592 A Large Lipoma: An Unusual Presentation of the Tongue

Background Lipomas are commonly identified tumours of the body however they are rarely found in the oral cavity. Rarer still is it to report a case of a lipoma in the tongue as they are more commonly located in the buccal mucosa. Objectives To diagnose and explore the pathogenesis of a soft-tissue swelling of unknown origin Method A thorough patient history and clinical examination was undertaken followed by magnetic resonance imaging (MRI) which revealed an alarming report at first glance. An incisional biopsy of the lesion was then carried out to aid in diagnosing the lesion. Results The swelling caused the patient no pain however the mere size of the lesion affected the patient’s tongue movement and function which therefore affected the patient’s quality of life. The imaging and the biopsy of the lesion led to a diagnosis of a large lipoma on the lateral border of the tongue. Conclusions To the authors’ best knowledge, we present a rare case of a patient whom we diagnosed with a large lipoma on the lateral border of the tongue. This case report discusses the stages of patient management from initial presenting complaint, up to the maintenance of the patient following the diagnosis of this lesion.

Gait change in tongue movement

During locomotion, humans switch gaits from walking to running, and horses from walking to trotting to cantering to galloping, as they increase their movement rate. It is unknown whether gait change leading to a wider movement rate range is limited to locomotive-type behaviours, or instead is a general property of any rate-varying motor system. The tongue during speech provides a motor system that can address this gap. In controlled speech experiments, using phrases containing complex tongue-movement sequences, we demonstrate distinct gaits in tongue movement at different speech rates. As speakers widen their tongue-front displacement range, they gain access to wider speech-rate ranges. At the widest displacement ranges, speakers also produce categorically different patterns for their slowest and fastest speech. Speakers with the narrowest tongue-front displacement ranges show one stable speech-gait pattern, and speakers with widest ranges show two. Critical fluctuation analysis of tongue motion over the time-course of speech revealed these speakers used greater effort at the beginning of phrases—such end-state-comfort effects indicate speech planning. Based on these findings, we expect that categorical motion solutions may emerge in any motor system, providing that system with access to wider movement-rate ranges.

Emerging Role of Ultrasound in Dysphagia Assessment and Intervention: A Narrative Review

Ultrasonography has gained increasing attention as a non-invasive and radiation-free instrument for the assessment of swallowing function. In the past decades, an extensive repertoire of ultrasonographic techniques, such as, B-mode dynamic scanning, pixel analysis, M-mode, Doppler, 3D reconstruction, and sonoelastography, has been applied in the evaluation of oropharyngeal structures and movement. Yet, a universal consensus on the examination protocols and clinical implications remains to be established. This review aimed to provide a brief introduction of the application of ultrasound in dysphagia assessment and intervention, encompassing the ultrasonography of swallowing-related muscles, tongue movement, and hyolaryngeal excursion, as well as ultrasound-guided interventions in the management of dysphagia. In addition to non-invasiveness, ultrasonography, a portable, easy to use, and low-cost technique, could compliment videofluoroscopic swallowing study as a first-line screening and follow-up tool for the evaluation of swallowing function, although further study is warranted to provide quantitative diagnostic and prognostic values. Finally, ultrasonography aids in the precisely targeted injection of botulinum toxin in patients exhibiting oropharyngeal muscle spasticity.

Adaptive brain activity changes during tongue movement with palatal coverage from fMRI data

Successful adaptation to wearing dentures with palatal coverage may be associated with cortical activity changes related to tongue motor control. The purpose was to investigate the brain activity changes during tongue movement in response to a new oral environment. Twenty-eight fully dentate subjects (mean age: 28.6-years-old) who had no experience with removable dentures wore experimental palatal plates for 7 days. We measured tongue motor dexterity, difficulty with tongue movement, and brain activity using functional magnetic resonance imaging during tongue movement at pre-insertion (Day 0), as well as immediately (Day 1), 3 days (Day 3), and 7 days (Day 7) post-insertion. Difficulty with tongue movement was significantly higher on Day 1 than on Days 0, 3, and 7. In the subtraction analysis of brain activity across each day, activations in the angular gyrus and right precuneus on Day 1 were significantly higher than on Day 7. Tongue motor impairment induced activation of the angular gyrus, which was associated with monitoring of the tongue’s spatial information, as well as the activation of the precuneus, which was associated with constructing the tongue motor imagery. As the tongue regained the smoothness in its motor functions, the activation of the angular gyrus and precuneus decreased.

Changes in tongue–palatal contact during swallowing in patients with skeletal mandibular prognathism after orthognathic surgery

This study aimed to evaluate improvement of tongue-palatal contact patterns during swallowing after orthognathic surgery in mandibular prognathism patients. Thirty patients with mandibular prognathism treated by orthognathic surgery (average age of 27 years, 3 months) and 10 controls (average age 29 years, 6 months) participated in this study. Tongue-palatal contact patterns of patients before and three months after surgery were evaluated by electropalatography (EPG) as well as controls. Whole total of tongue-palatal contact at 0.3, 0.2, and 0.1 sec before complete tongue-palatal contact during swallowing were evaluated. The duration of swallowing phases was also examined. Complete contact of tongue-tip in the alveolar part of individual artificial EPG plate were shown at 0.3, 0.2, and 0.1 sec before complete tongue-palatal contact in the controls, although incomplete contact in the alveolar part were shown at 0.3 sec in mandibular prognathism patients. Whole total of tongue-palatal contact at 0.3 and 0.2 sec before complete tongue-palatal contact was significantly lower in the patients before surgery than in the controls (p<0.05). However, these values increased after surgery. The duration of oral and pharyngeal phase was significantly longer in the patients before surgery than in the controls and the patients after surgery (p<0.01). This study demonstrated that the tongue-palatal contact pattern improved and the duration of oral and pharyngeal phase was shortened in mandibular prognathism patients during swallowing after orthognathic surgery. It is suggested that changes in maxillofacial morphology by orthognathic surgery can induce normal tongue movement during swallowing. (The data underlying this study have been uploaded to figshare and are accessible using the following DOI: https://doi.org/10.6084/m9.figshare.14101616.v1)

Preliminary study of articulatory characteristics in open bite subjects revealed by 3T magnetic resonance imaging movies

Objectives: Previous studies have reported that articulatory dysfunction accompanied by a certain type of malocclusion can be improved by orthodontic treatment. We developed a 3-T magnetic resonance imaging (MRI) movie method with tooth visualization that can display the dynamic movement of articulation without radiation exposure. To the best of our knowledge, there is currently no report on the possible differences in articulatory movement between subjects with a normal occlusion and those with malocclusion using the 3T MRI movie method. Thus, the objective of this study was to examine the articulatory difference between subjects with a normal occlusion and those with an open bite using an MRI movie. Materials and Methods: Twenty healthy adult females, ten with a normal occlusion and ten with an anterior open bite were recruited. The overbite of the open bite subjects was zero or smaller, and all of them exhibited a tongue-thrusting habit during swallowing. A turbo spin echo image with a contrast medium was used to visualize the anterior teeth, and articulatory movement during articulation of the vowel-consonant-vowel syllable (/asa/) was scanned. The difference in tongue movement between subjects with a normal occlusion and those with an open bite was compared by measuring seven variables. Moreover, the distance between the incisal edge and the tongue apex during articulation of /s/ and the speech duration were compared. Furthermore, frequency analysis on /s/ by fast Fourier transform power spectrum was performed. Results: The tongue apex of the open bite subjects moved more anteriorly than that of the normal subjects. However, there was no significant difference in the phonetic analysis between subjects with a normal occlusion and those with an open bite. Conclusion: The 3-T MRI movie was an efficient method to quantify articulatory tongue movements. Although there was a difference in tongue movement during swallowing between subjects with a normal occlusion and those with an open bite, the difference in the articulatory tongue movements was minimal, suggesting it could be a functional compensation.

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

Abstract Background Lactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold interventions vary widely, with little evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions. Methods Ultrasound measurements were conducted in five breastfeeding dyads, infants aged between four and 20 weeks, while feeding in their usual or ‘standard’ position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully. Results Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention. Conclusion These preliminary findings suggest that changes in fit and hold impact on infant tongue movement. Further research investigating short-and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.