Tongue Lesions: Diagnostic Challenges and Therapeutic Strategies

Description

The book offers in a single resource the whole coverage of different diseases and lesions, congenital or acquired, of the tongue, along with a complete spectrum of surgical techniques that can be used to achieve the best functional and aesthetic results. In addition to tongue embryology, surgical anatomy, histology and physiology, the book explores the differential diagnosis of congenital anomalies of the tongue and lingual lesions, as well as the most recent advances in surgical management (resection, reconstruction and surgical management of the neck in patients with tongue cancer). The volume includes unique chapters about tongue replantation and tongue allo-transplantation. Richly illustrated, this book provides an indispensable source of knowledge to all specialists and trainees entrusted with the care of patients suffering from tongue lesions. Preface Acknowledgments Contents 1: Embryology of the Tongue 1.1 Development of the Tongue 1.1.1 Anterior Two-Thirds: From First Arch 1.1.2 Posterior Third: From Third Arch 1.2 Development of Taste Buds and PapillaE 1.3 Development of the Nerve Supply 1.4 Summary of Tongue Development References 2: Surgical Anatomy of the Tongue 2.1 Overview: Key Facts About the Tongue 2.2 Structure of the Tongue 2.2.1 Important Relations 2.2.2 Anterior Two-Thirds 2.2.3 Terminal Sulcus (Sulcus Terminalis Linguae) 2.2.4 Posterior Third 2.2.5 Lingual Frenulum 2.2.6 Muscles of the Tongue 2.2.6.1 Intrinsic Tongue Muscles 2.2.6.2 Extrinsic Tongue Muscles 2.3 Blood Supply and Lymphatic Drainage 2.3.1 Arterial Supply 2.3.2 Venous Drainage 2.3.3 Lymphatic Drainage 2.4 Innervation of the Tongue 2.4.1 Motor Innervation: The Hypoglossal Nerve (CN-XII) 2.4.2 Tactile Sensory Innervation: The Lingual Nerve (CN-V3) 2.4.3 Taste Innervation 2.4.4 Lingual Nerve Injuries References 3: Histology of the Tongue 3.1 Lingual Papillae 3.2 Taste Buds (Caliculi Gustatererius) References 4: Physiology of the Tongue 4.1 Functions of the Tongue 4.1.1 Tongue: Tool to Taste Food 4.1.2 Tongue’s Role in Mastication 4.1.3 Removal of Hard and Ill-Tasting Substances 4.1.4 Swallowing Food 4.1.5 The Tongue: An Organ for Sucking 4.1.6 Tongue as an Organ of Speech 4.1.7 Intimacy 4.1.8 Medication Delivery 4.1.9 The Tongue: An Indicator of Health 4.2 Taste (Gustatory) Pathway 4.2.1 Neuronal Pathway for Taste 4.3 Taste Disorders 4.3.1 Types of Taste Disorders 4.3.1.1 Dysgeusia 4.3.1.2 Hypogeusia 4.3.1.3 Ageusia 4.3.2 Etiology of Taste Disorders 4.3.3 Symptoms 4.3.4 Diagnosis 4.3.4.1 History-Taking 4.3.4.2 Investigations 4.3.5 Prevention 4.3.6 Treatment 4.3.7 Prognosis References 5: Congenital Anomalies 5.1 Aglossia 5.2 Hemiglossia (Half-Tongue) 5.3 Microglossia 5.3.1 Definition 5.3.2 Epidemiology 5.3.3 Etiology 5.3.4 Clinical Picture and Treatment 5.4 Macroglossia 5.4.1 Definitions 5.4.2 Epidemiology 5.4.2.1 Frequency 5.4.2.2 Gender 5.4.2.3 Race 5.4.3 Etiology 5.4.3.1 Causes of Pseudo-Macroglossia 5.4.3.2 Causes of True Macroglossia 5.4.4 Clinical Presentation 5.4.5 Clinical Evaluation 5.4.6 Complications 5.4.7 Treatment 5.4.7.1 Medical Therapy 5.4.7.2 Sclerotherapy/Embolisation 5.4.7.3 Mechanical Therapy 5.4.7.4 Surgical Treatment 5.5 Bifid (Cleft) Tongue 5.5.1 Etiology 5.5.2 Treatment 5.6 Double Tongue/Accssory Tongue 5.6.1 Double Tongue 5.6.2 Accessory Tongue 5.7 Ankyloglossia 5.7.1 Definition 5.7.2 Prevalence 5.7.3 Etiology 5.7.4 Classification 5.7.4.1 Anterior/Posterior [21–23] 5.7.4.2 Complete/Partial [21–23] 5.7.4.3 Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) [24, 25] 5.7.4.4 Coryllos Classifications of Tongue-Tie [27] 5.7.4.5 Kotlow Classification of Tongue-Tie 5.7.5 Clinical Presentation 5.7.5.1 Feeding and Swallowing Difficulties 5.7.5.2 Speech Impairment/Development Disorders [34] 5.7.5.3 Gingival Recession/Dental Caries 5.7.5.4 Other Reported Problems 5.7.5.5 Social Concerns 5.7.6 Identification of Ankyloglossia (Tongue-Tie) [37] 5.7.7 Treatment 5.7.8 Prognosis 5.7.9 Pearls for Clinical Practice [44] 5.8 Black Hairy Tongue 5.9 Fissured Tongue 5.9.1 Definition 5.9.2 Epidemiology 5.9.3 Etiology 5.9.4 Treatment 5.10 Lingual (Sublingual) Varices 5.11 Lingual Thyroid Nodule 5.11.1 Definition 5.11.2 Pathogenesis 5.11.3 Epidemiology 5.11.3.1 Other Rare Sites 5.11.3.2 Clinical Presentation 5.11.4 Differential Diagnosis 5.11.5 Treatment References 6: Tongue Trauma 6.1 Common Tongue Injuries 6.1.1 Etiology 6.1.2 Sequelae 6.1.3 Management 6.1.3.1 To Suture or Not? 6.1.3.2 Principles of Management 6.1.3.3 Injuries of the Dorsal Surface 6.1.3.4 Penetrating Injuries 6.1.3.5 Lateral or Tip Injuries 6.1.3.6 Large Lacerations or Avulsion 6.1.3.7 Injuries of the Tongue Base 6.1.3.8 Tongue Injuries in Children with Coagulopathy 6.1.3.9 Postoperative Care 6.2 Complex Tongue Lacerations 6.2.1 Introduction 6.2.2 Etiology 6.2.3 Operative Management - Repair 6.2.3.1 Goals of Repair 6.2.3.2 Indications of Repair 6.2.3.3 Contraindications 6.2.3.4 Anesthesia 6.2.3.5 Positioning 6.2.3.6 Preparation 6.2.3.7 Technique 6.2.3.7.1 Three-Layer Technique 6.2.3.7.2 Two-Layer Technique 6.2.3.7.3 One-Layer Technique 6.2.4 Aftercare 6.2.5 Complications 6.3 Tongue Bites 6.3.1 Introduction 6.3.2 Etiology 6.3.3 Treatment 6.3.3.1 Indications 6.3.3.2 Procedure 6.3.4 Prognosis 6.4 Tongue Biting During Sleep 6.4.1 Introduction 6.4.2 Etiology 6.4.2.1 Bruxism 6.4.2.2 Facial Muscle Spasms 6.4.2.3 Illicit Drug Use 6.4.2.4 Lyme Disease 6.4.2.5 Nighttime Seizures 6.4.2.6 Rhythmic Movement Disorder 6.4.2.7 Sleep Apnea 6.4.3 Symptoms 6.4.4 Treatment 6.4.5 Prevention 6.4.5.1 Sleep Study 6.4.5.2 Mouth-Guard 6.4.5.3 Reduction of Stress 6.4.5.4 Avoidance of Illegal Drugs 6.4.5.5 Medications 6.5 Tongue Burn: Burning Mouth Syndrome 6.5.1 Introduction 6.5.2 Prevalence 6.5.3 Etiology of Tongue Burn 6.5.3.1 Tongue Burn (from Food or Liquid) 6.5.3.2 Burning Mouth Syndrome (BMS) 6.5.4 Pathogenesis of BMS 6.5.4.1 Peripheral and Central Neuropathies 6.5.4.2 Psychological Factors 6.5.5 Symptoms 6.5.5.1 Tongue Burn 6.5.5.2 Burning Mouth Syndrome 6.5.6 Complications 6.5.6.1 Tongue Burn 6.5.6.2 Burning Mouth Syndrome 6.5.7 Diagnosis 6.5.7.1 Tongue Burn 6.5.7.2 Burning Mouth Syndrome 6.5.8 Treatment 6.5.8.1 Tongue Burn 6.5.8.2 Burning Mouth Syndrome 6.5.8.2.1 Topical and Systemic Medications 6.5.8.2.2 Psychological/Psychiatric Intervention 6.5.9 Prevention 6.5.9.1 Tongue Burn 6.5.9.2 Burning Mouth Syndrome 6.5.10 Prognosis 6.5.10.1 Tongue Burn 6.5.10.2 Burning Mouth Syndrome 6.6 Conclusion References 7: Tongue Piercing 7.1 Introduction 7.2 Historical Review 7.3 Types of Piercing Jewellery 7.4 Complications of Tongue Piercing 7.4.1 Hemorrhage 7.4.2 Nerve Injury 7.4.3 Painful Ulceration and Inflammation 7.4.4 Infection 7.4.5 Bacterial Endocarditis 7.4.6 Transmission of Communicable Diseases 7.4.7 Allergic Reactions 7.4.8 Dental and Gum Alterations 7.4.9 Formation of Bacterial Plaque 7.4.10 Tissue Alteration 7.4.11 Sialorrhea 7.4.12 Panoramic X-ray Alteration 7.4.13 Aspiration 7.4.14 Other Complications 7.5 Conclusions and Recommendations References 8: Inflammation (Glossitis) 8.1 Overview 8.1.1 Introduction 8.1.2 Clinical Presentation 8.1.3 Diagnosis 8.1.4 Etiology 8.1.4.1 Allergic Reaction 8.1.4.2 Mechanical Irritation or Injury to the Mouth 8.1.4.3 Exposure to Irritants 8.1.4.4 Infections 8.1.4.5 Anemias 8.1.4.6 Vitamin B Deficiencies 8.1.4.7 Other Diseases/Conditions 8.1.5 Classification (Types) of Glossitis [13] 8.1.6 Epidemiology 8.1.7 Prevention 8.1.8 Treatment 8.2 Atrophic Glossitis 8.2.1 Synonyms 8.2.2 Definition 8.2.3 Etiology 8.2.4 Treatment 8.3 Median Rhomboid Glossitis (MRG) 8.3.1 Incidence 8.3.2 Etiology and Pathogenesis 8.3.3 Clinical Features 8.3.4 Diagnosis 8.3.5 Treatment 8.4 Benign Migratory Glossitis (Geogrpahic Tongue) 8.4.1 Synonyms 8.4.2 Definition 8.4.3 Prevalence 8.4.4 Etiology 8.4.5 Clinical Features and Diagnosis 8.4.6 Potential Complications 8.4.7 Treatment 8.4.8 Prognosis 8.5 Geometric Glossitis 8.5.1 Definition 8.5.2 Clinical Presentation 8.5.3 Etiology 8.5.4 Treatment 8.6 Strawberry Glossitis 8.6.1 Definitions 8.6.2 Etiology 8.6.3 Treatment References 9: Swellings of the Tongue 9.1 Classification 9.2 Causes of Acute Tongue Swellings 9.3 Causes of Chronic Tongue Swellings 9.4 Ranula 9.4.1 Definition 9.4.2 Anatomical Classification 9.4.3 Epidemiology 9.4.4 Etiology 9.4.5 Pathophysiology 9.4.6 Clinical Presentation 9.4.6.1 History-Taking 9.4.7 Clinical Examination 9.4.7.1 Complications 9.4.8 Evaluation/Investigations 9.4.8.1 Ultrasonography (US) 9.4.8.2 Computed Tomography (CT) Scan 9.4.8.3 Magnetic Resonance Imaging (MRI) 9.4.8.4 Biopsy 9.4.9 Differential Diagnosis 9.4.9.1 Oral (Simple) Ranula 9.4.9.2 Plunging (Cervical) Ranula 9.4.10 Treatment 9.4.10.1 Oral Ranulas: Treatment Options 9.4.10.1.1 Surgical Excision 9.4.10.1.2 Marsupialization/Micro-marsupialization 9.4.10.1.3 Laser Ablation, Cryosurgery, and Electrocautery 9.4.10.1.4 Intralesional Injection of a Sclerosant Agent 9.4.10.2 Plunging Ranulas: Treatment Options 9.4.10.3 Postoperative Care 9.4.10.4 Intra- and Postoperative Complications 9.4.10.4.1 Intraoperative Complications 9.4.10.4.2 Postoperative Complications 9.4.10.5 Recurrence 9.4.11 Prognosis 9.5 Sublingual Dermoid Cyst 9.5.1 Etiology: Classification 9.5.2 Anatomical Classification 9.5.3 Epidemiology 9.5.4 Pathology 9.5.5 History-Taking 9.5.6 Physical Examination 9.5.7 Complications 9.5.8 Evaluation/Investigations 9.5.8.1 Ultrasonography (US) 9.5.8.2 Computed Tomography (CT) Scan 9.5.8.3 Magnetic Resonance Imaging (MRI) 9.5.8.4 Cytology/Histology 9.5.9 Differential Diagnosis 9.5.9.1 Infections 9.5.9.2 Neoplasms 9.5.9.3 Cystic Lesions 9.5.10 Treatment 9.5.11 Prognosis References 10: Neoplastic Lesions of the Tongue 10.1 Classification 10.2 Benign Tumors 10.2.1 Granular Cell Tumors 10.2.2 Fibroepithelial Polyp (Traumatic Fibroma) 10.2.3 Papilloma 10.2.4 Mixed Salivary Tumor (Minor Salivary Glands) 10.2.5 Lingual Thyroid Nodule 10.2.6 Hemangioma 10.2.7 Lymphoepithelial Cysts 10.3 Malignant Tumors 10.3.1 Squamous Cell Carcinoma (SCC) 10.3.2 Alveolar Soft Part Sarcoma (ASPS) 10.3.2.1 Pathogenesis 10.3.2.2 Incidence 10.3.2.3 Clinical Presentation 10.3.2.4 Imaging 10.3.2.4.1 Computed Tomography (CT) Scan 10.3.2.4.2 Magnetic Resonance Imaging (MRI) 10.3.2.4.3 Angiography 10.3.2.5 Differential Diagnosis 10.3.2.6 Histopathology 10.3.2.7 Management 10.3.2.8 Prognosis 10.3.3 Synovial Sarcoma of the Tongue 10.3.3.1 Incidence: Location 10.3.3.2 Clinical Manifestations 10.3.3.3 Investigations: Diagnosis 10.3.3.3.1 Tumor Markers 10.3.3.3.2 Imaging 10.3.3.3.3 Histopathology 10.3.3.4 Management 10.3.3.4.1 Surgery 10.3.3.4.2 Chemoradiotherapy 10.3.3.4.3 Radiotherapy (RT) 10.3.4 Myoblastic (Myofibroblastic) Sarcoma 10.3.4.1 Pathology 10.3.4.2 Clinical Behavior 10.3.4.3 Differential Diagnosis 10.3.4.4 Treatment 10.3.5 Spindle Cell Sarcoma (SCS) 10.3.5.1 Introduction 10.3.5.2 Etiology: Pathogenesis 10.3.5.3 Stages of SCS 10.3.5.4 Clinical Presentation: Treatment 10.3.5.5 Prognosis 10.3.6 Kaposi Sarcoma (KS) 10.3.6.1 Introduction 10.3.6.2 Epidemiology 10.3.6.3 Etiology 10.3.6.3.1 Transmission 10.3.6.4 Pathology 10.3.6.5 Clinical Picture 10.3.6.5.1 Skin 10.3.6.5.2 Mouth 10.3.6.5.3 Gastrointestinal Tract 10.3.6.5.4 Respiratory Tract 10.3.6.6 Diagnosis 10.3.6.7 Differential Diagnosis of Kaposi Sarcoma 10.3.6.8 Classification 10.3.6.9 Prevention 10.3.6.10 Treatment References 11: Tongue Manifestations of Systemic Diseases 11.1 Overview 11.2 Gastrointestinal (GI) Diseases 11.2.1 Inflammatory Bowel Disease (IBD) 11.2.2 Pyostomatitis Vegetans (PSV) 11.2.3 Chronic Liver Disease (CLD) 11.2.4 Celiac Disease 11.3 Nutritional Diseases 11.3.1 Water-Soluble Vitamin Deficiency 11.3.2 Fat-Soluble Vitamin Deficiency/Toxicity 11.3.3 Mineral Deficiencies 11.4 Hematological Disorders 11.4.1 White Blood Cell (WBC) Disorders 11.4.1.1 Leukemia 11.4.1.2 Lymphoma 11.4.1.3 Cyclic Neutropenia 11.4.2 Platelet Disorders 11.4.3 Red Blood Cell (RBC) Disorders 11.4.3.1 Anemias 11.4.3.2 Hemochromatosis 11.4.3.3 Congenital Erythropoietic Porphyria (CEP) 11.4.3.4 Thalassemias 11.4.3.4.1 Sickle Cell Disease (SCD) 11.4.3.4.2 Polycythemia Vera 11.5 Autoimmune Diseases 11.5.1 Sjogren’s Syndrome (SS) 11.5.2 Kawasaki Disease 11.5.3 Systemic Lupus Erythematosus (SLE) 11.5.4 Scleroderma 11.6 Pulmonary Conditions 11.6.1 Granulomatosis with Polyangitis (GPA) 11.6.2 Sarcoidosis 11.7 Multi-system Conditions 11.7.1 Amyloidosis 11.7.2 Human Immunodeficiency Virus (HIV) Disease 11.7.2.1 Candidiasis 11.7.2.2 Herpes Simplex Virus (HSV) 11.7.2.3 Hairy Leukoplakia (HL) 11.7.2.4 Kaposi Sarcoma (KS) 11.7.2.5 Cytomegalovirus (CMV) 11.7.2.6 Human Papillomavirus (HPV) 11.7.2.7 Aphthous-Like Ulcerations 11.8 Cutaneous Diseases 11.8.1 Psoriasis 11.8.2 Acanthosis Negricans (AN) 11.9 Neurological Diseases 11.9.1 Neurofibromatosis (NF) Types 1 and 2 11.10 Endocrine Diseases 11.10.1 Diabetes Mellitus (DM) 11.10.2 Thyroid Gland Disorders 11.10.3 Parathyroid Gland (PTG) Disorders 11.10.4 Adrenal Gland Disorders 11.11 Renal Diseases 11.12 Drug-Induced Conditions 11.12.1 Aphthous Stomatitis 11.12.2 Dry Mouth (Hyposalivation or Xerostomia) 11.12.3 Lichen Planus (LP) 11.12.4 Candidiasis (Secondary to Inhaled Steroids) 11.13 Psychiatric Disorders References 12: Tongue Discoloration 12.1 Black Hairy Tongue (BHT) 12.1.1 Definition 12.1.2 Synonyms 12.1.3 Epidemiology 12.1.4 Pathogenesis 12.1.5 Etiology 12.1.5.1 Soft Diet 12.1.5.2 Tobacco, Tea, and Coffee Consumption 12.1.5.3 Alcohol Intake and Intravenous (IV) Drug Use 12.1.5.4 Poor Oral Hygiene 12.1.5.5 Hyposalivation or Dry Mouth 12.1.5.6 Overgrowth of Microorganisms 12.1.5.7 Certain Diseases and General Debilitation [8] 12.1.5.8 Certain Medications 12.1.5.9 Radiotherapy 12.1.5.10 Oral Hygiene Products 12.1.5.11 Melanoglossia 12.1.6 Clinical Presentation 12.1.6.1 Symptoms and Local Examination 12.1.6.2 General Examination 12.1.7 Diagnosis 12.1.8 Differential Diagnosis 12.1.8.1 Pseudo-Black Hairy Tongue 12.1.8.2 Oral Hairy Leukoplakia 12.1.8.3 Pigmented Fungiform Papillae 12.1.8.4 Acanthosis Nigricans 12.1.9 Prevention and Treatment 12.1.10 Complications 12.1.11 Prognosis 12.1.12 Pearls for Clinical Practice 12.2 Orange Tongue 12.2.1 Etiology 12.2.1.1 Poor Oral Hygiene: Food Debris 12.2.1.2 Overgrowth of Fungi (Oral Thrush) and Bacteria 12.2.1.3 Certain Medications 12.2.1.4 Acid Indigestion/Heartburn 12.2.1.5 Mold in the Environment 12.2.1.6 Excess Beta-Carotene (Carotenemia) 12.2.2 Clinical Presentation 12.2.3 Treatment 12.3 Strawberry (Bright Red) Tongue 12.3.1 Introduction 12.3.2 Symptoms 12.3.3 Etiology 12.3.3.1 Kawasaki Disease 12.3.3.2 Scarlet Fever 12.3.3.3 Food or Drug Allergy 12.3.3.4 Vitamin B12 Deficiency 12.3.3.5 Toxic Shock Syndrome 12.3.4 Complications 12.3.5 Differential Diagnosis: Glossitis 12.3.6 Treatment 12.3.7 Prognosis 12.4 Yellow Tongue 12.4.1 Introduction 12.4.2 Etiology 12.4.2.1 Oral Hygiene Products with Oxidizing Agents 12.4.2.2 Poor Oral Hygiene 12.4.2.3 Tobacco Use 12.4.2.4 Mouth Breathing or Dry Mouth 12.4.2.5 Black Hairy Tongue 12.4.2.6 Oral Thrush 12.4.2.7 Geographic Tongue 12.4.2.8 Certain Foods 12.4.2.9 Certain Medications and Drugs 12.4.2.10 Piercing, Tooth Extraction, or Tonsillectomy 12.4.2.11 Yellow Tongue with Other Diseases [72, 73] 12.4.2.11.1 Urinary and Respiratory Tract Infections 12.4.2.11.2 Scarlet Fever 12.4.2.11.3 Jaundice 12.4.2.11.4 Eczema and Autoimmune Conditions 12.4.2.11.5 Chronic Gastritis 12.4.2.11.6 Postnasal Drainage 12.4.2.11.7 Malignancy 12.4.2.11.8 Infectious Mononucleosis (IMN) 12.4.2.11.9 Human Immunodeficiency Virus (HIV) 12.4.2.11.10 Yellow Under-Tongue 12.4.3 Risk Factors 12.4.4 Symptoms 12.4.5 Complications 12.4.6 Prevention and Treatment Options 12.5 White Tongue 12.5.1 Etiology 12.5.1.1 Poor Oral Hygiene 12.5.1.2 Leukoplakia: Oral/Tongue Cancer 12.5.1.3 Oral Lichen Planus (LP) 12.5.1.4 Oral Thrush 12.5.1.5 Geographic Tongue 12.5.1.6 Syphilis 12.5.2 Clinical Presentation: Diagnosis 12.5.2.1 Leukoplakia 12.5.2.2 Oral Lichen Planus 12.5.2.3 Oral Thrush 12.5.2.4 Geographic Tongue 12.5.2.5 Syphilis 12.5.3 Treatment 12.5.3.1 Good Oral Hygiene 12.5.3.2 Other Measures 12.5.3.2.1 Probiotics 12.5.3.2.2 Baking Soda Scrub 12.5.3.2.3 Raw Garlic 12.5.3.3 Specific Treatment 12.5.4 Prognosis 12.6 Green Tongue 12.6.1 Introduction 12.6.2 Etiology 12.6.2.1 Previously Discussed Causes [11, 69, 91, 92] 12.6.2.2 Oral Cancer [93] 12.6.2.3 Other Causes 12.6.3 Diagnosis 12.6.4 Treatment 12.6.4.1 Treatment of the Cause 12.6.4.2 Proper Oral Hygiene 12.6.4.3 Scraping of the Tongue References 13: Tongue Fissures 13.1 Overview 13.1.1 Definition 13.1.2 Etiology 13.1.3 Characteristics of Fissured Tongue 13.1.4 Symptoms of Fissured Tongue 13.1.5 Diagnosis 13.1.6 Treatment of Fissured Tongue 13.1.6.1 Oral Hygiene 13.1.6.2 Flossing 13.1.6.3 Hydration 13.2 Congenital Tongue Fissures 13.2.1 Etiology 13.2.1.1 Melkersson-Rosenthal Syndrome 13.2.1.2 Down Syndrome 13.2.1.3 Cowden’s Syndrome 13.2.2 Diagnosis and Treatment 13.3 Acquired Tongue Fissures 13.3.1 Trauma [6, 7] 13.3.1.1 Tongue Bites 13.3.1.2 Cuts 13.3.1.3 Lacerations 13.3.1.4 Teeth Grinding 13.3.2 Benign Migratory Glossitis 13.3.3 Oral Psoriasis 13.3.4 Syphilitic Tongue Fissures 13.3.5 Nutritional Deficiency 13.3.5.1 Folic Acid (Vitamin B9) 13.3.5.2 Biotin (B7 or B8 in France) 13.3.5.3 Riboflavin (Vitamin B2) 13.3.6 Malignant Tongue Fissure References 14: Ulcers of the Tongue 14.1 Classification 14.2 Traumatic Ulcers 14.2.1 Dental Ulcers 14.2.1.1 Etiology 14.2.1.2 Location 14.2.1.3 Clinical Picture and Diagnosis 14.2.1.4 Treatment 14.2.1.5 Prognosis 14.2.2 Frenular Ulcers 14.2.2.1 Synonyms 14.2.2.2 Definition 14.2.2.3 Etiology 14.2.2.4 Location 14.2.2.5 Clinical Picture 14.2.2.6 Treatment 14.3 Inflammatory Ulcers 14.3.1 Herpetic Ulcers (True Herpes Linguis) 14.3.1.1 Etiology 14.3.1.2 Classification of HSV 14.3.1.3 Epidemiology of HSV 14.3.1.4 Site 14.3.1.5 Clinical Picture 14.3.1.6 Pathophysiology 14.3.1.7 Laboratory Tests 14.3.1.8 Differential Diagnosis 14.3.1.9 Management 14.3.1.9.1 Antiviral Medications 14.3.1.9.2 Topical Antivirals 14.3.1.9.3 Alternative Medicine 14.3.2 Tuberculous (TB) Ulcers 14.3.2.1 Etiology 14.3.2.2 Site 14.3.2.3 Clinical Picture 14.3.2.4 Diagnosis 14.3.2.5 Differential Diagnosis 14.3.2.6 Treatment 14.3.3 Syphilitic Ulcers 14.3.3.1 Transmission 14.3.3.2 Clinical Presentation 14.3.3.2.1 First Stage: Primary Syphilis 14.3.3.2.2 Second Stage: Secondary Syphilis 14.3.3.2.3 Late Stage 14.3.3.3 Diagnosis 14.3.3.4 Treatment of Oral Syphilis 14.3.4 Chronic Superficial Glossitis 14.3.4.1 Clinical Stages 14.3.4.2 Treatment 14.3.5 Chronic Ulcerative Stomatitis (CUS) 14.3.5.1 Definition 14.3.5.2 Clinical Picture 14.3.5.3 Diagnosis 14.3.5.4 Treatment 14.4 Dyspeptic (Aphthous) Ulcers 14.4.1 Introduction 14.4.2 Clinical Presentation 14.4.3 Classification (Types of Aphthous Ulcers) 14.4.3.1 Minor Aphthae 14.4.3.2 Major Aphthae 14.4.3.3 Herpetiform Aphthae 14.4.4 Etiology/Pathogenesis 14.4.4.1 Genetic Predisposition 14.4.4.2 Mechanical Injury 14.4.4.3 Microelement and Vitamin B12 Deficiencies 14.4.4.4 Stress 14.4.4.5 Food Allergies 14.4.4.6 Microbial Factors 14.4.4.7 Tobacco Smoking 14.4.4.8 Immunopathogenesis 14.4.4.9 Hormonal Defects 14.4.4.10 Drugs 14.4.4.11 Systemic Diseases 14.4.5 Management and Treatment of Aphthous Stomatitis 14.4.6 First-Line Therapy/Topical Therapy 14.4.6.1 Topical Gels, Creams, and Pastes 14.4.6.2 Topical Anesthetic 14.4.6.3 Topical Antimicrobials 14.4.6.4 Topical Antibiotics 14.4.6.5 Topical Corticosteroids 14.4.6.6 Topical Anti-Inflammatory Agents 14.4.6.7 Topical Analgesic/Anti-Inflammatory Spray and Rinses 14.4.6.8 Topical Hyaluronic Acid 14.4.7 Second-Line Therapy/Systemic Therapy 14.4.7.1 Levamisole 14.4.7.2 Thalidomide 14.4.7.3 Pentoxifylline 14.4.7.4 Colchicine 14.4.7.5 Zinc Sulfate 14.4.7.6 Azathioprine 14.4.7.7 Methotrexate 14.4.7.8 Prednisone 14.4.7.9 Vitamin B12 14.4.7.10 Dapsone 14.4.7.11 Rebamipide 14.4.7.12 Irsogladin 14.4.7.13 Cyclosporine a (CyA) 14.4.7.14 Adalimumab 14.4.7.15 Acyclovir 14.4.7.16 Montelukast 14.4.7.17 Infliximab (Remicade) 14.4.7.18 Etanercept (Enbrel) 14.4.7.19 Clofazimine 14.4.7.20 Penicillin G Potassium 14.5 Malignant Ulcers 14.5.1 Historical Perspectives 14.5.2 Classification of Oral Tumors 14.5.2.1 Malignant Tumors of the Oral Cavity 14.5.2.1.1 Squamous Cell Carcinoma (SCC) According to Macroscopic Features According to Microscopic Features 14.5.2.1.2 Rare Malignant Tumors 14.5.2.2 Precancerous Lesions of the Oral Cavity 14.5.2.3 Benign Tumors and Conditions of the Oral Cavity 14.5.2.3.1 Benign Tumors 14.5.2.3.2 Benign Conditions 14.5.3 TNM Staging Classification of Oral Cavity Carcinoma 14.5.4 Epidemiology and Demographics 14.5.4.1 Incidence of Tongue Cancer 14.5.4.2 Gender 14.5.4.3 Race 14.5.4.4 Age 14.5.5 Etiology/Risk Factors 14.5.5.1 Precancerous Lesions 14.5.5.1.1 Oral Leukoplakia 14.5.5.1.2 Oral Erythroplakia 14.5.5.1.3 Oral Erythro-Leukoplakia 14.5.5.1.4 Oral Lichen Planus 14.5.5.1.5 Oral Submucous Fibrosis and Actinic Cheilitis [158] 14.5.5.2 Risk Factors 14.5.5.2.1 Major Tongue Cancer Risk Factors Tobacco Smoking Alcohol Ingestion Human Papillomavirus (HPV) Plummer-Vinson Syndrome (PVS) Stem Cell Transplantation 14.5.5.2.2 Other Less Potent Risk Factors Lifestyle: Betel Nut Intake Genetic Factors General Factors Unproven Risk Factors 14.5.6 Pathogenesis 14.5.6.1 WHO Grading for Oral Cancer Dysplasia 14.5.6.2 Precancerous Conditions 14.5.6.3 Genetics 14.5.7 Pathology 14.5.7.1 Gross Pathology 14.5.7.2 Microscopic Pathology 14.5.7.2.1 Microscopic Types of Tongue Cancer Primary Tumor Secondary Tumor 14.5.7.2.2 Histopathology of SCC and Its Variants [171] Conventional Type Acantholytic Subtype Basaloid Subtype Spindle (Fusiform) Cell Subtype or Sarcomatoid Verrucous Subtype 14.5.8 Tumor Spread 14.5.8.1 Local (Direct) Spread 14.5.8.2 Lymphatic Spread 14.5.8.3 Hematogenous Spread 14.5.9 Diagnosis of Tongue Cancer 14.5.9.1 History-Taking and Symptoms 14.5.9.1.1 History-Taking 14.5.9.1.2 Symptoms 14.5.9.2 Physical Examination 14.5.9.2.1 Head Examination 14.5.9.2.2 Neck Examination 14.5.9.3 Clinical Presentation of Complications 14.5.9.3.1 Terminal Events 14.5.9.3.2 Direct Surgical Complications 14.5.9.3.3 Complications of Chemotherapy [174] 14.5.9.3.4 Complications of Radiation Therapy [175] 14.5.9.3.5 Complications of Chemotherapy and Radiation [176] 14.5.9.4 Laboratory Investigations 14.5.9.5 Plain X-Ray 14.5.9.6 Computed Tomography (CT) Scan 14.5.9.7 Positron Emission Tomography (PET)-CT Scan 14.5.9.8 Magnetic Resonance Imaging (MRI) 14.5.9.9 Ultrasonography 14.5.9.10 Other Diagnostic Studies 14.5.9.10.1 Evaluation Under Anesthesia (EUA) 14.5.9.10.2 Tumor Biopsy 14.5.9.10.3 Panendoscopy 14.5.10 Staging 14.5.10.1 Assessment of T-Category 14.5.10.2 Assessment of N-Category 14.5.10.2.1 Anterior Tongue 14.5.10.2.2 Lateral Tongue 14.5.10.2.3 Posterior Tongue 14.5.10.3 Assessment of M-Category 14.5.11 Differential Diagnosis 14.5.12 Prevention of Tongue Cancer 14.5.12.1 Primary Prevention 14.5.12.1.1 Screening 14.5.12.1.2 Prevention 14.5.12.2 Secondary Prevention 14.5.12.2.1 Follow-Up: Monitoring 14.5.12.2.2 Natural Components 14.5.12.2.3 Synthetic Retinoids 14.5.12.2.4 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 14.5.12.2.5 Endothelial Growth Factor Receptor (EGFR) Inhibition 14.5.12.2.6 Human Papilloma Virus (HPV)-Related Oro-Pharyngeal Carcinoma Vaccine 14.5.13 Treatment of Tongue Cancer 14.5.13.1 Overview 14.5.13.2 Radiation Therapy (RT) 14.5.13.2.1 Indications Indications of Adjuvant Therapy [225] 14.5.13.2.2 Techniques of Radiation Therapy [226] External Beam Radiotherapy (EBRT) Brachytherapy Orthovoltage Radiotherapy 14.5.13.2.3 Treatment of Nonsurgical Candidates 14.5.13.3 Chemotherapy 14.5.13.3.1 Targeted Therapy 14.5.13.4 Surgical Treatment 14.5.13.4.1 Surgical Approach 14.5.13.4.2 Management of the Neck 14.5.14 Prognosis 14.5.14.1 Prognostic Factors 14.5.14.1.1 Stage of the Tumor 14.5.14.1.2 Tumor Thickness 14.5.14.1.3 Perineural Invasion 14.5.14.1.4 Positive Surgical Margins 14.5.14.1.5 Cervical Lymph Node Metastases 14.5.14.1.6 Extracapsular Extension 14.5.14.1.7 Site of Tongue SCC 14.5.14.1.8 Other Factors 14.5.15 Summary: Tongue Cancer References 15: Glossectomy 15.1 Introduction 15.2 Indications and Contraindications 15.2.1 Indications 15.2.2 Contraindications 15.3 Classification of Glossectomy 15.3.1 Classification of Glossectomy by Laterality 15.3.2 Classification of Glossectomy by Resected Volume 15.3.3 Recently Proposed Classification 15.3.3.1 Type I Glossectomy (Mucosectomy) 15.3.3.1.1 Definition 15.3.3.1.2 Indications 15.3.3.2 Type II Glossectomy (Partial Glossectomy) 15.3.3.2.1 Definition 15.3.3.2.2 Indications 15.3.3.3 Type IIIa Glossectomy (Hemiglossectomy) 15.3.3.3.1 Definition 15.3.3.3.2 Indications 15.3.3.4 Type IIIb Glossectomy (Compartmental Hemiglossectomy) 15.3.3.4.1 Definition 15.3.3.4.2 Indications 15.3.3.5 Type IVa Glossectomy (Subtotal Glossectomy) 15.3.3.5.1 Definition 15.3.3.5.2 Indications 15.3.3.6 Type IVb Glossectomy (Near-Total Glossectomy) 15.3.3.6.1 Definition 15.3.3.6.2 Indications 15.3.3.7 Type V Glossectomy (Total Glossectomy) 15.3.3.7.1 Definition 15.3.3.7.2 Indications 15.3.3.8 Impact of Glossectomy Classification on Neck Dissection 15.4 Surgical Preparation 15.4.1 Equipment 15.4.2 Personnel 15.4.3 Preoperative Assessment 15.4.3.1 History-Taking 15.4.3.2 Physical Examination 15.4.3.3 Laryngoscopy and Imaging 15.4.4 Securing the Airway 15.4.5 Examination Under Anesthesia (EUA) 15.4.6 Draping 15.5 Surgical Approach 15.5.1 How to Choose the Appropriate Approach 15.6 Surgical Technique 15.6.1 Transoral Conventional Glossectomy 15.6.1.1 Indications and Contraindications 15.6.1.2 Operative Technique 15.6.2 Glossectomy via Transoral Robotic-Assisted Surgery (TORS) 15.6.2.1 History 15.6.2.2 Indications 15.6.2.3 Operative Technique 15.6.2.4 Outcome of TORS as a Cancer Treatment 15.6.2.5 Complications 15.6.2.6 Current Challenges 15.6.3 Transoral Laser Surgery (TOLS)/Transoral Laser Microsurgery (TLM) 15.6.3.1 Indications 15.6.3.2 Contraindications 15.6.3.3 Operative Technique [56, 63, 64] 15.6.3.4 Complications 15.6.4 Glossectomy via Lip-Split Mandibulotomy 15.6.4.1 Indications and Contraindications 15.6.4.2 Operative Technique [74] 15.6.4.3 Complications 15.6.5 Glossectomy via Trans-Cervical Pull-Through with Visor Incision 15.6.5.1 Indications and Contraindications 15.6.5.2 Operative Technique [74] 15.6.5.3 Complications 15.7 Complications/Risks of Glossectomy 15.7.1 Bleeding/Hematoma 15.7.2 Infection 15.7.3 Dysarthria (Difficult Speech) and Dysphagia 15.7.4 Alteration of Tongue Sensation 15.7.5 Aspiration 15.7.6 Urgent or Emergent Tracheostomy 15.7.7 Salivary (Oro-cutaneous) Fistula 15.7.8 Osteoradionecrosis 15.7.9 Positive Margins 15.7.10 Recurrence References 16: Surgical Management of the Neck 16.1 Overview 16.2 Relevant Anatomy 16.2.1 Level I 16.2.2 Level II 16.2.3 Level III 16.2.4 Level IV 16.2.5 Level V 16.2.6 Level VI 16.3 Classification of Neck Dissection 16.3.1 Radical Neck Dissection (RND) 16.3.2 Modified Radical Neck Dissection (MRND) 16.3.3 Selective Neck Dissection (SND) 16.3.3.1 SND for Oral Cavity Cancer 16.3.3.2 SND for Oropharyngeal, Hypopharyngeal, and Laryngeal Cancer 16.3.4 Extended Neck Dissection 16.4 Neck Dissection: Indications and Contraindications 16.4.1 Indications 16.4.2 Contraindications 16.4.2.1 Absolute Contraindications 16.4.2.2 Relative Contraindications [38, 39] 16.5 Neck Dissection: Operative Technique 16.5.1 Preparation 16.5.2 Anesthesia and Position 16.5.3 Incision 16.5.4 Raising Skin Flaps 16.5.5 Identifying Marginal Mandibular Nerve 16.5.6 Dissection 16.5.6.1 Superior Dissection 16.5.6.2 Inferior Dissection 16.5.6.3 Medial Dissection 16.5.7 Closure 16.6 Complications of Neck Dissection 16.6.1 Nerve Complications 16.6.1.1 Spinal Accessory Nerve (SAN) 16.6.1.2 Marginal Mandibular Nerve (MMN) 16.6.1.3 Phrenic Nerve 16.6.1.4 Sensory Branches of the Cervical Roots 16.6.1.5 Greater Auricular Nerve 16.6.1.6 Lingual Nerve 16.6.1.7 Vagus Nerve 16.6.1.8 Hypoglossal Nerve 16.6.1.9 Sympathetic Trunk 16.6.2 Wound Complications 16.6.3 Air Leak 16.6.4 Vascular Complications 16.6.4.1 Intraoperative Bleeding 16.6.4.2 Hematoma 16.6.4.3 Internal Jugular Vein (IJV) Complications 16.6.4.4 Carotid Artery Complications (Rupture/Blowout) 16.6.4.5 Chylous Fistula 16.6.5 Cardiac Arrhythmias 16.6.6 Facial/Cerebral Edema 16.6.7 Late Complications References 17: Reconstruction After Glossectomy 17.1 Introduction 17.2 Defects: Etiology and Classification 17.3 Reconstruction Options 17.3.1 Goals of Reconstruction 17.3.2 Overview 17.3.2.1 Regional Flaps 17.3.2.1.1 Pectoralis Major Myocutaneous Flap/Myofacial Flap Advantages Disadvantages Indications Contraindications Technique 17.3.2.1.2 Platysma Flap Indications Contraindications Potential Complications Technique 17.3.2.2 Free Tissue Transfer 17.3.2.2.1 Radial Forearm Free Flap (RFFF) Advantages Disadvantages Indications Contraindications Potential Complications Technique 17.3.2.2.2 Anterolateral Thigh Free Flap (ALTFF) Advantages Disadvantages Indications Contraindications Potential Complications Technique [16, 18, 19] 17.3.2.2.3 Rectus Abdominis Free Flap (RAFF) Advantages Indications Contraindications Technique 17.3.2.3 Reinnervation 17.4 Reconstruction Outcomes 17.4.1 Speech Outcomes 17.4.1.1 Intelligibility 17.4.1.2 Factors Affecting Speech 17.4.2 Swallowing Outcomes 17.4.2.1 Objective Evaluation of Swallowing 17.4.2.2 Recovery Time 17.4.2.3 Postoperative Diet 17.4.2.4 Factors Affecting Postoperative Swallow 17.4.3 Quality-of-Life (QOL) Outcomes 17.5 Reconstruction: Management Plan 17.5.1 For Defects Involving the Tongue Only ± Floor of the Mouth 17.5.1.1 Reconstruction After Partial Glossectomy 17.5.1.2 Reconstruction After Hemiglossectomy 17.5.1.3 Reconstruction After Subtotal, Near Total, or Total Glossectomy 17.5.2 For Concurrent Tongue and Mandible Defects 17.5.3 For Concurrent Tongue and Oropharyngeal or Hypopharyngeal Defects 17.6 How to Improve Outcomes 17.6.1 Preoperative Measures 17.6.2 Intraoperative Measures 17.6.3 Postoperative Measures 17.6.4 Surveillance/Follow-Up 17.7 Summary References 18: Tongue Replantation After Trauma 18.1 Overview 18.2 Tongue Replantation: Animal Model 18.2.1 Introduction 18.2.2 Surgical Technique [14] 18.2.2.1 Resection 18.2.2.2 Replantation 18.2.2.3 Closure 18.2.3 Clinical Implications 18.3 Tongue Replantation in Humans References 19: Tongue Allotransplantation 19.1 Introduction 19.2 Relevant Anatomy and Physiology 19.3 Current Modalities of Tongue Reconstruction 19.4 Challenges of Tongue Reconstruction 19.4.1 Tongue Movement 19.4.2 Tongue Sensation 19.4.3 Appropriately Sizing 19.4.4 Status of the Larynx 19.4.5 Reinnervation 19.5 Tongue Allotransplantation 19.5.1 Animal Models 19.5.2 Human Tongue Allotransplantation 19.5.3 Challenges in Human Tongue Allotransplantation 19.5.3.1 Donor Tissue Procurement 19.5.3.2 Timing of Allotransplantation 19.5.4 Immunosuppression for Composite Tissue Allotransplantation 19.6 Conclusion References