Assessment of pulmonary mechanics and breathing patterns during posturally induced glossoptosis in infants

Respiratory mechanics were studied in nine infants with glossoptosis-apnoea syndrome to determine whether glossoptosis may account for signs of both inspiratory and expiratory airway obstruction. Airflow, oesophageal pressure, inspiratory and expiratory time (Ti and Te), and inspiratory and expiratory resistance (Ri and Re) were measured before and during ventilatory phases characterised by glossoptotic pharyngeal obstruction, induced by turning the infants onto their backs. In addition, an attempt was made to correlate the abnormalities in pulmonary mechanics with the clinical features. During partial glossoptotic pharyngeal obstruction, a significant increase was observed in Te and Re and variable changes in Ti and Ri. During severe obstruction, the infants displayed obstructed inspiratory efforts often associated with stridor, as well as obstructed expiratory efforts often associated with audible grunting and retarded expiratory flow pattern. The expiratory grunt was loudest over the neck and mimicked bronchospasm over the chest. These findings indicate that glossoptotic pharyngeal obstruction induces functional airway obstruction which may affect both inspiration and expiration. Expiratory airway obstruction seems, at least in part, to be due to active braking of expiratory flow.

Heterotopic gastrointestinal and pancreatic tissue of the tongue: a case report

Heterotopic gastrointestinal mucosa of the tongue is a rare type of oral choristoma. Associated pancreatic tissue has never been reported to our knowledge. We present the case of an 8-month-old female infant with congenital cleft palate who had a tongue mass. On histologic evaluation the lesion consisted of gastrointestinal and pancreatic tissue. This choristoma may arise from entrapped multipotential endoderm during tongue development.

Evaluation and management of the lingual thyroid gland

Lingual thyroid gland is a rare clinical entity that is due to failure of descent of the gland anlage early in the course of embryogenesis. It may present with symptoms of dysphagia, upper airway obstruction, or even hemorrhage at any time from infancy through adulthood. We present two illustrative cases of lingual thyroid gland along with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment. The natural history of the condition is reviewed and a treatment strategy is outlined that focuses on the use of suppressive doses of thyroid hormone as the initial therapy. Surgical excision of the gland is reserved for more advanced cases of gland enlargement resulting in airway compromise, severe dysphagia that limits oral intake, or ongoing hemorrhage.

Lingual pressures induced by mouthgags

Airway obstruction from tongue edema following intraoral procedures is uncommon. However, the insidious nature of postoperative lingual edema and the gravity of acute airway obstruction requires diligent monitoring by the surgeon. The etiology of lingual edema is likely related to tissue ischemia, secondary to venous or arterial obstruction. This study shows that during normal usage the mouthgag can easily generate pressures which typically exceed venous pressure and often exceeds arterial pressure. Suspension of the mouthgag almost always exceeds arterial pressure. Whether that pressure is transferred to the respective arteries and veins is likely highly variable and relates to the patient's individual dentofacial anatomy. Avoidance of these high pressures should minimize the risk of postoperative lingual edema. The U.C. Davis Mouthgag Usage Protocol is presented.

[Follow-up study of dyskinesia-induced dysgnathias following myofunctional therapy]

Forty-eight patients with dysgnathia brought about by tongue dyskinesia underwent myofunctional therapy leading up to and at the beginning of orthodontic treatment. Short- and long-term results of this therapy were studied with the help of indirect palatography. Palatographs of empty swallowing and the test consonants "L", "N", "S" and "T" were evaluated visually and metrically. The palatographs were made prior to myofunctional therapy and thereafter first at the end of the therapy, then at the end of the control or supervision period, and finally, after on average 4 years. Visual evaluation revealed a clearly recognizable change in all functions when compared with the physiological palatographs. A change in the "S" consonant sound was the least conspicuous. Metric evaluation revealed for the 4 out of 5 of the test functions, namely, empty swallowing and the consonants "L", "N", and "T", marked long-term dorsal orientation of the tongue. The short-term changes in tongue function were more prevalent than the long-term.

Disseminated histoplasmosis presenting as tongue nodules in a patient infected with human immunodeficiency virus

A 39-year-old woman infected with human immunodeficiency virus had disseminated histoplasmosis that presented with nodules on her tongue. This is the seventh reported case of biopsy- and/or culture-proven oropharyngeal histoplasmosis in patients with acquired immunodeficiency syndrome. We review those previous reports and discuss the clinical features of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome.

Lingual thyroid: a new surgical approach--a case report

Ectopic lingual thyroid is a rare developmental anomaly, presenting in the adult with obstructive symptoms during respiration, deglutition and speech. The main therapeutic issue after exact diagnosis is the restoration of thyroid function, and surgical intervention, when necessary, has to deal with problems related to the site and function of the ectopic gland. A case of a 25-year-old female with dyspnoea and dysphagia due to a 3 x 4 cm ectopic lingual thyroid, excised by an original peroral approach via a mandibular midline osteotomy, is reported. Our surgical technique is described and the diagnostic and therapeutic problems are reviewed.

Lingual thyroid and hypothyroidism. Report of a case in a middle aged woman

There are approximately 400 reported cases of lingual thyroid (LT) with a clear cut prevalence in paediatric age. These glands are probably quantitatively deficient and function at marginal levels. Thyro-stimulating hormone (TSH) causes hypertrophy producing local symptoms and in younger patients may induce dangerous obstruction. The presumptive diagnosis is usually made by indirect laryngoscopy and thyroscintigraphy. The authors describe a case of LT in a middle aged patient in whom the anomaly remained undiscovered, being without local symptoms, and permitting a normal life. The discovery was made possible by the development in the last four years of a progressive, frank hypothyroidism, probably induced by silent thyroiditis into the ectopic gland.

Lingual thyroid presenting after previous thyroglossal cyst excision

Lingual thyroid is a rare lesion caused by maldescent of the thyroid gland. It is an important cause of a mass on the posterior third of the tongue, and may coexist with other developmental abnormalities such as thyroglossal cyst. The diagnosis is made by radioisotope scan. Treatment is indicated in the presence of symptoms and consists initially of thyroxine. Severe or unresponsive cases require complete excision through a lateral pharyngotomy. Hypothyroidism is common postoperatively, but may be avoided in some cases by transplantation of excised tissue. We present a case report and review of the literature.

Oral cytomegalovirus infection in an unrelated bone marrow transplantation with possible mediation by graft-versus-host disease and the use of cyclosporin-A

Graft-versus-host disease remains as a significant sequela in allogeneic bone marrow transplantation patients. Reports of oral presentations of cytomegalovirus infection in this patient population are rare. Although the usual manifestation of oral cytomegalovirus is mucosal ulceration, we report a case that we believe reflects a dynamic among graft-versus-host disease, cytomegalovirus, and the use of cyclosporin A, commonly used as an immunosuppressive agent in bone marrow transplantation.

Tongue, primary amyloidosis, and multiple myeloma

A case of macroglossia and resulting apertognathia because of primary amyloidosis in a 65-year-old man with multiple myeloma is described. In addition, a retrospective study of the oral manifestations of primary amyloidosis and multiple myeloma in the last 15 years is reported.

Lingual thyroid

Lingual thyroid is a rare cause of dysphagia and airway obstruction. A case is presented, with a discussion of the diagnosis and management.

Sudden infant death and acute posterior lingual inflammation

A case is described of sudden and unexpected death in a 5-month-old boy who was found to have acute inflammation with multifocal abscess formation at the base of his tongue adjacent to the epiglottis. The case demonstrates the vulnerability of the upper aerodigestive tract in infancy to possible anatomic or functional obstruction from intrinsic lesions and draws attention to the potentially lethal effects of critically-placed posterior lingual inflammation.

Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults

We operated on 38 adult patients with congenital ankyloglossia with deviation of the epiglottis and larynx. The results were as follows. 1) Most patients had Angle's class III malocclusion, irregular alignment of the upper teeth, and high hard palate. 2) Fifty percent of the patients in our study population had obstructive respiratory failure. Their vital capacity increased significantly after the operation, but changes of forced expiratory volume in 1 second were not prominent. 3) Subjective symptoms of this disease were stiffness of the shoulders, a cold feeling in the extremities, an obstructed feeling in the throat, insomnia, fatigue, dry skin, irritability and/or anxiety, and nervousness. These improved postoperatively. 4) Objective symptoms included snoring, muscle cramps, difficulty in playing wind instruments, hoarseness, and incorrect articulation. The objective symptoms, except for incorrect articulation, improved postoperatively.

Transoral surgical management of lesions of the base of the tongue

Lesions of the base of the tongue are rare in the pediatric population. However, when present these lesions may lead to airway obstruction and feeding difficulties. Two patients with lesions of the base of the tongue are described to demonstrate the diagnosis and management of this difficult clinical problem. The use of a transoral median glossotomy for total excision of these lesions is advised in this article. This approach affords excellent surgical exposure, early return to a normal diet, and lack of facial scars.

Necrosis of the tongue in a patient with intestinal infarction

A patient with a rare combination of bilateral lingual necrosis and intestinal infarction, caused by giant cell arteritis, is described and the literature reviewed.