The lymph vessels of the anterior two-thirds of the tongue drain into the submental and submaxillary glands, and these in turn into the deep cervical group which accompany the internal jugular vein. The vessels of the base converge into several large trunks which pass out behind the tonsils and drain directly into the deep cervical glands. One of these, which lies in the angle between the internal jugular and common facial veins, is frequently infected in cancer of the tongue.
Wounds are commonly produced by the teeth, as, for instance, when a child falls on the chin with the tongue protruded, or when an epileptic bites his tongue during a fit. Less frequently a foreign body, such as a pipe-stem, a bullet, or a displaced tooth, is driven into the tongue. The immediate risk is hæmorrhage, particularly when the posterior part of the tongue is implicated and the wound penetrates deeply. Of the later complications, infections and secondary hæmorrhage are the most serious, and they are most liable to occur when a foreign body is embedded in the tongue.
Treatment.—In superficial wounds near the tip the oozing is efficiently arrested by sutures, but in deeper wounds a ligature must be applied to the bleeding vessel. Secondary hæmorrhage is much more difficult to arrest on account of the friable state of the tissues, and it may be necessary to ligate the lingual or even the external carotid in the neck.
To prevent infective complications any foreign body must be removed and an antiseptic mouth-wash regularly employed.
Cases have been recorded in which such a foreign body as a bullet, a needle, or a piece of a pipe-stem, has remained embedded in the substance of the tongue for a long period, and caused a firm, indolent swelling liable to be mistaken for a new growth.
Dental Ulcer.—The continuous friction of a jagged tooth, or of an ill-fitting dental plate, is liable to cause swelling and excoriation of the side of the tongue. A painful superficial ulcer forms, and if the irritation continues and infection occurs, the surrounding parts become indurated, the ulcer assumes a crater-like appearance, not unlike that of a commencing epithelioma. If such an ulcer does not promptly heal on the removal of the irritant, a portion of the margin should be removed and submitted to microscopic examination to make sure that it is not cancerous.
Inflammatory Affections.—Acute Parenchymatous Glossitis is usually due to the action of streptococci. Although it affects mainly the mucous membrane and submucous tissue, it causes a diffuse œdematous swelling of the whole organ, and this may extend to the ary-epiglottic folds and give rise to œdema of the glottis. As a rule it does not go on to suppuration.
The onset is sudden, and is marked by pain and stiffness of the tongue, particularly when the patient attempts to masticate or to speak. The tongue rapidly swells, and in the course of twenty-four or forty-eight hours may fill the mouth and protrude beyond the teeth. There is profuse salivation, and in addition to difficulty in swallowing and speaking there may be considerable interference with respiration. The salivary and lymph glands in the submaxillary space are enlarged and tender. The symptoms begin to subside in three or four days, unless suppuration occurs.
The treatment consists in administering a sharp purge and employing a mouth-wash; leeches may be applied to the submaxillary region with benefit. When the swelling is excessive, it may be necessary to make longitudinal incisions into the substance of the tongue, and dyspnœa may call for laryngotomy. If an abscess forms it must be opened.
A similar condition has been met with in patients who have contracted the “foot and mouth disease” of cattle. Vesicles form on the mucous membrane, and after bursting, ulcerate, and a mixed infection with streptococci occurs, leading to diffuse œdema. Portions of the tongue may become gangrenous, and the infection may spread to the tissues of the neck and set up one form of angina Ludovici. The condition is usually fatal.