Dr. Mohamed Selima. The tongue is a mobile muscular organ can assume a variety of shapes and positions. The tongue is partly in the oral cavity and partly.

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Presentation transcript:

Dr. Mohamed Selima

The tongue is a mobile muscular organ can assume a variety of shapes and positions. The tongue is partly in the oral cavity and partly in the pharynx. At rest it occupies essentially all the oral cavity proper. The tongue is a mobile muscular organ can assume a variety of shapes and positions. The tongue is partly in the oral cavity and partly in the pharynx. At rest it occupies essentially all the oral cavity proper. INTRODUCTION

3 The tongue is divided into two part, an anterior buccal portion and posterior pharyngeal portion. These are separated by V-shaped sulcus on its superior surface at the apex is formen caecum from which thyroid gland developed. The tongue is divided into two part, an anterior buccal portion and posterior pharyngeal portion. These are separated by V-shaped sulcus on its superior surface at the apex is formen caecum from which thyroid gland developed.

Benign Tumors: Benign are uncommon compared with malignant sq. cell carcinoma. Haemangioma Papilloma Lymphangioma Lipoma Neurofibroma Benign are uncommon compared with malignant sq. cell carcinoma. Haemangioma Papilloma Lymphangioma Lipoma Neurofibroma

Sq.cell carcinoma Lymphoma Sarcoma Malignant Tumors:

Aetiology Cancer of the tongue uncommon below the age of 50 years (50-70 years) used to be common In men than women (the sex incidence is now approaching parity).

Pathology Two-thirds of the tongue cancer arise in the ant. 2/3 rd and 1/3 rd in the posterior part. The commonest sites are the sides of the ant. 2/3 rd of the tongue. The commonest sites are the sides of the ant. 2/3 rd of the tongue. Posterior tumors are much more to be in the midline. Posterior tumors are much more to be in the midline. Two-thirds of the tongue cancer arise in the ant. 2/3 rd and 1/3 rd in the posterior part. The commonest sites are the sides of the ant. 2/3 rd of the tongue. The commonest sites are the sides of the ant. 2/3 rd of the tongue. Posterior tumors are much more to be in the midline. Posterior tumors are much more to be in the midline.

Gross appearance The tumor usually occurs as malignant ulcer. Less often it take, the form of hard submucous nodule or deep fissure. Rarely it occurs as diffuse hard infiltration of whole tongue. (wooden tongue) The tumor usually occurs as malignant ulcer. Less often it take, the form of hard submucous nodule or deep fissure. Rarely it occurs as diffuse hard infiltration of whole tongue. (wooden tongue)

9Saleh M. Al Salamah

Histology The tumor is usually poorly diff. Squamous cell carcinoma. Posterior tumors are less well diff.

Spread of carcinoma of the TONGUE Local (direct to the floor of the mouth, gums and pharynx). Lymphatic spread. Blood spread (very rare) Local (direct to the floor of the mouth, gums and pharynx). Lymphatic spread. Blood spread (very rare)

The patient may seek advice because of mass or ulcer in the tongue. But more often he present with other symptoms which includes: 1.Pain 2.Profuse salvation and fowl breathing 3.Severe haemorrhage 4.Fixation of the tongue (ankyloglossia) 5.Alteration of the voice 6.Lump of glands in the neck 7.dysphagia 1.Pain 2.Profuse salvation and fowl breathing 3.Severe haemorrhage 4.Fixation of the tongue (ankyloglossia) 5.Alteration of the voice 6.Lump of glands in the neck 7.dysphagia

TERMINAL EVENTS: Death from an uncontrolled primary tumors occurs as result of: Inhalation bronchopneumonia. Haemorrhage from erosion of the lingual artery. Combined cancerous cachexia and starvation. Asphyxia. Death from an uncontrolled primary tumors occurs as result of: Inhalation bronchopneumonia. Haemorrhage from erosion of the lingual artery. Combined cancerous cachexia and starvation. Asphyxia.

T R E A T M E N T Biopsy confirms the diagnosis the treatment by SURGERY or RADIOTHERAPY or Combination of two. I. RADIOTHERAPY Usually reserved for tumors of the posterior third and for inoperable cases or as combination. I. RADIOTHERAPY Usually reserved for tumors of the posterior third and for inoperable cases or as combination.

II.SURGERY Local excision by partial or hemiglossectomy in case a lesion at the tip of the tongue or small lesion in the ant. 2/3 rd with 2 cm of healthy tissue at all sides. Radical block dissection, if the lymph nodes enlarged. The “commando” operations combined mandibulectomy and neck dissection. II.SURGERY Local excision by partial or hemiglossectomy in case a lesion at the tip of the tongue or small lesion in the ant. 2/3 rd with 2 cm of healthy tissue at all sides. Radical block dissection, if the lymph nodes enlarged. The “commando” operations combined mandibulectomy and neck dissection.

PROGNOSIS For patient with LN negative with tumors in the ant. 2/3 rd there is 50%, 5 years survival. For patient with posterior 1/3 rd of the tongue with negative LN %, 5 years survival. For patient with LN negative with tumors in the ant. 2/3 rd there is 50%, 5 years survival. For patient with posterior 1/3 rd of the tongue with negative LN %, 5 years survival.