Lingual Function Research Articles

Correlation between altered lingual function and speech disturbances  

Correlation between altered lingual function and speech disturbances  

Device-Assisted Therapy for Lingual Function Rehabilitation: A “How To” Guide for Clinicians

Purpose:Lingual function rehabilitation is a frequently targeted area of exercise-based dysphagia treatment. This tutorial aims to provide a detailed guideline for clinicians on how to apply currently available evidence for implementation of lingual rehabilitation exercises both with and without device-assisted modalities.Method:We provide a detailed review of existing definitions of lingual function parameters (e.g., strength and endurance) with currently available normative values for clinical reference. Guidelines are also provided on how to use available lingual manometry (Iowa Oral Performance Instrument and Tongueometer) to aid in both assessment and treatment. With respect to determining exercise targets based on the lingual function assessment, we review the importance of leveraging principles of exercise physiology into the rehabilitation planning. Strategies for incorporating exercise physiology principles into strength and endurance training are provided along with a case example illustrating these concepts.Conclusions:This tutorial serves as a framework for clinical implementation of comprehensive lingual function assessment and rehabilitation. Considerations regarding barriers in access to equipment and clinical advocacy are also discussed.

The Function of the Mammal Extrinsic Tongue Musculature in the Transition from Suckling to Drinking.

The transition from suckling to drinking is a developmental pathway that all mammals take. In both behaviors, the tongue is the primary structure involved in acquiring, transporting, and swallowing the liquid. However, the two processes are fundamentally different: during suckling, the tongue must function as a pump to generate suction to move milk, whereas during drinking, the tongue moves backwards and forwards through the mouth to acquire and move water. Despite these fundamental differences, we have little understanding of how tongues role varies between these behaviors. We used an infant pig model to investigate the relationships between anatomy, physiology, and function of the tongue to examine how lingual function is modulated in the transition from infancy to adulthood. We found that while some muscles were proportionally largest at birth, others were proportionally larger at the time of weaning. Furthermore, we found variation in tongue movements between suckling and drinking along both the mediolateral and anteroposterior axes, resulting in differences in tongue deformation between the two behaviors. The extrinsic tongue muscles also changed in function differently between drinking and suckling. Genioglossus increased its activity and turned on and off earlier in the cycle during drinking, whereas hyoglossus fired at lower amplitudes during drinking, and turned on and off later in the cycle. Together, the data highlight the significant need for high neuroplasticity in the control of the tongue at a young age in mammals and suggest that the ability to do so is key in the ontogeny and evolution of feeding in these animals.

Effect of Tongue Thrust on Implants Integration

The human tongue is a muscular organ with a variety of life-important functions. Mastication and swallowing, taste, and speech are vital functions. From the analysis of the lingual function, clinical considerations during the oral-pharyngeal phase of swallowing, the tongue thrusts anteriorly and laterally, creating enormous pressure. If it applies to freshly inserted dental implants, it could be leading to early implant failure. Different authors have calculated this pressure between 20 and 200 kPa, depending on tongue volume, producing resultant torsion forces on implant abutment. The work aims to understand the importance of the destabilizing action of the tongue in the post-operative period. When the use of implants resting in quiescence for a long time under the gums is not possible, because of anatomical reasons (for example: thin ridge), or: immediate loading is planned, the action of the tongue must be considered. We are proposing some solutions to the problem to improve therapeutic safety: 1)Attach immediate provisional prostheses to existing adjacent teeth. 2)Immediately upon implants insertion, rigidly connect implants. 3)When an immediate loading protocol is implemented, the operator should follow the guideline, taking care to apply correctly balanced axial forces, without any lateral stress. Our professional experience, based on over 10.000 clinical cases performed during 35 years, confirms that, with implants emerging in the oral cavity, handling in proper way the tongue thrust during the healing period makes the difference. All what has been here implemented about this subject, represents the development of the legacy left by Prof. Ugo Pasqualini, an Italian dentist who, since the seventies, has been deepening the topic of the risks tied to the intra-oral stresses acting on the emerging part of the implants.

Exeresis of bilateral mandibular torus due to speech impairment – case report

Mandibular torus is a slow-growing bone exostosis with well-defined borders, usually oval and bilateral in shape. Diagnosis is made through clinical and radiographic findings. Surgical removal is necessary when there is a prosthetic indication, recurrent trauma, and in rare cases, due to phonetic disorders. The interference in speech caused by the torus, is due to its size and location, which interferes with the usual positioning of the tongue, changing the articulation points, and thus making pronunciation difficult. Therefore, the aim of this study is to report a clinical case of excision of a bilateral mandibular torus due to speech impairment. A 47-year-old male patient sought dental care complaining of bone growth in the mandible. The clinical examination showed a bilateral increase in the lingual region of the mandible, which was unilobular on the right side and trilobular on the left side, measuring approximately 20x20mm. The patient underwent a surgical procedure to remove the torus under local anesthesia. In the 7-day postoperative period, suture dehiscence was observed, as well as traumatic ulcers and pain complaints. The patient reported that he did not pay attention to postoperative care. As a method of treatment of suture dehiscence, a metronidazole paste was used, as well as a laser therapy protocol, ensuring soft tissue healing. After complete healing, in the clinical evaluation, the patient did not present difficulties in pronunciation. Therefore, it is concluded that, although uncommon, the torus, due to its growth, can interfere with the positioning of the tongue and, consequently, with phonetics, which is a plausible indication for the surgical procedure. Once, the normal bony contours of the mandible are re-established, as well as repositioning and lingual function.

Non-Instrumental Test for the Evaluation of Tongue Function.

The tongue undergoes various negative adaptations in the presence of local or systemic pathologies, adversely its behavior within the body context. Tongue assessments to correctly diagnose its functions are carried out using instrumentation, such as ultrasonography, magnetic resonance imaging, electromyography and different intraoral devices (swallowing, strength, posture, phonesis). Currently, there is no dynamic non-instrumental test in the scientific literature to highlight any lingual dysfunctions. The article describes a non-instrumental test for the assessment of lingual function in the body context, to obtain preliminary information on the quality of the neurological activities of the tongue, with respect to the balance and muscle strength that the patient expresses. The text briefly reviews the anatomy of the tongue and describes a clinical case to better understand how to use this test. Further studies will be needed for the validation of the test.

Two Distinct Clinical Phenotypes of Bulbar Motor Impairment in Amyotrophic Lateral Sclerosis.

Objective: Understanding clinical variants of motor neuron diseases such as amyotrophic lateral sclerosis (ALS) is critical for discovering disease mechanisms and across-patient differences in therapeutic response. The current work describes two clinical subgroups of patients with ALS that, despite similar levels of bulbar motor involvement, have disparate clinical and functional speech presentations.Methods: Participants included 47 healthy control speakers and 126 speakers with ALS. Participants with ALS were stratified into three clinical subgroups (i.e., bulbar asymptomatic, bulbar symptomatic high speech function, and bulbar symptomatic low speech function) based on clinical metrics of bulbar motor impairment. Acoustic and lip kinematic analytics were derived from each participant's recordings of reading samples and a rapid syllable repetition task. Group differences were reported on clinical scales of ALS and bulbar motor severity and on multiple speech measures.Results: The high and low speech-function subgroups were found to be similar on many of the dependent measures explored. However, these two groups were differentiated on the basis of an acoustic measure used as a proxy for tongue movement.Conclusion: This study supports the hypothesis that high and low speech-function subgroups do not differ solely in overall severity, but rather, constitute two distinct bulbar motor phenotypes. The findings suggest that the low speech-function group exhibited more global involvement of the bulbar muscles than the high speech-function group that had relatively intact lingual function. This work has implications for clinical measures used to grade bulbar motor involvement, suggesting that a single bulbar measure is inadequate for capturing differences among phenotypes.

LINGUAL BRAKE ANALYSIS AND EVALUATION IN CHILDREN IN THE AMAZON FACULTY - IAES

The lingual brake is an important structure for the musculoskeletal growth of the baby's jaws, inuencing the act of sucking, speaking and feeding. There is an alteration called ankyloglossia (Ankylos: Linked and Glossa: Tongue), dened as a congenital malformation that alters mobility and lingual function. Brake change occurs when a portion of the tissue that should have suffered apoptosis during embryonic development remains on the underside of the tongue, restricting its movement. The lingual brake is formed by a connective tissue rich in elastic bers, lined with nonkeratinized stratied paved epithelium, containing adipose cells, muscle bers and blood vessels. Any anatomical or functional brake deciency can have an impact on functions based on their severity. Its diagnosis is not difcult, as it is very visible and can be done through the "Tongue Test". Surgical removal of the brake is necessary when it causes gingival retraction, diastema, hindering orthodontic, speech therapist, prosthetic and aesthetic treatment. It is advisable to wait for the individual's growth process, especially between 6 months and 6 years of life. The treatment performed for this anomaly is the frenectomy, which consists in the complete removal of the brake insert. The objective of the present study was to conduct a research that evaluated the lingual brake of children, and the need for surgical treatment at the pediatric dentistry clinic at Amazon Faculty - IAES through a questionnaire. It was a cross-sectional, descriptive and observational study, which evaluated the lingual brake of children. Data were analyzed quantitatively and qualitatively using the statistical data program. The software used for data analysis was Epi Info version 7.2.2.6 for windows. It was concluded that of the 50 lingual brakes evaluated, 14% presented alteration, with a preference for females. It was clear the need for an early diagnosis, besides the need for a multidisciplinary team

Minimally invasive ethyl cellulose ethanol ablation in domesticated cats with naturally occurring head and neck cancers: Six cats.

It is difficult to retain tumoricidal doses of ethanol in large or unencapsulated tumours without causing intoxication or damaging surrounding tissue. Ethyl cellulose-ethanol ablation (ECEA) overcomes this limitation by trapping ethanol intratumorally. To evaluate the safety of ECEA and to develop a clinically feasible workflow, a single-arm pilot study was performed in cats with lingual/sublingual squamous cell carcinoma (SCC). Six cats underwent intratumoral injection of 6% ethyl cellulose in ethanol. Subjects were observed overnight. There was mild bleeding and transient hyperthermia, and injection site pain and swelling that improved with anti-inflammatory drugs. Serum ethanol was minimally elevated; the mean concentration peaked 1 hour after injection (129 +/- 15.1nM). Cats were rechecked at weeks 1 and 2; booster treatments were given in cats (n=3) with stable quality of life and partial response to therapy. Recheck examinations were then performed monthly. The longest tumour dimension increased in each animal (progressive disease via cRECIST); however, estimated tumour volume was reduced in 3 of 6 cats, within 1 week of ECEA. All cats were euthanized (median survival time 70 days) because of local tumour progression and/or lingual dysfunction that was likely hastened by ECEA. ECEA is not a viable treatment for feline lingual/sublingual SCC; tumour volume was effectively reduced in some cats, but the simultaneous loss of lingual function was poorly tolerated. Further optimization may make ECEA a useful option for SCC at other oral sites in the cat, and for head and neck malignancies in other species.

Tongue function characteristics in infants experiencing breastfeeding difficulties and changes in breastfeeding after frenotomy procedures

The aims of the study were to describe tongue function in infants experiencing breastfeeding difficulties and to examine changes in breastfeeding after frenotomy procedures. Mothers, and their infants, facing difficulties in breastfeeding were referred to the Vilnius University hospital Žalgirio clinic after assessment of breastfeeding quality by a lactation specialist. Anatomy evaluations included the type of ankyloglossia, tongue function, and the need for a frenotomy. All mothers completed the breastfeeding questionnaire twice, once during the referral consultation and 1month later. The total breastfeeding hindrance score was calculated before and after the frenotomy. Fifty infants were included in the study and their mean age was 29.6days (min age 1day and max 78days). The male to female ratio was 1.8:1.0. Of all infants, 70% had severe lingual function alterations and their mothers were facing issues in breastfeeding. After the frenotomy, there was a significant reduction in breastfeeding hindrance in infants who had disturbed function and aberrant anatomic characteristics. It was found that for type II ankyloglossia, the frenotomy procedure was significant more (p = 0.002) beneficial, than for type I ankyloglossia. After the frenotomy, there was a significant improvement in nine out of 14 criteria of breastfeeding (p = 0.001). Frenotomy procedures had a positive effect on improving breastfeeding. Current study analyses issues with breastfeeding. Dental practitioners and pediatricians should be familiar with this topic, as early and timely minimal invasive surgical intervention has a significant impact for better comfort of the mothers and continuation of breastfeeding.

Characterization of Dysphagia and Longitudinal Changes in Swallowing Function in Adults with Niemann-Pick Disease Type C Treated with Miglustat.

Niemann-Pick disease type C (NPC) is a rare, autosomal recessive neurodegenerative disease, characterized by progressive psychiatric and neurological deficits. Neurological symptoms include cognitive decline and dysphagia. Aspiration pneumonia secondary to dysphagia is a leading cause of death in NPC. Miglustat is currently the only approved disease-specific treatment shown to be effective in stabilizing neurological symptoms. Miglustat has previously been reported to halt or improve early dysphagia and cognitive symptoms. Here we examine the characteristics of dysphagia, the relationship between dysphagia and the presence of cognitive impairment, and longitudinal changes in swallowing function during miglustat treatment in adult-and-adolescent-onset NPC. Retrospective analysis of videofluoroscopic swallow studies (VFSS) was completed for ten adults with NPC (mean age 28.44 years ± 9.34 years). Participants were recruited through the Royal Melbourne Hospital in Australia between 2008 and 2015. The Bethlehem Swallowing Scale and the Penetration-Aspiration Scale were used to quantify VFSS data. Dysphagia was present in 90% of participants at baseline with reduced lingual function and a delayed swallowing reflex as the most common symptoms. Swallow impairment appeared to stabilize during miglustat therapy for periods up to 66 months, with no significant changes in scores (p > 0.05). Data were in accordance with the literature and support the use of miglustat as an efficacious treatment for reducing swallowing impairment and stabilizing cognitive function. Findings provide detailed information on the impairments experienced by patients, give context to events leading to aspiration in NPC and, importantly, inform how management of dysphagia can complement pharmaceutical treatment.

A case report of a long-term abandoned torn lingual nerve injury repaired by collagen nerve graft induced by lower third molar extraction

BackgroundThe lingual nerve plays an important role in multiple functions, including gustatory sensation and contact sensitivity and thermosensitivity. Misdiagnosed conservative treatments for serious lingual nerve (LN) injuries can induce the patient to serious mental disability. After continuous observation and critical diagnosis of the injury, in cases involving significant disruption of lingual nerve function, microneurosurgical reconstruction of the nerve is recommended. Direct anastomosis of the torn nerve ends without tension is the recommended approach. However, in cases that present significant gaps between the injured nerve ends, nerve grafts or conduits (tubes of various materials) are employed. Recently, various reconstruction materials for peripheral nerves were commercially offered especially in the USA, but the best method and material is still unclear in the world. There currently exists no conventional protocol for managing LN neurosensory deficiency in regard to optimal methods and the timing for surgical repair. In Japan, the allograft collagen nerve for peripheral nerves reconstruction was permitted in 2017, and we tried to use this allograft nerve and got a recommendable result.Case presentationThis report is a long-term abandoned torn LN reconstructed with allograft nerve induced by the lower third molar extraction.ConclusionsIn early sick period, with the exact diagnosis, the LN disturbance should be managed. In a serious condition, the reconstruction with allograft nerve is one of the recommendable methods.

TONGUE FUNCTION, SALIVARY FLOW RATE AND IgA, IgM AND IgG TOTAL SALIVARY LEVELS IN CHRONIC CHAGASIC PATIENTS

Although microscopic alterations have been detected in tongues and salivary glands of chagasic patients and the identification of biomarkers in saliva has proved advantageous, there are no studies evaluating tongue function and total salivary IgA, IgG and IgM levels in chronic chagasic patients. The aim of this study was to evaluate tongue function, salivary flow rate, and total salivary IgA, IgG and IgM levels comparing chronic and non-chronic chagasic individuals. 37 patients were selected: chronic cardiac chagasic patients (n=6), chronic chagasic patients with the associated form of the disease (cardiopathy and megaesophagus) (n=11), and nonchagasic individuals (n=20). The tongue function underwent a phonoaudiological evaluation.The salivary f low rate was measured by sialometry. The total salivary IgA, IgG and IgM levels were evaluated by sandwich ELISA assay. Chagasic patients with the associated form of the disease presented higher salivary flow rate and lower salivary protein levels. No significant differences were noted in the lingual function or in the total salivary immunoglobulin levels among the groups. Although patients with chagasic megaesophagus presented higher levels of salivary flow and lower salivary protein, the fact that there were no significant differencesin lingual function and total salivary immunoglobulin levels among the groups led to the conclusion that chronic chagas disease does not modify the lingual function or the total IgA, IgG and IgM salivary levels. The present study was the first to evaluate the function of the tongue and salivary total immunoglobulin levels in Chagas disease.

Diagnosis, classification and management of ankyloglossia including its influence on breastfeeding.

Ankyloglossia is defined as a congenital malformation that alters lingua/ mobility and function. ft is listed as one of the possib/e reasons behind problems with breastfeeding. Due to current WHO recommendations that encourage mothers to breastfeed exclusively up to 6 months of age, quick recognition of any obstacles in the suction mechanism and determining the possible reasons for problems should be a priority. A review of the literature was conducted concerning the diagnosis of ankyloglossia, possible methods of treatment and their efficacy in improving breastfeeding quality. The authors of the research cited claim that any surgica/ intervention should be performed only in cases of symptomatic ankylog/ossia interfering with sucking mechanisms. The most frequent surgical procedure performed in newborns with symptomatic ankyloglossia is frenulotomy. ft is a simple procedure with a low risk of complications. The literature gives a great number of studies confirming both the short and long-term efficacy of tongue-tie release in improving breastfeeding quality with emphasis on decreasing mothers' discomfort, nipple pain and trauma.

Submental Muscle Activation During Lingual Tasks in Healthy Adults.

Lingual strengthening exercises are established to improve lingual function, thereby oral swallowing. This study measured submental muscle activation during maximum isometric pressure (MIP) lingual tasks in healthy adults, tasks that are or can be adopted in lingual strengthening exercises. In addition, the effects of age and gender on submental muscle activation are examined. Forty-nine participants between the ages of 18 to 35 years and greater than 60 years were included in the study. Participants completed trials of intraoral MIP lingual elevation, protrusion, and depression, during which submental muscle activation was measured using surface electromyography (sEMG). Peak amplitude measures were normalized and log transformed, following which a three-way ANOVA was performed. Peak amplitudes of submental muscle activation were highest during lingual MIP protrusion, followed by lingual depression, and were least during lingual elevation. No significant differences in peak amplitudes were observed between older and younger adults, but higher peak amplitudes were recorded in women. The differential effects of lingual task, age, and gender on peak submental muscle activation are examined. The potential impact of incorporating tasks adopted in this study in lingual strengthening exercises to improve oral and pharyngeal swallowing is discussed.

A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study

ObjectivesA programme was introduced in Canterbury, New Zealand to evaluate the diagnosis and treatment of frenulum releases in newborn infants with suspected tongue-tie (ankyloglossia). The primary goals were to support breastfeeding and ensure that unnecessary surgery was avoided. MethodsLocal healthcare professionals reached consensus on a pathway for improving management of infants with tongue-tie and breast-feeding difficulties. This embedded an expert breast-feeding review and assessment of lingual function using a validated method, the Bristol Tongue-tie Assessment Tool (BTAT). Infants with breastfeeding problems related to tongue-tie had a frenotomy at a hospital outpatient clinic. An education programme was developed to support introduction of the new clinical pathway and included seminars and online information for healthcare professionals and the general public. ResultsFrenotomy intervention rate reduced markedly from 11.3% in 2015 to 3.5% by mid-2017. Feeding methods were not different before or after surgery between infants who received a frenotomy and those who did not. Initially, the BTAT threshold for frenotomy was set at ≤5, however the final clinical pathway combined a breastfeeding assessment and a BTAT threshold of ≤4. The education programs assisted with the changes in practice, while increased use of the clinician guidance and public health information websites confirmed growing awareness of tongue-tie and community breastfeeding support. ConclusionsEstablishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.

Impaired Tongue Function as an Indicator of Laryngeal Aspiration in Adults with Acquired Oropharyngeal Dysphagia: A Systematic Review.

Tongue function assessment typically forms part of a clinical bedside swallowing evaluation (CBSE). The predictive value of lingual function for calculating aspiration risk in isolation is not known. The aim of this systematic review was to collate current evidence on the utility of assessing lingual deficits for predicting aspiration. Health databases Medline, CINAHL, Cochrane Library, SpeechBITE, AMED and Embase were searched from inception to November 2016. Studies were included if there was a comparison between a clinical lingual assessment (index test) and aspiration on instrumental assessments (reference test) in adults who had been diagnosed with oropharyngeal dysphagia. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. Sensitivity, specificity, predictive values, likelihood ratios and odds ratios were extracted or calculated where possible. A best evidence synthesis and receiver operator curve (ROC) analysis for sensitivity and specificity were conducted. Twelve studies were included, of which only one had a low risk of bias. The ROC curve, predictive values and likelihood ratios did not show a relationship between lingual function and aspiration. Best evidence synthesis showed moderate evidence that when motility and strength are jointly assessed, they are not associated with aspiration. Other lingual assessment variables indicated either limited or conflicting evidence of an association. There is currently no evidence to indicate that there is a predictive relationship between lingual deficits as part of a CBSE and aspiration in adults with acquired oropharyngeal dysphagia. Recommendations for clinical practice and future research are made.

Evaluation of lingual function by tongue pressure measurement and motion capture system

Evaluation of lingual function by tongue pressure measurement and motion capture system

The Influence of Oropalatal Dimensions on the Measurement of Tongue Strength.

Tongue strength is routinely evaluated in clinical swallowing evaluations since lingual weakness is an established contributor to dysphagia. Tongue strength may be clinically quantified by the maximum isometric tongue pressure (MIP) generated by the tongue against the palate; however, wide ranges in normal performance remain to be fully explained. Although orthodontic theory has long suggested a relation between lingual function and oral cavity dimensions, little attention has been given to the potential influence of oral and palatal structure(s) on healthy variance in MIP generation. Therefore, anterior and posterior tongue strength measures and oropalatal dimensions were obtained across 147 healthy adults (aged 18-88years). Age was confirmed as a significant, independent predictor explaining approximately 10.2% of the variance in anterior tongue strength, but not a significant predictor of posterior tongue strength. However, oropalatal dimensions predicted anterior tongue strength with over three times the predictive power of age alone (p<.001). Significant models for anterior tongue strength (R 2=.457) and posterior tongue strength (R 2=.283) included a combination of demographic predictors (i.e., age and/or gender) and oropalatal dimensions. Palatal width, estimated tongue volume, and gender were significant predictors of posterior tongue strength (p<.001). Therefore, oropalatal dimensions may warrant consideration when accurately differentiating between pathological lingual weakness and healthy individual difference.

The tongue and ventilation: a recipe for failure?

Since publication of the studies by the functionalist school (Ricketts, Linder-Aronson, Gola...), the role of function, and ventilation in particular, appears to be taken more widely into account. The close interconnection of ventilation / growth / lingual function and malocclusion is now evident to all. However, although an ENT diagnosis of a ventilation defect and its etiology is now standard practice, treatment of the condition is not always sufficient to ensure a functional environment conducive to orthodontic stability, even when rehabilitation is prescribed. In some instances, certain highly-invasive surgical treatments can even exacerbate the initial situation.