Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia

Deep Upscale U-Net for automatic tongue segmentation

In a treatment or diagnosis related to oral health conditions such as oral cancer and oropharyngeal cancer, an investigation of tongue's movements is a major part. In an automatic measurement of such movement, it must first start with a task of tongue segmentation. This paper proposes a solution of tongue segmentation based on a decoder-encoder CNN-based structure i.e., U-Net. However, it could suffer from a problem of feature loss in deep layers. This paper proposes a Deep Upscale U-Net (DU-UNET). An additional up-sampling of the feature map from a contracting path is concatenated to an upper layer of an expansive path, based on an original U-Net structure. The segmentation model is constructed by training DU-UNET on the two publicly available datasets, and transferred to the self-collected dataset of tongue images with five tongue postures which were recorded at a far distance from a camera under a real-world scenario. The proposed DU-UNET outperforms the other existing methods in our literature reviews, with accuracy of 99.2%, mean IoU of 97.8%, Dice score of 96.8%, and Jaccard score of 96.8%.

Force, alternate movements, snap, suction and vibration functions of tongue are altered in oral submucous fibrosis patients

Background

One of the most common clinical manifestations of oral submucous fibrosis (OSMF) is restricted tongue movements. However, the characterization of involvement is needed to better understand the impairment of its functioning. In the present study, force, alternate movements, snap, suction, and vibration functions of the tongue were investigated in OSMF patients.

Methods

A total of 53 OSMF and 40 healthy individuals were recruited in the present study. Clinical parameters were used for the diagnosis and grading of OSMF. Alternate movements, snap, suction, vibration of the tongue and tongue force were assessed using standard methodology.

Results

Out of 53 OSMF subjects, 22 (42%) were in early stages and 31 (58%) in late stages. There were statistically significant differences between the OSMF and healthy individuals for tongue functions such as protrusion, retraction, lateral movements, altered snap, suction, and tongue vibration (p < 0.00001). All of the aforementioned tongue functions were more affected in advanced stage OSMF than in early stage OSMF (p < 0.00001).

Conclusion

Force, alternate movements, snap, suction and vibration functions of tongue are significantly altered in OSMF patients. The performance of the tongue movements by the OSMF subjects worsened with the disease progression.

Myofunctional orofacial examination tests: a literature review

INTRODUCTION

Myofunctional orofacial examination (MOE) is an important tool for the assessment of the stomatognathic system and orofacial functions, and the early diagnosis of orofacial myofunctional disorders. Therefore, the purpose of the study is to scan the literature and determine the most preferred test for myofunctional orofacial examination.

MATERIALS AND METHODS

A literature review was conducted to collect information. Pubmed and ScienceDirect database was explored by using keywords gained by MeSH (Medical Subject Headings).

RESULTS

Fifty-six studies were retrived from the search and all of the studies were screened and evaluated regarding the subject, aim, conclusions and the orofacial myofunctional examination test they used. It has been observed that traditional evaluation and inspection methods have been replaced by newer and methodological approaches in recent years.

CONCLUSIONS

Although the few tests used differ, 'Orofacial Examination Test With Scores' (OMES) was found to be the most preferred myofunctional orofacial evaluation method from ENT to cardiology.

A case study on myofunctional therapy and malocclusions created by oral habits

Purpose

To demonstrate the effect of an orofacial myofunctional therapy intervention by an interdisciplinary team composed of a registered dental hygienist who is also a certified orofacial myologist (COM^®), a general dentist, and an orthodontist on the elimination of oral habits and changes in dental malocclusion.

Method

This case study describes a 7-year-old female who underwent an individualized myofunctional therapy program and was given supervised education on a series of exercises targeting the muscles of mastication and facial expression over 5 months. Correct oral rest postures of the tongue and the lips were also established through therapy.

Results

The intervention enabled the client to eliminate multiple oral habits, which corrected oral rest postures of the lips and tongue. This correction consequently improved the client's malocclusion and further prepared the client for future orthodontic treatment.

Conclusion

Myofunctional therapy facilitated the elimination of unfavourable oral habits that led to malocclusion. Eliminating oral habits better prepared the client for orthodontic treatment and retention. Use of an interdisciplinary team facilitates optimal client care.

Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents-Preliminary Report and Step-by-Step Technique Showcase

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.

Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia

Background

A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one‐third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two‐thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual‐palatal suction (LPS).

Objective

This study aims to explore the utility and normative values of TRMR‐LPS as an adjunct to functional assessment of tongue mobility using TRMR‐TIP.

Study Design

Cross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population.

Methods

Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate.

Results

There was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R² 0.31 vs 0.05, P < .0001).

Conclusions

This study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility.