LANGUAGE

From Big Medical Encyclopedia

LANGUAGE. Contents:

Comparative anatomy...... 488

Embryology........... 488

Anatomy and histology....... 488

Physiology............ 490

Pathology............. 490

Malformations........ 490

Damages.......... 491

Diseases.......... 491

Tumours............ 492

Language [lingua (PNA, JNA, BNA)] — the muscular body of an oral cavity participating in chewing, suction, swallowing and an articulation; contains flavoring receptors.

A comparative anatomy

At fishes language is presented by an unpaired fold of the mucous membrane located at a mouth floor on edge of the I branchiate arch; is an organ of touch, has flavoring kidneys, but it is deprived of own muscles. At land vertebrata the muscles which stood apart from hypoglossal muscles grow into language; muscles of language are innervated by a hypoglossal nerve, flavoring kidneys — glossopalatine. Language of amphibians contains glands producing sticky slime; at nek-ry types he can jump out for the purpose of capture of production forward. At amniot language develops from several rudiments merging among themselves; also the trifacial participates in its innervation, except glossopalatine and hypoglossal nerves. At reptiles the form and mobility of language vary. Language of birds thin, the keratosic, has no own muscles. At mammals muscles of language reach the greatest development; the body is very mobile, rich with glands and is supplied with nipples.,

the Embryology

Language develops from the ventral ends of branchiate arches. Its front department (body) is put kpered from an oropharyngeal membrane, is covered with an ectodermal epithelium, and the back department (root) comes from primary throat and is covered an entoderm of l by a ny epithelium. The germ

of 4 weeks has 3 rudiments of a body of language representing thickenings of the I branchiate arch: pair distal lingual hillocks (lateral lingual kidneys) and the unpaired proximal lingual hillock (an average lingual kidney) located between them. In the same time the root of language in the form of a median eminence (copula) on site of connection II and III of branchiate arches is put. Between a proximal hillock and a median eminence the beginning of a thyroid diverticulum where deepening — the so-called blind opening of language which is border between front and back departments of body forms later is located. At a germ of 6 weeks * rudiments of language merge among themselves; language grows in length and width and in process of growing of muscles into it rises over a bottom of an oral cavity. In the beginning it is covered with a simple cubic epithelium, to-ry afterwards becomes two-layer, and then multilayer. Muscles of language migrate from occipital myotomes, but * gast muscular elements is formed of a mesenchyma in the language. The differentiation of muscles begins in a root of language at a germ of 6 weeks. At this time in language the number of vessels increases, and nerve fibrils grow into it. Laying of glands in language occurs at a germ of 10 — 11 weeks. Approximately during the same period nipples of language are put. All structures develop at first in a root of language, then in his body. At the end of the pre-natal period at a fruit nipples, glands, muscles, vessels and nerves of language are well-marked.

The anatomy and histology

Distinguish a top (apex linguae), a body (corpus linguae) and a root (radix linguae) of language. The newborn has short language, wide and thick, on average its length is 40 mm, width is 25 mm, thickness is 10 mm. Language entirely lies in an oral cavity, its root is located horizontally. In process of growth of the child the root of language gradually falls together with a throat, getting more and more vertical position. Within the first year of life glands of language intensively develop. Myelination of nerve fibrils in language continues up to 5 years. To 10-year age the structural differentiation of language comes to the end.

The sizes and a form of language have specific features. At adults its length is equal to 70 — 120 mm, width of 45 — 75 mm, weight (weight) of 69 — 95 g. At men the sizes of language are about 9 — 10% more, than at women.

The upper surface of language, or its back (dorsum linguae), is turned to the sky, a lower surface (facies inf. linguae) adjoins a mouth floor; the edge of language (margo linguae) borders on teeth and gums, the root of language is turned to a throat. On a back of the tongue the median furrow (sulcus medianus) is visible, on border of a body and a root there passes the boundary furrow (sulcus terminalis) having the V-shaped form. The blind opening of language (foramen caecum linguae) is in the conjunction of two branches of a boundary furrow on the centerline (tsvetn. tab., Art. 464, fig. 1). In relation to a boundary furrow in a back of the tongue allocate a prefurrow part (pars presulcalis) and a postfurrow part (pars postsulcalis). From a root of language to an epiglottis there are median also two side lingual and epiglottidean folds (plica glossoepiglottica med., plicae glossoepiglotticae lat.), between to-rymi the pair pole of an epiglottis (vallecula epiglottica) is located. The lower surface of language with the pair fringed fold (plica fimbriata) located on it connects to a mouth floor by means of a bridle (frenulum linguae) limiting the extreme movements of language.

The mucous membrane of language consists of a multilayer flat epithelium and own plate. The lower surface of language smooth, is covered with not keratosic epithelium; there is a submucosa thanks to what the mucous membrane is mobile. On a back of the tongue the submucosa is absent, and the mucous membrane is not movably connected to an aponeurosis of language (aponeurosis linguae), to-ry consists preferential of collagenic fibers. Over an aponeurosis in own plate of a mucous membrane there are textures of small arteries and veins.

A prefurrow part of a back of the tongue and its edge are covered with nipples. Distinguish threadlike, cone-shaped, fungoid, zhelobovidny, leaflike nipples (tsvetn. the tab., Art. 464, fig. 4 — 7). The individual pattern of a surface of language depends on extent of development and an arrangement of separate types of nipples. Threadlike nipples (papillae filiformes) — the most numerous (to 500 on 1 cm2), have length on average of 1,5 mm, width — to 0,6 mm, are covered with partially multilayer flat keratosic epithelium in this connection have a whitish shade. They are located on all upper surface of a body and a top of language, giving it a velvety look. The basis of a nipple is formed by connecting fabric of own plate of a mucous membrane. Secondary nipples, each of depart from a basis to-rykh it is covered with a multilayer flat keratosic epithelium. Vessels and nerves enter a basis of nipples of language. Separate nerve fibrils together with capillaries get into secondary nipples. Threadlike nipples have tactile sensitivity, and also provide ability of language to perception of volume and a form of the objects getting to an oral cavity. Cone-shaped nipples (papillae conicae) differ from threadlike in only stronger keratinization of epithelial layer. Fungoid nipples (papillae fungiformes) are localized on a top of language (to 90 on

i of cm2) and in a middle part of a back (to 40 — 50 on 1 cm2). They it is more threadlike by the sizes, have the narrowed basis and expanded «hat», are covered with a multilayer flat not keratosic epithelium in this connection have reddish color. In fungoid nipples thermoreceptors and flavoring kidneys are put (see. Flavoring analyzer). Zhelobovidny nipples (papillae vallatae) in number from 7 to 12 are located in one row before a boundary furrow, without towering over a surface of language. Each nipple has the form of the cylinder to dia. 2 — 3 mm it is also surrounded with the roller (vallum papillae), from to-rogo it separates a circular fillet (sulcus papillae). In the epithelium covering walls of a fillet there are several rows of flavoring kidneys. In a fillet glands open serous (so-called ebnerovsky). Leaflike nipples (papillae foliatae) are in the tail of edges of language in the form of in parallel the located eminences (folia papillae) divided by furrows. They are well-marked at children. In an epithelium of furrows there are flavoring kidneys, in furrows between nipples serous glands open. At the edges of a root of language chechevitsevidny nipples (papillae lentiformes) similar to fungoid meet.

The mucous membrane of a root of language is deprived of nipples, under an epithelium in it the follicles forming a lingual almond (tonsilla lingualis) are located limf. Lingual glands (glandulae linguales) lie in a mucous membrane and surface layers of muscles of language; they treat small sialadens (see). Serous glands have the branched tubular form; they are in the locations of zhelobovidny and leaflike nipples (tsvetn. tab., Art. 464, fig. 3). The secret of these glands facilitates contact of feedstuffs with flavoring kidneys. Mucous glands (see) — branched alveolar and tubular, are localized in a root and edges of language. In the field of a top of language the mixed front lingual gland lies (gl. lingualis ant.), or nunova, gland. Its channels open on a lower surface of language.

Muscles of language (tsvetn. tab., Art. 464, fig. 2) subdivide into internal own muscles of language and external (skeletal) muscles of language. Internal muscles change a form of language (extend, shorten, flatten). External muscles go to language from the next skeletal educations. This division is conditional since that and others have homogeny, are anatomically connected and jointly participate in the movements of language. Internal muscles form a trekhmernoprostranstvenny lattice in language, in to-ruyu fibers of external muscles are interwoven. On a direction of fiber distinguish top and bottom longitudinal muscles (mm. longitudinales sup. et inf.), to-rye last from an epiglottis to a top of language, a cross muscle of language (m. transversus linguae) and a vertical muscle of language (m. verticalis linguae). Muscles of the right and left parties are divided by the partition of language (septum linguae) passing in the median plane. Genioglossal muscle (t. genioglossus) begins from a mental awn (spina mentalis) of a mandible, fanlikely disperses in a body of language, alternating with bunches of a vertical muscle of language, pulls language forward and down. The hypoglossal and lingual muscle (m. hyoglossus) goes from a hypoglossal bone to a body of language, partially proceeds in a vertical muscle, moves language down and back. The non-constant part of this muscle beginning from a small horn of a hypoglossal bone is called a hryashcheyazychny muscle (m. chondroglossus). Shiloyazychny muscle (t. styloglossus) originates from an awl-shaped shoot of a temporal bone, approaches a root of language and proceeds in longitudinal muscles; it pulls language back and up. Besides, to language go a palatoglossal muscle (m. palatoglossus) and glo - an exact and lingual part of an upper constrictor of a throat (pars glossopharyn-gea m. constrictoris pharyngis sup.).

Tendinous fibers of muscles are interwoven into an aponeurosis of language and its partition, a part of fibers probodat an aponeurosis and terminates in a mucous membrane, reaching the basis of nipples.

In language in addition to the ischerchenny muscle fibers making the ground mass of muscles branched fibers meet with it is central the located kernels, the reminding cardiomyocytes.

Blood supply and

lymph drainage. Language krovosnab-zhatsya by a lingual artery (a. lingualis) departing from an outside carotid artery (a. carotis ext.). The lingual artery gives dorsal branches to a back of the tongue (rr. dorsales) also proceeds in a deep artery of language (a. profunda linguae), passes edges to its top. The lingual artery anastomoses with other branches of an outside carotid artery (the upper thyroid, front, ascending pharyngeal); an intraorganny anastomosis is formed between both lingual arteries and between branches of an artery of one party. Venous outflow happens on a lingual vein (v. lingualis) in an internal jugular vein (v. jugularis int.).

Limf, vessels form networks in a mucous membrane and muscles of language. Taking away limf, vessels go preferential on the course of arteries. The lymph from a top of language flows in mental (nodi lymph, submentales), submandibular (nodi lymph, sub-mandibulares) and deep lateral cervical limf, nodes (nodi lymph, cervicales laterales profundi) both parties. From a body and a root of language the lymph drainage comes in submandibular and deep lateral cervical nodes of the party, including in a jugular and biventral node (nodus lymph, jugulodigastricus) and a jugular and scapular and hypoglossal node (nodus lymph, jugulo-omohyoideus).

The innervation is carried out by sensitive, motive and vegetative nerve fibrils. The mucous membrane of two front thirds of language is innervated by a lingual nerve (n. lingualis) which is a branch of a mandibular nerve (item mandibularis). The flavoring fibers which are contained in a lingual nerve pass further on a drum string (chorda tympani) into a facial nerve (see). The mucous membrane of a root of language is innervated by lingual branches (rr. linguales) of a glossopharyngeal nerve (see), a pole of an epiglottis and the next to it the site of a root of language — an upper guttural nerve (n. laryngeus sup.), being a branch of a vagus nerve (see). Afferent fibers form various nerve terminations in all fabrics and structures of language: free terminations,


touch corpuscles, trailer flasks, bulbar little bodies, neuromuscular spindles. Muscles of language, outside and internal, are innervated by a hypoglossal nerve (see). The sympathetic innervation of language proceeds from an upper cervical node (gangl. cervicale sup.), a sympathetic trunk, parasympathetic — from a submandibular node (gangl. sub-mandibulare).

Physiology

of Function of language are diverse. He actively participates in processing of food in an oral cavity, promoting its movement between groups of teeth at chewing, to grinding of food weight, its hashing with saliva. High tactile sensitivity of a surface of language allows to define existence in food of the firm not chewed or inedible inclusions. When food


Fig. 1. The diagrammatic representation of distribution of nipples and zones of perception of flavoring irritants on upper on-ve rkhn to an awn (back)

of language: 1 — nitevid

ny nipples; 2 — fungoid nipples; 3 — zhelobovidny nipples; 4 — leaflike nipples; 5 — a boundary furrow. On the left half of language zones of perception of flavoring irritants are shaded (horizontal solid lines showed a zone of perception bitter, horizontal discontinuous — sweet, by slanting solid lines — salty, slanting discontinuous — acid).



the lump reaches rather uniform consistence, the movements of language in combination with reduction of muscles of a soft palate and a throat are provided by its proglatyvaniye. Rising up and nestling on the sky, I. isolates an oral cavity from a nasal cavity, providing thus division of oral and nasal breath. At babies language participates in the act of suction. The movements of muscles of language take part in formation of sounds of the speech, and also musical sounds, exert impact on an articulation and a timbre of a voice.

In a mucous membrane of language, its nipples, various on a structure, the main part of the receptor device of an organ of taste is concentrated (see Taste, the Flavouring analyzer). Various sites of a surface of language have unequal sensitivity to flavoring irritants. So, the root of language, acid — edges of language, salty — edges and a tip of language, to sweet — a tip of language (fig. 1) is more sensitive to bitter taste.


Pathology

carry malformations, damages, inflammatory diseases, tumors To pathology of language.

Malformations. Among inborn malformations of language increase in its sizes (a macroglossia, a megaloglossiya) meets more often. At the same time the articulation is broken, there is an inconvenience at reception pishchig secondary deformations of dentitions, disturbances of a bite can develop (see). Treatment of a macroglossia operational. Operation is shown at considerable functional disturbances, and also (seldom) as additional at operational treatment of deformations of a mandible. Make wedge-shaped excision of a part of language. The symmetric cuts through all thickness of language dispersing from its central part to side departments of a top excise a part of language and put stitches. The forecast after operational treatment usually favorable.

Carry so-called folded language to anomalies of development, on a surface to-rogo there pass deep folds or furrows (see Glossitg a folded glossitis).

Inborn not fusion of a blind opening of language is one of displays of inborn median fistulas of a neck. At this Anomaliya at the patient can often be observed aggravations of inflammatory process. In these cases operational treatment — excision of walls of a blind opening with sewing up of edges of a wound is shown. Forecast favorable.

The struma of a root of language (a craw of language) meets seldom, represents an additional or distopirovan-ny thyroid gland. It has an appearance of a node of rounded shape to dia. 1 — 2: the cm, to-ry is located in the field of a blind opening of language. As the struma of language keeps functions of a thyroid gland, before its removal it is necessary to investigate function of normally located thyroid gland; in case of insufficiency of the last excision of a struma of language can lead to development of a myxedema (see). In the conditions of preservation of function of normally located thyroid gland surgery — excision of a struma of language is shown. The forecast after an operative measure favorable.

Rather often at the normal sizes and a form of language anomaly of its bridle (frenulum linguae) — increase in the area of its connection with a lower surface of language or, more rare, its shortening meets. Such provision of a bridle limits mobility of language, especially its tops that leads to disturbance of clearness речи^


especially at a pronunciation of consonants. Treatment operational. At the shortened bridle of language operation is made at chest age. If the bridle represents only a thin fold of a mucous membrane, it is cut scissors from a lower surface of language, holding it in the raised situation with the flat metal pallet with a narrow longitudinal cut on the end. If a bridle more massivn or operation are made at later age, in order to avoid its repeated shortening during the scarring of a wound the bridle is extended by means of plastics. The forecast after operational treatment favorable.

Damages. Superficial injury of a mucous membrane of language is possible during chewing of food (biting), during the falling, blow in a mandible, during an epileptic seizure, during the traumatizing by pieces of a bone, foreign bodys, and also in the presence of keen edges of carious cavities in teeth, the remains of the destroyed tooth crowns and roots, incorrectly imposed seals, the wrong provision of dentures. Thermal damages of language can arise at reception of excessively hot food, hiting at to a hot subject (burn) or to a cold metallic surface (frostbite). Chemical damages of language arise at hit in a mouth of sharply irritating chemical substances, in particular acids and alkalis.

Superficial damages of language after elimination of action of the injuring factor quickly begin to live, do not demand special treatment, except processing by antiseptic agents (e.g., spirit solution of iodine). Appoint rinsings of an oral cavity desinfectants { solutions of Furacilin, hydrogen peroxide, potassium permanganate, etc.). At deeper, avulsive wounds make the surgical treatment (see. Surgical treatment of wounds) consisting in economical avivement and imposing of the deep, pulling together seams through all thickness of muscles. Cut wounds of language are admissible to be taken in without excision of their edges. Foreign bodys delete. First aid at chemical burns is carried out by the general rules (plentiful rinsing by neutralized solutions). Superficial burns of language do not demand special treatment, at deeper burns open bubbles, make antiseptic processing, appoint rinsings disinfecting solutions. Forecast favorable.

Features of fighting damages. The isolated wounds of language meet seldom. More often they are combined with maxillofacial damages. At wounds of area of a mouth quite often language is damaged by splinters of bones of jaws, crowns of teeth, etc. Extensive damages of language can lead to asphyxia owing to its hypostasis or retraction (see Retraction of language). In connection with told, as a rule, assistance at wounds of language it is combined with the help at wounds of maxillofacial area (see Jaws, features of fighting damages). At the bleeding wounds of language first aid consists in a dense tamponade with deduction of a tampon teeth. In PMP bleeding from an available part of language is stopped imposing of deep seams, on wounds is closer to a root of language — bandaging of a lingual artery to one or on both sides that is most often carried out in MSB (About Honey B). At the isolated wounds of language foreign bodys delete, economically excise a wound with suture through all thickness of muscles. At crush of language its resection or amputation is shown. At care of such wounded first of all catering services matter. Food shall be liquid, in some cases it is entered only via the probe. On elimination of inflammatory complications make rekonstruktivnoplastichesky operations, including at a glossosteresis from the remains of fabrics of a mouth floor find a rag, from to-rogo create similarity of language.

Diseases. Secondary changes of language are most often observed, to-rye can be display of the most different diseases. Are characteristic decolourization of language because of education at dysfunctions went on its surfaces of a plaque. - kish. path, secondary defeats I. at nek-ry inf. diseases (measles, scarlet fever, typhus), and also at diseases of blood. E.g., at scarlet fever language is laid over in the beginning, and by 4th day becomes bright red, with the acting nipples — so-called crimson language (see tsvetn. the tab. to St. Scarlet fever, t. 23, Art. 272, fig. 1).

Functional disturbances of language are possible at the diseases of a nervous system connected with damage of the nerves providing its diverse innervation. Defeats of a hypoglossal nerve lead to disturbance of mobility of language, shift of its tip in one party, to difficulty of chewing, indistinctness of the speech. At neuritis of a glossopharyngeal nerve sensitivity in back department of language is broken, and at damage of a lingual nerve — in lobbies and its side departments. Short-term attacks of sharp pains in language are characteristic of neuralgia of a lingual nerve or all third branch of a trifacial, and also can be observed at neuralgia of a glossopharyngeal nerve (see Sikar a syndrome).

Inflammatory diseases can be limited to language (see the Glossitis) or to proceed along with damage of a mucous membrane of a mouth (see Roth, an oral cavity; Stomatitis).

Nonspecific pyoinflammatory diseases — abscesses and phlegmons of language — divide on superficial and deep. Penetration of contagiums most often happens at disturbance of an integrity of a mucous membrane — scratches, pricks a fish bone, biting and other damages of language, through not overgrown blind opening of language at stomacaces, and also a lymphogenous way at quinsy. The disease can be shown in the form of limited abscess in surface layers of muscles of language, a diffuse phlegmonous inflammation, phlegmon and abscess of a root of language.

At limited abscess in surface layers of muscles of language there is a painful consolidation in the beginning, then limited infiltrate is formed, to-ry in the subsequent it is softened. Body temperature increases sometimes to 38 °, increase regional limf. nodes. Because of morbidity of movements of language chewing, swallowing are at a loss. Patients with a phlegmonous inflammation of language have a wedge, a picture heavier. Are noted severe pain in language, its hypostasis, asymmetrical is more often. The language increased in sizes is covered with a dirty-gray plaque, is not located in an oral cavity, its movements are limited, sharply painful. The possibility of meal, swallowing is broken (even liquids), and in hard cases breath is at a loss. At patients the pungent putrefactive smell from a mouth is noted, dense sticky saliva is emitted, the speech is violated. Temperature increases to 39 °, regional limf, nodes are increased and painful.

Especially hard abscesses and phlegmons in the field of a root of language proceed, to-rye are localized in friable cellulose between own muscles of language and in cellulose between genioglossal and hypoglossal and lingual muscles. There is pain during the swallowing, soon the general state sharply worsens, raises body temperature, the fever is noted. Language is sharply edematous, painful, dense and slow-moving. Emergence on a neck of a dense painful swelling in mental area, especially near a body of a hypoglossal bone is characteristic. Abscess and phlegmon of a root of language should be differentiated with phlegmon of a mouth floor of anaerobic genesis (Ludwig's quinsy), for a cut heavier current, extensive hypostasis of mental area and front department of a neck, signs of a mephitic gangrene — separate bluish-crimson and bronze spots, existence of vials of gas are characteristic (see Ludwig quinsy).

Limited abscesses of language open with a slit in the place of the greatest protrusion. Drainage of a wound is not required. After such operation of the patient feels sense of relief at once. At phlegmons of language slits, but wider, do also on an upper or side surface. Opening of a suppurative focus quickly improves a condition of the patient though the wound repair can drag on because of rejection of nekrotizirovanny sites of fabrics. Deep abscesses in the field of a root of language open with extraoral access. In mental area make a section of skin on the centerline, cut hypodermic cellulose, tendinous connection of two maxillary and hypoglossal muscles, a stupid way muscles of a mouth floor stratify and get into a suppurative focus. The wound is drained. Appoint antibacterial pharmaceuticals; special attention is paid on a gigabyte. the maintenance of an oral cavity (plentiful rinsings, wiping by the tampons moistened weak disinfecting r-ra-mi). Food shall be warm, liquid, with the sufficient content of proteins, vitamins; plentiful drink is recommended. At the complicated and painful swallowing liquid is entered parenterally. In cases of disturbance of breath tracheotomy can be required (see). At the active, correctly carried out treatment the forecast, as a rule, favorable.

Tubercular defeat of language more often happens secondary and develops at tuberculosis of a respiratory organs. Inflammatory process in language begins with a mucous membrane; there is a tubercular ulcer, sharply painful deckle-edged and a flat bottom, sluggish granulations with a yellowish plaque. The ulcer is more often localized in the field of a top or verkhnebokovy department of language, increases slowly, happens single more often, but perhaps multiple defeat and even disseminated through all surface of language at generalized process. Treatment — specific antitubercular (see. Antituberculous remedies; Tuberculosis, philosophy of treatment). The forecast at the isolated tuberculosis of language favorable. At simultaneous defeat of other bodies (e.g., a pulmonary tuberculosis) the forecast depends on weight and prevalence of process.

Syphilitic defeat of language is possible in all stages of syphilis (see). Primary syphilis of language is shown by formation of a typical single hard ulcer; at secondary syphilis the multiple papules inclined to formation of erosion and ulcers of rounded shape with accurate edges, a smooth brilliant surface and infiltrirovanny basis are observed; at tertiary syphilis defeat of language proceeds with formation of gummas. A special form of syphilitic defeat of language at tertiary syphilis is the intersticial glossitis with the diffusion infiltrate penetrating all thickness of language (see the Glossitis, an intersticial glossitis). The diagnosis is based on a wedge, yielded, results bacterial. and serol. researches. Treatment specific (see. Antisyphilitic means; Syphilis, treatment). The forecast for life at timely and correct treatment favorable.

The actinomycosis of language is observed seldom. The disease is connected with penetration through the injured mucous membrane of language of radiant fungi — actinomycetes. It is shown in the form of very dense, accurately limited, and then hilly node in the beginning. Further formation of the low-painful massive inflammatory centers is characteristic, in the thickness to-rykh there are purulent cavities, and at break them — fistulas; development of deeper abscess or phlegmon of language is possible. The diagnosis of an actinomycosis is confirmed by results bacterial. and immunol. researches. Treatment — an immunotherapy, use of antibacterial pharmaceuticals, an operative measure (see the Actinomycosis). The forecast at the isolated defeat of language and timely treatment usually favorable.

Tumors of language happen high-quality and malignant.

Dobrokachestven ny tumors. From benign tumors papillomas most often meet (see Papilloma, a papillomatosis). Usually papilloma of language has rounded shape, is located on a leg more often, is more rare — on the wide basis. The surface of papilloma smooth, is covered with a mucous membrane, color a cut does not differ from coloring of a normal mucous membrane of language. Multiple papillomas of language macroscopically have an appearance of a cauliflower. Treatment operational — excision or a cryolysis (see

the Cryosurgery). The forecast at timely treatment favorable. However a recurrence and a malignancy of papillomas are possible.

Very seldom in language develop a hemangioma (see), a lymphangioma (see) at an angiofibroma (see), fibroma (see) at a granular cell myoblastoma (see the Myoblastoma granular cell), a neurinoma (see). The hemangioma of language is located superficially more often, has cyanotic coloring, easily bleeds (tsvetn. tab., Art. 336,

fig. 11). The lymphangioma of language has a myagkoelastichesky consistence and is located in the thickness of language. The angiofibroma of language has a plotnoelastichesky consistence and is covered with not changed mucous membrane. Fibroma — a dense, hilly tumor, is localized usually in the thickness of language. Fibroma of language of the big sizes deforms it, can squeeze surrounding fabrics. The mucous membrane over a tumor is usually thinned, an atrofichna. Slow growth and lack of disturbance of integrity of the mucous membrane covering them are characteristic of all benign tumors of language.

Treatment of benign tumors operational. Make an economical glossectomy or excise a tumor within healthy fabrics. Forecast favorable.

Malignant tumors. The most frequent malignant tumor of language is cancer. In an etiology of cancer of language a part is played by addictions — smoking, the use of hard alcoholic drinks, hot and spicy food, chewing of tobacco, a betel, and also continuous traumatizing a mucous membrane of language the carious teeth which are badly made by dentures. The started forms of periodontosis (see), formation of a dental calculus, a constant infection in an oral cavity also promote emergence of damages, to-rye contribute to development of cancer. The essential role in developing of cancer of language belongs to pretumor diseases, napr, leukoplakias (see). The malignancy of a leukoplakia, by data A. L. Mashkilleysona (1971), occurs in 20% of cases.

Cancer of language averages 1,5% of all malignant new growths over our country. Much more often it develops at men. The most widespread localization of cancer, by data A. I. Pachesa (1971) — a side surface of language (62%); the root of language is surprised at 27%, a back of the tongue — at 7%, a top of language — at 3% of patients. At gistol. a research find planocellular cancer in 95% of patients with cancer of language, keratosic is more often. Adenogenny tumors, coming from small sialadens — an adenocarcinoma, a mucoepidermoid tumor, a tsistadenoidny carcinoma are quite rare (see Sialadens).

Macroscopically growth of a tumor can be exophytic in the form of fungoid education with an ulceration on a surface and endophytic. The last growth form of a tumor meets more often. Process at the same time is localized by hl. obr. in the thickness of language (an infiltrative form) can be also followed by an ulceration of a mucous membrane (an infiltrative and ulcer form; tsvetn. tab., Art. 336, fig. 12). Tumoral process quickly extends to a root of language, a mouth floor, palatal handles, and also to the opposite side of language. Frequency of innidiation, by data A. I. Pachesa (1983), increases from 43% at localization of a tumor in a front half of language to 71% at its localization in a back half. Metastasises of cancer of lobbies and average departments of language appear in mandibular and average jugular deep cervical in the beginning limf, nodes. Cancer of back departments of language metastasizes first of all in upper jugular and deep cervical limf. nodes.

In an initial stage of development of cancer of language subjective feelings come down to moderate morbidity, burning sensation at reception of salty, hot, rough food. In process of development of a disease of pain amplify, often irradiate in an ear. Due to growth of a tumor hypersalivation amplifies, the fetid smell from a mouth appears. In late stages when the tumor extends to a mouth floor, a root of language and palatal handles, pains become painful, the speech and swallowing are violated, opening of a mouth is at a loss. Cancer of language quite often is complicated by the bleeding caused by an arrosion of blood vessels.

In the USSR it is accepted a wedge, classification of cancer of language by stages of tumoral process. The I stage — the tumor up to 1 in size hardly in the greatest measurement limited to a mucous membrane and a submucosa, metastasises in regional limf, nodes and the remote metastasises are not defined. II stage: a) the tumor to

2 sd in the greatest measurement, sprouts in the subject fabrics on depth up to 1 cm, metastasises in regional limf, nodes are not defined; b) a tumor of I or Pa of a stage, the single movable metastasis in a regional limf, a node on the party of defeat is defined, the remote metastasises are not defined. III stage: a) the tumor to 3 cm in the greatest measurement, edge of infiltration is determined by the centerline or passes to a mucous membrane of a mouth floor, metastasises into regional limf, nodes and the remote metastasises are not defined; b) a tumor

of I, or 111a stages, multiple movable metastasises in regional limf, nodes or restrictedly a movable metastasis on the party of defeat or on the opposite side are defined by Pa, the remote metastasises are not defined. IV stage: a) the tumor affects almost all language, extends to surrounding soft tissues and face bones, metastasises in regional limf, nodes and the remote metastasises are not defined; b) a tumor of any degree of prevalence with not movable metastasises in regional limf, nodes or the remote metastasises.

According to the International system of clinical classification of cancer (see) prevalence of tumoral process in language define as follows: T — primary tumor; TIS — a preinvazivny carcinoma (carcinoma in situ); T0 — primary tumor is not defined; Tkh — a tumor of 2 cm or less in the greatest measurement; T2 — a tumor more than 2 cm, but no more than 4 cm in the greatest measurement; T3 — a tumor

more than 4 cm in the greatest measurement; T4 — a tumor extends to bones, muscles, skin; Tkh — it is impossible to define fully prevalence of primary tumor. N — regional limf, nodes; N0 — regional limf, nodes are not struck; Nj — are palpated mobile limf, nodes on the party of defeat; N2 — are palpated mobile limf, nodes on the opposite side or on both sides; N3 — are palpated motionless regional limf, nodes; Nx — to estimate a condition limf, nodes are impossible. M — the remote metastasises; M0 — the remote metastasises are not defined; Mg — the remote metastasises are defined; Mkh — it is impossible to define existence of the remote metastasises. Using this classification it is possible to reflect briefly and rather in detail by means of the specified symbols the corresponding stage of tumoral process. E.g., a tumor of language of 2 cm or less in the greatest measurement with palpated mobile regional limf, nodes on the party of defeat and without the remote metastasises it is possible to designate as follows — Т^Мо.

The diagnosis of cancer of language is made on the basis of survey, by palpations of a tumor and limf, nodes in zones of regional innidiation. Language is examined by means of the pallet and mirrors; conjoined manipulation is reasonable. Apply a stomatoskopiya — survey of a mucous membrane by means of the special optical device, obespechi-


Fig. 2. Diagrammatic representation of a stage of operation of an electroresection of a half of language for cancer: language is partially cut by an electroknife on the centerline, from a stump by means of catgut seams the tip of language is created; the dashed line shows borders of the excised fabrics of language and a bottom of an oral cavity.

howling increase by 20 times and allowing to estimate more precisely the nature of damage of a mucous membrane of language, and also to make an aim biopsy. In cases of an ulceration of a tumor produce tsi l. a research separated, at an infiltrative growth form — tsi-tolite. a research of punctate from a tumor. If tsitol. the research does not allow to specify the diagnosis, resort to a biopsy.

Tactics of cancer therapy of language is defined by prevalence of tumoral process. At cancer of I and Pa of a stage in a crust, time the leading method is radiation therapy. It will be out by means of therapeutic gamma devices (see Gamma devices). The single focal dose on primary center makes 200 is glad (2 Gr), a total focal dose 4000 is glad (40 Gr). The second stage of beam treatment — implementation of cobalt needles (see. Radioactive drugs). It is carried out after subsiding of the reactive phenomena caused by a remote gamma therapy (see). The focal dose at an interstitial gamma therapy depends on degree of clinically defined resorption of a tumor by the time of the end of outside radiation and fluctuates within 2000 — 4000 is glad (20 — 40 Gr).

Also combined treatment is possible, a cut carry out in two steps. At the first stage carry out a remote gamma therapy and after subsiding of the reactive phenomena, on average in 2 — 3 weeks, carry out an electroresection of a half of language (fig. 2). In nek-ry cases are limited to operational treatment.

At detection of metastasises in regional limf, nodes radical neck operation is shown. The patient with single mobile metastasises make operation face-tsialno-futlyarnogo of excision of cellulose of a neck. During the performance of this operation the internal jugular vein, a grudino-klyuchichnosostsevidny muscle and an eleventh cranial nerve remain. In late stages of a disease at patients with multiple or it is limited by movable metastasises in regional limf, nodes make more radical operation of Krayl (see Krayl operation) with excision of a fatty tissue of a neck, grudino - a clavicular and mastoidal muscle, an internal jugular vein.

At cancer of language III of a stage the combined or complex treatment with inclusion of system or regional chemotherapy is shown. The combined treatment is performed in two stages. In the beginning carry out a remote gamma therapy, then carry out the operation consisting in an electrosurgical glossectomy and fabrics of a mouth floor. The issue of a resection of a mandible is resolved depending on prevalence of process. In the presence of metastasises in regional limf, nodes radical neck operation is carried out along with operation on primary center later 3 — 4 weeks after the termination of a course of radiation therapy. At a recurrence of cancer of language make electrosurgical excision of again formed centers of defeat. In respect of complex treatment before radiation therapy in some cases carry out system polychemotherapy by vinblastine, a methotrexate, ?bleomitsiny. The same drugs can be used also for regional intra arterial chemotherapy, edges it is carried out through the catheter entered into a superficial temporal artery to the level of a lingual artery.

The forecast depends hl. obr. from a stage of a disease. Five-year survival at cancer of language I of a stage makes 85%, at cancer of the II stage — 75%, Sha of a stage — 35 — 40%. At bilateral metastasises and a recurrence of cancer the forecast adverse.

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N. G. Kolosov, page 9, M. — JI., 1953; D e-N and O. P. Anatomiya's owl of anastomotic bonds of ekstraorganny and intraor-ganny arteries of language, Arkh. annate., gistol. and embriol., t. 65, No. I, page 92, 1973; For a mustache and e in V. I. and d river. Surgical stomatology, M., 1981; Mashkilleyson

A. JI. A precancer of a red border of lips and a fir-tree -

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Lehrbuch der Anato mie des Menschen, hrsg v. H. Ferner u. J. Staubesand, Bd 2, S. 45, Miinchen u. a., 1979; TNM Classification of malignant tumors, ed. by M. H. Harmer, Geneva, 1978.

V. F. Rudko; A. I. Paches, V. JI. Liu-bayev (PMC.), V. S. Speransky (An., gist., embr.); author of color slides S. I. Kolinov.

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