Tongue Elevation Research Articles

Orofacial Muscle Strength and Associated Potential Factors in Healthy Korean Community-Dwelling Older Adults: A Pilot Cross-Sectional Study

Most previous studies on orofacial muscle strength have focused on older adults with conditions associated with sensorimotor deficits, such as stroke. However, the modifiable oral health factors that directly impact orofacial muscle strength and swallowing ability in healthy older adults remain unexplored. This pilot study explored the potential factors associated with orofacial muscle strength, particularly oral health conditions, in 70 healthy adults aged ≥65 years living independently without any diseases that cause dysphagia or sensorimotor deficits. The Iowa Oral Performance Instrument (IOPI) was used to assess orofacial muscle strength (tongue elevation, and cheek and lip compression). Statistical analyses were conducted using an independent t-test, one-way ANOVA, and multivariate linear regression. In the final regression models after adjustment, older age and fewer remaining teeth were significantly associated with reduced tongue and cheek strengths (p < 0.05). Socio-demographic factors, such as age, and oral health conditions, such as discomfort in pronunciation or mastication due to oral problems, poor self-rated oral health, and reduced salivary flow, were associated with tongue, cheek, and lip muscle strengths (p < 0.05). Early active oral health interventions can help prevent a decline in orofacial muscle strength in healthy older adults.

High-density surface electromyography evaluation of the suprahyoid muscles in patients with Parkinson's disease

Background and purposeHigh-density surface electromyography (HD-sEMG) allows non-invasive analysis of motor unit (MU) activity and recruitment. This study examines MU recruitment features as well as action potential using HD-sEMG in the suprahyoid muscles of patients with Parkinson's disease (PD) and assesses alterations caused by cervical percutaneous interferential current stimulation. MethodsElectrical activity of the suprahyoid muscles during tongue elevation was measured using HD-sEMG. Maximum voluntary contraction (MVC) was measured, then the modified entropy, coefficient of variation, correlation coefficient, and root mean square (RMS) were examined. For comparison, HD-sEMG was also conducted on healthy controls. In addition, this study assessed the impact of cervical percutaneous interferential current stimulation on HD-sEMG in patients with PD (Hoehn–Yahr stages 2–4) over 8 weeks. ResultsTwenty-two patients with PD (mean age 71.7 ± 6.0, 7 females) and 14 healthy controls (mean age 74.9 ± 6.1, 7 females) were included. The RMS at 60 % MVC was significantly lower in patients with PD than in healthy controls (p = 0.007). After cervical percutaneous interferential current stimulation, the correlation coefficients at 40 % and 60 % MVC significantly decreased (p = 0.040 and p = 0.048, respectively), and the RMS at 60 % MVC significantly increased (p = 0.035). ConclusionHD-sEMG of the suprahyoid muscles showed characteristic findings in patients with PD and was able to detect subtle changes due to electrical stimulation intervention. Thus, HD-sEMG could be a promising tool for evaluating swallowing-related muscle conditions and interventions.

Analysis of the suprahyoid muscles during tongue elevation: High-density surface electromyography as a novel tool for swallowing-related muscle assessment.

High-density surface electromyography (HD-sEMG) has enabled non-invasive analysis of motor unit (MU) activity and recruitment, but its application to swallowing-related muscles is limited. We aimed to investigate the utility of HD-sEMG for quantitatively evaluating the MU recruitment characteristics of the suprahyoid muscles during tongue elevation. We measured the sEMG activity of the suprahyoid muscles of healthy participants during tongue elevation using HD-sEMG. Maximum voluntary contraction (MVC) was measured, followed by data collection during sustained and ramp-up tasks to capture suprahyoid muscle activity. Changes in the temporal/spatial MU recruitment patterns within individual suprahyoid muscles were analysed. This study enrolled 16 healthy young adults (mean age: 27.8 ± 5.3 years; eight males and eight females). Increasing muscle force corresponded to a decrease in modified entropy and correlation coefficient and an increase in the coefficient of variation. No significant differences were observed between male and female participants. The results of this study, consistent with those observed in other muscles, such as the vastus lateralis muscle, suggest that HD-sEMG is a valuable and reliable tool for quantitatively evaluating MU recruitment in the suprahyoid muscles. This measurement technique holds promise for novel assessments of swallowing function.

Assessment and rehabilitation of tongue motor skills with myofunctional therapy in obstructive sleep apnea: a systematic review and meta-analysis.

The first objective of this study was to compare tongue motor skills between patients with obstructive sleep apnea (OSA) and healthy participants. Second, the effect of oropharyngeal myofunctional therapy (MFT) on the tongue muscular qualities of patients with OSA was evaluated. Searches were conducted in 5 electronic databases up to July 2023. Risk of bias was assessed via the Joanna Briggs Institute appraisal checklist for cross-sectional studies (aim number 1) and the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials (aim number 2). Pooled standardized mean differences and 95% confidence intervals were calculated using a random-effects model. Thirteen studies including 520 adults and one study including 92 children addressed aim number 1. Compared to healthy adults, individuals with OSA had no significant difference in tongue protrusion strength (9 studies, n = 366; standardized mean difference [95% confidence interval], -0.00 [-0.45, 0.44]) or endurance (5 studies, n = 125; 0.31 [-0.26, 0.88]) but presented a lower tongue elevation strength (6 studies, n = 243; 1.00 [0.47, 1.53]) and elevation endurance (3 studies, n = 98; 0.52 [0.11, 0.94]). In children, tongue elevation strength was lower but elevation endurance was higher in those with OSA than in healthy children. Two randomized controlled trials (28 adults, 54 children) addressed aim number 2 and were of poor methodological quality. In these studies, myofunctional therapy improved tongue motor skills in patients with OSA. Tongue elevation motor skills are decreased in adults with OSA, whereas tongue protrusion motor skills seem preserved. Very few data are available in children. There are also too few data about the impact of myofunctional therapy on tongue motor skills. Poncin W, Willemsens A, Gely L, Contal O. Assessment and rehabilitation of tongue motor skills with myofunctional therapy in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2024;20(9):1535-1549.

Oral Health-Related Factors Associated with Dysphagia Risk among Older, Healthy, Community-Dwelling Korean Adults: A Pilot Study.

Most previous studies addressing dysphagia examined individuals who already had diseases causing dysphagia and did not pay much attention to oral health conditions as a risk factor. This pilot study investigated 62 healthy adults aged 65 years or older who were living independently in the community, performed basic activities of daily living independently, and had no history of a causative disease of dysphagia to identify the factors associated with dysphagia risk, especially oral health. The Dysphagia Risk Assessment Scale was used to screen the patients for dysphagia. Hyposalivation was diagnosed by evaluating the unstimulated salivary flow rate, and orofacial muscle strength (anterior tongue elevation, buccinator muscle, and lip strength) was quantitatively measured using the Iowa Oral Performance Instrument. To analyze the factors associated with dysphagia risk, the Mann-Whitney test, Kruskal-Wallis test, and multiple logistic regression analyses were conducted. In the final regression model adjusted for sociodemographic characteristics, the oral health-related factors independently associated with dysphagia risk were buccinator muscle strength, hyposalivation, and subjective masticatory discomfort (p < 0.05). Therefore, our findings suggest that weak buccinator muscle strength, hyposalivation, and subjective masticatory discomfort are valuable indicators for the early detection of dysphagia in older, healthy, independent, community-dwelling adults.

GIANT ORAL EPIDERMOID CYST EMPTYING AS AN EMERGENCY MANEUVER

Epidermoid cyst (EC) in the oral cavity represents less than 0.01% of all cysts, being identified as 30 mm or less, yet giant cysts have been reported. Male, 21 years old, complaining of difficulty swallowing, speaking, and breathing. Intraoral examination showed tongue elevation with projection to the posterior region, obliterating the oropharynx due to a large soft painless bulge on the floor of the mouth. Magnetic resonance imaging revealed a well-defined homogeneous mass causing reduction of the airway space in the oropharynx and measuring 7.1 × 6.0 × 9.2 cm. Diagnostic hypotheses were dermoid or epidermoid cyst. Incisional biopsy and marsupialization were performed through intraoral access, with immediate reduction of the lesion. A yellowish pasty material, compatible with keratin, was drained until complete restoration of occlusion, swallowing, phonation, and breathing. Histopathological examination revealed an epidermoid cyst. The postoperative course was uneventful. EC in the mouth floor can reach large proportions, causing complications. Epidermoid cyst (EC) in the oral cavity represents less than 0.01% of all cysts, being identified as 30 mm or less, yet giant cysts have been reported. Male, 21 years old, complaining of difficulty swallowing, speaking, and breathing. Intraoral examination showed tongue elevation with projection to the posterior region, obliterating the oropharynx due to a large soft painless bulge on the floor of the mouth. Magnetic resonance imaging revealed a well-defined homogeneous mass causing reduction of the airway space in the oropharynx and measuring 7.1 × 6.0 × 9.2 cm. Diagnostic hypotheses were dermoid or epidermoid cyst. Incisional biopsy and marsupialization were performed through intraoral access, with immediate reduction of the lesion. A yellowish pasty material, compatible with keratin, was drained until complete restoration of occlusion, swallowing, phonation, and breathing. Histopathological examination revealed an epidermoid cyst. The postoperative course was uneventful. EC in the mouth floor can reach large proportions, causing complications.

Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines.

Dysphagia can affect more than 50% of stroke patients in the acute phase. Aspiration pneumonia is a serious complication that can be prevented with dysphagia screening and assessment. Measurement of tongue elevation pressure is suggested to be a useful tool in aspiration risk screening. This study aimed to assess the diagnostic accuracy of maximum anterior tongue elevation strength (Pmax) in acute stroke care. In this prospective study, data were collected in a neurology department (stroke center) where patients formed a consecutive case series. The sample consisted of thirty stroke patients who failed an initial dysphagia screening. Patients underwent anterior tongue elevation strength measurement (index test) during bedside dysphagia assessment by a speech-language pathologist and flexible endoscopic evaluation of swallowing (reference test) by an otorhinolaryngologist on the same day. Outcome variables (index values in kPa, reference values interpreted on the penetration-aspiration scale) were used for estimating measures of diagnostic accuracy in aspiration risk screening. Ten patients aspirated on instrumental evaluation. At the cut-off point of ≤ 34 kPa the analysis showed 90% sensitivity, 35% specificity, 41% positive predictive value, and 88% negative predictive value. The area under the curve (AUC) for Pmax was AUC = 0.700 (95% CI [0.500-0.900]). Although individuals with low anterior tongue elevation strength tend to have a higher risk of aspiration, this variable alone is not capable of screening aspiration in acute stroke. In combination with a thorough noninstrumental bedside examination, it might have the potential to reduce the number of false positive cases. Further studies in this area would be worthwhile.

The effect of tongue elevation muscle training in patients with obstructive sleep apnea: A randomised controlled trial.

Oropharyngeal myofunctional therapy is a multi-component therapy effective to reduce the severity of obstructive sleep apnoea (OSA). However, existing protocols are difficult to replicate in the clinical setting. There is a need to isolate the specific effectiveness of each component of the therapy. To assess the effects of a 6 weeks tongue elevation training programme in patients with OSA. We conducted a multicentre randomised controlled trial. Eligible participants were adults diagnosed with moderate OSA who presented low adherence to continuous positive airway pressure therapy (mean use <4h per night). The intervention group completed a 6 weeks tongue elevation training protocol that consisted in anterior tongue elevation strength and endurance tasks with the Iowa Oral Performance Instrument. The control group completed a 6 weeks sham training protocol that involved expiratory muscle training at very low intensity. Polygraphy data, tongue force and endurance, and OSA symptoms were evaluated pre- and post-intervention. The primary outcome was apneoa-hypopnea index (AHI). Twenty-seven patients (55 ± 11 years) were recruited. According to modified intention-to-treat analysis (n= 25), changes in AHI and c did not significantly differ between groups. Daytime sleepiness (Epworth Sleepiness Scale) and tongue endurance significantly improved in the intervention group compared to the control group (p= .015 and .022, respectively). In the intervention group, 75% of participants had a decrease in daytime sleepiness that exceeded the minimal clinically important difference. Six weeks of tongue elevation muscle training had no effect on OSA severity.

Numerical investigation of effects of tongue articulation and velopharyngeal closure on the production of sibilant [s

A numerical simulation of sibilant /s/ production with the realistically moving vocal tract was conducted to investigate the flow and acoustic characteristics during the articulation process of velopharyngeal closure and tongue movement. The articulation process was simulated from the end of /u/ to the middle of /s/ in the Japanese word /usui/, including the tongue elevation and the velopharyngeal valve closure. The time-dependent vocal tract geometry was reconstructed from the computed tomography scan. The moving immersed boundary method with the hierarchical structure grid was adopted to approach the complex geometry of the human speech organs. The acoustic characteristics during the co-articulation process were observed and consistent with the acoustic measurement for the subject of the scan. The further simulations with the different closing speeds of the velopharyngeal closure showed that the far-field sound during the co-articulation process was amplified with the slower closing case, and the velum closure speed was inverse proportional to the sound amplitude with the slope value of − 35.3 dB s/m. This indicates possible phonation of indistinguishable aeroacoustics sound between /u/ and /s/ with slower velopharyngeal closure.

The effects of tongue elevation using a weighted plastic bottle on the tongue pressure and activity of suprahyoid muscles.

A rise in tongue pressure coincides with an increase in the suprahyoid muscle activity. The aim was to investigate the effects of holding a weighted plastic bottle on tongue pressure and the suprahyoid muscle activity. Eighteen participants (8 men and 10 women; mean age 42 ± 16 years) participated in this study. All participants had no history of speech, language, hearing or swallowing disorders and no tooth loss, and they did not require dentures. Healthy participants held gauzes connected with a plastic bottle with increasing resistive loads of 0g, 250 g, 500 g and 750 g, between their palate and tongue. The maximum tongue pressure and average tongue pressure were measured during a 5s hold. The average tongue pressure was defined as the mean tongue pressure data in each task. The suprahyoid muscle activity was measured using the electromyogram (EMG). The root mean square of the EMG signals measured while lifting different loads and while performing the head lifting exercises was compared. All variables were examined using the Friedman's test and Wilcoxon signed-rank test. The maximum tongue pressure (p < .05) and average tongue pressure values (p < .05) increased gradually in the anterior-median region with increasing resistive loads, and the root mean square amplitudes for 250 g, 500 g and 750 g were not significant compared with head lifting exercises. These results indicated that plastic bottle holding could be a potential strength training tool for the tongue and the suprahyoid muscles.

Effects of tongue strengthening exercises on tongue muscle strength: a systematic review and meta-analysis of randomized controlled trials

Tongue strengthening exercise (TSE) has been proposed as an intervention to increase tongue strength and improve swallowing. However, clinical evidence of its effectiveness is lacking. In this review, seven databases were searched from inception to September 30, 2021 for randomized controlled trials that compared tongue strengths between the TSE intervention and control groups, obtained from maximal tongue elevation peak force in kilopascals (kPa). The Cochrane risk of bias tool was used for quality assessment. In total, 12 studies with 388 participants were included. The pooled meta-analysis demonstrated that the anterior tongue strength (ATS) (MD = 5.34 kPa; 95% CI 3.28–7.40; I2 = 71%) and posterior tongue strength (MD = 8.12; 95% CI 3.45–12.79; I2 = 90%) were significantly higher in the TSE intervention than that in the control group. Among healthy participants, subgroup analysis showed that TSE had improvements on ATS in all age groups, with the greatest improvement in old people (≥ 65 years) (MD = 8.01; 95% CI 4.39–11.64; I2 = 30%). Meta-regression analysis revealed a nonsignificant trend toward greater improvement on tongue strength with increasing TSE duration. This study provides positive evidence that TSE may be beneficial in improving tongue strength and could be applied for adults, especially healthy older adults.

Orofacial Muscle Strength across the Dysarthrias.

This study compared orofacial muscle strength between normal and dysarthric speakers and across types of dysarthria, and examined correlations between strength and dysarthria severity. Participants included 79 speakers with flaccid, spastic, mixed spastic–flaccid, ataxic, or hypokinetic dysarthria and 33 healthy controls. Maximum pressure generation (Pmax) by the tongue, lips, and cheeks represented strength. Pmax was lower for speakers with mixed spastic–flaccid dysarthria for all tongue and lip measures, as well as for speakers with flaccid or spastic dysarthria for anterior tongue elevation and lip compression. Anterior tongue elevation and cheek compression tended to be lower than normal for the hypokinetic group. Pmax did not differ significantly between controls and speakers with ataxic dysarthria on any measure. Correlations were generally weak between dysarthria severity and orofacial weakness but were stronger in the dysarthria groups with more prominent orofacial weakness. The results generally support predictions that orofacial weakness accompanies flaccid and/or spastic dysarthria but not ataxic dysarthria. The findings support including type of dysarthria as a variable of interest when examining orofacial weakness in motor speech disorders.

Comparative Analysis of the Differences in Dentofacial Morphology According to the Tongue and Lip Pressure.

The aim of this study was to evaluate the effects of the tongue and lip pressure on dentofacial morphology. The subjects comprised 194 patients with malocclusion. Anterior and posterior tongue elevation and lip pressures were evaluated using the Iowa Oral Performance Instrument (IOPI) device. The lateral cephalograms of each subject were traced and digitized to perform the analysis. Statistical analysis was used to investigate the relationship between perioral muscle force and the cephalometric variables. Anterior and posterior tongue pressure was both higher in males than in females. No sex difference in lip pressure was observed. The group with a low posterior tongue pressure showed a short ramus height, short posterior facial height, and clockwise-rotated mandible. On the other hand, lip pressure had a significant influence on maxillary incisor angulation. Skeletal pattern was not found to be significantly related with lip pressure. The anterior tongue pressure appeared as a mixed pattern of the two results. Tongue pressure was related to skeletal measurements, such as short posterior facial height, and lip pressure was related to the angulation of the anterior teeth. This study suggests that there may be differences in dentofacial morphology according to the differences in perioral muscle force.

The effect of an anti-slip surface on objective measures of tongue strength in healthy adults

Purpose: Instrumental assessments of tongue strength have provided clinicians with the ability to obtain quantitative measures to document lingual weakness. A technical challenge with a common instrument is that the surface of the of the bulb-shaped sensor is smooth and can be slippery when contacted by the tongue. This study evaluated whether adding a textured layer to the bulb leads to enhanced strength measures in neurologically normal adults. Methods: Maximum-effort maneuvers for anterior and posterior tongue elevation, right and left tongue lateralization, and tongue protrusion were available from 62 healthy adults using the Iowa Oral Performance Instrument (IOPI). The IOPI tongue bulb was either bare or covered with a single layer of gauze. The maximum pressure (Pmax) exerted on the bulb from three trials was used as the outcome variable for each task. Results: In addition to significant main effects for both bulb-cover and task, there was a significant interaction between the use of gauze and the direction of the tongue-strength maneuver. Pmax was significantly greater when a gauze-covered bulb was used for tongue lateralization and protrusion but not for tongue elevation maneuvers. Conclusion: Using a single-layer of gauze on the smooth tongue-bulb helped reduce slippage of the tongue and resulted in greater Pmax values when evaluating tongue strength in the lateral and protrusive directions, but not for tongue elevation. Efforts to develop a more permanent solution to texturizing the bulb’s surface are needed.

Tongue Posture, Tongue Movements, Swallowing, and Cerebral Areas Activation: A Functional Magnetic Resonance Imaging Study

The aim of this study was to pinpoint the cerebral regions implicated during swallowing by comparing the brain activation areas associated with two different volitional movements: tongue protrusion and tongue elevation. Twenty-four healthy subjects (11—males 22 ± 2.9 y; 13—females 23 ± 4.1 y; were examined through functional magnetic resonance imaging (fMRI) while performing two different swallowing tasks: with tongue protrusion and with tongue elevation. The study was carried out with the help of fMRI imaging which assesses brain signals caused by changes in neuronal activity in response to sensory, motor or cognitive tasks. The precentral gyrus and the cerebellum were activated during both swallowing tasks while the postcentral gyrus, thalamus, and superior parietal lobule could be identified as large activation foci only during the protrusion task. During protrusion tasks, increased activations were also seen in the left-middle and medial frontal gyrus, right thalamus, inferior parietal lobule, and the superior temporal gyrus (15,592-voxels; Z-score 5.49 ± 0.90). Tongue elevation activated a large volume of cortex portions within the left sub-gyral cortex and minor activations in both right and left inferior parietal lobules, right postcentral gyrus, lentiform nucleus, subcortical structures, the anterior cingulate, and left insular cortex (3601-voxels; Z-score 5.23 ± 0.52). However, the overall activation during swallowing tasks with tongue elevation, was significantly less than swallowing tasks with tongue protrusion. These results suggest that tongue protrusion (on inferior incisors) during swallowing activates a widely distributed network of cortical and subcortical areas than tongue elevation (on incisor papilla), suggesting a less economic and physiologically more complex movement. These neuromuscular patterns of the tongue confirm the different purpose of elevation and protrusion during swallowing and might help professionals manage malocclusions and orofacial myofunctional disorders.

Understanding the Lingual Frenulum: Histological Structure, Tissue Composition, and Implications for Tongue Tie Surgery.

Lingual frenotomy has become an increasingly common surgical procedure, performed for a broad range of indications from birth through adulthood. This study utilizes histology to define the structure and tissue composition of the lingual frenulum and floor of mouth (FOM) fascia. En bloc specimens of anterior tongue, lingual frenulum, and FOM tissues were harvested from ten embalmed adult cadavers. An additional three fresh tissue cadaveric specimens were frozen with the tongue supported in an elevated position, to enable harvesting and paraffin embedding of the elevated lingual frenulum as a discrete specimen. All 13 specimens were prepared as ten-micron coronal sections using stains to determine the general morphology of the lingual frenulum, its relationship to neighbouring structures (Mason's Trichrome), presence of elastin fibers (Verhoeff-van Gieson), and collagen typing (Picrosirius Red). Our results have shown a submucosal layer of fascia spanning horizontally across the FOM was present in all specimens, with variability in fascial thickness and histologic composition. This FOM fascia suspends the sublingual glands, vessels, and genioglossus from its deep surface. The elevated lingual frenulum is formed by a central fold of this FOM fascia together with the overlying oral mucosa with variability in fascial thickness and composition. With tongue elevation, the fascia mobilizes to a variable extent into the fold forming the frenulum, providing a structural explanation for the individual variability in lingual frenulum morphology seen in clinical practice.

The influence of training variables on lingual strength and swallowing in adults with and without dysphagia

AbstractBackgroundSwallowing disorders (dysphagia) occur in a large proportion of individuals over the age of 60. The improvement of tongue strength by resistance exercise is postulated to be directly related to lingual‐palatal pressure generation and bolus propulsion into the pharynx during swallowing. To the best of our knowledge, however, there is no evidence‐based discussion evaluating the strength training variables of the tongue for improving tongue strength maximally.MethodsTo solve this problem, we reviewed the relationships between different resistance training variables (i.e. training period, intensity, duration of muscle contraction, volume, and frequency) and the change in muscle strength in the lingual muscle.ResultsOur findings show that tongue strength training may improve anterior and posterior tongue strength in both healthy adults and patients with dysphagia. Anterior and posterior tongue strength gradually increased and did not reach a plateau after at least 8 weeks of training. Data for other variables were insufficient to draw clear conclusions. Available data suggest that a training intensity of 60–100% of maximum tongue strength, a contraction time of 2–3 s, a total number of 90–120 repetitions per day, and a training frequency of three times per week appears to result in an improvement in maximal isometric tongue elevation strength in adults with and without dysphagia.ConclusionsFuture studies are warranted to better determine if there are dose–response relationships in tongue strength training in healthy adults and patients with dysphagia.

Influence of sex and resistance training status on orofacial muscle strength and morphology in healthy adults between the ages of 18 and 40: A cross-sectional study.

To compare the orofacial muscle strength and facial muscle thickness between resistance-trained and non-resistance trained men and women. Resistance-trained (25 men and 22 women) and non-resistance trained (21 men and 30 women) adults (18-40 years) had standard measurements of orofacial muscle strength (ie, anterior tongue elevation, cheek compression, and lip compression) and ultrasound measurements of facial muscle thickness. Body composition (percent fat, etc.) was estimated using ultrasound prediction Equations. A Bayesian analysis of variance (ANOVA) with between subject factors of training status (yes/no) and sex (man/woman) were used to determine differences in muscle size and strength. Body mass, height, and percent fat were similar between resistance-trained and non-resistance trained individuals, while appendicular lean mass was higher in resistance-trained. There were no differences in orofacial muscle strength between resistance-trained and non-resistance trained. However, men had greater strength in every task except for anterior tongue strength which was similar between sexes (men: 66 vs women: 64 kPa). Handgrip strength was greater in men and in those who were resistance-trained. The frontalis muscle was greater in women than in men and in those who were non-resistance-trained than those resistance-trained. None of the other muscles differed by training status, however, all were greater in men. Results from our cross-sectional study would suggest that exercise-stimulation to the facial muscles during resistance training of the limbs and trunk did not reach a level where orofacial muscle strength could be changed. Sex differences in facial muscle thickness are very unique, although the reasons are unclear.

Tongue position for lingual frenulum assessment

ABSTRACT Purpose: to compare the movements of elevation and protrusion of the tongue in order to determine which position provides better lingual frenulum assessment. Methods: a database of 92 audiovisual recordings of subjects over six-years of age diagnosed with ankyloglossia was used to verify the shape of the tip of the tongue during tongue elevation and protrusion. The Chi-Square Test for Proportion was applied to verify possible differences between the postures of elevation and protrusion. The significance level of 5% (p&lt;0.05) was adopted. Results: the statistical analysis demonstrated that both shapes, i.e., the V-shaped one and the heart-shaped one are more visible during tongue elevation than during tongue protrusion. Conclusion: elevation is the position that allows the best observation of the shape of the tip of the tongue.

Surgical treatment of ankyloglossia using an ophthalmic topical anesthetic and a tentacannula for tongue elevation: a case report

Introduction: Ankyloglossia is characterized by the presence of a short lingual frenum that can be inserted from the alveolar ridge to the lingual apex and, until promoting a true fusion of the tongue to the floor. A short lingual frenum can generate several problems such as phonetic disorders. Objective: To describe a surgical technique for the treatment of ankyloglossia using a topical ophthalmic anesthetic and a tentacannula for tongue elevation. Case report: A 15-year-old female was referred for lingual frenulum surgery due to speech impairment. Clinical examination revealed the presence of ankyloglossia which was both hindering the pronunciation of T, D, L phonemes and reducing tongue mobility. The surgical technique chosen was a lingual frenectomy. An ophthalmic topical anesthetic was initially applied to the lateral borders of the frenum with the patient in an upright position and in the presence of adequate aspiration. With the aid of a tentacannula the tongue was raised and the frenulum gradually released with a Goldman-Fox serrated scissor. The topical anesthetic was continuously trickled onto the surgical site during surgery. Results: No postoperative pain was reported by the patient, healing occurred normally and there was no recurrence of abnormal frenulum insertion. Conclusion: The advantages of this technique in comparison to conventional methods which use infiltrative anesthesia include less trauma and a more precise evaluation of tongue movements during surgery, because there will be better control of mobility for the patient when compared to infiltrative techniques.