A Comparison of Ultrasound Echo Intensity to MRI as a Metric for Tongue Fat Evaluation

Study Objectives Tongue fat is associated with obstructive sleep apnea (OSA). Magnetic resonance imaging (MRI) is the standard for quantifying tongue fat. Ultrasound echo intensity has been shown to correlate to fat content in skeletal muscles but has yet to be studied in the tongue. The objective of this study is to evaluate the relationship between ultrasound echo intensity and tongue fat. Methods Ultrasound coronal cross-sections of ex-vivo cow tongues were recorded at baseline and following three 1 milliliter serial injections of fat into the tongue. In humans, adults with and without OSA had submental ultrasound coronal cross-sections of their posterior tongue. Average echo intensity of the tongues (cow/human) were calculated in ImageJ software. Head and neck MRI were obtained on human subjects to quantify tongue fat volume. Echo intensity was compared to injected fat volume or MRI derived tongue fat percentage. Results Echo intensity in cow tongues showed a positive correlation to injected fat volume (rho = 0.93, p<0.001). In human subjects, echo intensity of the tongue base strongly correlated with MRI-calculated fat percentage for both the posterior tongue (rho = 0.95, p<0.001) and entire tongue (rho = 0.62, p<0.001). Larger tongue fat percentages (rho = 0.38, p=0.001) and higher echo intensity (rho = 0.27, p=0.024) were associated with more severe apnea-hypopnea index, adjusted for age, BMI, sex and race. Conclusions Ultrasound echo intensity is a viable surrogate measure for tongue fat volume and may provide a convenient modality to characterize tongue fat in OSA.

Descriptive Statistical Analysis Report on the Results of Questionnaire and Observations on Patients With Physiological Halitosis Who Visited the KUMC Halitosis Clinic- A Retrospective Study

Background: We initiated to prepare the basic data that could help us to understand the characteristics of patients with physiological halitosis symptoms in Korea and aid in explaining the causes of these symptoms. Methods: We collected questionnaire and dietary analysis results from the data of 246 adult patients diagnosed with physiological halitosis symptoms, collected the data from the patients’ salivary measurements and the analysis data of patients’ tongue and throat management status. Using the SPSS (IBM SPSS™, Ver. 22.0) program, we performed a frequency analysis, calculating the correlation coefficient Phi with an independence test.Results: The mean age and one standard deviation of 246 patients with physiological halitosis was 41.85±11.63 years. The proportion of women, the proportion of patients who replaced breakfast with fast food or skipped breakfast, with beverage drinking habits such as coffee, tea, or carbonated drink, with irregular or insufficient consumption of water, who recognized their own oral malodor, suffering anxiety or stress over oral malodor, with an introverted personality, with insufficient unstimulated salivation volume, with incorrect tongue management, and with PND (Postnasal drip) or PTC (Posterior Tongue Coating) were all statistically analyzed to be significant (p < 0.05). As a result of the correlation analysis, the Phi values of the seven pairs of the bivariate variables were from 0.137 to 0.196, and the Phi values of the five pairs of the bivariate variables - the Phi value between the breakfast pattern variable and the regular diet variable, the Phi value between the stimulating menu variable and the drinking variable, the Phi value between the unstimulated saliva variable and the stimulated saliva variable, the Phi value between the unstimulated saliva variable and the sedimentation ratio of saliva variable, and the Phi value between the stimulated saliva variable and the sedimentation ratio of saliva variable - were from 0.203 to 0.394 (p < 0.05). Conclusion: We could suggest the 10 potential common risk factors related to physiological halitosis symptom, and the five pairs of variables with Phi values ranging from 0.20 to 0.40 could be judged to have a moderate correlation.

P155 Effects of upper airway muscle training on upper airway physiology in people with obstructive sleep apnea

Introduction Previous studies demonstrate that oropharyngeal exercises can reduce obstructive sleep apnoea (OSA) severity. However, the physiological mechanisms underlying this improvement are unknown. Thus, this study aimed to evaluate the effects of a speech-pathology led, targeted upper airway muscle training protocol on upper airway physiology. Methods People with mild-moderate OSA (n=12 studied to date, 5 females, 7 males) completed 12 weeks of daily upper airway muscle training targeting the muscles of the tongue and soft palate. Pre- and post-training outcome measures included anterior and posterior tongue muscle strength and endurance and upper airway collapsibility via the upper airway collapsibility index. Results Preliminary findings indicate that 12 weeks of targeted exercise training improved anterior and posterior tongue muscle strength, respectively (54.3±12.7 vs. 61.5±7.7kPa, p&lt;0.01, 50.1±8.5 vs. 58.0±8.5kPa, p&lt;0.01), and anterior and posterior tongue muscle endurance, respectively (15.7±10.9 vs. 24.1±8s, p&lt;0.01, 9.5±4.2 vs. 23.3±17.7s, p&lt;0.01). The upper airway collapsibility index improved post-training (25.5±18.9 vs. 12.26±12.11 %, p=0.03). Conclusions Twelve weeks of upper airway muscle training improved tongue muscle strength, endurance and upper airway collapsibility in people with mild-moderate OSA. These physiological changes provide insight into the potential mechanisms mediating reductions in OSA severity with oropharyngeal exercises. This research was supported by the 2019 Phillips/ASA Sleep Research grant.

Objective Improvement After Frenotomy for Posterior Tongue-Tie: A Prospective Randomized Trial

Objective Infants with posterior tongue-tie (PTT) can have substantial difficulty with breastfeeding and bottle-feeding. This study aimed to address the dearth in investigational objective data surrounding PTT release to better quantify the postoperative impacts of frenotomy for ankyloglossia. Study Design Prospective randomized, controlled trial. Setting Private practice clinic. Methods In a prospective, randomized controlled trial, infants 3 to 16 weeks of age with PTT undergoing frenotomy were examined using a bottle-feeding system capable of objectively measuring tongue function. Validated patient-reported outcome measures were also obtained simultaneously. Results Forty-seven infants with PTT were enrolled into an observational/control arm (n = 23) or interventional/surgical treatment arm (n = 24). The total cohort consisted of 29 (61.7%) male infants with a median age of 39 days. At the day 10 time point, the interventional arm demonstrated statistically significant improvement in 11 objectively obtained feeding metrics, indicating faster tongue speed, more rhythmic and coordinated sucking motions, and a tongue more capable of adapting to varying feeding demands. Significant improvement in breastfeeding self-efficacy was reported in the interventional group while poor self-confidence persisted in the observational group. Infant reflux symptoms improved in the interventional group while not in the control group. Nipple pain also persisted in the control group but improved in the surgical cohort. Conclusions When measured 10 days after frenotomy for PTT, infants improve feeding parameters using an objective bottle-feeding system. Similar improvements are seen with patient-reported outcomes when PTT is released. Posterior tongue-tie is a valid clinical concern, and surgical release can improve infant and maternal symptoms.

Ectomesenchymal Chondromyxoid Tumor: A Rare Association With an Asymmetrical Soft Palate Cleft

Ectomesenchymal chondromyxoid tumor (ECT) is a rare oral lesion first described by Smith et al. in 1995 . These tumors are typically painless, slow growing and benign masses occurring predominantly on the anterior tongue dorsum. Prior to this seminal report, many ECTs may have been misdiagnosed due to the histological similarities with other lesions. Immunohistochemical stains aid in definitive diagnosis of an ECT. A total of 39 papers since published have reported 96 patients with ECT. Most lesions involve the anterior aspect of the tongue, with only 6 occurring in the posterior tongue and 2 involving the hard palate. ECTs are considered to develop from ectomesenchymal cells of neural crest cells that have migrated to the tongue during embryological development. This paper is of a rare case of ECT of the posterolateral tongue occurring in association with an unusual asymmetrical soft palate cleft. It is postulated that since the tongue develops before the formation of the soft palate, an ECT lesion occurring on the posterior aspect may have a causal contribution to the development of the soft palate cleft.

The association between oral dryness and use of dry-mouth interventions in Sjögren’s syndrome patients

Objective Sjögren’s syndrome patients use different dry-mouth interventions for the relieve of their oral dryness. Recently, it was shown that patients with dry-mouth complaints have regional differences in perceived intra-oral dryness. Therefore, the aim of the present study was to investigate whether the use of dry-mouth interventions is related to the perceived regional oral dryness. Materials and methods A cross-sectional study was performed among Sjögren’s patients. Volunteers could anonymously administer various questionnaires, including the Regional Oral Dryness Inventory (RODI), Xerostomia Inventory (XI), Bother Index (BI) and a list of dry-mouth interventions. Results Sjögren’s syndrome patients use a wide variety for the relieve of oral dryness. “Drinking water’’ and “moistening the lips’’ were used most frequently. Dry-mouth interventions, “drinking water’’, “rinsing of the mouth”, and “drinking small volumes” had significant associations with the RODI-scores of the posterior palate, and anterior and posterior tongue, respectively. On the other hand, “using mouth gel’’ had a significant association with the RODI-scores of the inside cheeks. Conclusion Sjögren’s syndrome patients are more likely to use mouth gels when their inside cheeks were experienced as most dry, while they drank water, rinsed their mouth or drank small volumes if the posterior palate, and anterior and posterior tongue were considered as dry. It can be concluded that intra-oral dryness affects dry-mouth perception and thereby also the use of the various dry-mouth interventions. Clinical relevance The therapeutic choice of dry-mouth interventions by Sjögren’s syndrome patients seems to some extent to be related to dryness at specific intra-oral regions.

What’s new for the clinician? - Excerpts from and summaries of recently published papers

The World Health Organization (WHO) considers breast milk as the best source of nourishment for infants. Although exclusive breastfeeding is recommended up to 6 months of age, globally only 40% of children under this age are exclusively breastfed and this is mainly due to negative breastfeeding experiences. There are many different causes for negative breastfeeding experiences such as poor weight gain, necessitating supplementation, poor latch, maternal nipple pain, and oral restrictions like a tongue-tie (ankyloglossia) and/or lip-tie. Ankyloglossia (either the decrease in mobility for the tongue by classic anterior tongue-tie or a submucosal restriction, a posterior tongue-tie) and a superior tethered labial frenulum can cause altered latch and sucking mechanics. Studies have shown that a frenotomy, if adequately performed, can improve breastfeeding scores and relieve nipple pain with little or no serious complications.

Tongue and Lip Comparisons between Healthy and Nondysphagic Poststroke Individuals

<b><i>Background:</i></b> The lips and tongue play a substantial role in efficient clearance of food from the mouth and pharynx into the esophagus. No study has compared oral pressures between healthy individuals and poststoke individuals who report functional swallow abilities. <b><i>Aim:</i></b> The current study aimed to investigate the presence of differences in oral pressures between healthy individuals and poststroke individuals who report functional swallowing abilities. <b><i>Design:</i></b> This is a controlled matched pair study. <b><i>Population:</i></b> Eighteen control participants (CG) and 18 nondysphagic poststroke participants (NDSG) were enrolled into this study. <b><i>Methods:</i></b> The Iowa Oral Performance Instrument (IOPI) was used to measure and compare tongue strength, endurance, and functional lingual and labial pressures between sex and age-matched pairs. <b><i>Results:</i></b> Six paired, two-tailed <i>t</i> tests revealed that tongue and lip pressures were different between the 2 groups. Maximum anterior tongue pressures and posterior tongue pressures were also different, i.e., <i>t</i>(17) = –2.89 (<i>p</i> = 0.010) and <i>t</i>(17) = –2.85 (<i>p</i> = 0.011), with the CG presenting higher pressures. Right lip pressures were significantly lower in the NDSG compared to the CG, i.e., <i>t</i>(17) = 2.45 (<i>p</i> = 0.0001). Left lip pressures were significantly lower in the NDSG compared to the CG, i.e., <i>t</i>(17) = –5.43 (<i>p</i> = 0.0001). Tongue endurance, i.e., <i>t</i>(17) = 0.092 (<i>p</i> = 0.928) and saliva swallow pressures, i.e., <i>t</i>(17) = –0.490 (<i>p</i> = 0.63) were not different. <b><i>Conclusion:</i></b> Although poststroke participants reported functional swallowing abilities, there were differences in tongue and lip pressures but not in endurance or saliva swallow pressures. <b><i>Clinical Rehabilitation Impact:</i></b> Poststroke individuals without complaints of dysphagia who are not assessed may experience subclinical dysphagia that could negatively impact their nutrition and quality of life.

Microsurgical Management of Early Onset Alveolar Soft Part Sarcoma of the Oral Tongue: Case Report and Review of the Literature

Objectives: Alveolar soft part sarcoma is a rare subset of soft tissue sarcomas, typically presenting in subjects 15 to 35 years of age. Usual presentation sites are the trunk, extremities, and the head and neck. Subjects younger than 5 years are rarely affected. Methods: In this retrospective case report, we present a 16-month old male with a rapidly growing soft tissue mass of the anterior and posterior tongue, found to be alveolar soft part sarcoma. Results: The subject was treated with primary surgical resection and the resulting defect was reconstructed with a radial forearm free flap. Conclusions: To our knowledge, this is the youngest subject to have been diagnosed with alveolar soft part sarcoma. Surgical extirpation and microvascular reconstruction were successful, and the patient remains disease free 4 years post-operatively.