Lateral Tongue Research Articles

Ansa Cervicalis Stimulation Effects on Upper Airway Patency: A Structure-Based Analysis.

Ansa cervicalis stimulation (ACS) of the infrahyoid muscles has been proposed as a neurostimulation therapy for obstructive sleep apnea (OSA). ACS stabilizes the pharynx by pulling it caudally, but its specific effects on flow limitation caused by palatal, oropharyngeal lateral wall, tongue base, or epiglottis collapse remains unclear. To quantify the effect of ACS on collapsibility of different pharyngeal flow-limiting structures. Participants with OSA underwent bilateral ACS during drug-induced sleep endoscopy. Maximum inspiratory airflow was assessed over a range of positive airway pressures while ACS was applied. The flow-limiting structure for each breath was classified based on manometric and endoscopic findings and a linear mixed-effects model characterized their response to ACS. The influence of patient characteristics was explored with univariate models. Forty-one participants yielded 1761 breaths for analysis. On average, bilateral ACS decreased the observed pharyngeal critical closing (PCRIT) and opening (POPEN) pressures by -3.0 [95% confidence interval: [-3.6, -2.3] and -3.7 [-4.4, -3.0] cmH2O, respectively (p<0.001). During tongue base obstruction, modeled ACS effects for PCRIT and POPEN were -2.0 [-2.7, -1.4] and -3.1 [-3.8, -2.4] cmH2O, respectively (p<0.001). Greater reductions were generally observed for other flow-limiting structures. A lower apnea-hypopnea index was associated with a greater decrease in POPEN (p<0.01). Other patient characteristics, including body mass index, did not influence PCRIT or POPEN (p>0.05). Bilateral ACS decreased collapsibility of all airway flow-limiting structures. ACS generally had greater effects on palatal, oropharyngeal lateral wall, and epiglottic collapse than the tongue base.

The Tongue Flap and Reconstruction of the Oral Defect: Our Experience

The tongue flap has proven to be a reliable and easily obtained local flap in oral defects repair surgery. We have different types of the tongue flap; lateral tongue flap with proximal pedicle, and with distal pedicle; dorsal tongue flap anterior and posterior; ventral tongue flap. The use of the tongue flap requires a first intervention, coverage of substance loss; and in the second intervention, flap withdrawal.

Imaging Biomarkers of Oral Dysplasia and Carcinoma Measured with In Vivo Endoscopic Optical Coherence Tomography.

Optical coherence tomography is a noninvasive imaging technique that provides three-dimensional visualization of subsurface tissue structures. OCT has been proposed and explored in the literature as a tool to assess oral cancer status, select biopsy sites, or identify surgical margins. Our endoscopic OCT device can generate widefield (centimeters long) imaging of lesions at any location in the oral cavity-but it is challenging for raters to quantitatively assess and score large volumes of data. Leveraging a previously developed epithelial segmentation network, this work develops quantifiable biomarkers that provide direct measurements of tissue properties in three dimensions. We hypothesize that features related to morphology, tissue attenuation, and contrast between tissue layers will be able to provide a quantitative assessment of disease status (dysplasia through carcinoma). This work retrospectively assesses seven biomarkers on a lesion-contralateral matched OCT dataset of the lateral and ventral tongue (40 patients, 70 sites). Epithelial depth and loss of epithelial-stromal boundary visualization provide the strongest discrimination between disease states. The stroma optical attenuation coefficient provides a distinction between benign lesions from dysplasia and carcinoma. The stratification biomarkers visualize subsurface changes, which provides potential for future utility in biopsy site selection or treatment margin delineation.

Mucinous Adenocarcinoma of The Lateral Tongue with Benign Clinical Appearance: A Diagnostic Challenge

Mucinous Adenocarcinoma of The Lateral Tongue with Benign Clinical Appearance: A Diagnostic Challenge

&lt;b&gt;Treatment of lingual nerve paresthesia through photobiomodulation therapy: a case report employing an approach integrating extraoral and intraoral modalities&lt;/b&gt;

Aims: Oral nerve injuries are the primary cause of paresthesia in the head and neck regions. To report the managing of a combined protocol involving extraoral and intraoral photobiomodulation (PBM) therapy for lingual nerve paresthesia. Case report: A 38-year-old female patient underwent 25 PBM sessions using laser with dual wavelength infrared (810nm + 980 nm). The extraoral application included 6 seconds and 6J per point. per point, 1W, 4.91 cm², 1.2 J/cm. The intraoral protocol with 0.3W of power, a spot size of 0.38 cm², 15.78 J/cm² of energy density, 6J of energy per point, for 20 seconds. Results: Assessment of neurosensitivity on the dorsum of the tongue was a 75% improvement. On the lateral tongue improved to 50%. In the floor of the mouth, PBM demonstrated a 25% improvement. Conclusion: PBM is an important treatment option in the case of lingual nerve paresthesia. The use of PBM should be considered as a feasible, non-invasive treatment approach.

Verrucous carcinoma on lateral tongue in association with oral submucous fibrosis: A rare case report

Oral verrucous carcinoma (VC) is a rare tumor, which a clinical variant of well differentiated oral squamous cell carcinoma characterized by exophytic growth or cauliflower like growth in appearance. It establishes in older individuals, who has habit of chronic tobacco chewing and predominance in males. Oral submucous fibrosis (OSMF) is a chronic, insidious, potentially malignant disorder associated with betel nut chewing habit. The development of oral squamous cell carcinoma (OSCC) is seen in one-third of the OSMF patients, but the development of VC is rarely seen in such patients. In the literature a very few cases of OSMF with VC are reported. Here, we present such a rare case in a 25 years old female patient with VC in conjunction with OSMF.

Oral mucosa - an examination map for confocal laser endomicroscopy within the oral cavity: an experimental clinical study

ObjectivesConfocal laser endomicroscopy (CLE) is an optical method that enables microscopic visualization of oral mucosa. Previous studies have shown that it is possible to differentiate between physiological and malignant oral mucosa. However, differences in mucosal architecture were not taken into account. The objective was to map the different oral mucosal morphologies and to establish a “CLE map” of physiological mucosa as baseline for further application of this powerful technology.Materials and methodsThe CLE database consisted of 27 patients. The following spots were examined: (1) upper lip (intraoral) (2) alveolar ridge (3) lateral tongue (4) floor of the mouth (5) hard palate (6) intercalary line. All sequences were examined by two CLE experts for morphological differences and video quality.ResultsAnalysis revealed clear differences in image quality and possibility of depicting tissue morphologies between the various localizations of oral mucosa: imaging of the alveolar ridge and hard palate showed visually most discriminative tissue morphology. Labial mucosa was also visualized well using CLE. Here, typical morphological features such as uniform cells with regular intercellular gaps and vessels could be clearly depicted. Image generation and evaluation was particularly difficult in the area of the buccal mucosa, the lateral tongue and the floor of the mouth.ConclusionA physiological “CLE map” for the entire oral cavity could be created for the first time.Clinical relevanceThis will make it possible to take into account the existing physiological morphological features when differentiating between normal mucosa and oral squamous cell carcinoma in future work.

Plausible mechanisms in malignisation of non-habit related chronic nonhealing traumatic ulcers of oral cavity.

Chronic nonhealing ulcers of the oral mucosa and lateral tongue, in particular, can transform into invasive oral squamous cell carcinoma (OSCC). Sometimes these ulcers do not heal even after the removal of the etiological agent that actually initiated these lesions, something similar to what happens in "neoplasia." Numerous factors have been postulated in the literature; however, the exact mechanism remains unclear. We hereby would suggest few plausible factors that could be considered for future studies to shed light on some untapped territories in the pathogenesis of OSCC arising from chronic nonhealing traumatic ulcers in purview of chromoanagenesis and the concepts of "quantum entanglement and coherence."

Progressive loss of upper limb function as a presenting feature of glenohumoral metastasis from a primary tongue malignancy

Skeletal distant metastasis occurs rarely in head and neck squamous cell carcinoma. Palliative chemo or radio-therapy, immunotherapy or surgical treatment are indicated depending on the site, number of bony metastases and performance score of the patient; however with guarded prognosis. Due to the high mortality of patients with distant metastasis, early detection by imaging and identification of biomarkers can aid in prognostication and treatment planning.This paper describes a rare occurrence of shoulder skeletal metastasis in two patients who underwent initial definitive surgery followed by adjuvant therapy for lateral tongue squamous cell carcinoma.

Tongue bracing robustness under perturbation: Comparison of L1 versus L2 speech with and without bite-block

Lateral tongue bracing is a universal speech posture observed across many languages [Gick et al., 2017, JSLHR 60; Liu et al., 2022, JIPA, Phonetica 79]. Previous work has found that under perturbation by 10 mm bite-blocks, there is less lateral contact during a speaker’s L2 speech compared to their L1 speech [Bengtson et al., 2023, J. Acoust. Soc. Am. 154]. However, the research did not investigate lateral contact without bite-blocks and the effect of this perturbation on posture remains unclear. The present study addresses this by comparing a speaker’s L1 and L2 speech both with and without bite-block perturbation, with the hypothesis that posture during speech movement is more robustly maintained under perturbation with more language experience. Participants will read two short texts in their L1 and L2 separately, both with and without 10 mm bite-blocks, and F1/F2 of cardinal vowels will be compared between bite-block conditions for each language. L2 proficiency will be collected for each participant and results will be reported with relevance to posture and speech movement coordination for L1 versus L2, with implications discussed for proficiency. [Work supported by NSERC].

Quantification of oxygen consumption in head and neck cancer using fluorescent sensor foil technology.

Head and neck squamous cell carcinoma (HNSCC) patients suffer from frequent local recurrences that negatively impact on prognosis. Hence, distinguishing tumor and normal tissue is of clinical importance as it may improve the detection of residual tumor tissue in surgical resection margins and during imaging-based surgery planning. Differences in O2 consumption (OC) can be used to this aim, as they provide options for improved surgical, image-guided approaches. In the present study, the potential of a fluorescent sensor foil-based technology to quantify OC in HNSCC was evaluated in an in vitro 3D model and in situ in patients. In vitro measurements of OC using hypopharyngeal and esophageal cell lines allowed a specific detection of tumor cell spheroids embedded together with cancer-associated fibroblasts in type I collagen extracellular matrix down to a diameter of 440 µm. Pre-surgery in situ measurements were conducted with a handheld recording device and sensor foils with an oxygen permeable membrane and immobilized O2-reactive fluorescent dyes. Lateral tongue carcinoma and carcinoma of the floor of the mouth were chosen for analysis owing to their facilitated accessibility. OC was evaluated over a time span of 60 seconds and was significantly higher in tumor tissue compared to healthy mucosa in the vicinity of the tumor. Hence, OC quantification using fluorescent sensor foil-based technology is a relevant parameter for the differentiation of tumor tissue of the head and neck region and may support surgery planning.

A case report on the simultaneous occurrence of cancer in The Tongue and Breast

Squamous cell carcinoma (SCC) affecting the tongue commonly emerges along its lateral border, yet occurrences specifically on the dorsum, especially at the midline, are notably rare. This study delves into the incidence rates of SCC localized on the tongue, alongside an investigation into simultaneous lesions of the breast. 50-year-old female presented with an ulcerative growth on the left side of the tongue, accompanied by speech difficulty and chewing discomfort persisting for a month. Previous history included breast surgery five years prior, along with ongoing diabetes medication. No history of habits, trauma, or prior ulcer formation was reported. Clinical examination revealed a whitish-yellow, firm, ulcerative lesion extending on the left lateral tongue surface, measuring 7.2x3.1x2.5cm with an exophytic growth of 4.7x2.1cm. The lesion, extending to the dorsal tongue surface, displayed erythematous flooring interspersed with slough and pale mucosa. Limited tongue movement and palpable submandibular nodes were noted. Initial diagnostic findings indicated stage IV metastatic carcinoma of the tongue (T4aN2M1). pathology revealed severe epithelial dysplasia with an invasive pattern in the form of islands, demonstrating altered cellular features, pleomorphism, inflammatory infiltrate, vascularity, and areas of hemorrhage. Lymph nodal analysis showed metastatic deposits in one of three left level II B lymph nodes.

Single-Stage Peninsular-Shaped Lateral Tongue Flap for Personalized Reconstruction of Various Small- to Moderate-Sized Intraoral Defects: A Retrospective Case Series with Tongue Function Evaluation Using the Functional Intraoral Glasgow Scale.

Herein, we present our experience using a single-stage peninsular-shaped lateral tongue flap (pLTF) to cover various intraoral defects and confirm the versatile utility and effective application of pLTF in intraoral defect reconstruction. This study included eight cases (six males and two females; average age 60.3 ± 16.9 years) of intraoral defect reconstruction performed by a single surgeon between August 2020 and May 2023 using the single-stage pLTF technique. Electronic medical records and photographs of the patients were collected and analyzed. The functional intraoral Glasgow scale (FIGS) was used to evaluate preoperative and postoperative tongue function. Defect sizes ranged from 3 cm × 3 cm to 4 cm × 6 cm. Notably, all defects were successfully covered with pLTFs, and the flap sizes ranged between 3 cm × 4.5 cm and 4.5 cm × 7.5 cm. The flaps completely survived without any postoperative complications. At follow-up (average, 9.87 ± 2.74 months), no patient had tumor recurrence or significant tongue functional deficits. The mean preoperative and postoperative FIGS were 14.75 ± 0.46 and 14.00 ± 0.92, respectively (p = 0.059). Thus, the single-stage pLTF technique is a good reconstructive modality for various small to moderate intraoral defect coverage in selected cases for personalized intraoral reconstruction.

Abstract 14918: Apical Cardiomyopathy in a Transplanted Heart

Case description: A 67 year old female presented for annual review to the transplant clinic 4 years post orthotopic heart transplant for nonischemic dilated cardiomyopathy. She was asymptomatic. Her medical history included hypothyroidism, hypertension, osteoporosis, restless leg syndrome and calcineurin inhibitor related complications - CKD 3b, impaired glucose tolerance and a left partial glossectomy with neck dissection for stage 3 SCC of the left lateral tongue. Medications included aspirin, atorvastatin, prednisolone, tacrolimus, septrin and ropinirole. Family history was significant for heart failure in her father. She was a nonsmoker and did not consume alcohol. Physical examination was unremarkable. Diagnostic tests are shown below. Discussion: Apical hypertrophic cardiomyopathy (ApHCM) has rarely been described in post cardiac transplant populations. Characterized by increased left ventricular apical wall thickness, it results in a ‘spade-like’ appearance on imaging and is associated with marked T wave inversion on ECG. ApHCM is associated with progression to heart failure, apical aneurysm, ventricular arrhythmias and increased mortality rates. Patients may be asymptomatic at diagnosis. Regarding screening, criteria exist for the selection of donor hearts pre transplant with caution exercised if LVH &gt;13mm. Causes of non HCM hypertrophy in this population include calcineurin inhibitors, hypertension, obesity and graft versus host disease. Data for treatment for ApHCM is lacking however it follows the path of classical HCM, involving the use of beta and calcium channel blockers to reduce demand ischemia and management of sequelae.

Defining Epiglottic Collapses Patterns in Obstructive Sleep Apnea Patients: Francia-Lugo Classification

Obstructive Sleep Apnea (OSA) is characterized by repetitive collapse of the upper airway during sleep. Drug-Induced Sleep endoscopy (DISE) is used to identify the collapse site. Among the possible sites of collapse, the epiglottis occurs more frequently than previously described. In this study, we reviewed DISE findings and classified different epiglottic collapse patterns. We found 104 patients (16.4%) with epiglottis collapse (primary 12.5% and secondary 3.9%). We described the following patterns of epiglottis collapse: Anterior–Posterior (AP) collapse with rigid component “trapdoor type” (48%); AP collapse with lax component “floppy type” (13.5%); Lateral– Lateral (LL) collapse with omega shape component “book type” (14.5%); and secondary due to lateral pharyngeal wall or tongue base collapse (24%). The identification of the epiglottic collapse pattern is crucial in decision-making when attempting to ameliorate OSA. These findings in OSA phenotyping could influence the type of treatment chosen.

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Robustness of lateral tongue bracing in second language speech

Lateral tongue bracing, a universal speech posture, is an actively maintained robust position, akin to standing and locomotion [Gick et al., 2017, JSLHR 60; Liu et al., 2022, JIPA, Phonetica 79]. Studying the robustness of bracing in second-language (L2) speakers can provide insight into learning of speech posture. In this study, we investigate the extent to which speaking in a second language affects the robustness of lateral tongue bracing compared to first language (L1) speech. Participants read two short texts, one in their native language and one in their second language, under a 10 mm bite-block condition. Intra-oral videos are analyzed for the percentage of time bracing occurred in continuous speech. Our preliminary results showed a decrease in the overall percentage of lateral contact during L2 continuous speech compared to L1. These insights invite a reassessment of our existing parallel posture model. We suggest adapting this model to account for the cognitive demands of L2, and the possible role of learning language-specific articulatory settings in postural robustness for L2 speakers.

Deep bite -An insight

Deep bite is one of the most common malocclusion which affects children and even adults leading to a number of oral health problems. Patients with deep bite encounter periodontal and temporomandibular problems. Deep overbite refers to the increase of overlap of maxillary incisors over mandibular incisors beyond normal coverage of 30-40%. There are many factors which lead to the development of deep bite like inherent and acquired factors. Inherent factors like tooth morphology, skeletal patterns, rotation of condyle affects the bite. Acquired factors like muscle habits, loss of posterior tooth support or lateral tongue thrust may affect the bite. Deep bite can be corrected by number of different methods which include intrusion of anterior teeth, extrusion of posterior teeth or a combination of both. In non-growing patients surgical treatment is a suitable option to achieve stable results.This article describes various appliances and their biomechanics involved for correcting deepbite malocclusion

Fluorescent Guided Sentinel Lymph Mapping of the Oral Cavity with Fluorescent-Labeled Tilmanocept.

With the shift toward utilization of sentinel lymph node biopsy (SLNB) in oral cavity cancer, improved techniques for intraoperative sentinel node identification are needed. This study investigates the feasibility of fluorescently labeled tilmanoscept in SLNB in an oral cancer rabbit model. An animal study was designed using 21 healthy male New Zealand rabbits. Gallium-68-labeled tilmanocept labeled with IRDye800CW was injected submucosally into the buccal mucosa (n = 6) or lateral tongue (n = 7) followed by PET imaging. One hour after injection, SLNB was performed using fluorescence imaging followed by a bilateral neck dissection and sampling of non-nodal surrounding tissue. All tissues were measured for radioactivity and fluorescence. In addition, eight rabbits were injected with delayed SLNB performed 48 h after injection. Buccal injections all had ipsilateral SLN drainage and tongue injections exhibited 18.2% contralateral drainage. An average of 1.9 ± 1.0 SLN (range 1-5) were identified. In addition, an average of 16.9 ± 3.3 non-sentinel lymph nodes were removed per animal. SLNs had an average of 0.69 ± 0.60 percent-of-injected dose (%ID) compared with non-sentinel nodes with 0.012 ± 0.025 %ID and surrounding tissue with 0.0067 ± 0.015 %ID. There was 98.0% agreement between sentinel lymph nodes identified using fluorescence compared to radioactivity with Cohen's kappa coefficient of 0.879. In 48-h delayed SLNB, results were consistent with 97.8% agreement with radioactivity and Cohen's Kappa coefficient of 0.884. Fluorescence identified additional lymph nodes that were not identified by radioactivity, and with one false negative. Fluorescent-labeled Tc-99 m-tilmanocept represents a highly accurate adjunct to enhance SLNB for oral cavity cancer. N/A Laryngoscope, 134:1299-1307, 2024.

3D hyoid and tongue kinematics reveal mechanism of tongue base retraction during swallowing in Didelphis virginiana

In anthropoid primates, tongue base retraction (TBR) is a key event for airway protection and bolus propulsion during swallowing. In macaques, hyoid protraction and elevation during swallowing reduce the oral volume and squeeze the tongue base to retract. This novel hyoid-powered hydraulic TBR mechanism implies that the morphology and position of the hyoid are functionally relevant for TBR performance. However, macaque’s highly derived craniofacial and hyoid morphology precludes inference on the evolutionary history and driving mechanism of TBR across mammal phylogeny at large. Here we use biplanar videoradiography and the XROMM workflow to infer TBR mechanism in Didelphis virginiana through high-resolution 3D hyolingual kinematics. Similar to macaques, Didelphis has an incomplete hyoid cornu, which would enable a large hyoid range of motion that facilitates oral volume reduction. Unlike macaques, Didelphis hyoid has a more posteriorly resting hyoid position. We predict that TBR will occur in Didelphis through a similar hyoid-powered hydraulic mechanism. We find Didelphis deploys TBR during the first opening (O1) phase (liquid) or slow-open phase (solid) of jaw cycle with retraction and elevation of midline posterior tongue markers. Minimal retraction occurs in lateral tongue markers where extrinsic lingual muscles insert. The tongue base and posterior tongue are lengthening, narrowing and increasing in height during TBR, consistent with predictions based on muscular hydrostat model. The tongue base was not isovolumetric during TBR, but the volume change was orders of magnitude smaller than that observed in macaques. Hyoid protraction and elevation occur before and continue throughout TBR, which strongly suggest concurrent reduction of oral volume as well. Our preliminary data suggest the TBR mechanism in opossums may differ in important ways from that utilized by macaques, where opossums could employ a combination of hydrostatic deformation and hydraulic mechanism to drive retraction of tongue base. We provide novel insights into the conservation of TBR across therian mammals and extend our understanding on the form-function relationships between the hyolingual apparatus and swallowing biomechanics. Hinds Fund, University of Chicago This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.