Tongue Model Research Articles

Evaluation of a 3D Printed Silicone Oral Cavity Cancer Model for Surgical Simulations.

Adequate surgical margins are essential in oral cancer treatment, this is, however, difficult to appreciate during training. With advances in training aids, we propose a silicone-based surgical simulator to improve training proficiency for the ablation of oral cavity cancers. A silicone-based tongue cancer model constructed via a 3D mold was compared to a porcine tongue model used as a training model. Participants of varying surgical experience were then asked to resect the tumors with clear margins, and thereafter asked to fill out a questionnaire to evaluate the face and content validity of the models as a training tool. Eleven participants from the Otolaryngology-Head and Neck Surgery unit were included in this pilot study. In comparison to the porcine model, the silicone model attained a higher face (4 vs. 3.6) and content validity (4.4 vs. 4.1). Tumor consistency was far superior in the silicone model compared to the porcine model (4.1 vs. 2.8, p = 0.0042). Fellows and staff demonstrated a better margin clearance compared to residents (median 3.5 mm vs. 1.0 mm), and unlike the resident group, there was no incidence of positive margins. The surgical simulation was overall useful for trainees to appreciate the nature of margin clearance in oral cavity cancer ablation.

Observation of Tongue Form at Rest and during Articulation by Using a Tongue Model Constructed from Ultrasonic Tongue Images

Observation of Tongue Form at Rest and during Articulation by Using a Tongue Model Constructed from Ultrasonic Tongue Images

A Low Budget Perineal Repair Model

BACKGROUND We designed a low-cost model to prepare junior surgeons for the limited accessibility and visibility of perineal lacerations. This model has advantages over the classical beef tongue model including lower cost, being easier to build, and lasting longer. METHODS To build the model, follow the instructions as described in appendix A. Users were surveyed to compare the model against established simulated formats. RESULTS Each of our models can made in about 5 minutes and costs $2.09 in materials per model. Our model was directly compared to the classical beef tongue model used by many programs to simulate perineal repairs. At our program, it took residents on average 15 minutes to create their beef tongue model and cost $16.50 per model which had to be used immediately and discarded afterwards due to the meat spoiling. Overall, our model was seen as a useful training tool to be used in addition to our current curriculum. It does not require significant preparation to build or use unlike the beef tongue model, and it is sufficiently cheap for medical students and residents to take home. DISCUSSION/CONCLUSION Many medical models are prohibitively expensive for the individual to purchase or are reserved for rare training sessions in a simulation center due to their scarcity. This is an efficient and practical model which accurately demonstrates the limited space and visibility of perineal repairs while also allowing residents to conveniently practice 3rd and 4th degree repairs, which are so infrequent in modern obstetrical practice.

Motor control similarity between speakers saying "a souk" using inverse atlas tongue modeling.

Finite element models (FEM) of the tongue have facilitated speech studies through analysis of internal muscle forces indirectly derived from imaging data. In this work, we build a uniform hexahedral FEM of a tongue atlas constructed from magnetic resonance imaging data of a healthy population. The FEM is driven by inverse internal tongue tissue kinematics of speakers temporally aligned and deformed into the same atlas space, while performing the speech task "a souk" allowing muscle activation predictions. This work aims to investigate the commonalities in tongue motor strategies in the articulation of "a souk" predicted by the inverse tongue atlas model. Our findings report variability among five speakers for estimated muscle activations with a similarity index using a dynamic time warp function. Two speakers show similarity index > 0.9 and two others < 0.7 with respect to a reference speaker for most tongue muscles. The relative motion tracking error of the model is less than 2% which is promising for speech study applications.

A novel flap design technique for subtotal tongue reconstruction with an “Individualized and Convenient Tongue Model”

BackgroundTo achieve improved functional outcomes in subtotal tongue reconstruction, a flap design with sufficient volume and appropriate shape is necessary. In this study, we introduce an “Individualized and Convenient Tongue Model” (ICTM) for flap design in subtotal tongue reconstruction. MethodsBy studying the anatomical morphology of the tongue, we found a similar geometry within the dorsum and body of the tongue as well as the mouth floor. This can be used to create an ICTM through folding and splicing. We can simulate tongue defects in the ICTM and transform defect shapes into guide plates for flap design. In this study, fifty-eight patients requiring subtotal tongue reconstruction were randomly divided into two groups: an ICTM group (35 patients) and a conventional group (31 patients). In the ICTM group, we individually designed profunda artery perforator flaps (PAPFs) or anterolateral thigh flaps (ALTFs) using the ICTM method. In the conventional group, the flap was designed according to the surgeon’s clinical experience. Patient demographics, operative and follow-up data were recorded. Swallowing, speech intelligibility, and cosmetic results were assessed using appropriate scales. ResultsAll flaps survived, although there were no significant differences in tumor size, operation time, flap size, and complication rate compared to the conventional group. Patients in the ICTM group had significantly improved speech intelligibility (p = 0.019), cosmetic appearance (p = 0.009), and swallowing ability (p = 0.003). ConclusionsThe ICTM technique is an effective and convenient solution for subtotal tongue reconstruction that provides an individualized flap design and improves functional outcomes compared to the conventional design.

Electrical impedance myography method of measuring anisotropic tongue tissue

Objective. To date, measurement of the conductivity and relative permittivity properties of anisotropic biological tissues using electrical impedance myography (EIM) has only been possible through an invasive ex vivo biopsy procedure. Here, we present a novel forward and inverse theoretical modeling framework to estimate these properties combining surface and needle EIM measurements. Methods. The framework here presented models the electrical potential distribution within a monodomain, homogeneous, and three-dimensional anisotropic tissue. Finite-element method (FEM) simulations and tongue experimental results verify the validity of our method to reverse-engineer three-dimensional conductivity and relative permittivity properties from EIM measurements. Results. FEM-based simulations confirm the validity of our analytical framework, with relative errors between analytical predictions and simulations smaller than 0.12% and 2.6% in a cuboid and tongue model, respectively. Experimental results confirm qualitative differences in the conductivity and the relative permittivity properties in the x, y, and z directions. Conclusion. Our methodology enables EIM technology to reverse-engineer the anisotropic tongue tissue conductivity and relative permittivity properties, thus unfolding full forward and inverse EIM predictability capabilities. Significance. This new method of evaluating anisotropic tongue tissue will lead to a deeper understanding of the role of biology necessary for the development of new EIM tools and approaches for tongue health measurement and monitoring.

Articulation differences of /s/ observed using inverse tongue atlas modeling

Depending on the vowel context, the consonant /s/ can be articulated by engaging different functional units of the tongue. An inverse finite element (FE) tongue model comprising hexahedral elements generated from a 4D statistical MRI atlas of 22 speakers performing the speech tasks “a geese” (tongue moving forwards) and “a souk” (tongue moving backwards) is used to study this articulatory behavior. The model uses a state-of-the-art inverse tracking controller to simulate the motion of internal tissue points of the different speakers deformed into the atlas space. Motion tracking is successfully carried out by minimizing the L2-norm of velocity error of FEM nodes using the Cottle–Dantzig algorithm. The results show that for “a-geese,” the utterance of /s/ in context of vowel /i/ showed increase in activation of tongue protruder muscles such as genioglossus posterior, floor muscle geniohyoid by ∼5% more than in the case of “a-souk.” In “a-souk” relative activity increased in the tongue retractor muscles mid- and anterior-genioglossus, and superior longitudinal by ∼4%. Our findings are consistent with subject-specific state-of-the-art models and with articulatory expectations. The inverse atlas tongue model can be further used to estimate such articulation behavior on extended datasets of subjects performing more variations of speech tasks.

Establishment of a diverse head and neck squamous cancer cell bank using conditional reprogramming culture methods.

Most laboratory models of head and neck squamous cell cancer (HNSCC) rely on established immortalized cell lines, which carry inherent bias due to selection and clonality. We established a robust panel of HNSCC tumor cultures using a "conditional reprogramming" (CR) method, which utilizes a rho kinase inhibitor (Y-27632) and co-culture with irradiated fibroblast (J2 strain) feeder cells to support indefinite tumor cell survival. Sixteen CR cultures were successfully generated from 19 consecutively enrolled ethnically and racially diverse patients with HNSCC at a tertiary care center in the Bronx, NY. Of the 16 CR cultures, 9/16 were derived from the oral cavity, 4/16 were derived from the oropharynx, and 3/16 were from laryngeal carcinomas. Short tandem repeat (STR) profiling was used to validate culture against patient tumor tissue DNA. All CR cultures expressed ΔNp63 and cytokeratin 5/6, which are markers of squamous identity. Human papillomavirus (HPV) testing was assessed utilizing clinical p16 staining on primary tumors, reverse transcription polymerase chain reaction (RT-PCR) of HPV16/18-specific viral oncogenes E6 and E7 in RNA extracted from tumor samples, and HPV DNA sequencing. Three of four oropharyngeal tumors were p16 and HPV-positive and maintained HPV in culture. CR cultures were able to establish three-dimensional spheroid and murine flank and orthotopic tongue models. CR methods can be readily applied to all HNSCC tumors regardless of patient characteristics, disease site, and molecular background, providing a translational research model that properly includes patient and tumor diversity.

Uppermost Katian (Ka4, Upper Ordovician) conodonts in South China: Biostratigraphy, biofacies, and paleobiogeography

The conodont fauna from the Daduhe Formation in southwestern Sichuan and northeastern Yunnan, southwestern China, is analyzed and correlated with the uppermost Ordovician Amorphognathus ordovicicus conodont Biozone. This age assignment is further supported by the graptolites from the same sections, indicating a Ka4 Stage Slice, i.e., from the Dicellograptus complexus to Paraorthograptus pacificus graptolite biozones. Two common conodont species of the Upper Ordovician, Hamarodus brevirameus and Scabbardella altipes, are reported for the first time from the upper Katian in South China. The analysis of conodont biofacies indicates that the conodont fauna in the Daduhe Formation belongs to the cool-water Hamarodus brevirameus–Dapsilodus mutatus–Scabbardella altipes Biofacies. This discovery provides additional evidence for the cold tongue model during the Late Ordovician. The distribution of Yaoxianognathus yaoxianensis confirms the close biogeographical ties among South China, North China and Tarim. This distinctive species of eastern Gondwana might have originated in North China and dispersed to Tarim and South China.

Prequel to the Stories of Warm Conveyor Belts and Atmospheric Rivers: The Moist Tongues Identified by Rossby and His Collaborators in the 1930s

Abstract The model of atmospheric rivers (ARs) has been around since the 1990s. A closely related model is the warm conveyor belt (WCB) developed in the 1970s. Looking further back in time, a phenomenon known as the “moist tongue” was intensively investigated in the late 1930s and early 1940s by Rossby and his collaborators using the innovation of isentropic analysis. This article aims to establish a historical perspective on the development of the moist tongue model and its relevance to the current models of WCBs and ARs. As it turns out, the moist tongue was identified as an extension of moist air into a region of lower moisture content on the selected isentropic charts. Most moist tongues are driven by large-scale cyclonic and anticyclonic eddies and are often accompanied by surface cold fronts in close proximity. Ahead of the moist tongues, areas of continuous precipitation are caused mainly by the motion of moist air up the steep isentropic slopes over warm fronts or topographical features. In the warm season, the mere presence of a moist tongue could be sufficient to give thunderstorms. A reanalysis dataset is used to reexamine the structures and evolutions of two moist tongue events in 1936. It is shown that not all but some of the moist tongues fit well with the modern conceptual models of WCB and AR. These two case studies also serve to elucidate the usefulness of reanalysis data for investigating historical high-impact weather events that were poorly understood due to the lack of observational data.

A tutorial on articulatory muscles and ArtiSynth: Tongue and suprahyoid muscles, and 3D tongue model

AbstractThis article has two main purposes: (i) to review the placement and function of the tongue and suprahyoid muscles concerning speech articulation, and (ii) as a biomechanical simulation tool to study how those muscles are involved in articulation, to introduce a 3D tongue model distributed by a 3D modelling platform called ArtiSynth. The 3D tongue model can be combined with other structural models to provide the outline of the oral cavity. This article presents examples of muscular simulations for/i/and/ɑ/using the jaw‐hyoid‐tongue model in ArtiSynth.

Tongue model construction based on ultrasound images with image processing and deep learning method.

The purpose of this paper is to construct a 3D tongue model and to generate an animation of tongue movement for speech therapy in patients with lateral articulation (LA). The 3D tongue model is generated based on ultrasound (US) images, which are widely used in many clinics. A tongue model is constructed by extracting the tongue surfaces from US images with the help of image processing techniques and a deep learning method. A reference tongue model is generated first using US images of a normal speaker, and a model of an LA patient is then constructed by modifying the reference tongue model. An animation of the tongue movement is generated by deforming the model according to a time sequence. The accuracy of the tongue surfaces estimated by a deep learning method were 22/45 = 49% and 29/45 = 64% for US images of a normal speaker and an LA patient, respectively. In addition, the maximum vertical errors between the ground truth and the estimated spline curves were 1.01 and 1.03 mm for US images of a normal speaker and an LA patient, respectively. We have constructed a tongue model and generated a tongue movement animation of an LA patient using US images. The maximum vertical error between the ground truth and the estimated spline curves was only 1.03 mm, and we have confirmed that the generated tongue model is very useful for speech therapy in LA patients.

3D Patient-Specific Biomechanical Model of the Tongue for the Management of Tongue Tumors: Conceptualization to Reality.

Increasing use of tobacco by the younger generation has resulted in an increase in oral cavity tumors. Surgical treatment is radical and results in severe functional morbidity. Using computer-aided designing technology, surgical and rehabilitative planning can be better. We present here our concept of a patient-specific biomechanical 3D model of the tongue and its clinical utility in the management of tongue tumors. Using fused deposition modeling, the 3D model of the tongue was printed which easily differentiates the tumor and the uninvolved tongue by printing in two different colors. The 3D tongue model was used by the surgical and rehabilitation teams to frame the treatment and plan the rehabilitation taking into account the patient preferences and needs. The model was used in two patients with operable squamous cell carcinoma (SCC) of the tongue, and the utility of the model in margin planning, surgical defect assessment, and its aid in the reconstruction and rehabilitation was assessed. Two patients with Stage III SCC of the tongue underwent the surgery based on the plan evolved from the 3D model. All the surgical margins assessed by the frozen section analysis were clear. The model helped in addressing the discordance between patient expectations and surgical outcomes. We found that the model aided the reconstructive surgeon in planning the flap harvest based on the pre-operative defect assessment, which, in turn, translated into better rehabilitative outcomes. 3D biomechanical tongue model is a novel concept and aids in improving the overall treatment outcomes. The realistic 3D reconstructed image model helps the oncologist in planning the resection, enables the reconstructive surgery to more precisely predict the defect volume, and lastly the rehabilitative team in developing better rehabilitation strategies.

Frozen Section Analysis and Real-Time Magnetic Resonance Imaging of Surgical Specimen Oriented on 3D Printed Tongue Model to Assess Surgical Margins in Oral Tongue Carcinoma: Preliminary Results.

BackgroundA surgical margin is the apparently healthy tissue around a tumor which has been removed. In oral cavity carcinoma, a negative margin is considered ≥ 5 mm, a close margin between 1 and 5 mm, and a positive margin ≤ 1 mm. Currently, the intraoperative surgical margin status is based on the visual inspection and tissue palpation by the surgeon and intraoperative histopathological assessment of the resection margins by frozen section analysis (FSA). FSA technique is limited and susceptible to sampling errors. Definitive information on the deep resection margins requires postoperative histopathological analysis.MethodsWe described a novel approach for the assessment of intraoperative surgical margins by examining a surgical specimen oriented through a 3D-printed specific patient tongue with real-time Magnetic Resonance Imaging (MRI). We reported the preliminary results of a case series of 10 patients, prospectively enrolled, with oral tongue carcinoma who underwent surgery between February 2020 and April 2021. Two radiologists with 5 and 10 years of experience, respectively, in Head and Neck radiology in consensus evaluated specimen MRI and measured the distance between the tumor and the specimen surface. We performed intraoperative bedside FSA. To compare the performance of bedside FSA and MRI in predicting definitive margin status we computed the weighted sensitivity (SE), specificity (SP), accuracy (ACC), area under the ROC curve (AUC), F1-score, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). To express the concordance between FSA and ex-vivo MRI we reported the jaccard index.ResultsIntraoperative bedside FSA showed SE of 90%, SP of 100%, F1 of 95%, ACC of 0.9%, PPV of 100%, NPV (not a number), and jaccard of 90%, and ex-vivo MRI showed SE of 100%, SP of 100%, F1 of 100%, ACC of 100%, PPV of 100%, NPV of 100%, and jaccard of 100%. These results needed to be validated in a larger sample size of 21- 44 patients.ConclusionThe presented method allows a more accurate evaluation of surgical margin status, and the first clinical experiences underline the high potential of integrating FSA with ex-vivo MRI of the fresh surgical specimen.

Design of an Artificial Tongue Driven by Shape Memory Alloy Fibers.

Dysphasia is one of the complications which may cause functional disability after the surgical treatment of oral cancer. The loss of the function derived by tongue and other oral tissues impairs the retention and delivery of liquids and food masses as well as the swallowing motion into pharynx. As accumulation of liquids or food masses in the larynx can lead to pneumonia, therefore swallowing support to improve each coordination of the tongue, the epiglottis and the esophagus in the process of swallowing is highly desirable. In this study, we designed a new artificial tongue which was capable of contracting to deliver the bolus masses in the swallowing propulsion phase in the oral cavity. We designed a two-layered artificial tongue simulating the anatomical identical muscle structures with the longitudinal muscle, and the transverse muscle-genioglossus layer. A silicone rubber material was used for the surface layer, and the covalent shape memory alloy fibers (diameter: 150µm) were implemented in the secondary structure beneath of the silicone rubber material of the artificial tongue. Its contraction was driven by with shape memory alloy fibers shortage inside of the artificial tongue unit. The actuation was accurately controlled by the originally designed electrical current input with pulse width modulation. Firstly, we examined a prototype structure of the artificial tongue as well as the changes in unit thickness as it constricted by electric power supply switching. Secondly, we performed a feasibility study of the prototype into the head-neck medical training model with larynx-tracheal structure with esophagus. The results were as follows: a) the artificial tongue model showed a large contraction with a motion to increase upward pressure, b) the tongue unit expressed the capability of reducing shallow space between dorsal tongue surface and palate in the oral cavity model. Therefore, the first artificial tongue design with active contractile motion will be useful orally installable device for improving delivery function of bolus masses through swallowing procedure in dysphasia.Clinical Relevance- The active artificial tongue system designed for the first time exhibited an effective contractile motion to support bolus food masses propulsion in swallowing process in the oral cavity in the patients with dysphasia.

Development of a Spoon Motion Navigation Algorithm for the Mealtime Assistant Simulator

In aging society like Japan, maintaining the quality of life (QOL) is an important objective. The oral cavity has various significant functions that contribute to the QOL. Elderly people are susceptible to the swallowing disorders owing to various factors associated with advancing age. In such cases, mealtime assistance can provide elderly persons appropriate eating situations. Thus, mealtime assistance skills are essential for students in nursing and caregiver education. Recently, simulation education has attracted attention as an effective educational process for nursing and caregiver students before their clinical practice in a hospital or care house. In this educational process, a patient model that mimics specific symptoms called the simulation model, is used to learn the symptoms and its care process in the same clinical environment as actual. We have attempted to develop several oral care simulation models, and we have earlier developed a prototype of mealtime assistance simulation model. This simulation model had a tongue model with a sensor system to detect spoon motions, and its fundamental functions were evaluated via spoon detection experiments. Based on the earlier achievements, in this study, we develop an evaluation system of feeding skill using a spoon. The pressing force and position by spoon on the tongue model were estimated by transfer functions derived from experiments. In addition, we developed an algorithm that leads students’ spoon position and pressing force in the correct position.

Abstract 2882: Coronin 1B overexpression promotes invasion of HPV- HNSCC

Abstract Introduction: Amplification of chromosome 11q13 is the most common DNA aberration in human papilloma virus negative (HPV-) head and neck squamous cell carcinoma. (HSNCC). The 11q13 region encodes various genes known to enhance invasion and drive tumor progression. CORO1B (coronin 1B) flanks the core 11q13 region and is amplified in 7-14% of HNSCC cases. Coronin 1B governs cell motility in fibroblasts by negatively regulating the ability of the Arp 2/3 nucleator cortactin to stabilize the actin cytoskeleton during mesenchymal cell migration. This study seeks to determine the impact of CORO1B amplification and protein overexpression in driving HNSCC progression. Experimental Procedures: Two patient cohorts were used to assess the impact of CORO1B amplification or overexpression on patient outcome. In addition, HNSCC cell lines lacking or overexpressing coronin 1B were assayed for invadopodia function using gelatin degradation assays. Three-dimensional invasion was analyzed using tumor spheroid and organotypic assays. Invasive and cervical lymph node metastatic potential of CORO1B was evaluated using knockdown and overexpression cells in orthotopic tongue models. Data Summary: CORO1B amplification and overexpression in patient tumors correlates with enhanced patient decline. Coronin 1B-null cell lines display decreased invadopodia function, with a 30-60% decrease in extracellular matrix-mimicking gelatin degradation. HNSCC tumor spheroids lacking coronin 1B expression decreased 3D invasion in native collagen I, while overexpression enhanced invasive capabilities in both tumor spheroids and organotypic cultures. Coronin 1B knockdown cells show decreased lymph node metastasis, while mice with tumors overexpression coronin 1B have enhanced lymph node metastasis and decreased survival. CORO1B amplification protein overexpression predict poor overall patient survival. Conclusion: The identification of coronin 1B overexpression as an important mediator in promoting HNSCC invasive processes may define a novel aggressive subset of locoregional involved HNSCC, warranting enhanced clinical intervention. Citation Format: Jessica L. Allen, Elyse L. Walk, Kristen L. Rhodes, Steven M. Markwell, Brenen W. Papenberg, Hong Wu, Marileila Garcia, James E. Bear, Scott A. Weed. Coronin 1B overexpression promotes invasion of HPV- HNSCC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2882.

Ultrasound monitoring of a deformable tongue-food gel system during uniaxial compression–an in vitro study

This study presents a novel ultrasound method for exploring the mechanical deformability of artificial tongue models (ATMs) topped with agar and/or gelatin food gels during uniaxial compression. The ATMs were made from polyvinyl alcohol and displayed different levels of rigidity and surface roughness. We quantified deformation of the ATM-food system as it underwent compression induced by a texture analyzer. We collected real-time measurements via an ultrasound transducer (1 MHz) placed beneath the ATM, enabling to monitor non-invasively the ultrasound time of flight (ToF) and the apparent reflection coefficient (R*) of the ATM-food interface. The results on ToF reflected the tie between the level of force and ATM deformation; they were also precise enough to identify gel fracture. R* was a crucial parameter influenced by both ATM properties (rigidity, surface roughness) and food gel properties (syneresis, ability to mold to surface asperities).

Three-Dimensional Digitalized and Printed Tongue Models of the Cow, Dog, Pig, and Horse for Undergraduate Veterinary Educationh

Three-Dimensional Digitalized and Printed Tongue Models of the Cow, Dog, Pig, and Horse for Undergraduate Veterinary Educationh

Personalized biomechanical tongue models based on diffusion-weighted MRI and validated using optical tracking of range of motion

For advanced tongue cancer, the choice between surgery and organ-sparing treatment is often dependent on the expected loss of tongue functionality after treatment. Biomechanical models might assist in this choice by simulating the post-treatment function loss. However, this function loss varies between patients and should, therefore, be predicted for each patient individually. In the present study, the goal was to better predict the postoperative range of motion (ROM) of the tongue by personalizing biomechanical models using diffusion-weighted MRI and constrained spherical deconvolution reconstructions of tongue muscle architecture. Diffusion-weighted MRI scans of ten healthy volunteers were obtained to reconstruct their tongue musculature, which were subsequently registered to a previously described population average or atlas. Using the displacement fields obtained from the registration, the segmented muscle fiber tracks from the atlas were morphed back to create personalized muscle fiber tracks. Finite element models were created from the fiber tracks of the atlas and those of the individual tongues. Via inverse simulation of a protruding, downward, left and right movement, the ROM of the tongue was predicted. This prediction was compared to the ROM measured with a 3D camera. It was demonstrated that biomechanical models with personalized muscles bundles are better in approaching the measured ROM than a generic model. However, to achieve this result a correction factor was needed to compensate for the small magnitude of motion of the model. Future versions of these models may have the potential to improve the estimation of function loss after treatment for advanced tongue cancer.