Unilateral paralysis of the tongue results in deflection to the affected side when the organ is protruded. Complete paralysis of the tongue, which is generally due to a central lesion, produces rapid atrophy and difficulty in swallowing. In the second stage of anesthesia the tongue frequently tends to fall back, pushing down the epiglottis over the trachea. In such cases pushing forward the angle of the jaw is frequently effective, acting, as it does, on the extrinsic and accessory muscles of the tongue.
In addition to simple pyogenic ulcers, which occur on the mucous membrane of the tongue and lips, the tongue is affected by tubercular, syphilitic, and carcinomatous ulcers. The syphilitic ulcers generalty affect the dorsum, and can be comparatively easily differentiated, whereas tubercular and epitheliomatous ulcers generally affect the margin, are not always easy of differentiation, and generally demand excision of the tongue. Tubercular ulcers, however, are not so common as carcinomatous, and affect generally younger subjects. As a carcinomatous growth increases in size it tends to spread to the floor of the mouth, tonsil, etc. Pain over the anterior two-thirds, supplied by the lingual nerve, and salivation are generally pronounced in advanced cases, and to relieve these section of the lingual nerve has been done. Hemorrhage, also, is sometimes serious. In excising the tongue it is generally well to begin by ligaturing both lingual arteries in the neck, and, at the same time, to remove the submaxillary salivary gland on the affected side, as it contains numerous lymphatic glands, which are generally involved at an early stage, and any other lymphatic glands in the submaxillary region, while, if necessary, by prolonging the posterior end of the wound upwards and backwards, the internal jugular and the glands surrounding it may be exposed. The facial artery is almost necessarily cut if this be done. The mylo-hyoid muscles may next be cut through, and then the mucous membrane of the floor of the mouth, taking care to cut it close to the jaw on the diseased side. The two wounds in the neck are then packed with iodoform gauze. The tongue can now be drawn well forward in the mouth, and divided as far back as possible, care being taken to pass a stitch through the stump to prevent its falling back upon the epiglottis, and, with the same end in view, it is generally desirable to leave the genio-hyoids and genio-hyo-glossi intact on at least one side. The tongue has also been removed, after dividing the lower jaw, and by cutting out from the mouth by ecraseur, or scissors, without previous ligature of the lingual.
The palate separates the buccal from the nasal cavities, and consists of two parts-hard and soft. The hard palate is formed by the palatal processes of the superior maxillary and palate bones, which present at their junction in the middle line the palatal crest, while the premaxillary bone forms the portion in the centre, anterior to the anterior palatine canal, which bears the upper incisor teeth. The anterior palatine canal transmits the naso-palatine nerves. The hard palate becomes thinner posteriorly, and presents the posterior nasal spine projecting backwards from it. The posterior palatine canal, which transmits the vessels of that name (from internal maxillary), and the anterior palatine nerve (from Meckel's ganglion), is situated at the postero-external angle of the hard palate just inside the alveolus of the wisdom tooth. The hard palate is covered by a firm muco-periosteum, bound together by a quantity of connective tissue, which contains numerous mucous glands. It is nourished by the posterior palatine vessels, which run forward close to the bone to the anterior palatine foramen. The arch of the palate varies considerably in different individuals, and is said to be very high in congenital idiots. The soft palate is continued backwards from the posterior end of the hard palate, and consists anteriorly of a firm aponeurosis covered by mucous membrane, while posteriorly it contains muscles, etc., and is very movable. Its posterior free border presents two arches, folds of mucous membrane-the pillars of the fauces-on either side surrounding the isthmus of the fauces or entrance to the pharynx. The anterior pillar contains the palato-glossi muscles and fuses with the dorsal aspect of the tongue, and the posterior contains the palato-pharyngei muscles and fuses with the pharyngeal wall. Between the pillars of the fauces the tonsils aie lodged. Where the soft palate is cleft, the cleft is narrowed in swallowing by the superior constrictor. The levator palati and tensor palati muscles, on the other hand, arise near together from the Eustachian tube, and tend to widen it. The former passes down and inwards into the palate, while the latter descends to the hamular process (which is situated behind and to the inner side of the wisdom tooth), round which its tendon turns to run inwards. The soft palate derives its blood-supply from the posterior palatine of the internal maxillary and the ascending palatine of the facial, which latter accompanies the levator palati to the soft palate, and is cut in operations dividing that muscle. The palate itself is enervated by palatine branches from Meckel's ganglion, while the tensor palati is supplied by the third division of the fifth through the otic ganglion, and the levator palati, palato-pharyngei, and palato-glossi and azygos uvulae by the eleventh through the pharyngeal plexus.
Cleft palate consists of a median cleft, which may vary from a bifid uvula to a complete separation, involving both soft and hard palates, and extending up to the premaxilla. Complete cases may be either uni- or bilateral, the nasal septum frequently fusing with one side in the former. When the cleft is quite complete, it generally passes on either side of the premaxilla, which then projects forwards, the condition being usually associated with double hare-lip. It is well to note, however, that the "anterior extremity of the cleft generally does not run between the lateral incisor and canine, but between the central and lateral incisors, owing to a want of union between the two centres of which each lateral mass of the premaxilla is composed (the central or central incisor portion being called the endo-gnathion, and the lateral the meso-gnathion, while the rest of the maxilla is called the exo-gnathion). Sometimes this splitting involves the tooth germ of the lateral incisor, a supernumerary incisor being produced.
The height of the arch of the palate is of importance in some cases where an osteoplastic flap is used to remedy the condition, those cases presenting a high arch being the more hopeful. Sometimes a muco-periosteal flap is taken. The operation, where the hard palate is involved, is called uranoplasty, and in either case the incision is made close to the alveolar border and not extended as far back as the position of the wisdom tooth, so as to preserve the blood-supply.
Staphylorrhaphy is the refreshing and bringing together of the edges of a cleft of the soft palate. In such cases it is frequently necessary to divide the tensor and levator palati muscles in order to relax the parts, and this may be done by a lateral cut with scissors parallel to the cleft (Bryant), or by introducing a narrow-bladed knife, with the edge upwards, in front and to the inside of the hamular process till the point presents at the upper part of the cleft, which cuts the tensor, and then on withdrawing it cuts the levator posteriorly (Pollock). In Ferguson's method a knife with the blade at right angles to the handle is passed up through the cleft, and the levator cut on the posterior surface of the palate, the tensor being left intact.