Secondary Tongue Research Articles

Stevens-Johnson syndrome secondary to massive inflammatory hyperplasia of bilateral lingual margins: a case report and literature review.

Stevens-Johnson syndrome (SJS), also known as the multifactorial erythematous drug eruption, is a class of adverse reactions of the skin and mucous membranes primarily caused by drug allergy often involving the oral cavity, eyes, and external genital mucosa, generally accompanied by fever, and can be life-threatening in severe cases. In February 2022, the Department of Stomatology, the First Affiliated Hospital of Zhengzhou University admitted a patient with huge inflammatory hyperplasia of bilateral lingual margins secondary to SJS. Upon admission, no other obvious symptoms were observed except for tongue hyperplasia. The patient suffered from a severe adverse drug reaction caused by acetaminophen 2 months ago and was complicated by liver dysfunction and pulmonary infection. After 1 month of treatment and rehabilitation, he developed a secondary tongue mass and was subsequently admitted to Dept. of Oral and Maxillofacial Surgery Ward 2, the First Affiliated Hospital of Zhengzhou University. After completing the examination, the tongue mass was surgically removed. After a follow-up of 11 months, the patient's condition was satisfactory and no temporary discomfort was observed. The case of tongue mass secondary to SJS is extremely rare. If a stomatologist encounters a similar case, we should carefully inquire about the drug allergy history and recent medication history, and be alert to whether or not they had adverse drug reactions recently.

A rare case of a lingual mass in a neonate

A large lingual cyst was noted on the 22-week antenatal ultrasound, which grew in proportion to the foetus on serial imaging. An elective c-section was performed in view of possible airway obstruction, and the neonate initially required oxygen to maintain saturations. Aged 1 month, the baby developed significant breastfeeding difficulties secondary to rapid cyst and secondary tongue enlargement, completely filling the oral cavity. Fifteen millilitres of fluid were aspirated in clinic, resulting in reduction of tongue size and immediate improvement in feeding. The patient subsequently underwent surgical excision of the cyst, which filled most of the anterior two-thirds of the tongue up to the foramen caecum. Histology supported the diagnosis of lingual thyroglossal duct cyst. A rare variant of thyroglossal duct cysts, these cysts can be potentially difficult to manage. More commonly located in the tongue base, we present an even rarer variant, that of an anterior tongue cyst.

Change in reimbursement and costs in German oncological head and neck surgery over the last decade: ablative tongue cancer surgery and reconstruction with split-thickness skin graft vs. microvascular radial forearm flap.

Defects after ablative tongue cancer surgery can be reconstructed by split-thickness skin grafts or free microvascular flaps. The different surgical options may influence costs, reimbursement, and therefore possible profits. Our goal was to analyze the development of these parameters for different procedures in head and neck reconstruction in Germany over the last decade. After tumor resection and neck dissection of tongue cancer, three different scenarios were chosen to calculate costs, reimbursement, length of stay (LoS), and profits. Two options considered were reconstruction by split-thickness skin graft with (option Ia) and without (option Ib) tracheotomy. In addition, we analyzed microvascular reconstruction with radial forearm flap (option II). Furthermore, unsatisfactory results after options Ia and Ib may make secondary tongue plastic with split-thickness skin grafting necessary (option I+). The calculations were performed considering the German Diagnosis Related Group (DRG) system and compared to the specific DRG cost data of 250 German reference hospitals. The overall average length of stay (aLoS) declined from 16.7 to 12.8days with a reduction in every option. Until 2011, all options showed similar accumulated DRG reimbursement. From 2012 onwards, earnings almost doubled for option II due to changes in the DRG allocation. As was expected, the highest costs were observed in option II. Profits (reimbursement minus costs) were also highest for option II (mean 2052 €, maximum 3630 Euros in 2015) followed by options Ia (765 €) and Ib/I+ (681 €). Average profits over time would be 17 to 19% higher if adjusted for inflation. We showed the development of the DRG allocation of two commonly used methods of reconstruction after ablative tongue cancer surgery and the associated LoS, reimbursement, costs, and profits. As expected, the highest values were found for microvascular reconstruction. Microvascular reconstruction may also be the primary choice of treatment from a medical point of view. However, prolonged operation times, intensive care, and hospital stay in connection with complex microvascular operations can easily turn profits into losses as opposed to the results of simple, reliable, and fast split-thickness skin grafting. The inflation rate influences profits in reimbursement systems where costs are based on a previous period of time. Surgeons find themselves daily in an area of conflict between economic interests and medical decision-making. Due to its multidimensional aspects, the choice of the reconstructive technique should be primarily based on the best medical care for the patient. But there should also be awareness of the economic risk of all three surgical procedures.

An electromagnetic articulometer study of tongue and lip troughs

Troughs, which are a discontinuity in anticipatory coarticulation (Perkell 1968), have been shown to occur in the tongue body in /ipi/ and lips in /usu/. An electromagnetic articulometer (EMA) study of a single subject reported previously showed that intraoral pressure during the consonant could not be solely responsible for the downwards tongue body movement observed during the labial consonants (/p, b, m, f, v/); results supported the hypothesis of a secondary tongue gesture during the consonant. Lip troughs during /s/ in rounded contexts were more ambiguous, possibly because of inconsistencies in corpus design. Six new subjects have been recorded using a WAVE EMA system and a revised corpus. Tongue trough magnitudes decreased in the order /f, v/ > /p, b/ > /m/, serving to disprove the aerodynamic hypothesis; they were deeper for long than short consonants (e.g., [iffi] > [ifi]), and converged to the same point in asymmetric vowel contexts. The same type of convergence during the consonant was observed ...

Formation of the secondary tongue in Hynobius leechi and Ambystoma mexicanum (Amphibia: Urodela)

Tongue development in several developmental stages of the metamorphosing newt Hynobius leechi (Hynobiidae) and the paedomorphic Ambystoma mexicanum (Ambystomatidae) before and after artificially induced metamorphosis was studied by light microscopy (LM) and scanning electron microscopy (SEM). In H. leechi the anlage of the glandular field (lingual glands) of the secondary tongue appears under the free tip of the primary tongue and is clearly seen in late larvae (developmental stage approx. 65). The epithelium of the primary tongue is stratified and composed of epithelial cells, AB-positive goblet cells, some superficial ciliated cells, very few Leydig cells and typical taste buds. Later more or less radially arranged tubular glands (lingual glands) develop in the anterior portion of the prospective secondary tongue, which open in furrows lined in their upper region by the surface epithelium (“neck portion”). Fully developed glands are variously long, moderately branched and contain columnar secretory cells that are preferably AB-positive in their upper region, but AB- and PAS-negative in their terminal portions. Posteriorly the tubular glands become shorter in favour of the neck portion and then are abruptly replaced by a heavily ciliated area containing indentations of the epithelium interspersed with numerous goblet cells (crypts). This zone is considered as a modified remnant of the former primary tongue. Formation of the secondary tongue, often described as “fusion” of the glandular field with the primary tongue, is considered as a process levelling the free, probably regressive end of the primary tongue and the posterior part of the growing glandular field. The development of the secondary tongue of metamorphosing A. mexicanum follows the same pattern. However, the putative anlage of lingual glands in semiadult paedomorphic specimens may be considered as a further character indicating partial metamorphosis in this species. In the transformed axolotl we demonstrate the secondary tongue with lingual glands, epithelial folds with noticeable numbers of AB-PAS-positive goblet cells at the lower surface of the free tip of the secondary tongue, and, contrary to H. leechi, tubular glands immediately behind the dentary.

Secondary Onlay Free Flap Reconstruction of Glossectomy Defects following Initial Successful Flap Restoration

Patients who undergo tongue reconstruction over time may develop gradual worsening of dysarthria and dysphagia secondary to flap atrophy. At our institution, these patients undergo a secondary flap onlay procedure for augmentation of the neotongue. We review a total of 11 patients with total glossectomy defect who underwent secondary tongue augmentation with secondary onlay free flap consisting of radial forearm free flap (n = 6) and rectus free flap (n = 5). There was improvement in swallowing in 7 of 11 patients. Five (45.4%) patients achieved gastric tube independence. Seven (63.6%) patients achieved a varying degree of oral intake. All patients achieved tracheostomy independence. Dysarthria was improved in all patients. There were no flap failures. Therefore, a secondary onlay flap technique is feasible and may improve dysphagia and dysarthria to achieve gastric tube and tracheostomy independence in total glossectomy patients with delayed tongue atrophy.

Structural diversification of the gustatory organs during metamorphosis in the alpine newt Triturus alpestris.

Gustatory organs of the taste bud type occur in the epithelial lining of the oropharyngeal cavity of alpine newt larvae. They resemble the taste buds of bony fish, both in appearance (as revealed by scanning electron microscopy) and in detailed internal structure (seen on transmission electron micropscopy). During metamorphosis, at stage 55 of development, the secondary tongue (i.e. the soft tongue) is well formed and the anlages of taste discs are clearly apparent. Somewhat later, taste discs also appear in the epithelial lining outside the tongue, paralleling the disappearance of the taste buds. Well-developed taste discs of the newt differ from taste buds mainly by their structurally diversified set of 'associate cells' (mucous, wing and glial cells), which have no synaptic contact with nerve fibres. These cells accompany the neurosensory cellular components of the taste disc, i.e. the taste receptor cells and basal cells. This indicates that gustatory organs in metamorphosed newts, regardless of their small dimensions, fulfil the criteria established for taste discs previously defined in other Caudata and Anura species. Therefore, in the development of the newt there are two subsequent types of gustatory organs and two generations of the tongue: primary, in the larvae, and secondary, in metamorphosed animals.

The epithelia of the protrusible tongue of Eurycea longicauda guttolineata (Hoolbrook 1838) (Urodela: Plethodontidae).

In this study the lingual and sublingual glands, the lingual stem and the epithelial surface of the protrusible secondary tongue were investigated by light, scanning and transmission electron microscopy. The quality of the secretions of the epithelia was characterized histochemically. The lingual epithelium is formed by superficial (pavement) and goblet cells and at the margin of the tongue pad are also regions covered by ciliated cells. On the dorsal part of the tongue there are goblet cells of type A with mainly acidic secretions and of type B containing neutral secretions. Most of the goblet cells on the ventral side of the tongue (hypoglottis) show a strong alcian blue/PAS positive reaction (type I) and some produce neutral secretions (type II). The glandular cells of the lingual gland react positively to alcian blue and PAS in the apical region of the gland. In contrast there is only alcian blue-positive staining in the basal part of the gland. The size and complexity of the inclusion bodies of the secretory granules increase in a basal direction. In addition, there are ciliated cells in the glandular epithelium. Although the epithelium of the lingual stem is thin, it is double-layered. The cell types observed in this region are identical to those of the ventral part of the protrusible tongue. At the margin of the sublingual gland are trough-like structures. In the center, tubular parts are observed. The cells of this gland are stain strongly with alcian blue (pH 1.0) mainly in the basal part of the gland. The results of this are compared to the tongue pad and the lingual gland of Salamandra salamandra and Ambystoma mexicanum.

Two generations of the tongue and gustatory organs in the development of Hynobius dunni Tago.

In the development of Hynobius dunni there are two consecutive generations of the tongue and two generations of gustatory organs (taste buds and taste disks). The anlage of the developing secondary tongue appears just in front of the free ending of the primary tongue beginning at the larval developmental stage 62. From stage 67, a gradual reduction in the anterior part of the gill skeleton that supports the primary tongue occurs as the developing secondary tongue replaces the primary one. The lining of the entire oropharyngeal cavity of larvae contains only gustatory organs of the taste bud (TB) type. In younger larvae, the sensory area of a TB has a diameter of between 10 and 13 microm, while in older larvae, TBs reach 16-18 microm in diameter. After metamorphosis, some gustatory organs in the secondary tongue with a sensory area of 26-36 microm in diameter appear. In older animals they may reach as much as 56-71 microm. In other regions of the oropharyngeal epithelium than the tongue, these organs have an ellipsoid shape with a major axis of about 50 microm. On the basis of the cytomorphological criteria established previously, these organs were designated as taste disks. Thus, the presence of two generations of gustatory organs is characteristic of some urodeles, as well as frogs.

Morphological differentiation of taste organs in the ontogeny of Salamandra salamandra.

Morphological studies presented here provide additional cytological evidence that in the postnatal development of Salamandra salamandra there are two successive generations of taste organs: premetamorphic taste buds (TBs) in larval forms and taste disks (TDs) in postmetamorphic animals. The TBs have been found in the epithelium of the whole oropharyngeal cavity of larval forms, while in adults TDs appear only at the end of metamorphosis. The TDs can be papillary (or fungiform) on the soft (secondary) tongue and non-papillary outside the tongue. Two main cyto-morphological criteria distinguishing TDs from TBs have been established: (1) high differentiation of "nonsensory" components of a taste organ into several kinds of cells (often named "associate cells")--at least mucous cells and, separating them, wing cells; (2) a considerably larger area of the sensory epithelium than that in TBs, as the consequence of the large size of the mucous cells. In contrast to TDs each TB consists of longitudinally elongated supporting cells and taste cells, as well as of horizontally oriented basal cells, adjacent to the basement membrane. The sensory area in TBs measures 10-12 microm in diameter, while that in TDs has diameter of 45-90 microm. The anlage of the secondary tongue appears as a small folding of the floor epithelium just in front to the tip of the primary tongue in larvae 3 cm long, and is definitely formed in an animal with body length of about 6 cm.

The secondary tongue of Salamandra salamandra: histochemical and ultrastructural aspects of the developing lingual epithelium

The development of the lingual epithelium of Salamandra salamandra was investigated with emphasis on histochemical and ultrastructural aspects. The temporal and spatial occurrence and the typical appearance of various cell types; i.e. pavement cells, replacement pavement cells, basal cells, mitochondria rich cells, goblet cells and glandular cells have been analysed and documented in detail from the young larval stage up to the metamorphosed animal (2 months after metamorphosis). It is shown that anatomical re- and de novo-constructions related to the formation of the secretory tongue led to distinct changes in the cellular equipment of the epithelium of the tongue, including various histochemical properties. Finally, functional aspects of the morphological characteristics are discussed in detail and compared with respective findings in other species.

The epithelium of the tongue of Ambystoma mexicanum: Ultrastructural and histochemical aspects

The distribution pattern of taste buds and goblet cells and histochemical and ultrastructural aspects of the tongue epithelium of Ambystoma mexicanum are here described. This study is also concerned with the developmental stages and origins of the epithelial cells. Pavement cells and goblet cells of the stratum superficiale are replaced by basal cells of the stratum germinativum in larvae and neotenous adults. The pavement cells of the larvae are characterized by a marginal layer of mucin grana. Decompaction of the mucins occurs immediately before extrusion in the adult. The larval goblet cell type (type I), which is also present in the adult, contains unfused grana of irregular shape. At the tip of the tongue, a further type (type II) of goblet cells is found. In the type II cells the intracellular secretory grana fuse to a single homogeneous mass. Leydig cells of the tongue epithelium are discerned by light microscopy first in the semi-adult, apparently correlated with partial metamorphosis. In the course of ontogenesis and induced metamorphosis the secretion changes to neutral glycoconjugates. The mucins of the pavement cells change first followed by those of the goblet cells. The glands of the secondary tongue show a dorso-ventral pattern of varying secretory qualities. Taste buds are found at the anterior margin of the tongue and along the base of the gill clasps in the early larva. They are already distributed all over the tongue at the end of the early larval phase.

The lingual epithelium of Salamandra salamandra: metamorphotic changes during its ontogenesis

The development of the epithelia of the secondary tongue of Salamandra salamandra is described on the basis of light microscopic and scanning electron microscopic studies of defined developmental stages. A glandular area with radial ridges and furrows is formed anterior to the primary tongue during the larval phase. Epithelial cones--each a compact anlage of a gland lying in the furrows--displace the lamina propria. The glandular area grows upward and latero-caudad during metamorphosis and forms the secondary tongue by fusing with the primary tongue. Lumina within the gland anlage appear at the beginning of metamorphosis. They open as glandular tubules towards the oral cavity at the climax of metamorphosis. The epithelial lining becomes single layered and differentiates into gland cells. The glands are increasingly surrounded by fibers of the musculus genioglossus. At the orifice of the gland, the gland cells mingle with the multilayered epithelium of the surface of the tongue. This contains two types of goblet cells in addition to the villus-shaped covering cells which leave gaps for the taste buds. The goblet cells are formed before (type I) and during (type II) metamorphosis and replace the typical larval goblet cells. The new mushroom-shaped part of the secondary tongue is characterized by aborally running septae of connective tissue, visible after digestion with pankreatin. The tip of the primary tongue which originally covers the glandular part becomes completely integrated. It is characterized by crypts which become shallower caudally.

Structure and function of the hyolingual system in Hynobius and its bearing on the evolution of prey capture in terrestrial salamanders.

The Hynobiidae is generally regarded as the most phylogenetically basal and least derived extant family of terrestrial salamanders. As in the other families of terrestrial salamanders, prey capture in the Hynobiidae is accomplished by lingual prehension. In Hynobius, the prey capture system appears to be a mosaic of derived and primitive features. This, in conjunction with previous studies, suggests that the hyolingual systems of all families of terrestrial salamanders have evolved various degrees of specialization since the appearance of the common ancestral condition. We propose that the generalized feeding system for the extant terrestrial salamanders includes a hyolingual skeleton comprised of one basibranchial, one pair of radial or radial-like structures, two pairs of ceratobranchials, two pairs of epibranchials, one pair of ceratohyals, and one urohyal arranged in a configuration similar to that of Hynobius; a simple, sac-like secondary tongue pad; a lift and thrust system of tongue projection; a four-part gape cycle; and a forward head and body surge. Modifications to this general plan, previously described for the disparate families, include various changes in the size, shape, and definition of the tongue pad, changes in the specific types of structures and configurations in the anterior hyolingual skeleton, secondary ossification in the posterior hyolingual skeleton, the appearance of various protrusion, projection, and flipping systems for tongue protraction, simplification of the kinematic gape profile, and loss of the forward head and body surge. The evolutionary trends in these modifications have provided a rich data set from which much phylogenetic information has been inferred. © 1996 Wiley-Liss, Inc.

Observations on the Freshfield Glacier, Canadian Rockies

This is a brief study of one of the large and little known glaciers of the Canadian Alps. It is nine miles long and covers an area of about 22 square miles. The surface velocity of the ice on a line across the dissipator was found to range between 3 and nearly 5 inches per day. The glacier is retreating, the amount for the past twenty years being estimated at 925 feet. A secondary tongue advances into and retreats from a small side valley intermittently and independently of the main glacier.