Advertisement

The oral tongue and floor of mouth in three dimensions (3D): A digital anatomical model derived from radiology, peer-reviewed literature, and medical illustration

Published:October 21, 2022DOI:https://doi.org/10.1016/j.otot.2022.10.006
      Combining published literature, radiographic imaging, and medical illustration, this study aimed to develop an anatomically accurate 3-dimensional (3D) digital model of the human tongue, and to make this model publicly available for education and training purposes. The intrinsic and extrinsic muscles of the tongue were manually segmented from a head and neck CT angiogram of a healthy 29-year-old female. Data derived from published anatomical studies were compiled to provide additional anatomical detail to each tongue muscle. These anatomical details were then incorporated into a model by a 3D medical illustrator. A total of nine muscles were segmented for this study, along with the mandible and the hyoid bone. 3D meshes of the extrinsic muscles of the tongue, intrinsic muscles of the tongue, and the mylohyoid were created from CT angiography segmentation data. These meshes were refined in digital 3D space based off data from peer-reviewed anatomical studies. The final model was then uploaded to a publicly available 3D model repository. The tongue is a complex 3D organ with important roles in swallowing, speaking, and airway protection. By combining radiographic data with published anatomical descriptions, and through the collaboration between neuroradiology, head and neck surgery, and medical illustration, we developed an anatomically accurate, detailed 3D model of the oral tongue, which may serve as a powerful anatomy teaching aid.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Operative Techniques in Otolaryngology-Head and Neck Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Flint PW
        • Francis HW
        • Haughey BH
        • et al.
        Cummings Otolaryngology : Head and Neck Surgery.
        Elsevier, Philadelphia, PA2021
        • Sanders I
        • Mu L.
        A three-dimensional atlas of human tongue muscles.
        Anat Rec (Hoboken). 2013; 296: 1102-1114
        • Abd-El-Malek S.
        Observations on the morphology of the human tongue.
        J Anat. 1939; 73: 201-210
        • Sakamoto Y.
        Configuration of the extrinsic muscles of the tongue and their spatial interrelationships.
        Surg Radiol Anat. 2017; 39: 497-506
        • Sanders I
        • Mu L
        • Amirali A
        • et al.
        The human tongue slows down to speak: Muscle fibers of the human tongue.
        Anat Rec (Hoboken). 2013; 296: 1615-1627
        • Takemoto H.
        Morphological analyses of the human tongue musculature for three-dimensional modeling.
        J Speech Lang Hear Res. 2001; 44: 95-107
        • Hiiemae KM
        • Palmer JB.
        Tongue movements in feeding and speech.
        Crit Rev Oral Biol Med. 2003; 14: 413-429
        • Bassiri Gharb B
        • Tadisina KK
        • Rampazzo A
        • et al.
        Microsurgical anatomy of the terminal hypoglossal nerve relevant for neurostimulation in obstructive sleep apnea.
        Neuromodulation. 2015; 18: 721-728
        • Hou TN
        • Zhou LN
        • Hu HJ.
        Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea.
        Clin Radiol. 2011; 66: 526-529
        • Colevas AD
        • Yom SS
        • Pfister DG
        • et al.
        NCCN guidelines insights: head and neck cancers, version 1.2018.
        J Natl Comprehensive Cancer Network. 2018; 16: 479-490
        • Lazarus CL
        • Husaini H
        • Anand SM
        • et al.
        Tongue strength as a predictor of functional outcomes and quality of life after tongue cancer surgery.
        Ann Otol Rhinol Laryngol. 2013; 122: 386-397
        • Stokes W
        • Ramadan J
        • Lawson G
        • et al.
        Bleeding complications after transoral robotic surgery: A meta-analysis and systematic review.
        Laryngoscope. 2021; 131: 95-105
        • Standring S
        • Gray H.
        Gray's Anatomy : The Anatomical Basis of Clinical Practice.
        Elsevier, Amsterdam2021
        • Norton NS
        • Netter FH.
        Netter's Head and Neck Anatomy for Dentistry.
        Elsevier, Philadelphia, PA2017
        • Janfaza P.
        Surgical Anatomy of the Head and Neck.
        Lippincott Williams & Wilkins, Philadelphia2001
        • DePaul R
        • Abbs JH.
        Quantitative morphology and histochemistry of intrinsic lingual muscle fibers in Macaca fascicularis.
        Acta Anat (Basel). 1996; 155: 29-40
        • Barnwell YM
        • Klueber K
        • Langdon HL.
        The anatomy of the intrinsic musculature of the tongue in the early human fetus: part 1, M. longitudinalis superior.
        Int J Oral Myol. 1978; 4: 5-8
        • Barnwell YM
        • Langdon HL
        • Klueber K.
        The anatomy of the intrinsic musculature of the tongue in the early human fetus: part II, M. longitudinalis inferior.
        Int J Oral Myol. 1978; 4: 5-8
        • Toure G
        • Vacher C.
        Anatomic study of tongue architecture based on fetal histological sections.
        Surg Radiol Anat. 2006; 28: 547-552
        • Stone M
        • Woo J
        • Lee J
        • et al.
        Structure and variability in human tongue muscle anatomy.
        Comput Methods Biomech Biomed Eng Imaging Vis. 2018; 6: 499-507
        • Xing F
        • Stone M
        • Goldsmith T
        • et al.
        Atlas-based tongue muscle correlation analysis from tagged and high-resolution magnetic resonance imaging.
        J Speech Lang Hear Res. 2019; 62: 2258-2269
        • Fang Q
        • Fujita S
        • Lu X
        • Dang J.
        A model-based investigation of activations of the tongue muscles in vowel production.
        Acoustical Sci Technol. 2009; 30: 277-287
        • Miller JL
        • Watkin KL
        • Chen MF.
        Muscle, adipose, and connective tissue variations in intrinsic musculature of the adult human tongue.
        J Speech Lang Hear Res. 2002; 45: 51-65
        • Fang WS
        • Wiggins 3rd, RH
        • Illner A
        • et al.
        Primary lesions of the root of the tongue.
        Radiographics. 2011; 31: 1907-1922
        • Drake RL
        • Drake RL
        • Gray H.
        Gray's Atlas of Anatomy.
        Churchill Livingstone, Philadelphia2008
        • Mu L
        • Sanders I.
        Human tongue neuroanatomy: Nerve supply and motor endplates.
        Clin Anat. 2010; 23: 777-791
        • Saito H
        • Itoh I.
        The three-dimensional architecture of the human styloglossus especially its posterior muscle bundles.
        Ann Anat. 2007; 189: 261-267
        • Mills N
        • Pransky SM
        • Geddes DT
        • et al.
        What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum.
        Clin Anat. 2019; 32: 749-761
        • Heiser C
        • Knopf A
        • Hofauer B.
        Surgical anatomy of the hypoglossal nerve: A new classification system for selective upper airway stimulation.
        Head Neck. 2017; 39: 2371-2380
        • Silverstein K
        • Costello BJ
        • Giannakpoulos H
        • et al.
        Genioglossus muscle attachments: An anatomic analysis and the implications for genioglossus advancement.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 686-688
        • Sonoda N
        • Tamatsu Y.
        Observation on the attachment of muscles onto the hyoid bone in human adults.
        Okajimas Folia Anat Jpn. 2008; 85: 79-90
        • Grammatica A
        • Piazza C
        • Ferrari M
        • et al.
        Step-by-step cadaver dissection and surgical technique for compartmental tongue and floor of mouth resection.
        Front Oncol. 2021; 11613945
      1. Rathee M, Jain P. Anatomy, Head and Neck, Stylohyoid Muscle. StatPearls Publishing, Treasure Island (FL), 2021.

        • Prades JM
        • Gavid M
        • Asanau A
        • et al.
        Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve.
        Surg Radiol Anat. 2014; 36: 141-146
        • Bejjani GK
        • Sullivan B
        • Salas-Lopez E
        • et al.
        Surgical anatomy of the infratemporal fossa: the styloid diaphragm revisited.
        Neurosurgery. 1998; 43 (discussion 852-843): 842-852
        • Ozveren MF
        • Ture U
        • Ozek MM
        • et al.
        Anatomic landmarks of the glossopharyngeal nerve: a microsurgical anatomic study.
        Neurosurgery. 2003; 52 (discussion 1410): 1400-1410
        • Cho JH
        • Kim JK
        • Lee HY
        • et al.
        Surgical anatomy of human soft palate.
        Laryngoscope. 2013; 123: 2900-2904
        • Mu L
        • Chen J
        • Li J
        • et al.
        Innervation of human soft palate muscles.
        Anat Rec (Hoboken). 2021; 304: 1054-1070
        • Kuehn DP
        • Azzam NA.
        Anatomical characteristics of palatoglossus and the anterior faucial pillar.
        Cleft Palate J. 1978; 15: 349-359
        • Sakamoto Y.
        Morphological features of the branching pattern of the hypoglossal nerve.
        Anat Rec (Hoboken). 2019; 302: 558-567
        • Aoki C
        • Nara T
        • Kageyama I.
        Relative position of the mylohyoid line on dentulous and edentulous mandibles.
        Okajimas Folia Anat Jpn. 2011; 87: 171-176
        • Otonari-Yamamoto M
        • Nakajima K
        • Tsuji Y
        • et al.
        Imaging of the mylohyoid muscle: separation of submandibular and sublingual spaces.
        AJR Am J Roentgenol. 2010; 194: W431-W438
        • Ryu EJ
        • Kim DH.
        Anatomical insights of the mylohyoid for clinical procedures in dentistry.
        Clin Anat. 2021; 34: 461-469
        • El Haddioui A
        • Bravetti P
        • Gaudy JF
        Anatomical study of the arrangement and attachments of the human medial pterygoid muscle.
        Surg Radiol Anat. 2007; 29: 115-124
        • Choi P
        • Iwanaga J
        • Dupont G
        • et al.
        Clinical anatomy of the nerve to the mylohyoid.
        Anat Cell Biol. 2019; 52: 12-16
        • Mooney SM
        • Sukato DC
        • Azoulay O
        • et al.
        Systematic review of submental artery island flap versus free flap in head and neck reconstruction.
        Am J Otolaryngol. 2021; 42103142
        • Gavilán J
        • Castro A
        • Rodrigáñez L
        • et al.
        Functional and selective neck dissection.
        Thieme, New York2020: 1 (online resource)
        • De-Ary-Pires B
        • Ary-Pires R
        • MA Pires-Neto
        The human digastric muscle: patterns and variations with clinical and surgical correlations.
        Ann Anat. 2003; 185: 471-479
        • Cohen DS
        • Low GM
        • Melkane AE
        • et al.
        Establishing a danger zone: An anatomic study of the lingual artery in base of tongue surgery.
        Laryngoscope. 2017; 127: 110-115
        • Lauretano AM
        • Li KK
        • Caradonna DS
        • et al.
        Anatomic location of the tongue base neurovascular bundle.
        Laryngoscope. 1997; 107: 1057-1059
        • Sarna K
        • Sonigra KJ
        • Amuti T
        • et al.
        Mandela Idenya P. The Journey of the Lingual Artery from the Neck to the Oral Cavity: A Cadaveric Study.
        Craniomaxillofac Trauma Reconstr. 2022; 15: 39-45
        • Moore EJ
        • Janus J
        • Kasperbauer J.
        Transoral robotic surgery of the oropharynx: Clinical and anatomic considerations.
        Clin Anat. 2012; 25: 135-141
        • Seki S
        • Sumida K
        • Yamashita K
        • et al.
        Gross anatomical classification of the courses of the human lingual artery.
        Surg Radiol Anat. 2017; 39: 195-203
        • Xu H
        • Jazayeri L
        • Matros E
        • et al.
        Anatomy, Exposure, and Preparation of Recipient Vessels in Microsurgical Head and Neck Reconstruction.
        J Reconstr Microsurg. 2021; 37: 97-110
        • Shima H
        • von Luedinghausen M
        • Ohno K
        • et al.
        Anatomy of microvascular anastomosis in the neck.
        Plast Reconstr Surg. 1998; 101: 33-41
        • Mata JR
        • Mata FR
        • Souza MC
        • et al.
        Arrangement and prevalence of branches in the external carotid artery in humans.
        Ital J Anat Embryol. 2012; 117: 65-74
        • Devadas D
        • Pillay M
        • Sukumaran TT.
        A cadaveric study on variations in branching pattern of external carotid artery.
        Anat Cell Biol. 2018; 51: 225-231
        • Sakamoto Y.
        Gross anatomical observations of attachments of the middle pharyngeal constrictor.
        Clin Anat. 2014; 27: 603-609
        • Tubbs RS
        • Rasmussen M
        • Loukas M
        • et al.
        Three nearly forgotten anatomical triangles of the neck: triangles of Beclard, Lesser and Pirogoff and their potential applications in surgical dissection of the neck.
        Surg Radiol Anat. 2011; 33: 53-57
        • Lopez R
        • Lauwers F
        • Paoli JR
        • et al.
        Vascular territories of the tongue: anatomical study and clinical applications.
        Surg Radiol Anat. 2007; 29: 239-244
        • Iwanaga J
        • Choi PJ
        • Vetter M
        • et al.
        Anatomical study of the lingual nerve and inferior alveolar nerve in the pterygomandibular space: Complications of the inferior alveolar nerve block.
        Cureus. 2018; 10: e3109
        • Sittitavornwong S
        • Babston M
        • Denson D
        • et al.
        Clinical anatomy of the lingual nerve: A review.
        J Oral Maxillofac Surg. 2017; 75 (926 e921-926 e929)
        • Behnia H
        • Kheradvar A
        • Shahrokhi M.
        An anatomic study of the lingual nerve in the third molar region.
        J Oral Maxillofac Surg. 2000; 58 (discussion 652-643): 649-651
        • Kikuta S
        • Iwanaga J
        • Kusukawa J
        • et al.
        An anatomical study of the lingual nerve in the lower third molar area.
        Anat Cell Biol. 2019; 52: 140-142
        • Al-Amery SM
        • Nambiar P
        • Naidu M
        • et al.
        Variation in Lingual Nerve Course: A Human Cadaveric Study.
        PLoS One. 2016; 11e0162773
        • Kim SY
        • Hu KS
        • Chung IH
        • et al.
        Topographic anatomy of the lingual nerve and variations in communication pattern of the mandibular nerve branches.
        Surg Radiol Anat. 2004; 26: 128-135
        • Iwai T
        • Sugiyama S
        • Oguri S
        • et al.
        Anatomical Relationship Between the Lingual Nerve and Submandibular Duct.
        J Craniofac Surg. 2022; 33: 949-950
        • Iwanaga J
        • Cleveland MK
        • Wada J
        • et al.
        How to avoid iatrogenic lingual nerve injury in the retromolar area: an anatomical study of retromolar pad and lingual nerve.
        Surg Radiol Anat. 2020; 42: 523-528
        • Rusu MC
        • Nimigean V
        • Podoleanu L
        • et al.
        Details of the intralingual topography and morphology of the lingual nerve.
        Int J Oral Maxillofac Surg. 2008; 37: 835-839
        • Iaconetta G
        • Solari D
        • Villa A
        • et al.
        The Hypoglossal Nerve: Anatomical Study of Its Entire Course.
        World Neurosurg. 2018; 109: e486-e492
        • Salame K
        • Masharawi Y
        • Rochkind S
        • et al.
        Surgical anatomy of the cervical segment of the hypoglossal nerve.
        Clin Anat. 2006; 19: 37-43
        • Nathan H
        • Levy J.
        The course and relations of the hypoglossal nerve and the occipital artery.
        Am J Otolaryngol. 1982; 3: 128-132