The mouth cavity. The apex of the tongue is turned upward, and on the right side a superficial dissection of its undersurface has been made. (Frenulum labeled at center right.)
Sagittal section of nose mouth, pharynx, and larynx. (Frenulum linguae is the topmost label at right.)
The frenulum (or frenum) of the tongue, tongue web, lingual frenulum, frenulum linguae, or fraenulum[1] is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the human tongue.
The tongue starts to develop at about four weeks. The tongue originates from the first, second, and third pharyngeal arches which induces the migration of muscles from the occipital myotomes. A U-shaped sulcus develops in front of and on both sides of the oral part of the tongue. This allows the tongue to be free and highly mobile, except at the region of the lingual frenulum, where it remains attached. Disturbances during this stage cause tongue tie or ankyloglossia. During the sixth week of gestation, the medial nasal processes approach each other to form a single globular process that in time gives rise to the nasal tip, columella, prolabium, frenulum of the upper lip, and the primary palate.[2] As the tongue continues to develop, frenulum cells undergo apoptosis, retracting away from the tip of the tongue, and increasing the tongue's mobility.[3]
During early gestation (as early as four weeks) the lingual frenulum serves as a guide for the forward growth of the tongue. After birth the tip of the tongue continues to elongate, giving the impression of the frenulum retracting, though in reality this has been going on for some time before birth. This is what gives the impression that the frenulums of some previously tongue-tied infants will "stretch" with age and growth. In reality the tongue often just grows beyond the frenulum, although some do also stretch and/or rupture after mild accidents. Many others continue to cause problems throughout life, unless corrected.[4]
Anatomy
The thin strip of tissue that runs vertically from the floor of the mouth to the undersurface of the tongue is called the lingual frenulum. It tends to limit the movement of the tongue, and in some people, it is so short that it actually interferes with speaking.
A hump of tissue near the base of the tongue houses a series of saliva gland ducts. The two largest ducts are called Wharton's Ducts and they empty the submandibular (submaxillary) and sublingual salivary glands into a small prominence on either side of the frenulum, the sublingual caruncle. These ducts can be quite active in some persons, and upon occasion, a considerable amount of saliva may erupt from them while talking, eating, yawning, or cleaning the teeth in a process known as gleeking. The sublingual saliva glands empty through a series of tiny ducts in the tissue on either side of Wharton's ducts. The tongue is attached to the floor of the oral cavity by the frenulum.
Sketch of an open mouth showing the frenulum and surrounding structures
Superficial veins run through the base of the frenulum known as varicosities. Their presence is normal, becoming more and more prominent as one ages.[5]
Disorders
Ankyloglossia
Ankyloglossia, also known as tongue-tie, is a congenital anomaly characterised by an abnormally short lingual frenulum; when severe, the tip of the tongue cannot be protruded beyond the lower incisor teeth.[6] There are two generalized classifications of ankyloglossia, anterior and posterior tongue-ties. A frenulum attached close to the tip of the tongue is commonly referred to as an "anterior tongue-tie". A frenulum that is attached near the bottom of the tongue, and is sometimes submucosal (not visible), but causes restriction is referred to as a "posterior tongue-tie".[7]
Additionally, an abnormally short frenulum in infants can be a cause of breastfeeding problems, including sore and damaged nipples and inadequate feedings.[8] The resultant trouble breastfeeding results in slower weight gain in affected infants.[9]
The absence of the inferior labial (100% sensitivity; 99.4% specificity) and lingual frenulum (71.4% sensitivity; 100% specificity) was found to be associated with classical and hypermobility types of Ehlers-Danlos syndrome.[10]
Trauma related to oral sex
Traumaticlesions on the ventral surface (undersurface) of the tongue, especially the lingual frenulum, can be caused by friction between the tongue and the mandibular central incisor teeth during cunnilingus and other oral sexual activities (such as anilingus)[11][12][13][14] in what is sometimes known as "cunnilingus tongue" or "cunnilingus syndrome".[15]
The condition manifests as pain and soreness on the undersurface of the tongue,[16] and sometimes the throat.[15] The ulceration of the lingual frenum caused by cunnilingus is typically oriented horizontally, the lesion corresponding to the contact of the ventral tongue with the incisal edge of the mandibular incisor teeth when the tongue is in its most forward position and the lingual frenulum is stretched.[11] The ulceration has a nonspecific appearance, and is covered with a fibrinous exudate and surrounded by an erythematous (red) "halo".[16][17] Chronic ulceration at this site can cause linear fibrous hyperplasia (irritation fibroma).[11][16]
Topical anesthetic may be used to relieve symptoms while the lesion heals.[16] Fibrous lesions may require surgical excision with a frenectomy.[16] The incisal edges of the mandibular teeth can be smoothed to minimize the chance of trauma.[11] This type of lesion usually resolves in 7–10days, but may recur with repeated performances.[11]
↑ Notestine, G. E (2005-12-14). "The importance of the identification of ankyloglossia (short lingual frenulum) as a cause of breastfeeding problems". J Hum Lact. NCBE. 6 (3): 113–5. doi:10.1177/089033449000600316. PMID2400555. S2CID35233771.
↑ De Felice, Claudio; Toti, Paolo; Di Maggio, Giovanni; Parrini, Stefano; Bagnoli, Franco (2001-05-22). "Absence of the inferior labial and lingual frenula in Ehlers-Danlos syndrome". The Lancet. 357 (9267): 1500–1502. doi:10.1016/S0140-6736(00)04661-4. PMID11377605. S2CID24967022.
The tongue is a muscular organ in the mouth of a typical tetrapod. It manipulates food for chewing and swallowing as part of the digestive process, and is the primary organ of taste. The tongue's upper surface (dorsum) is covered by taste buds housed in numerous lingual papillae. It is sensitive and kept moist by saliva and is richly supplied with nerves and blood vessels. The tongue also serves as a natural means of cleaning the teeth. A major function of the tongue is the enabling of speech in humans and vocalization in other animals.
The salivary glands in many vertebrates including mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands, as well as hundreds of minor salivary glands. Salivary glands can be classified as serous, mucous, or seromucous (mixed).
A mouth ulcer (aphtha) is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually or multiple ulcers may appear at once. Once formed, an ulcer may be maintained by inflammation and/or secondary infection.
The paired submandibular glands are major salivary glands located beneath the floor of the mouth. In adult humans, they each weigh about 15 grams and contribute some 60–67% of unstimulated saliva secretion; on stimulation their contribution decreases in proportion as parotid gland secretion rises to 50%. The average length of the normal adult human submandibular salivary gland is approximately 27 mm, while the average width is approximately 14.3 mm.
The sublingual gland is a seromucous polystomatic exocrine gland. Located underneath the oral diaphragm, the sublingual gland is the smallest and most diffuse of the three major salivary glands of the oral cavity, with the other two being the submandibular and parotid. The sublingual gland provides approximately 3-5% of the total salivary volume.
Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease the mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth.
A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth. Ranulae present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland caused by local trauma. If small and asymptomatic further treatment may not be needed, otherwise minor oral surgery may be indicated.
An oral medicine or stomatology doctor/dentist has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities including oral cancer, salivary gland disorders, temporomandibular disorders and facial pain, taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region.
The submandibular duct is one of the salivary excretory ducts. It is about 5 cm long, and its wall is much thinner than that of the parotid duct. It drains saliva from each bilateral submandibular gland and sublingual gland to the sublingual caruncle in the floor of the mouth.
Sialolithiasis is a crystallopathy where a calcified mass or sialolith forms within a salivary gland, usually in the duct of the submandibular gland. Less commonly the parotid gland or rarely the sublingual gland or a minor salivary gland may develop salivary stones.
A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of the upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure that is performed on infants, children, and adults. A similar procedure frenulotomy is where a tight frenulum may be relieved by making an incision in the tight tissue.
Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:
Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.
Tongue diseases can be congenital or acquired, and are multiple in number. Considered according to a surgical sieve, some example conditions which can involve the tongue are discussed below. Glossitis is a general term for tongue inflammation, which can have various etiologies, e.g. infection.
Cunnilingus is an oral sex act involving a person stimulating the vulva of another by using the tongue and lips. The clitoris is the most sexually sensitive part of the vulva, and its stimulation may result in a woman becoming sexually aroused or achieving orgasm.
The sublingual space is a fascial space of the head and neck. It is a potential space located below the mouth and above the mylohyoid muscle, and is part of the suprahyoid group of fascial spaces.
The sublingua ("under-tongue") is a muscular secondary tongue found below the primary tongue in tarsiers and living strepsirrhine primates, which includes lemurs and lorisoids. Although it is most fully developed in these primates, similar structures can be found in some other mammals, such as marsupials, treeshrews, and colugos. This "second tongue" lacks taste buds, and in lemuriforms, it is thought to be used to remove hair and other debris from the toothcomb, a specialized dental structure used to comb the fur during oral grooming.
In human anatomy, the mouth is the first portion of the alimentary canal that receives food and produces saliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth.
Salivary gland diseases (SGDs) are multiple and varied in cause. There are three paired major salivary glands in humans: the parotid glands, the submandibular glands, and the sublingual glands. There are also about 800–1,000 minor salivary glands in the mucosa of the mouth. The parotid glands are in front of the ears, one on side, and secrete mostly serous saliva, via the parotid ducts, into the mouth, usually opening roughly opposite the second upper molars. The submandibular gland is medial to the angle of the mandible, and it drains its mixture of serous and mucous saliva via the submandibular duct into the mouth, usually opening in a punctum in the floor of mouth. The sublingual gland is below the tongue, on the floor of the mouth; it drains its mostly mucous saliva into the mouth via about 8–20 ducts, which open along the plica sublingualis, a fold of tissue under the tongue.
Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.
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