Lingual Muscles Research Articles

The Compartmental Tongue.

Tongue anatomy and function is widely described as consisting of four extrinsic muscles to control position and four intrinsic muscles to control shape. This myoarchitecture cannot, however, explain independent tongue body and blade movement nor accurately model the subtlety of observed lingual shapes. This study presents the case for a finer neuromuscular structure and functional description. Using the theoretical framework of the partitioning hypothesis, evidence for neuromuscular compartments of each of the lingual muscles was discerned by reviewing studies of lingual anatomy, hypoglossal nerve staining, hypoglossal motoneuron axon tracing, muscle fiber type distribution, and electromyography. Muscle fibers of the visible human female were manually traced to produce a three-dimensional atlas of muscular compartments. A kinematic study was undertaken to determine the degree of independent movement between different parts of the tongue. A simple biomechanical model was used to demonstrate how synergistic groups of compartments can control sectors of the tongue. Results indicated as many as 10 compartments of genioglossus, two each of superior and inferior longitudinal, eight of styloglossus, three of hyoglossus, and six each of transversus and verticalis, while palatoglossus may not have a significant role in tongue function. Kinematic analysis indicated independent control of five sectors of the tongue body, and biomechanical modeling demonstrated how this control may be achieved. Evidence is presented for a lingual structure based on neuromuscular compartments, which work together to position and shape sectors of the tongue and independently control tongue body and blade.

Use of Ultrasound to Verify the Impact of Telemedicine Myofunctional Therapy on Sleep Apnea Syndrome: Study Protocol Proposal.

The anatomy of the upper airways influences the risk of obstructive sleep apnea (OSA). The size of soft tissue structures, such as the tongue, soft palate, and lateral walls of the pharynx, contributes to the pathogenesis of OSA. New lines of treatment for sleep apnea, such as myofunctional therapy (MT), aim to strengthen the oropharyngeal musculature to improve the defining parameters of apnea. The present protocol uses ultrasound imaging to measure the size of the lingual musculature non-invasively and cost-effectively and evaluates the changes in its morphology. Eligible patients include those with OSA who have undergone submental cervical ultrasound and drug-induced sleep endoscopy before starting MT with the AirwayGym app. Follow-up evaluations are conducted at 3 months after beginning treatment. Patients diagnosed with OSA via questionnaires and polysomnography or respiratory polygraphy are evaluated anatomically and functionally using the Iowa Oral Performance Instrument, a tongue digital spoon, somnoscopy, and submental cervical ultrasound to assess their responses to the AirwayGym app. The lingual thickness (mm) and volume (cm3) and the distance between both lingual arteries (mm) are measured. The AirwayGym app helps users and therapists monitor the patient performance of MT. Incorporating submental ultrasound can be a useful non-invasive tool to evaluate OSA and MT.

Recent insights into the morphology, molecular characterization and tissue localization of the caprine Sarcocystis species infecting domestic goats (Capra hiricus): Sarcocystis moulei, Sarcocystis capracanis, and Sarcocystis hircicanis

Ninety-seven (64.67%) out of 150 domestic goats (Capra hiricus) carcasses were found to be infected by Sarcocystis moulei, Sarcocystis capracanis, and Sarcocystis hircicanis sarcocysts. Sarcocystis moulei macrosarcocysts were detected in the cardiac, esophageal, skeletal, lingual, and diaphragmatic muscles of seven goats (4.67%) out of the 150 examined animals, whereas the microscopic Sarcocystis species were found in (90/150 = 60%). Two morphotypes of S. moulei were observed. Morphotype (I) macrosarcocysts were large-sized oval, ovoid, spherical, and measured 2–7 mm in length x 2–6 mm in width. Sarcocystis moulei morphotype (II) macrosarcocysts were spindle-shaped, spheroid, sometimes elongated, and measured 1.8–6 x 0.5–2 mm. By TEM, all S. moulei morphotypes were ultrastructurally the same and had a sarcocyst wall that was characterized by highly branched or cauliflower-like villar protrusions (VP) with dumbbell-like structures. The VP interior was packed with well-developed microtubules in longitudinal and cross arrangements. Sarcocystis moulei cyst wall was 3–6 μm thick. Sarcocystis capracanis microsarcocysts detected herein had a cyst wall that ranged from 4–8 μm in thickness. The VP was upright finger-like or cylindrical. The PVM had electron-dense corrugations in the region of the VP. Few amounts of microfilaments were detected inside the cores of VP. Sarcocystis hircicanis had a thinner cyst wall (~1–3 μm) with hairy long VP that ranged from 1 to 7.5 μm in length. Microtubules were missing inside the cores of the VP. The three caprine Sarcocystis species were molecularly characterized on the level of the 18S rRNA, 28S rRNA, and Cox1 genes.

Corticobasal syndrome mimicking Foix-Chavany-Marie syndrome with suggested 4-repeat tauopathy by tau PET

BackgroundCorticobasal syndrome (CBS) is a neurodegenerative disease diagnosed based on clinical manifestations such as asymmetrical parkinsonism, limb apraxia, and speech and language impairment. The background pathology of CBS is commonly a variety of proteinopathies, but association with cerebrovascular disease has also been reported. Foix-Chavany-Marie syndrome (FCMS) is a rare neurological disorder characterized by facio-pharyngo-glossal diplegia with automatic-voluntary movement dissociation presenting with bilateral paresis of the facial, lingual, pharyngeal and masticatory muscles. FCMS is commonly attributable to stroke. Transactive response DNA binding protein of 43 kD (TDP-43) proteinopathy is also known as the pathological background of FCMS, while the pathological background of the majority of CBS cases consists of diverse tauopathies instead of TDP-43 proteinopathy. In this report, we describe a case mimicking FCMS that was finally diagnosed as CBS with suggested 4-repeat tauopathy.Case presentationA 68-year-old female started experiencing difficulty speaking followed by difficulty writing, and especially texting, several years before her visit. Her impairment had been gradually worsening, and she came to our hospital. On neurological examination, she demonstrated the facial apraxia, frontal lobe dysfunction, and upper motor neuron signs. She presented some characteristics suggestive of FCMS. Her symptoms exhibited rapid progression and myoclonus, parkinsonism, and left-side dominant cortical sensory deficit occurred, resulting in the fulfillment of diagnostic criteria for CBS after 9 months. Tau PET imaging displayed notable ligand uptake in the brainstem, subthalamic nuclei, basal ganglia, and bilateral subcortical frontal lobe, suggesting that her pathological background was 4-repeat tauopathy. As a result of her progressive dysphagia, she became unable to eat and passed away after 12 months.ConclusionWe hereby present an atypical case of CBS showing clinical features mimicking FCMS at first presentation. TDP-43 proteinopathy was suspected based on the clinical symptoms in the early stages of the disease; however, the clinical course and imaging findings including tau PET suggested that her pathological background was 4-repeat tauopathy.

Assessing Swallowing Dysfunction Aggravation in Chronic Obstructive Pulmonary Disease Patients Using Ultrasonic Measurements With Swallowing Movement Parameters.

To investigate the correlation between ultrasonic measurements of swallowing movement parameters and aggravation of swallowing dysfunction in patients with chronic obstructive pulmonary disease (COPD). COPD patients with swallowing dysfunction (n = 120) and COPD patients with normal swallowing function (n = 100) treated in our hospital between January 2020 and January 2023 were included in observation and control groups, respectively. The correlation between ultrasonic measurements of swallowing movement parameters and COPD with swallowing dysfunction was analyzed. The observation group was divided into mild and severe groups according to their Gugging Swallowing Screen (GUSS) scores. The correlation between ultrasonic measurements of swallowing movement parameters and COPD exacerbation combined with swallowing dysfunction was analyzed. In the observation group, Hyoid muscle thickness, hyoid bone displacement, geniohyoid muscle movement distance, HLAS, and CSR were lower compared to the control group, negatively associated with COPD-related swallowing issues. Conversely, geniohyoid muscle movement time and minimum hyohyoid distance (NHLA) were higher in the observation group, positively correlated with COPD-related swallowing dysfunction. In COPD patients with swallowing problems, the severe group exhibited lower values for lingual muscle thickness, hyoid bone displacement, geniohyoid muscle movement distance, HLAS, and CSR compared to the mild group, while geniohyoid muscle movement time and NHLA were higher in the severe group. Receiver operating characteristic (ROC) curves were created, indicating the promising diagnostic utility of these parameters for assessing the presence and severity of swallowing dysfunction in COPD patients. The ultrasonic measurement of swallowing motion parameters can effectively assess swallowing dysfunction in COPD patients.

Polyautoimmunity manifest as inflammatory myopathy, uveitis, and progressive cutaneous depigmentation in a mixed breed dog: a case report

BackgroundPolyautoimmunity is the expression of more than one autoimmune disease in a single patient. This report documents polyautoimmunity in a mixed breed dog with concurrent uveitis, cutaneous depigmentation, and inflammatory myopathy.Case presentationA 1-year-old male neutered mixed breed dog was presented for progressive generalized leukotrichia and leukoderma, bilateral panuveitis, and masticatory muscle atrophy. The latter progressed to myositis of lingual, pharyngeal, and masticatory muscles confirmed by biopsy. Temporalis muscle was completely replaced by adipose and fibrous tissue, and necrotic myofibers with extensive infiltration of mononuclear cells indicated active myositis of lingual muscle. Skin biopsies showed severe melanin clumping in epidermis, hair follicles, and hair shafts, and perifollicular pigmentary incontinence. Uveitis, depigmentation, and myositis affecting the masticatory, pharyngeal, and tongue muscles were diagnosed based on clinical, histological, and laboratory findings.ConclusionsTo the authors’ knowledge, this is the first report of concurrent uveitis, progressive cutaneous depigmentation, and inflammatory myopathy in a dog.

Megaoesophagus in a pet rabbit

AbstractA 1‐year‐old, male, lop‐eared rabbit presented for anorexia and weakness. A dental trim and medical treatment for gastrointestinal stasis were implemented. Owners reclaimed the animal after 2 days. Two‐weeks later, its condition had worsened, and regurgitation was observed. Thoracic radiographs followed by barium contrast oesophagram revealed bronchopneumonia and megaoesophagus. A computed tomographic examination ruled out any structural compression (tumours, vascular ring anomalies). Treatment with assisted feeding, antibiotics and sildenafil was started. Increased regurgitations and worsening respiratory distress were observed. The rabbit died 16 days later. At postmortem examination, the oesophagus was dilated and filled with food, and the lungs showed patchy pneumonia and lobular consolidation. Generalised muscular atrophy and pericardial effusion were observed. Histopathological examination revealed severe broncho‐ and aspiration pneumonia, and moderate multifocal muscle degeneration affecting skeletal, lingual and oesophageal muscle and myocardium. The final diagnosis was acquired megaoesophagus. This is the first report of megaoesophagus in a rabbit.

OROMANDIBULAR DYSTONIA: PREVALENCE, CLINICAL AND DEMOGRAPHIC DATA, THERAPEUTIC STRATEGIES OUT-COME FOR HUNDRED PATIENTS IN SANA’A CITY, YEMEN

Background and aims: Dystonia is a movement disease characterized by persistent, uncontrollable muscle contractions that often lead to abnormal postures. The tongue, jaw, and mouth are all affected by OMD, which is an uncommon focal dystonia. OMD is a rare public health problem that takes time to diagnose and treat because it is frequently identified as psychogenic. This study sought to ascertain the frequency, demographics, clinical features, and treatment outcomes of patients with mandibular dystonia (OMD) in Sana'a, Yemen. Methods: A prospective cross-sectional study was conducted; the study included 100 Yemeni adults attending the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana'a University Clinics and Departments of Oral, Maxillofacial and Neurosurgery at Kuwait University Hospital and some private centers for maxillofacial medicine and neurosurgery in the city of Sana’a during the year 2022. The selected patients were complaining of contraction or involuntary movement of the masticatory, lingual and/or lower facial muscles. Age, gender, age at onset of illness, duration of illness, personal habits, type of OMD, previous and current treatments, and their outcomes were recorded on a standard, pre-designed questionnaire. Results: The incidence rate of OMD is 19/100,000/year. Most of the patients (92%) are male while only 8% are female. The first episode onset is after stress (29%), 11% after illness, 6% after dental treatment, and 48% without causes. Jaw deviation dystonia was dominant at 65%, followed by jaw closing dystonia (42%), jaw protrusion dystonia (29%), and jaw opening dystonia (27%). After current treatment out-come, there was improvement on ability to eat ( from 12% to 24%, p=0.02), to speak (from 25% to 43%, p=0.007), the rate of no pain raised from 46% to 57%, the rate of no discomfort raised from 21% to 34% (p=0.04) and the score ≤ 5 of OMD raised from 47% to 72% (p=0.0003). Conclusion: The incidence of OMD in Sana’a city is remarkably high, predominantly male, and peaks at 30, 40, and 50 years of age. Jaw deviation dystonia was the dominant type followed by jaw closing dystonia. After the current treatment outcome, the ability to eat has improved, the rate of pain and discomfort has decreased. Peer Review History: Received: 25 February 2023; Revised: 17 March; Accepted: 28 April 2023, Available online: 15 May 2023 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, sally.elzahaby@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com

AAV-driven expression of channelrhodopsin-2 in lingual myofibers enables light activation of lingual electromyogram activity

Contraction of the tongue muscles is needed for effective swallowing, speaking and breathing. Thus, inadequate tongue muscle activation can contribute to devastating conditions such as dysarthria, dysphagia, and obstructive sleep apnea. Existing treatments for these clinical conditions are often ineffective and/or poorly tolerated. Optogenetic technology allows for exceptional temporal and spatial precision for stimulating cells and may therefore provide a tool activating the tongue muscles to promote airway patency or enhance swallow function. The purpose of the current study was to test the hypothesis that lingual injection of an AAV9 vector encoding channelrhodopsin-2 (ChR2) would enable light-induced activation of tongue motor units during spontaneous breathing. An AAV9 vector (pACAGW-ChR2-Venus-AAV9, 8.29E11vg) was injected into the posterior tongue in adult C57BL/6Jmice, targeting the genioglossus. After 12 weeks, mice were anesthetized and posterior tongue electromyographic (EMG) activity was recorded during spontaneous breathing. Photostimulation of the tongue was achieved using a high-powered 473 nm light emitting diode positioned near the injection site. Single pulse as well as pulse train stimulation paradigms of varied intensity and duration were performed. Light-evoked EMG responses increased with the intensity (1-way ANOVA on ranks, p=0.002) and duration (1-way ANOVA on ranks, p<0.001) of single light pulses. Trains of light pulses were able to evoke lingual EMG bursts that were comparable to endogenous tongue muscle activation with XII nerve intact. Experiments were repeated after bilateral transection of XII nerve, and light stimuli were still effective at activating lingual EMG. Histology confirmed lingual myofiber transgene expression that was concentrated near the site of AAV injection. These experiments demonstrate the feasibility of using optogenetic stimulation to activate tongue musculature. This novel approach could potentially have application in clinical conditions in which reduced lingual muscle activity is problematic. 2R01HD052682-11A1 (DDF, BJB), MBI Graduate Fellowship Award (MLS) 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.

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.

Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation.

The major goal of the study was to determine whether changes in tongue morphology under selective hypoglossal nerve therapy for obstructive sleep apnea were associated with alterations in airway patency during sleep when specific portions of the hypoglossal nerve were stimulated. This case series was conducted at the Johns Hopkins Sleep Disorders Center at Johns Hopkins Bayview Medical Center. Twelve patients with apnea implanted with a multichannel targeted hypoglossal nerve-stimulating system underwent midsagittal ultrasound tongue imaging during wakefulness. Changes in tongue shape were characterized by measuring the vertical height and polar dimensions between tongue surface and genioglossi origin in the mandible. Changes in patency were characterized by comparing airflow responses between stimulated and adjacent unstimulated breaths during non-rapid eye movement sleep. Two distinct morphologic responses were observed. Anterior tongue base and hyoid-bone movement (5.4 [0.4] to 4.1 [1.0] cm (median and [interquartile range]) with concomitant increases in tongue height (5.0 [0.9] to 5.6 [0.7] cm) were associated with decreases in airflow during stimulation. In contrast, comparable anterior hyoid movement (tongue protrusion from 5.8 [0.5] to 4.5 [0.9] cm) without significant increases in height (5.2 [1.6] to 4.6 [0.8] cm) were associated with marked increases in airflow during sleep. Tongue protrusion with preservation of tongue shape predicted increases in patency, whereas anterior movement with concomitant increases in height were associated with decreased pharyngeal patency. These findings suggest that pharyngeal patency can be best stabilized by stimulating lingual muscles that maintain tongue shape while protruding the tongue, thereby preventing it from prolapsing posteriorly during sleep. Fleury Curado T, Pham L, Otvos T, etal. Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation. J Clin Sleep Med. 2023;19(5):947-955.

Electrodiagnostic features of myasthenia gravis in patient with predominantly bulbar symptoms. Case report

Myasthenia gravis is an autoimmune disease, the clinical manifestations of which are in the form of weakness and pathological muscle fatigue. We present the clinical case of a patient with predominantly lingual muscle involvement. The patient was diagnosed with a generalized 2A–2B form of myasthenia gravis. Dysarthria and weakness of the masticatory muscles were observed at the onset of the disease. The diagnosis was established 1.5 months after the appearance of the first complaints. Diagnosis at the outpatient stage was hampered by the epidemiological history and the short duration of symptoms that occurred only after eating. All of the above determines the importance of clinician`s alertness about the possibility of this disease manifesting itself in such a rather specific and rare group of symptoms.

Motoric Automatisms of the Maxillofacial Region: a Lecture

INTRODUCTION. Effective kinesitherapy of peripheral and central paralysis of the mimic, masticatory, lingual and pharyngeal muscles requires in-depth study of the features of the cooperative work of these muscles in the norm and in pathology. AIM. To acquaint rehabilitation specialists with motor automatisms of the brachiofacial area and show the principles of their practical use. MATERIAL AND METHODS. We studied more than 70 literature sources on involuntary activity of the maxillofacial region and adjacent regions muscles as well as we summarized our own experience in rehabilitation of patients with peripheral facial neuropathies and with bulbar and pseudobulbar syndromes RESULTS AND DISCUSSION. The study showed that the face, neck, and arm are involved in various mesencephalic-bulbar automatisms, both normal (ontogenetic and psychosomatic synkinesia, postural-ocular and postural-mandibular reflexes) and pathological (trunk eye-facial synkinesia, oral automatic reflexes), much more closely than other body parts. All of them, with the exception of facial hyperkinesias, may serve as a basis for optimizing kinesitherapy methods for movement disorders of the brachiofacial region. CONCLUSION. The face, neck, and hand are closely involved in a variety of stem and subcortical automatisms. The better the physical therapist is familiar with the features of the existing or potentially available to the patient reflex activity in the part of the body being rehabilitated, the more effective the rehabilitation treatment will be. The face, neck and arm are closely involved in a variety of stem and subcortical automorphisms. The better a doctor or an instructor in exercise therapy is acquainted with the reflex activity present or potentially available in the part of the body to be rehabilitated, the more effective the rehabilitation treatment will be.

Severe Ankyloglossia and its Surgical Management: Case Report

Ankyloglossia or tongue-tie is a singularly congenital case qualified by a specific no elastic and dense frenum within lingual muscle. Also it’s occurs when there is an union of the tongue’s body to the mouth’s floor, reducing her motion [1]. Its prevalence ranged of 0.02% to 12%. Lack of unified consensus may explain these rates changing on prevalence of ankyloglossia [2]. A higher incidence revealed in studies exploring neonates in comparison to those realized in other population was revealed by Reddy et al. 2014 [3]. The authors suggested the resolution of beginner variants of ankyloglossia during development justifying the age related difference of prevalence [4].

Lateral vocalization in Brazilian Portuguese.

Lateral vocalization is a cross-linguistically common phenomenon where a lateral is realized as a glide, such as [w,j], or a vowel [u, i]. In this paper, we focus on the articulatory triggers that could cause lateral vocalization. We examined Brazilian Portuguese, a language known for the process of lateral vocalization in coda position. We examined the lateral in onset and coda position in four vocalic environments and compared the dynamic tongue contours and contours at the point of maximum constriction in each environment. We also performed biomechanical simulations of lateral articulation and the vocalized lateral. The results indicate increased tongue body retraction in coda position, which is accompanied by tongue body raising. Simulations further revealed that vocalized laterals mainly recruit intrinsic lingual muscles along with the styloglossus. Taken together, the data suggest that vocalization is a result of positional phonetic effects including lenition and additional retraction in the coda position.

Histological changes in lingual striated muscle tissue of human cadavers to estimate the postmortem interval.

Although there are physiological methods to determine the postmortem interval (PMI), interval forensic histopathology can be applied to obtain accuracy. The aim was to describe the histological changes in human lingual striated musculature at different PMI. Seven groups were formed according to increasing PMI of 6, 12, 24, 48, 72, 96 and 120h postmortem (PM). Each group was made up of 16 samples of tongues from each cadaver. The samples were fixed in buffered formaldehyde at 10% and processed for embedding in paraplast. Section 5μm thick were cut and dyed with H&E for analysis. The study was approved by the Bioethics Committee of the Universidad San Francisco de Quito, Ecuador. The histological changes in the striated muscle cells of the tongue were associated with the different PMI. From 6 to 24h PM, there were initial changes in the cellular and nuclear morphology. At 48h PM, at least 50% of the samples presented poorly conserved and reduced muscle striations. At 72h PM, 100% of the cases presented myofibers with altered morphology, cytoplasmic vacuoles (93.75%), edema (68.55%) and pyknosis (93.75%). At 96 and 120h PM, the myofibers presented pyknotic nuclei, and they were absent in the rest. The changes in the histology of the human lingual striated muscle make it possible to estimate the PMI, either in the early phase (0-72h) or the late phase (92-120h). However, further research is needed to verify, refine and expand on these results.

A Newly Discovered Tendon Between the Genioglossus Muscle and Epiglottic Cartilage Identified by Histological Observation of the Pre-Epiglottic Space

Epiglottic retroversion is difficult to explain anatomically. One reason is inadequate structural identification of the ligaments in the submucosal tissue anterior to the epiglottis (pre-epiglottic space, PES). Although studies have shown that tongue root movement plays a role in epiglottic retroversion, few morphological reports have investigated the attachment of the lingual muscles to the epiglottis. This study reconstructed the fiber structure of the PES by comprehensively analyzing fiber alignment in the PES focusing on the hyoepiglottic ligament, which runs between the lingual muscles and the epiglottis. Gross and microscopic observations of the submucosal structures from the tongue to the larynx of 20 cadavers (10 men, 10 women; mean age 79 years) were performed. A tendon continuing from the posterior part of the genioglossus muscle and attaching to the center of the epiglottic cartilage was identified in the midline area of the epiglottis. We named this tendon the glossoepiglottic tendon. In contrast, the hyoepiglottic ligament is found between the hyoid bone and the epiglottis and is attached from the lateral margin of the epiglottic cartilage to its base. Furthermore, the glossoepiglottic tendon consists of a high-density fiber bundle that is thicker than the hyoepiglottic ligament. These results show that the conventional hyoepiglottic ligament has a two-layer structure consisting of an upper fiber bundle connected to the genioglossus muscle and a lower fiber bundle connected to the hyoid bone. Sustained contraction of the posterior part of the genioglossus muscle therefore places the epiglottis under persistent traction, suggesting that its relaxation may cause epiglottic retroversion.

Immunohistological insight into the correlation between cardiac and lingual musculature in chronic chagas disease

Aim: To assess and compare the inflammatory infiltrate, area of muscle cells, microvessel density (MVD) and expression of cytokines in the myocardium (MM) and lingual (LM) musculature between chagasic and non chagasic individuals. Methods: Fragments of MM and LM from autopsied chronic chagasic (CC) (n=18) and non chagasic individuals (n=24) were histologically processed for histochemical and immunohistochemical evaluation. Was assessed the MVD by CD31 and quantification of immune cells infiltrated in MM and LM, and also expression of IL-1, IL-10 and TGF- β1. Results: There were higher intensity of inflammation and larger area of muscle cells in the myocardium and tongue of chagasic compared to non-chagasic individuals (p<0.0001). In the chagasic individuals, there was a positive correlation: regarding to the MVD between the LM and MM (p=0.049); between area of MM and density of leukocytes expressing TGF-β1 (p=0.049); and IL-10 correlate with the MM and LM (p=0.029). Conclusions: The correlation between the density of leukocytes immunostained by anti-TGF-β1 and hypertrophy in the myocardium suggests the participation of this cytokine in cardiac muscle hypertrophy. Moreover, the hypertrophy in the myocardium and lingual muscles, and the concomitant expression of CD31 and IL-10 between the myocardium and lingual musculature in chagasic individuals suggests that evaluation of the tongue musculature presents certain similarities changes as a myocardium muscle in CC. However, it needs more studies to verify in other phases of the disease, if the parasite is installed in the tongue or if the mechanisms are reflex of systemic changes in level of immune response.

Effect of Functional Training for Tongue and Lips on Cognitive Function, Lingual Muscle and Orbicularis Oris Muscle in Older Adults

Effect of Functional Training for Tongue and Lips on Cognitive Function, Lingual Muscle and Orbicularis Oris Muscle in Older Adults

Magnetic Resonance Imaging-Based Radiomics Features Associated with Depth of Invasion Predicted Lymph Node Metastasis and Prognosis in Tongue Cancer.

BackgroundAdequate safe margin in tongue cancer radical surgery is one of the most important prognostic factors. However, the role of peritumoral tissues in predicting lymph node metastasis (LNM) and prognosis using radiomics analysis remains unclear.PurposeTo investigate whether magnetic resonance imaging (MRI)‐based radiomics analysis with peritumoral extensions contributes toward the prediction of LNM and prognosis in tongue cancer.Study typeRetrospective.PopulationTwo hundred and thirty‐six patients (38.56% female) with tongue cancer (training set, N = 157; testing set, N = 79; 37.58% and 40.51% female for each).Field Strength/Sequence1.5 T; T2‐weighted turbo spin‐echo images.AssessmentRadiomics models (Rprim, Rprim+3, Rprim+5, Rprim+10, Rprim+15) were developed with features extracted from the primary tumor without or with peritumoral extensions (3, 5, 10, and 15 mm, respectively). Clinicopathological characteristics selected from univariate analysis, including MRI‐reported LN status, radiological extrinsic lingual muscle invasion, and pathological depth of invasion (DOI) were further incorporated into radiomics models to develop combined radiomics models (CRprim, CRprim+3, CRprim+5, CRprim+10, CRprim+15). Finally, the model performance was validated in the testing set. DOI was measured from the adjacent normal mucosa to the deepest point of tumor invasion.Statistical TestsChi‐square test, regression analysis, receiver operating characteristic curve (ROC) analysis, decision analysis, spearman correlation analysis. The Delong test was used to compare area under the ROC (AUC). P < 0.05 was considered statistically significant.ResultsOf all the models, the CRprim+10 reached the highest AUC of 0.995 in the training set and 0.872 in the testing set. Radiomics features were significantly correlated with pathological DOI (correlation coefficients, −0.157 to −0.336). The CRprim+10 was an independent indicator for poor disease‐free survival (hazard ratio, 5.250) and overall survival (hazard ratio, 17.464) in the testing set.Data ConclusionRadiomics analysis with a 10‐mm peritumoral extension had excellent power to predict LNM and prognosis in tongue cancer.