During their first few years,
infants swallow viscerally, i.e. with the tongue
between the teeth. As the deciduous dentition is
completed, the visceral swallowing is gradually
replaced by somatic swallowing.
TONGUE THRUST
ETIOLOGY

1.genetic factors
2. learned behavior (habit)
3.maturation
4.mechanical restriction
5.neurological disturbances
6.psyhcogenic factors
7.craniofacial growth and maturation
8 .open spaces during mixed dentition
9.other factors
Classification of tongue thrust

 According to Moyers
a. normal infantile swallow
b. normal mature swallow
c. simple tongue thrust swallow
d. complex tongue thrust swallow
e. retained infantile swallow
• Visceral (infantile) swallow – During the normal
infantile swallow, the tongue lies between the gum
pads and the mandible is stabilized by obvious
contractions of the facial muscles. The buccinator
muscle is particularly strong in the infantile
swallow as it is during infantile nursing.
• The cessation of the infantile swallow and the
appearance of the mature swallow are not a simple
on-and-off phenomenon. Rather, elements of both
intermix during the primary dentition and
sometimes even in to the early mixed dentition.
• This normal appearance of feature of both the
infantile and mature swallow is termed the
“Transitional swallow”. Diminishing of
buccinator activity is part of the transitional
period, but the most characteristic feature of the
start of cessation of the infantile swallow is the
appearance of contractions of the mandibular
elevators during the swallow as they stabilize the
teeth in occlusion.
• Normal Mature Swallow - The normal mature
swallow is characterized by very little lip and
cheek activity, and the contraction of the
mandibular elevators bringing the teeth into
occlusion.
• During the mixed dentition, when some teeth are
missing and there is normal interdental spacing,
the lips may contract a bit to secure the seal. All of
these features are not seen all of the time in all
kinds of swallows in young children during the
transitional period.
• Simple Tongue – Thrust Swallow - The simple
tongue – thrust swallow typically displays
contractions of the lips, mentalis muscle, and
mandibular elevators and the teeth are in
occlusion as the tongue protrudes into an open
bite. There is a normal teeth together swallow, but
a “Tongue-thrust” is present to seal the open bite.
• A simple tongue – thrust swallow may also be
found with hypertrophied tonsils which are not
enlarged and / or inflamed sufficiently to prompt a
tooth apart swallow.
Malocclusion associated with simple tongue thrust
swallow
• Complex Tongue – thrust Swallow - The complex
tongue – thrust swallow is defined as tongue-
thrust with a teeth-apart swallow. Patients with a
complex tongue-thrust combine contractions of
the lip, facial, and mentalis muscles, lack of
contractions of the mandibular elevators, a
tongue-thrust between the teeth, and a teeth apart
swallow.
Malocclusion associated with complex tongue thrust
swallow
Retained infantile swallow
• It is defined as predominant persistence of the
infantile swallowing reflex after the arrival of
permanent teeth
• The tongue thrusts strongly between the teeth in
front and on both sides.
• Patient with a retained infantile swallow have
serious difficulties in mastication, they ordinarily
occlude on only one molar in each quadrant.
• The retained infantile swallowing may be
associated with skeletal cranio-facial development
syndromes and neural deficits.
• Excessive anterior face height often produces
severe frontal open bites and extremes of adaptive
swallowing behaviour as the neuromusculature
attempts to cope with skeletal imbalance.such
strained adaptive swallowing behaviour must be
carefully discriminated from the complex and
retained infantile swallow.
ROLE OF TONGUE IN
MALOCCLUSION
 The importance of the tongue in the development of normal
occlusion. (AJODO, NOV 1950, VOL 36,ISSUE 11)

Normal arch form requires sufficient dimension to

accommodate the teeth. The most important natural
forces which can increase mandibular arch dimension
are those of the tongue.

The normal expansive forces of the tongue are exerted

to their maximum only when it can be accommodated
within the mandibular arch. When the tongue, during
deglutition, operates from a higher position, its
expansive forces on the mandibular teeth are
diminished.
•Arch dimension gained through the influences of normal
tongue function tends to remain stable. The coordinating
forces of the tongue, lips, and cheeks, when allowed to
develop a proper equilibrium during the early stages of
facial growth, usually maintain their balance.

• The highly abnormal form and the diminutive size of

the mandibular arch found associated with congenital
aglossia provide proof of the vital importance of normal
tongue form and function to normal occlusion.
•As the tongue thrusts forward between the maxillary
and the mandibular teeth, the peripheral portions no
longer lie between the occlusal surfaces of the posterior
teeth resulting in supraeruption of the posterior teeth
leading to a open bite
Tongue size abnormalities also influences the dentition
and leads to malocclusion like aglossia leads to
crowded teeth and macroglossia leads to open bite.
 REFERENCES

• GROWTH AN DEVELOPMENT OF TONGUE –GREYS

ANATOMY
• EMBRYOLOGY – INDERBIR SINGH
• ORAL PATHOLOGY-SHAFER
• TEXT BOOK OF ORTHODONTICS -WILLIAM R PROFITT
• Principles and practice of orthodontics – T. M. GRABER
• HAND BOOK OF ORTHODONTICS- ROBERT E MOYERS
THANK
YOU..
DEVELOPMENT OF
SALIVARY GLANDS

PRESENTED BY: DR. ABHIMANYU ROHMETRA

PG IST YEAR,
DEPTT OF ORTHODONTICS
 CONTENTS
• DEVELOPMENT OF SALIVARY GLANDS
• STAGES OF DEVELOPMENT (6 STAGES)
• POSTNATAL DEVELOPMENT
• CLASSIFICATION
• HISTOLOGICAL CHARACTERISTICS OF
SALIVARY GLANDS
• CLINICAL APPLICATIONS
• CONCLUSION
• REFERENCES
Development Of Salivary
Gland
-

Interaction of epithelium with underlying

mesenchyme to form functional part
Of the Gland.

Epithelium mesenchyme interaction also called as

secondary induction (mesenchyme is in close
proximity to epithelium)

Mesenchyme consists of fibroblast , mast cells

and macarophage cells , extracellular matrix.
Extracellular matrix classified into two
1)Basal Lamina
2)Extracellular Matrix

1)Basal Lamina – type IV collagen ,heparin sulfate &

other glycoproteins that interact with laminin & enactin

2)Extracellular Matrix – synthesises collagen type I &

type III , the glycoprotiens fibronectin & proteoglycans
such as chondroitin sulfate.

Regulates cell proliferation , cell differentiation &

morphogenesis.
Differentiation : - process responsible for
development of cell specificity & diversity as
observed at molecular level.

Morphogenesis : - Formation of size and shape.

 Growth Pattern of Salivary Gland
Functional Glandular tissue (parenchyma)

Epithelial Outgrowth (Glandular Bud)

Connective tissue Stroma (Capsule & Septa) form from mesenchyme

Mesenchyme composed of neural crest cells , mesoderm , it is called

as “Ectomensenchyme “

Ectomenechyme essential for normal differentiation of salivary gland.

Epithelial Bud forms during development

 Bud Closet to stomodeum

Differentiate into main excretory duct

Distal portion arborizes to form terminal portion of duct system

Secretory end / pieces / acini

 Developmental Initiation :

1)Parotid Gland : 6th week of Prenatal Life

2)Submandibular Gland : 7th week of Prenatal

Life

3)Sublingual Gland : 8th week of Prenatal Life

1)Minor salivary gland : 12th week of Prenatal Life

6 Stages
FORMATION
OF BUD
FORMATION
OF CORD

CYTODIFFERENTIATION

BRANCHING OF CORDS

CANALIZATION OF CORDS

FORMATION OF LOBULE
 Stages of Development : - 6 Stages
Stage : I , Formation : Induction of oral epithelium by
underlying mesenchyme

Buccal epithelium induces proliferation

Tissue thickening & formation of the epithelial cord

Condensation of mesenchyme by basal lamina

Stage : II , Formation and Growth of epithelial cord :

Cell proliferation

Epithelial Bud

Solid cord

Condensation and proliferation in mesenchyme

Stage : III , Initiation of branching in “Terminal parts of
Epithelial cord & continuation of glandular differention.”

Epithelial cord proliferates rapidly

Branches in terminal bulbs (presumption acini)

Growth in length of solid cord

Differentiate

Berry like terminal buds forms

Stage : IV , Repetative Branching of Epithelial cord and
Lobule formation
Glandular epithelium surrounds entire glandular parenchyma

Lobulation

Connective tissue differentiates

Forms extensive tree like structure of bulbs

Branching continues at terminal portion of cord

Stage : V , Cananlization of presumptive acini

6th week seen usually

Epithelial cord

Canalizes

Forms hollow tube / duct

 Canalization : - 2 Mechanisms
1) Different rates of cell proliferation for outer & inner cell
layers of epithelial

2) Fluid secretion of duct cell increases hydrostatic

pressure & produce a lumen with in the cord
Stage : VI , Cytodifferentiation

Cytodifferentiation of Acini and intercalated duct initiates

Increased in mitotic activity

Shifted from epithelial cord to terminal bud region and proacinar cells

Cell division

Mature or adult acinar cells forms

Postnatal Growth/Development
1) Maturation of stimulus

Secretion coupling which links secretogogue

Membrane receptors to signal transduction pathways

Controlls acinar cell secretion

2) Establishment of neural connection from the

autonomic nervous system
Classification
 1) According to amount of secretion of saliva -

a) Minor Gland – 0.5 to 0.75 L

b) Major Glands– more than 0.75 L

Major Glands – 1) Parotid

2) Submandibular Previously called as Submaxillary
3) Sublingual

Minor Gland – according to locations

Buccal , Lingual , Labial , Palatine
2) According to Presence of Excretory Duct : --

a. Exocrine Gland –with duct system

b. Endocrine Gland – without duct system

 3)According to Secretion : -

1) Serous Secretion : - (water + enzyme ) –

Parotid

2) Mucous Secretion : - (Mucin) -- Palatine

3) Mixed – (Both) ---- Submandibular + Sublingual

Histological characteristics Of Major
Salivary Glands
1)Parotid Gland : -
- Serous Type
- Interlobular connective tissue large in number
- Fat Cells distinguished, lack of Mucigen
2) Submandibular Gland
-Mixed Gland
- More straited ducts fewer intercalated ducts
- Acinis are either purely serous or mucous.
- Serous demilunes are present
3) Sublingual Gland
- mixed
- acinis mucous secreting
- few purely serous acini
- intercalated ducts are virtually absent
- absence of striations in columner cells
 DUCTS

Intercalated duct cells

• The secretions pass from the acinus to a short

intercalated duct: the duct cells tend to be
cuboidal,
 Striated duct cells

• The intercalated duct then pass abrupt into

another short but wide, striated duct,

• The striated duct are lined by cells which are much

more columnar than the cells of the intercalated duct.
 These striated ducts then pass abruptly into
two epithelial cell layered excretory ducts
and finally to the stratified squamous
epithelial cell lined
ACINUS

INTERCALATED
DUCT Terminal COLLECTING
DUCT DUCT
a
 Myoepithelial cells

• These cells constrict the acini and ducts to

felicitate salivary secretary flow.

• In myoepithelial cells the nucleus lies in a broader

part of the cell and is surrounded by mitochondria
and strands of endoplasmic reticulum. The remainder
of the cells consists of longitudinally arranged
myofibrils.
MYOEPETHELIAL CELLS
 Minor Salivary Gland

-Uncapsulated – labial , buccal , glossopalatine

& lingual

-Numerous small ducts.

 XEROSTOMIA (Dry mouth syndrome)

• Xerostomia is a subjective feeling of oral

dryness. It is generally accompanied by
salivary gland hypofunction and severe
reduction in secretion of whole saliva.
 Systemic Manifestations

• Throat – xerostomia causes dryness,

hoarsness and persistent dry cough
• Nose – dryness of nasal mucous leads to –
burning , pain and inflammation.
• Eyes – Causes, dryness, burning, itching,
feeling that eyelids stick together, blurred
vision, sensitivity to light.
• GIT = Constipation.
 1.Mucoceles

Retention cyst of Minor salivary Gland , ducts contains mucus

lower lip

Site – Lower lip

Pathology – Seepage of mucus into connective tissue

Treatment – surgical excision

 2. Salivary Flow Rate

a.Incidence to caries
b.Periodontal Diseases
c.Calculus formation
d.Mucosal inflammation due to friction of wire
 3. Cystic Fibrosis

-Caucassian children (one in 2000 birth) leads to

pulmonary , digestive , nutritional difficulties.

– CFTR (Cystic Fibrosis Transmembranous Regulator)

given
-Chloride Channel.
 4) Aging effect

•Decrease in salivary flow

•Histological Changes seen

•Acinar cell hypretrophy , interductal
deposits , fibrosis.
 5. Alteration of functions & structure

a.Sjogren syndrome

Absence of diminuation of saliva and tear

Extensive Lymphoid filteration and atrophy

b.Salivary Calculi

Sacculation of parotid duct

 6.Salivary Duct Stone

Site – submandibular
-- Calcium phosphate in the form of
hydroxyapatite is primary mineral
compound
 CONCLUSION
Saliva is the glandular secretion which constantly
bathes the teeth and the oral mucosa.

The presence of saliva is vital to the maintenance

of healthy oral tissues. Severe reduction of
salivary output not only results in a rapid
deterioration in oral health but also has a
detrimental impact on quality of life.
 REFERENCES

• GROWTH AN DEVELOPMENT–GREYS ANATOMY

• EMBRYOLOGY – INDERBIR SINGH
• ORAL PATHOLOGY-SHAFER
• HAND BOOK OF ORTHODONTICS- ROBERT E
MOYERS
• TEXT BOOK OF ORTHODONTICS -WILLIAM R
PROFITT
• Principles and practice of orthodontics – T. M.
GRABER
THANK
YOU..