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IntroductionNormal Tongue AnatomyRecommended Imaging ApproachImaging Features of LesionsSurgical ManagementSummaryWhat makes the head and neck region so challenging and interesting is its compact geography of small but important structures Assessment of the head and neck is greatly aided by the generation of differential diagnoses using subdivision of the anatomy into spaces along identifiable and logical boundaries Tailored spacespecific differential diagnoses can be formulated by recalling the anatomic contents of the spaces The root of the tongue is an important subregion of the oral cavity associated with very specific differential diagnoses It is relatively resistant to primary neoplastic and infectious processes due to its high percentage of skeletal muscle and lack of significant lymphatic tissue (1) In contrast many acquired lesions are found within adjacent regions such as the base of the tongue and the sublingual and submandibular spaces Squamous cell carcinoma invariably invades the deep tongue from adjacent mucosal surfaces of the oral cavity and anterior oropharynx and doe The tongue is a complex of muscle groups with a fibrous scaffold consisting of the hyoglossal membrane and midline lingual septum The musculature of the tongue is separated into intrinsic and extrinsic groups The intrinsic muscles comprise most of the mobile tongue and are named for their orientation vertical transverse inferior longitudinal and superior longitudinal They provide the mobile tongue with a wide range of motion The extrinsic muscles include the genioglossus geniohyoid hyoglossus styloglossus and palatoglossus muscles These muscles are responsible for the raising and lowering as well as the forward and backward motion of the tongue as a unit The hyoglossal membrane anchors the inferior posterior edge of the tongue to the hyoid bone The lingual septum inserts into the hyoglossal membrane and extends superiorly along the midline of the tongue (Figs 1–3) It divides the tongue into halves and provides attachments for the transverse intrinsic muscles (45) Many of the congenital lesions in the root of the tongue are found in children These lesions are more frequently evaluated with MR imaging because it does not make use of ionizing radiation Moreover MR imaging provides excellent softtissue characterization which is important in the suprahyoid neck Diffusionweighted imaging may be useful for differentiating epidermoid from dermoid cysts since the former often show diffusion restriction Sedation is often required in children under 7 years of age although specific training and the use of audiovisual entertainment systems can significantly reduce this need (6) In adults the assessment of masses of the oral cavity and suprahyoid neck is often begun with CT due to its greater speed lower cost and wider availability With modern CT exceptional anatomic detail can be achieved and then reconstructed in other planes Adding an additional limited CT sequence with the gantry parallel to the angle of the mandible can significantly Lesions involving the root of the tongue can be classified into congenital vascular and nonvascular lesions infections and neoplasms (Table) Treatment of lesions involving the root of the tongue varies depending on the disease entity and the extent of the lesion Some lesions may be managed medically or even with observation Lingual thyroids may be managed with thyroid suppressive therapy and observation if they remain stable and asymptomatic (27) However many lesions involving the root of the tongue including some lingual thyroids require surgical management There are a variety of surgical approaches used to resect lesions involving the root of the tongue These approaches may be divided into transoral and transcervical approaches Classic transoral approaches were invasive and left the patient with significant morbidity An anterior midline labiomandibuloglossotomy involves an osteotomy of the mandible and division of the oral tongue along the lingual septum An alternative transoral approach is known as a mandibular swing in which the mandible is reflected laterally after osteotomy This approach allows access The root of the tongue is composed of bilateral genioglossusgeniohyoid muscle complexes and the midline lingual septum These structures play an important role in tongue mobility and provide support for the mobile tongue The root of the tongue is deep to the mobile tongue sublingual and submandibular spaces and base of the tongue It contains little mucosal surface or lymphatic tissue The location and composition of this area make it resistant to acquired lesions however a large majority of lesions are congenital Some specific lesion characteristics can help tailor the differential diagnosis Solid highdensity lesions in the midline are likely lingual thyroids These lesions may be verified with nuclear medicine imaging Calcifications may represent goiterous transformation Phleboliths are highly specific for venous malformations Multilocular thinrim enhancing cystic lesions are classic for lymphatic malformations especially if fluidfluid levels are found Fat within Author Wayne S Fang Richard H Wiggins Anna Illner Bronwyn E Hamilton Gary L Hedlund Jason P HuntCited by Publish Year 2011.