Midline Tongue Research Articles

Acute Cognitive Dysfunction in a Patient With Traumatic Brain Injury: A Clinical Vignette.

Acute Cognitive Dysfunction in a Patient With Traumatic Brain Injury: A Clinical Vignette.

3D Hyolingual Kinematics Reveal New Insights Into the Biomechanical and Neural Control of Chewing and Swallowing in Macaque Primates

Hyolingual kinematics are difficult to measure, but are central to hypotheses regarding musculoskeletal mechanisms and motor control. Recent application of biplanar videoradiography to the study of hyolingual kinematics in nonhuman primates provides new insight into tongue movements during chewing and swallowing, and into the role of hyoid movement in tongue base retraction and the oral phase of swallowing. During grape chewing, complex shape changes in the tongue were dominated by a combination of flexion in the tongue’s sagittal planes and roll about its long axis. As hypothesized for humans, in macaques during tongue retraction the molar region of the tongue rolls to the chewing side simultaneous with sagittal flexion, while the tongue tip flexes to the balancing side. Twisting and flexion reach their maxima early in the fast close phase of chewing cycles, positioning the food bolus between the approaching teeth prior to the power stroke. The muscular drivers of these movements are likely to include a combination of intrinsic and extrinsic tongue muscles. Nerve block of tactile sensation from trigeminal innervated oral structures decreased feeding performance, and the fast open phase of the gape cycle became significantly longer, relative to the other phases. The tongue made similar shapes in both the control and nerve block conditions, but the pattern of tongue‐jaw coordination became significantly more variable after the block. Disruption of oral somatosensation impacts feeding performance by introducing variability into the typically tight pattern of tongue‐jaw coordination. During primate swallowing, tongue base retraction (TBR) drives the food bolus across the oropharynx towards the esophagus but the mechanics of TBR are poorly understood. XROMM of four macaque monkeys falsifies both the hypothesis that extrinsic tongue muscle shortening pulls the tongue base posteriorly, and the muscular hydrostat hypothesis that intrinsic muscle shortening displaces the tongue base posteriorly by increasing tongue length. Our data suggest a novel hydraulic mechanism of TBR: shortening and rotation of suprahyoid muscles compresses the tongue between the hard palate, hyoid and mouth floor, squeezing the midline tongue base and food bolus back into the oropharynx. Hyoid elevation and protraction are powered by concentric activation and rotation of mylohyoid and digastric, followed by concentric activation of geniohyoid. This research suggests that structure, function, and coordination of mylohyoid and geniohyoid muscles are especially important determinants of swallowing performance in macaques, and probably humans.

Ectopic Lingual Thyroid: A Case Presentation

ABSTRACTBackgroundThe lingual thyroid gland is a rare clinical entity that was found to occur due to the failure of the thyroid gland to descend into its normal ectopic pretracheal position during embryogenesis. The reported incidence of lingual thyroid is 1 in 100,000, and it is more common in females, with a female:male ratio of 3:1. When located at the base of the tongue, the ectopic gland is often asymptomatic but may cause local symptoms, such as, dysphagia, dysphonia, upper airway obstruction, hemorrhage, and often hypothyroidism. The diagnosis of lingual thyroid is usually made clinically and radionuclide scanning is used to confirm the diagnosis. A case of lingual thyroid is presented for its rarity and differential diagnosis of midline base of the tongue lesions.Case descriptionA 35-year-old woman presented with complaints of increasing difficulty in breathing and a constant foreign object sensation in the throat (FOSIT) for the past one year. Flexible video-laryngoscopic examination revealed a well-demarcated midline tongue base lesion measuring 3 × 3 cm. Technetium 99m scan reported it to be ectopic thyroid gland tissue. Transoral excision of the lesion was done along with cauterization with bipolar cautery.ConclusionLingual thyroid is a rare developmental anomaly, the treatment of which is still controversial in view of the rarity of the condition. It should be included in the differential diagnosis of midline masses of the base of the tongue, especially in children and adolescents. The approach to treatment should be transdisciplinary and should not only take into consideration the clinical condition of the lesion but also the hormonal aspects of the patient.How to cite this articleRao KS, Shenoy VS, Kamath PM,et al.Ectopic Lingual Thyroid: A Case Presentation. Int J Head Neck Surg 2021;12(1):37–39.

Does asymmetry in tongue anatomy affect asymmetry in tongue position? Glossectomy and control subjects

Glossectomy surgery removes part of the tongue due to cancer. The resulting anatomical asymmetries may affect motor symmetry. This study examines anatomical and positional tongue asymmetry in glossectomies and controls. The goals are to determine the extent of the anatomical asymmetries, and their effect on resting asymmetry. We expect that patients with unilateral resections will be more asymmetrical than controls, but that their midline tongue will be centered in the oral cavity (OC), because their dentition is unchanged and the tongue will rest in its familiar position. 3-D tongue volumes were extracted from high-resolution MRI data using Matlab. Tongue volumes were calculated for the whole tongue, both halves and the septum using ITK-SNAP. We bisected the OC in the sagittal plane from the mandibular symphysis to the center of the spinal cord. The tongue volume was calculated in each half of the OC. Results showed more anatomical asymmetry in the patients; seven patients and three controls had a volume difference of 3% or more between the left and right tongue. Positional measures showed that the septum was mostly in one half of the OC. When the septum volume was removed, the tongue volume distributed fairly equally in the OC.

XROMM and diceCT reveal a hydraulic mechanism of tongue base retraction in swallowing

During primate swallowing, tongue base retraction (TBR) drives the food bolus across the oropharynx towards the esophagus and flips the epiglottis over the laryngeal inlet, protecting against penetration and aspiration of food into the airway. Despite the importance of TBR for swallowing performance, the mechanics of TBR are poorly understood. Using biplanar videoradiography (XROMM) of four macaque monkeys, we tested the extrinsic muscle shortening hypothesis, which posits that shortening of the hyoglossus and styloglossus muscles pulls the tongue base posteriorly, and the muscular hydrostat or intrinsic tongue muscle hypothesis, which suggests that, because the tongue is composed of incompressible fluid, intrinsic muscle shortening increases tongue length and displaces the tongue base posteriorly. Our data falsify these hypotheses. Instead we suggest a novel hydraulic mechanism of TBR: shortening and rotation of suprahyoid muscles compresses the tongue between the hard palate, hyoid and mouth floor, squeezing the midline tongue base and food bolus back into the oropharynx. Our hydraulic mechanism is consistent with available data on human tongue swallowing kinematics. Rehabilitation for poor tongue base retraction might benefit from including suprahyoid muscle exercises during treatment.

Assessment of Midline Lingual Point-Pressure Somatosensation Using Von Frey Hair Monofilaments.

Detection and discrimination threshold estimates for oral point pressure are assessed using Von Frey Hair monofilaments. Consistent with previously published protocols, threshold estimates are determined using a two-interval forced choice (2-IFC) paradigm with a three down/one up approach. Detection threshold estimates determine the mean force in which a participant can identify the presence of pressure. During the detection threshold procedure, the participant is instructed to choose which of two sequentially presented observation intervals contained the tactile test stimulus. If the participant performs three correct detections in a row (i.e., 3 'hits'), the researcher decreases the stimulus to the next lower target force level. With one incorrect detection (a 'miss'), the researcher increases the force delivered to the next higher level. This threshold estimation approach is known as a 3-down/1-up adaptive staircase. Reponses are recorded on a paper ballot, and a participant's estimated threshold is defined as the geometric mean of five reversals. During the discrimination threshold procedure, the participant is asked to make a choice between two serially presented stimuli as to which is the "harder" or "stronger" pressure. The same scoring of 'hits', 'misses', and stopping points are used. Detection and discrimination testing for oral point pressure at tongue midline takes approximately 20 min to complete. Using these commercially-available clinical tools, individual touch sensation profiles for the midline tongue can be achieved in a relatively time and cost effective means.

Assessment of Midline Lingual Point-Pressure Somatosensation Using Von Frey Hair Monofilaments

Detection and discrimination threshold estimates for oral point pressure are assessed using Von Frey Hair monofilaments. Consistent with previously published protocols, threshold estimates are determined using a two-interval forced choice (2-IFC) paradigm with a three down/one up approach. Detection threshold estimates determine the mean force in which a participant can identify the presence of pressure. During the detection threshold procedure, the participant is instructed to choose which of two sequentially presented observation intervals contained the tactile test stimulus. If the participant performs three correct detections in a row (i.e., 3 'hits'), the researcher decreases the stimulus to the next lower target force level. With one incorrect detection (a 'miss'), the researcher increases the force delivered to the next higher level. This threshold estimation approach is known as a 3-down/1-up adaptive staircase. Reponses are recorded on a paper ballot, and a participant's estimated threshold is defined as the geometric mean of five reversals. During the discrimination threshold procedure, the participant is asked to make a choice between two serially presented stimuli as to which is the "harder" or "stronger" pressure. The same scoring of 'hits', 'misses', and stopping points are used. Detection and discrimination testing for oral point pressure at tongue midline takes approximately 20 min to complete. Using these commercially-available clinical tools, individual touch sensation profiles for the midline tongue can be achieved in a relatively time and cost effective means.

Quantifying Tongue Tip Shape in Apical and Laminal /s/: Contributions of Palate Shape.

Purpose Anterior tongue shape during /s/ production is often described as "tip-up" or apical, versus "tip-down" or laminal. Typically, this is determined by observing the shape of the anterior midline tongue. The purpose of this study was to identify methods of curvature calculation that quantify the observed shape differences and to examine whether the shape differences were affected by palate shape. Previous work shows that palate height has some effect (Grimm et al., 2017). Method Four curvature-based measures were applied to a series of points selected along the tongue surface in midsagittal cine magnetic resonance images during speech. The measures were minimal curvature, averaged largest curvature (ALC), normalized ALC, and interpolated normalized ALC. These measures were compared to visual judgments of apical and laminal /s/. Anterior palate shape was measured from dental casts. Results The apical /s/ contained a flat or concave region in the anterior tongue, while the laminal /s/ had a convex shape along the entire tongue. Thus, the laminal shape was less complex than the apical. The last 2 metrics, based on averages of multiple normalized curvatures, captured this complexity difference. Subjects with a more steeply sloped anterior palate tended to use laminal /s/. Conclusions The tongue shape for the 2 /s/ types was best defined by complexity of the shape, rather than local anterior shape. Statistical quantities that measured curvature in multiple locations, and normalized across subjects, were best at distinguishing the 2 /s/ shapes. Interpolating additional points between the manually selected ones did not improve the method. Supplemental Material https://doi.org/10.23641/asha.9733709.

The value of MRI texture analysis based on gray level co-occurrence matrix to predict cervical lymph node metastasis in tongue carcinoma patients

Objective To evaluate the value of MRI texture analysis based on gray level co-occurrence matrix to predict cervical lymph node metastasis in patients with tongue carcinoma. Methods A total of 70 patients with tongue carcinoma confirmed by pathology were analyzed retrospectively. The patients were divided into cervical lymph node (LN) metastasis group (unilateral LN+,n=18; bilateral LN+,n=22) and no cervical lymph node metastasis(LN-,n=30). T1W, T2W and contrast-enhanced T1W images of the largest section of tumor were selected. ROI of the lesion was manually drew and GLCM texture parameters (energy, contrast, correlation, inverse difference and entropy) were extracted. The tumor length, thickness and para-lingual distance between tumor and tongue midline were also measured. Differences of all parameters were compared between LN+ group and LN- group, unilateral and bilateral cervical lymph node metastasis group, the parameters with statistically significant difference in predicting the efficiency of cervical lymph node metastasis were analyzed. The diagnostic efficiency of lymph node metastasis was calculated. Results The correlation, inverse difference and entropy based on T2WI showed significant difference (Zcorrelation=2.97, tinverse difference=5.14, tentropy=2.41; P 0.05). The diagnostic sensitivity of radiologists was 65.0% (26/40), the specificity was 80.0% (24/32) on cervical lymph node metastasis. Conclusion Texture analysis based on T2WI can predict cervical lymph node metastasis in patients with tongue carcinoma. Entropy has certain value in predicting bilateral cervical lymph node metastasis. Key words: Tongue neoplasms; Lymphatic metastasis; Magnetic resonance imaging; Gray level co-occurrence matrix; Texture analysis

Comparing acoustic and articulatory targets in short-term visual feedback training of non-native vowels

Theories of speech production aim to explain how talkers express abstract linguistic forms as audible events that are intelligible to both speaker and listener. The relationship among planned units of speech, their articulatory implementation, and their acoustic consequences is thus a key issue in speech research. The work reported here is part of a larger project designed to investigate the effects of visual acoustic and visual articulatory feedback on second language (L2) learners’ production and perception of non-native speech sounds. L2 talkers from a variety of language backgrounds practiced producing an English vowel, /æ/, while receiving visual feedback on either (1) first and second formant frequencies, provided by a real-time spectrographic display, or (2) tongue back position, shown using a talker-driven tongue avatar. Kinematic data were recorded using an electromagnetic articulograph (EMA) system that tracked tongue midline and lateral movement during vowel productions. Pronunciation accuracy was analyzed by calculating acoustic and kinematic Mahalanobis distances between L2 productions and target (native talker) exemplars. Initial analyses of a single subject’s data showed that both types of visual feedback training improved pronunciation, suggesting that both acoustic and articulatory information are recruited during vowel production.

Lingual leiomyomatous hamartoma with bifid tip of tongue and ankyloglossia in an infant

AbstractLingual leiomyomatous hamartoma (LLH) is a rare cause of midline tongue swelling. LLH with bifid tongue and ankyloglossia is still rarer, and so far only one case report in an adult exists in the literature. Here, we report a 5 months old male infant with a 1.5 cm × 0.5 cm LLH with bifid tongue and ankyloglossia.

The value of multi-parameters MRI of tongue carcinoma in predicting cervical node metastases

Objective The aim of this study was to determine whether multi- parameters MRI of tongue carcinoma have the potential to predict cervical lymph node metastases. Methods A total of 46 patients with tongue carcinoma, who underwent MRI scan preoperatively, were investigated retrospectively and were divided into cervical lymph node (LN) metastases group (unilateral LN+, n=16; bilateral LN+, n= 14) and no cervical lymph node metastases group (LN-, n=16) according to their pathological grading. Of the 40 patients with tongue carcinoma underwent plain and contrast MRI scan, 6 patients have plain MRI scan, and 32 have DWI examination.The ADC value, tumor length, tumor thickness, sublingual distance between tumor and sublingual space, and para- lingual distance between tumor and tongue midlinedetermined from MRI, were preoperatively estimated and compared with the pathological findings of cervical lymph nodes. A unpaired t test was used to analyze normal distributed continuous data, and a Mann-Whitney U test was used to analyze abnormally distributeddata. The ROC was used to evaluate the efficacy of MRI in predicting the metastasis of cervical lymph nodes. Results The indexes of ADC value, tumor length, tumor thickness, and para- lingual distance between tumor and tongue midline, which all showed significant difference between LN+ group and LN- group (all P 0.05). The index of ADC value showed significant difference between unilateral LN+ group and bilateral LN+ group (P 0.05). The ROC curve analysis of the ADC value, tumor length, tumor thickness, and para- lingual distance between tumor and tongue midline of the neck lymph node metastasis were carried out, with the cutoff set as 1.13×10-3 mm2/s, 31.08 mm, 17.33 mm and-2.26 mm. The corresponding area under curve(AUC), sensitivity, and specificity were 0.878, 90.9% and 90.0%; 0.822, 83.3% and 81.3%; 0.834, 86.7% and 81.3%; 0.794, 86.7% and 75.0%, respectively. The ROC curve analysis of the ADC of the bilateral neck lymph node metastasis was also carried out, with the cutoff of ADC value set as 1.07×10-3 mm2 /s, the corresponding AUC, sensitivity, and specificity were 0.806, 80.0% and 75.0%. Conclusion The ADC value, tumor length ,tumor thickness and para-lingual distance between tumor and tongue midline,determined from MR imaging, all can be used as independent factors in predicting cervical lymph node metastasis, where ADC value may be helpful to predict bilateral neck lymph node metastasis. Key words: Tongue neoplasms; Lymphatic metastasis; Magnetic resonance imaging

Dorsal midline tongue masses in children

Abstract Tongue masses are uncommon, and in children are usually due to congenital anomalies. Causes also include lingual thyroid, vascular lesions, and various cysts. We present a series of cases where children presented with a mass at the foramen caecum on the dorsum of the tongue in the midline. In each case, the diagnosis was different. Regardless of the child’s presentation, we believe detailed imaging to be essential for appropriate diagnosis and management. If the lesion is symptomatic or there is diagnostic uncertainty then excision for histopathology should be undertaken without delay.

Internal three dimensional tongue motion during “s” and “sh” from tagged magnetic resonance imaging; control and glossectomy motion

This study aims to ascertain the effects of tongue cancer surgery (glossectomy) on tongue motion during the speech sounds “s” and “sh.” Subjects were one control and three glossectomies. The first patient had surgery closed with sutures. The second had sutures plus radiation, which produces fibrosis and stiffness. The third was closed with an external free flap, and is of particular interest since he has no direct motor control of the flap. Cine and tagged-MRI data were recorded in axial, coronal and sagittal orientations at 26 fps. 3D tissue point motion was tracked at every time-frame in the word. 3D displacement fields were calculated at each time-frame to show tissue motion during speech. A previous pilot study showed differences in “s” production [Pedersen et al., JASA (2013)]. Specifically, subjects differed in internal tongue motion pattern, and the flap patient had unusual genioglossus lengthening patterns. The “s” requires a midline tongue groove, which is challenging for the patients. This study continues that effort by adding the motion of “sh,” because “sh” does not require a midline groove and may be easier for the patients to pronounce. We also add more muscles, to determine how they interact to produce successful motion. [This study was supported by NIH R01CA133015.]

Tongue‐mandible coupling movements during saliva swallowing

The purpose of this study was to measure the tongue and mandible positions and displacements in relation to the maxilla in the midsagittal plane to characterize the different saliva swallowing patterns by recording their kinematics. A 2D electromagnetic articulograph using four transducer coils, three attached to the upper surface of the tongue midline plus one attached to the chin anterior part allowed continuous evaluation of tongue and chin movements in twelve young adults in good general health. During 170s sequences recorded at a frequency of 100Hz, subjects were at rest, silently reading a text they had chosen. The subjects were free to swallow during the sequence. Deglutition of accumulated saliva was analysed after averaging all values obtained during successive 250ms periods. We identified three elementary swallowing patterns. Mean duration of tongue-mandible movements were 1·51±0·17s, 1·63± 0·14s and 2·00±0·08s for the first, second and third patterns respectively. In the light of other studies based on intra-oral pressure recordings, our results help to understand the tongue-mandible coupling behaviours involved in managing an in-mouth saliva bolus during the three elementary swallowing patterns identified.

Management of lingual hemangioma in a case with von Willebrand disease

Hemangiomas are the most common vascular tumors and von Willebrand disease is the most common inherited bleeding disorder. In this article, we report a 21-year-old female who had von Willebrand disease presenting with 1x1 cm lesion of the tongue. The lesion was located at the anterior one-third in midline tongue throughout full-thickness. The patient was administered cryoprecipitate preoperatively. Then the lesion was excised under local anesthesia. Histopathological examination revealed a hemangioma. No complication such as bleeding or infection after the operation was observed.

Case report of a congenital lingual leiomyomatous hamartoma: New epidemiologic findings and a review of the literature

We present an unusual case of a lingual leiomyomatous hamartoma, along with a current literature review of this previously under reported lesion. Described is a case of a 5 month-old male presenting with a posterior midline tongue mass and surgical excision yielded pathology consistent with a leiomyomatous hamartoma. A comprehensive literature review revealed thirty-nine cases of leiomyomatous hamartomas, a number much greater than previously reported. We conclude that these rare lesions are notably twice as common as previously reported and have equal gender predilection.

Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea

To determine the relationship between the lingual artery and lingual markers for preoperative evaluation of the lingual artery in patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). A 16-section computed tomographic angiography (CTA) of the lingual artery was performed in 87 inpatient cases with OSAHS, from December 2007 to May 2009. The course of the lingual artery and the anatomic relationship between the lingual artery and the lingual markers were analyzed using CTA imaging. The course of the lingual artery with the tongue in a resting position was similar to that of the Big Dipper constellation (Plough) in the sagittal view of CTA imaging. The first segment of the lingual artery declined approximately 19.27 ± 5.24 mm, the middle segment of the lingual artery was forward approximately 19.30 ± 6.79 mm, and the ascending segment of the lingual artery rose approximately 52.49 ± 10.98 mm. The entry point where the lingual artery entered into the tongue was adjacent to the tip of the greater horn of the hyoid bone. The relationship between the second segment of the lingual artery and the greater horn of the hyoid bone was relatively steady with the tongue in whatever position. The interval between the bilateral greater horn of the hyoid bone equalled that between the bilateral lingual arteries. Recognizing some lingual markers in the patients with OSAHS, such as the greater horn of the hyoid bone, foramen cecum, circumvallate papilla, lingual vein and tongue midline, may facilitate the surgeon's ability to define the course of the lingual artery accurately in the treatment of OSAHS.

Morphologic and histologic outcomes of tongue reduction surgery in an animal model

To describe the effect of anterior tongue reduction surgery on tongue size, morphology, and histology. Prospective experiment. Twenty-two 12-week-old Yucatan minipigs. Six sibling pairs had tongue reduction (Group B) or sham surgery (Group A), and underwent euthanasia the day of surgery. Five sibling pairs had tongue reduction (Group D) or sham surgery (Group C), and were raised for four weeks. Data collected included changes in tongue morphology, histology, and animal response to surgery. All animals tolerated surgery and maintained their weight. Tongue size was uniformly reduced in all animals as compared to sham surgery. Tongue reduction was stable long term in Group D. All animals had normal wound healing and neurovascular structure preservation. Fibrosis occurred at the repair site. Midline tongue reduction resulted in uniform tongue reduction in all dimensions and volume, without damaging neurovascular structures. Localized fibrosis is a sequela of healing.

Malacoplakia of the tongue: a case report and clinicopathologic review of 6 cases

Background Extra-urogenital tract malacoplakia is uncommon, with tongue malacoplakia being exceptionally rare. The nonspecific clinical presentation and variable histologic patterns can make recognition of this lesion and separation from other lesions challenging. There are only a few reported cases in the English literature. Materials and methods Five case reports of tongue malacoplakia were compiled from the literature (MedLine 1960–2008) and integrated with this case report. Results The patients included 4 males and 2 females, ranging in age from 9 to 98 years (mean, 64 years). Patients presented with difficulty swallowing, foreign body sensation, a mass lesion, or referred pain (neck or ear). Symptoms were present from a few days up to 18 months. The base of the tongue was the most frequent site, although midline tongue and half of the tongue were also affected. Radiographic studies demonstrated a mass, with a single lesion showing positron emission tomography positivity. Two patients had previous cancers (prostate and colorectal; larynx). This case report was a farm hand for horses, with gram-negative rods, suggestive of Rhodococcus equi identified. The lesions were 1 to 2 cm in greatest dimension. Histologically, there is pseudoepitheliomatous hyperplasia or ulceration with a heavy acute and chronic inflammatory infiltrate. The subepithelial spaces are completely filled with eosinophilic histiocytes, most of which contain granular material in their cytoplasm. Well-formed, blue, calcific bodies are noted, a few showing a “targetoid appearance” and concentric lamination. These Michaelis-Gutmann bodies are positive with von Kossa, iron, and periodic acid-Schiff stains. These findings support a diagnosis of malacoplakia. The differential diagnosis includes granular cell tumor, poorly differentiated carcinoma, and Langerhans histiocytosis. Patients are managed with antibiotic therapy and excision. Conclusions Tongue malacoplakia is rare, often presenting as a mass lesion. Histologic recognition of this abnormal phagocytic disorder will prevent potentially disfiguring surgery.