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Anatomy

Head and Neck

Question 101 of 180

A patient presents to ED complaining of an altered taste sensation. Taste sensation from the anterior two-thirds of the tongue is carried by which of the following nerves:

Answer:

Taste from the anterior two-thirds of the tongue is carried by the chorda tympani, branch of the facial nerve.

The tongue is a muscular structure that forms part of the floor of the oral cavity and part of the anterior wall of the oropharynx. The anterior two-thirds of the tongue are in the oral cavity. The posterior root of the tongue is attached to the mandible and the hyoid bone. The anterior wall of the oropharynx inferior to the oropharyngeal isthmus is formed by the upper part of the posterior one-third of the tongue.

A pair of mucosal pouches (valleculae), one on each side of the midline, between the base of the tongue and epiglottis, are depressions formed between the midline mucosal fold and two lateral folds that connect the tongue to the epiglottis.

By OpenStax [CC BY 4.0], via Wikimedia Commons

Tongue. (Image by OpenStax [CC BY 4.0], via Wikimedia Commons)

Papillae and Lingual Tonsil

The oral (anterior two-thirds) and pharyngeal (posterior one-third) surfaces are separated by a V-shaped terminal sulcus of the tongue. The superior surface of the oral part of the tongue is covered by papillae, the majority of which have taste buds on their surface. The mucosa of the pharyngeal surface of the tongue is irregular, because of the many small nodules of lymphoid tissue in the submucosa, collectively known as the lingual tonsil.

By Lesion (Own work) [CC BY-SA 3.0], via Wikimedia Commons

Papillae of the Tongue. (Image by Lesion (Own work) [CC BY-SA 3.0], via Wikimedia Commons)

Innervation

  • General sensation from the anterior two-thirds of the tongue is carried by the lingual nerve, branch of the mandibular nerve.
  • Taste from the anterior two-thirds of the tongue is carried by the chorda tympani, branch of the facial nerve.
  • Taste and general sensation from the posterior one-third of the tongue is carried by the glossopharyngeal nerve.
  • All muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.

Lymphatic Drainage

All lymphatics from the tongue ultimately drain into the deep cervical chain of nodes along the internal jugular vein. The pharyngeal part of the tongue drains through the pharyngeal wall directly into mainly the jugulo-omohyoid node of the deep cervical chain. The oral part of the tongue drains both directly into the deep cervical nodes and indirectly into these nodes by passing first through the mylohyoid muscle and into submental and submandibular nodes.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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