Neuromuscular organization of the superior longitudinalis muscle in the human tongue. 1. Motor endplate morphology and muscle fiber architecture

The Compartmental Tongue

PURPOSE

Tongue anatomy and function is widely described as consisting of four extrinsic muscles to control position and four intrinsic muscles to control shape. This myoarchitecture cannot, however, explain independent tongue body and blade movement nor accurately model the subtlety of observed lingual shapes. This study presents the case for a finer neuromuscular structure and functional description.

METHOD

Using the theoretical framework of the partitioning hypothesis, evidence for neuromuscular compartments of each of the lingual muscles was discerned by reviewing studies of lingual anatomy, hypoglossal nerve staining, hypoglossal motoneuron axon tracing, muscle fiber type distribution, and electromyography. Muscle fibers of the visible human female were manually traced to produce a three-dimensional atlas of muscular compartments. A kinematic study was undertaken to determine the degree of independent movement between different parts of the tongue. A simple biomechanical model was used to demonstrate how synergistic groups of compartments can control sectors of the tongue.

RESULTS

Results indicated as many as 10 compartments of genioglossus, two each of superior and inferior longitudinal, eight of styloglossus, three of hyoglossus, and six each of transversus and verticalis, while palatoglossus may not have a significant role in tongue function. Kinematic analysis indicated independent control of five sectors of the tongue body, and biomechanical modeling demonstrated how this control may be achieved.

CONCLUSION

Evidence is presented for a lingual structure based on neuromuscular compartments, which work together to position and shape sectors of the tongue and independently control tongue body and blade.

The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia

Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.

Developmental Functional Modules in Infant Vocalizations

Purpose Developmental functional modules (DFMs) are biological modules that are defined by their structural (morphological), functional, or developmental elements, and, in some cases, all three of these. This review article considers the hypothesis that vocal development in the first year of life can be understood in large part with respect to DFMs that characterize the speech production system. Method Literature is reviewed on relevant embryology, orofacial reflexes, craniofacial muscle properties, stages of vocal development, and related topics to identity candidates for DFMs. Results The following DFMs are identified and described: laryngeal, pharyngo-laryngeal, mandibular, velopharyngeal, labial complex, and lingual complex. These DFMs and their submodules, considered along with phenomena such as rhythmic movements, account for several well-documented features of vocal development in the first year of life. The proposed DFMs, rooted in embryologic, histologic, and kinematic properties, serve as low-dimensional control variables for the developing vocal tract. Each DFM is semi-autonomous but interacts with other DFMs to produce patterns of vocal behavior. Discussion Considered in relation to contemporary profiles and models of vocal development in the first year of life, DFMs have interpretive and explanatory value. DFMs complement other approaches in the study of infant vocalizations and are grounded in biology.

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.

Premature satellite cell activation before injury accelerates myogenesis and disrupts neuromuscular junction maturation in regenerating muscle

Satellite cell (SC) activation, mediated by nitric oxide (NO), is essential to myogenic repair, whereas myotube function requires innervation. Semaphorin (Sema) 3A, a neuro-chemorepellent, is thought to regulate axon guidance to neuromuscular junctions (NMJs) during myotube differentiation. We tested whether "premature" SC activation (SC activation before injury) by a NO donor (isosorbide dinitrate) would disrupt early myogenesis and/or NMJs. Adult muscle was examined during regeneration in two models of injury: myotoxic cardiotoxin (CTX) and traumatic crush (CR) (n = 4-5/group). Premature SC activation was confirmed by increased DNA synthesis by SCs immediately in pretreated mice after CTX injury. Myotubes grew faster after CTX than after CR; growth was accelerated by pretreatment. NMJ maturation, classified by silver histochemistry (neurites) and acetylcholinesterase (AchE), and α-bungarotoxin staining (Ach receptors, AchRs) were delayed by pretreatment, consistent with a day 6 rise in the denervation marker γ-AchR. With pretreatment, S100B from terminal Schwann cells (TSCs) increased 10- to 20-fold at days 0 and 10 after CTX and doubled 6 days after CR. Premature SC activation disrupted motoneuritogenesis 8-10 days post-CTX, as pretreatment reduced colocalization of pre- and postsynaptic NMJ features and increased Sema3A-65. Premature SC activation before injury both accelerated myogenic repair and disrupted NMJ remodeling and maturation, possibly by reducing Sema3A neuro-repulsion and altering S100B. This interpretation extends the model of Sema3A-mediated motoneuritogenesis during muscle regeneration. Manipulating the timing and type of Sema3A by brief NO effects on SCs suggests an important role for TSCs and Sema3A-65 processing in axon guidance and NMJ restoration during muscle repair.

Effect of carrot puree in vegetable juice on linguapalatal swallowing pressure

This study aimed to ascertain the influence of various amounts (0-30%) of carrot puree (CP) in vegetable juice on linguapalatal swallowing pressure in healthy volunteers. Twenty healthy women (age range: 20-22 years) swallowed a 17-ml drink in a natural state, and linguapalatal swallowing pressure was measured using a special sensor sheet. Peak magnitude (maximum pressure of the tongue pushing on the hard palate), integrated values of linguapalatal swallowing pressure on the waveform, and duration of linguapalatal swallowing pressure were increased with increases in CP concentrations. The total integrated value for 30% CP vegetable juice was larger than that of vegetable juice with no CP. The apparent viscosity of the vegetable juice with a low CP concentration was smaller than that with a high CP concentration at the same shear rate. These results suggest that vegetable juice containing CP affects mechanoreceptor activity in the mouth and generates a neuromotor response.

PRACTICAL APPLICATIONS

This study aimed to ascertain the influence of various amounts of carrot puree (CP) in vegetable juice on linguapalatal swallowing pressure measured by using a special sensor sheet in healthy volunteers. Obtained results of this study clearly showed that vegetable juice containing CP affects the movement of the tongue in maneuvering the bolus. Moreover, the results demonstrated that this effect depended on the concentration of CP in the vegetable juice. These findings are expected to provide clinically valuable data on the effect of mechanical stimulation during the oral stage of swallowing.

Slow-Myofiber Commitment by Semaphorin 3A Secreted from Myogenic Stem Cells

Recently, we found that resident myogenic stem satellite cells upregulate a multi-functional secreted protein, semaphorin 3A (Sema3A), exclusively at the early-differentiation phase in response to muscle injury; however, its physiological significance is still unknown. Here we show that Sema3A impacts slow-twitch fiber generation through a signaling pathway, cell-membrane receptor (neuropilin2-plexinA3) → myogenin-myocyte enhancer factor 2D → slow myosin heavy chain. This novel axis was found by small interfering RNA-transfection experiments in myoblast cultures, which also revealed an additional element that Sema3A-neuropilin1/plexinA1, A2 may enhance slow-fiber formation by activating signals that inhibit fast-myosin expression. Importantly, satellite cell-specific Sema3A conditional-knockout adult mice (Pax7CreER^T2 -Sema3A^fl °^x activated by tamoxifen-i.p. injection) provided direct in vivo evidence for the Sema3A-driven program, by showing that slow-fiber generation and muscle endurance were diminished after repair from cardiotoxin-injury of gastrocnemius muscle. Overall, the findings highlight an active role for satellite cell-secreted Sema3A ligand as a key "commitment factor" for the slow-fiber population during muscle regeneration. Results extend our understanding of the myogenic stem-cell strategy that regulates fiber-type differentiation and is responsible for skeletal muscle contractility, energy metabolism, fatigue resistance, and its susceptibility to aging and disease. Stem Cells 2017;35:1815-1834.

Magnetic implants in the tongue for assistive technologies: Tests of migration; oromotor function; and tissue response in miniature pigs

OBJECTIVE

Uncertain biological consequences of titanium-magnet (Ti-mag) tongue implants constrain application of the Tongue Drive System (TDS), a brain-tongue-computer interface for individuals with severe physical impairment. Here we describe oromotor function and tongue tissue response following Ti-Mag implantation and explantation in the miniature pig, an animal model with a tongue similar in size to humans.

DESIGN

A 1.8×6.2mm Ti-mag tracer was implanted into the anterior tongue in five Yucatan minipigs. X-rays were taken immediately and >six days after implantation to evaluate tracer migration. In three minipigs, the tracer was explanted >16days after implantation. Twenty-five days post-explantation, tongue tissue was harvested and processed for histological and immunohistochemical (IHC) markers of healing. In two minipigs tissue markers of healing were evaluated post-mortem following >12days implantation. Drink cycle rate (DCR) was characterized to determine the impact of procedures on oromotor function.

RESULTS

Neither implantation (N=5) nor explantation (N=3) changed DCR. X-rays revealed minimal tracer migration (N=4, 0-4mm). By histology and IHC a robust capsule was present two weeks post-implantation with limited fibrosis. Explantation produced localized fibrosis and limited muscle remodeling.

CONCLUSIONS

These findings suggest the safety of Ti-mag anterior tongue implants for assistive technologies in humans.

Subject-Specific Biomechanical Modelling of the Oropharynx: Towards Speech Production

Biomechanical models of the oropharynx are beneficial to treatment planning of speech impediments by providing valuable insight into the speech function such as motor control. In this paper, we develop a subject-specific model of the oropharynx and investigate its utility in speech production. Our approach adapts a generic tongue-jaw-hyoid model (Stavness et al. 2011) to fit and track dynamic volumetric MRI data of a normal speaker, subsequently coupled to a source-filter based acoustic synthesizer. We demonstrate our model's ability to track tongue tissue motion, simulate plausible muscle activation patterns, as well as generate acoustic results that have comparable spectral features to the associated recorded audio. Finally, we propose a method to adjust the spatial resolution of our subject-specific tongue model to match the fidelity level of our MRI data and speech synthesizer. Our findings suggest that a higher resolution tongue model - using similar muscle fibre definition - does not show a significant improvement in acoustic performance, for our speech utterance and at this level of fidelity; however we believe that our approach enables further refinements of the muscle fibres suitable for studying longer speech sequences and finer muscle innervation using higher resolution dynamic data.

Three speech sounds, one motor action: evidence for speech-motor disparity from English flap production

The assumption that units of speech production bear a one-to-one relationship to speech motor actions pervades otherwise widely varying theories of speech motor behavior. This speech production and simulation study demonstrates that commonly occurring flap sequences may violate this assumption. In the word "Saturday," a sequence of three sounds may be produced using a single, cyclic motor action. Under this view, the initial upward tongue tip motion, starting with the first vowel and moving to contact the hard palate on the way to a retroflex position, is under active muscular control, while the downward movement of the tongue tip, including the second contact with the hard palate, results from gravity and elasticity during tongue muscle relaxation. This sequence is reproduced using a three-dimensional computer simulation of human vocal tract biomechanics and differs greatly from other observed sequences for the same word, which employ multiple targeted speech motor actions. This outcome suggests that a goal of a speaker is to produce an entire sequence in a biomechanically efficient way at the expense of maintaining parity within the individual parts of the sequence.

Human tongue neuroanatomy: Nerve supply and motor endplates

The human tongue has a critical role in speech, swallowing, and respiration, however, its motor control is poorly understood. Fundamental gaps include detailed information on the course of the hypoglossal (XII) nerve within the tongue, the branches of the XII nerve within each tongue muscle, and the type and arrangement of motor endplates (MEP) within each muscle. In this study, five adult human tongues were processed with Sihler's stain, a whole-mount nerve staining technique, to map out the entire intra-lingual course of the XII nerve and its branches. An additional five specimens were microdissected into individual muscles and stained with acetylcholinesterase and silver staining to study their MEP morphology and banding patterns. Using these techniques the course of the entire XII nerve was mapped from the main nerve to the smallest intramuscular branches. It was found that the human tongue innervation is extremely dense and complex. Although the basic mammalian pattern of XII is conserved in humans, there are notable differences. In addition, many muscle fibers contained multiple en grappe MEP, suggesting that they are some variant of the highly specialized slow tonic muscle fiber type. The transverse muscle group that comprises the core of the tongue appears to have the most complex innervation and has the highest percentage of en grappe MEP. In summary, the innervation of the human tongue has specializations not reported in other mammalian tongues, including nonhuman primates. These specializations appear to allow for fine motor control of tongue shape.

The human tongue slows down to speak: muscle fibers of the human tongue

Little is known about the specializations of human tongue muscles. In this study, myofibrillar adenosine triphosphatase (mATPase) histochemical staining was used to study the percentage and distribution of slow twitch muscle fibers (slow MFs) within tongue muscles of four neurologically normal human adults and specimens from a 2-year-old human, a newborn human, an adult with idiopathic Parkinson's disease (IPD), and a macaque monkey. The average percentage of slow MFs in adult and the 2-year-old muscle specimens was 54%, the IPD was 45%, while the neonatal human (32%) and macaque monkey (28%) had markedly fewer slow MFs. In contrast, the tongue muscles of the rat and cat have been reported to have no slow MFs. There was a marked spatial gradient in the distribution of slow MFs with the highest percentages found medially and posteriorly. Normal adult tongue muscles were found to have a variety of uniquely specialized features including MF-type grouping (usually found in neuromuscular disorders), large amounts of loose connective tissue, and short branching MFs. In summary, normal adult human tongue muscles have by far the highest proportion of slow MFs of any mammalian tongue studied to date. Moreover, adult human tongue muscles have multiple unique anatomic features. As the tongue shape changes that are seen during speech articulation are unique to humans, we hypothesize that the large proportion of slow MFs and the anatomical specializations observed in the adult human tongue have evolved to perform these movements.

Spatiotemporal coupling of the tongue in amyotrophic lateral sclerosis

PURPOSE

The primary aim of the investigation was to identify deficits in spatiotemporal coupling between tongue regions in amyotrophic lateral sclerosis (ALS). The relations between disease-related changes in tongue movement patterns and speech intelligibility were also determined. Methods The authors recorded word productions from 11 individuals with ALS with mild, moderate, and severe dysarthria using an x-ray microbeam during word productions. A coupling index based on sliding window covariance was used to determine disease-related changes in the coupling between the tongue regions across each word.

RESULTS

The results indicated decreased spatiotemporal coupling of mid-posterior tongue regions and reduced tongue speed in the ALS-moderate subgroup. Changes in the range of tongue coupling relations and speed of movement were highly correlated with speech intelligibility.

CONCLUSIONS

These results provide new insights into the loss of lingual motor control due to ALS and suggest that measures of tongue performance may provide useful indicators of bulbar disease severity and progression.

Myosin heavy chain composition of the human genioglossus muscle

BACKGROUND

The human tongue muscle genioglossus (GG) is active in speech, swallowing, respiration, and oral transport, behaviors encompassing a wide range of tongue shapes and movement speeds. Studies demonstrate substantial diversity in patterns of human GG motor unit activation, but whether this is accompanied by complex expression of muscle contractile proteins is not known.

PURPOSE

The authors tested for conventional myosin heavy chain (MHC) MHCI, MHCIIA, MHCIIX, developmental MHCembryonic and MHCneonatal and unconventional MHCαcardiac, MHCextraocular, and MHCslow tonic in antero-superior (GG-A) and posterior (GG-P) adult human GG.

METHOD

SDS-PAGE, Western blot, and immunohistochemistry were used to describe MHC composition of GG-A and GG-P and the prevalence of muscle fiber MHC phenotypes in GG-A.

RESULTS

By SDS-PAGE, only conventional MHC are present with ranking from most to least prevalent MHCIIA > MHCI > MHCIIX in GG-A and MHCI > MHCIIA > MHCIIX in GG-P. By immunohistochemistry, many muscle fibers contain MHCI, MHCIIA, and MHCIIX, but few contain developmental or unconventional MHC. GG-A is composed of 5 phenotypes (MHCIIA > MHCI-IIX > MHCI > MHCI-IIA > MHCIIX). Phenotypes MHCI, MHCIIA, and MHCI-IIX account for 96% of muscle fibers.

CONCLUSIONS

Despite activation of GG during kinematically diverse behaviors and complex patterns of GG motor unit activity, the human GG is composed of conventional MHC isoforms and 3 primary MHC phenotypes.

Effects of club soda and ginger brew on linguapalatal pressures in healthy swallowing

Oral chemesthesis is the detection of chemicals that activate temperature and pain receptors in the oral mucosa. Presentation of orally chemesthetic input has been theorized to stimulate a faster, stronger swallow. We measured differences in peak linguapalatal swallowing pressures, pressure durations, and pressure adjustments in response to two volumes of water and carbonation (in Schweppes® Club Soda) and carbonation + gingerol (in Reed's Extra Ginger Brew) in 20 young adult women. There was a main effect of stimulus on linguapalatal swallowing pressure, F(6,74) = 6.247, p = 0.000, hp(2) = 0.536 (Reed's Extra Ginger Brew > Schweppes Club Soda > water). Rising and releasing linguapalatal pressure durations were greater for carbonation + gingerol and carbonation than for water. Our results add to the evidence that orally chemesthetic beverages influence greater neuromotor activity compared to water during the oral stage of swallowing. Our findings also suggest that there may be some benefit to the cumulative addition of chemosensory agents in a beverage. Clinically, this provides a theoretical basis for considering the use of these or chemically similar beverages as facilitating stimuli in patients who aspirate thin liquids.

Locations of the motor endplate band and motoneurons innervating the sternomastoid muscle in the rat

Sternocleidomastoid (SCM) is a long muscle with two bellies, sternomastoid (SM) and cleidomastoid (CM) in the lateral side of the neck. It has been widely used as muscle and myocutaneous flap for reconstruction of oral cavity and facial defects and as a candidate for reinnervation studies. Therefore, exact neuroanatomy of the SCM is critical for guiding reinnervation procedures. In this study, SM in rats were investigated to document banding pattern of motor endplates (MEPs) using whole-mount acetylcholinesterase (AChE) staining and to determine locations of the motoneurons innervating the muscle using retrograde horseradish peroxidase (HRP) tracing technique. The results showed that the MEPs in the SM and CM were organized into a single band which was located in the middle portion of the muscle. After HRP injections into the MEP band of the SM, ipsilaterally labeled motoneurons were identified in the caudal medulla oblongata (MO), C1, and C2. The SM motoneurons were found to form a single column in lower MO and dorsomedial (DM) nucleus in C1. In contrast, the labeled SM motoneurons in C2 formed either one (DM nucleus), two [DM and ventrolateral (VL) nuclei], or three [DM, VL, and ventromedial (VM)] columns. These findings are important not only for understanding the neural control of the muscle but also for evaluating the success rate of a given reinnervation procedure when the SM is chosen as a target muscle.

Myosin heavy-chain composition of the human hyoglossus muscle

The human tongue muscle hyoglossus (HG) is active in oromotor behaviors encompassing a wide range of tongue movement speeds. Here we test the hypothesis that the human HG is composed of "uncommon" myosin heavy-chain (MHC) isoforms MHCembryonic, MHCneonatal, and MHCslow tonic as has been reported for other head and neck muscles active during kinematically diverse behaviors. Following reaction of human HG with antibodies specific for MHCI, MHCIIA, MHCII, MHCembryonic, MHCextraocular, MHCneonatal, and MHCslow tonic, only antibodies to MHCI, MHCIIA, and MHCII label more than occasional muscle fibers. These antibodies describe five phenotypes with prevalence MHCIIA > MHCI > MHCI-IIX > MHCI-IIA > MHCIIX. In MHC composition, the human HG is thus similar to human appendicular muscles and many human head and neck muscles but different from human masseter and extraocular muscles which contain five or more MHC isoforms.

The innervation and organization of motor units in a series-fibered human muscle: the brachioradialis

We studied the innervation and organization of motor units in the brachioradialis muscle of 25 normal human subjects. We recorded intramuscular EMG signals at points separated by 15 mm along the proximodistal muscle axis during moderate isometric contractions, identified from 27 to 61 (mean 39) individual motor units per subject using EMG decomposition, and estimated the locations of the endplates and distal muscle/tendon junctions from the motor-unit action potential (MUAP) propagation patterns and terminal standing waves. In three subjects all the motor units were innervated in a single endplate zone. In the other 22 subjects, the motor units were innervated in 3-6 (mean 4) distinct endplate zones separated by 15-55 mm along the proximodistal axis. One-third of the motor units had fibers innervated in more than one zone. The more distally innervated motor units had distinct terminal waves indicating tendonous termination, while the more proximal motor units lacked terminal waves, indicating intrafascicular termination. Analysis of blocked MUAP components revealed that 19% of the motor units had at least one doubly innervated fiber, i.e., a fiber innervated in two different endplate zones by two different motoneurons, and thus belonging to two different motor units. These results are consistent with the brachioradialis muscle having a series-fibered architecture consisting of multiple, overlapping bands of muscle fibers in most individuals and a simple parallel-fibered architecture in some individuals.

A biomechanical model of cardinal vowel production: muscle activations and the impact of gravity on tongue positioning

A three-dimensional (3D) biomechanical model of the tongue and the oral cavity, controlled by a functional model of muscle force generation (lambda-model of the equilibrium point hypothesis) and coupled with an acoustic model, was exploited to study the activation of the tongue and mouth floor muscles during the production of French cardinal vowels. The selection of the motor commands to control the tongue and the mouth floor muscles was based on literature data, such as electromyographic, electropalatographic, and cineradiographic data. The tongue shapes were also compared to data obtained from the speaker used to build the model. 3D modeling offered the opportunity to investigate the role of the transversalis, in particular, its involvement in the production of high front vowels. It was found, with this model, to be indirect via reflex mechanisms due to the activation of surrounding muscles, not voluntary. For vowel /i/, local motor command variations for the main tongue muscles revealed a non-negligible modification of the alveolar groove in contradiction to the saturation effect hypothesis, due to the role of the anterior genioglossus. Finally, the impact of subject position (supine or upright) on the production of French cardinal vowels was explored and found to be negligible.

Potential therapeutic targets in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a disease of ever-increasing importance due to its association with multiple impairments and rising prevalence in an increasingly susceptible demographic. The syndrome is linked with loud snoring, disrupted sleep and observed apnoeas. Serious co-morbidities associated with OSA appear to be reversed by continuous positive airway pressure (CPAP) treatment; however, CPAP is variably tolerated leaving many patients untreated and emphasising the need for alternative treatments. Virtually all OSA patients have airways that are anatomically vulnerable to collapse, but numerous pathophysiological factors underlie when and how OSA is manifested. This review describes how the complexity of OSA requires multiple treatment approaches that are individually targeted. This approach may take the form of more specific diagnoses in terms of the mechanisms underlying OSA as well as rational pharmacological treatment directed toward such disparate ends as arousal threshold and ventilatory control/chemosensitivity, and mechanical treatment in the form of surgery and augmentation of lung volumes.

Genioglossus and intrinsic electromyographic activities in impeded and unimpeded protrusion tasks

Eight muscles invest the human tongue: four extrinsic muscles have external origins and insert into the tongue body and four intrinsic muscles originate and terminate within the tongue. Previously, we noted minimal activation of the genioglossus tongue muscle during impeded protrusion tasks (i.e., having subjects push the tongue against a force transducer), suggesting that other muscles play a role in the production of tongue force. Accordingly, we sought to characterize genioglossus tongue muscle activities during impeded and unimpeded protrusion tasks (i.e., having subjects slowly and smoothly move the tongue out of their mouth). Electromyographic (EMG) and single motor-unit potentials of the extrinsic genioglossus muscle were recorded with tungsten microelectrodes and EMG activities of intrinsic tongue muscles were recorded with hook-wire electrodes inserted into the anterior tongue body. Tongue position was detected by an isotonic transducer coupled to the tongue tip. Protrusive force was detected by a force transducer attached to a rigid bar. Genioglossus and intrinsic tongue muscles were simultaneously active in both impeded and unimpeded protrusion tasks. Genioglossus whole muscle EMG and single motor-unit activities changed faithfully as a function of tongue position, with increased discharge associated with protrusion and decreased discharge associated with retraction back to the rest position. In contrast, during the impeded protrusion task drive the genioglossus muscle remained constant as protrusion force increased. Conversely, intrinsic tongue muscle activities appropriately followed changes in both tongue position and force. Importantly, we observed significantly higher levels of intrinsic muscle activity in the impeded protrusion task. These observations suggest that protrusion of the human tongue requires activation of the genioglossus and intrinsic protrudor muscles, with the former more important for establishing anterior-posterior tongue location and the latter playing a greater role in the generation of protrusive force. A biomechanical model of these actions is provided and discussed.

Morphology and innervation of the human cremaster muscle in relation to its function

The electromyographic properties of the cremaster muscle (CM) are quite different from other skeletal muscles. It shows excessive spontaneous discharges, and the motor unit shape and firing frequency of the CM muscle differ from that of limb muscles. In this study, CM of six adult cadavers and six orchiectomy specimens were used to reveal the detailed histology of the muscle and provide an anatomophysiological explanation for these unusual electromyographic properties. Routine histochemical stains revealed the CM was composed of several distinct bundles of smooth and striated muscle fibers within connective tissue. The smooth muscle fibers that were more profuse than previously known and were not arranged in layers, but widely dispersed between striated muscle fibers. Bielschowsky silver staining technique, anti-neurofilament and anti-synaptophysin immunostaining showed the presence of multiple motor end-plates observed as a series of small dots or lines running along the striated muscle fibers and several nerve endings on a single muscle fiber. Myosin immunostaining confirmed the CM is a slow-twitch muscle, and alpha-actin smooth muscle immunostaining confirmed the presence of a large number of smooth muscle fibers. There were also small multipolar neurons forming nerve plexuses between smooth muscle fibers. Anti-GFAP immunostaining confirmed the presence of glial cells similar to astrocytes. In conclusion, the findings of this detailed anatomical study showed the CM, widely known as a striated muscle, contains a large number of smooth muscle fibers, and the spontaneous electromyographic discharges are due to the presence of multiple motor end-plates and dense innervation.

Regional volumetric change of the tongue during mastication in pigs

Structure and movement of the tongue have been studied extensively, but little study has been carried on its 3D deformation and ensuing volumetric changes during various functions. The purpose of this study is to investigate the volumetric changes of a regional section of the tongue during feeding. Four 12-week-old Yucatan miniature pigs were used. During natural mastication and water drinking, the width, length, thickness and volumetric changes were measured using six implanted ultrasonic crystals, which circumscribed a wedge-shaped volume in the region of the tongue body. Jaw movements were videotaped and digitized. Signals from these two sources were synchronized to allow real-time analyses. Significant volumetric changes (P < 0.001) were found in chewing, ingestion and drinking, and these changes were stereotypical in relation to rhythmic jaw movements. Volumetric change during chewing was not only more regular, but significantly larger (45.6%, P < 0.001) than that during ingestion (31.4%). The volumetric changes were less regular in drinking and the changing range (30.4%) was close to that during ingestion. Real-time analysis indicated that the volume began increasing at late jaw closing and reached the peak at late power stroke. The increase in duration of volume only took up 33.4% of the total chewing cycle length; significantly shorter than that of volume decrease. Correlation analysis revealed that the change in posterior dorsal and ventral widths had the greatest positive association with volumetric change (r = 0.43) in direction. The covariance calculations further indicated that dimensional changes in length and thickness coupled negatively with volumetric changes in amplitude. These results revealed that regional volumetric change of the tongue occurs during feeding and chewing requires larger volumetric changes than do ingestion and drinking. Volumetric expansion occurs in the phase of power stroke during chewing and is coupled with increases in widths in the direction and with decreases of thickness and length in the amplitude. The results further suggested that the regional volumetric expansion may play the determinant role in functional load production on its surrounding tissues, and may also imply that neuromuscular control of the tongue is region-specific, a notion incompatible with traditional scheme of categorizing muscle function in the tongue.

Internal kinematics of the tongue during feeding in pigs

Six ultrasonic crystals (Ø2 mm) were implanted into the tongue body to form a wedge-shaped configuration in six 12-week-old Yucatan minipigs. These crystals allow recording of the distance changes in bilateral lengths (RL/LL) and base thicknesses (RT/LT), and anterior (AW) and posterior (dorsal and ventral, PDW and PVW) widths during natural feeding. Results indicated that changes in all measured dimensions were stereotypical with considerable regularity. The greatest dimensional changes during chewing were seen in the AW (33.3%), significantly larger than those in other dimensions (P < 0.05-0.001). During ingestion, change in all widths and thicknesses reduced significantly compared with those during chewing (P < 0.05), but changes in the lengths (RL/LL) were significantly larger than those during chewing (P < 0.01). During drinking, overall dimensional changes reduced and amplitudes were symmetrically distributed in all dimensions. The timing analysis indicated that, during chewing, the reversal of dimensional decrease to increase in the PVW occurred first, followed by those of PDW, AW, RT/LT, and RL/LL (P < 0.05). During ingestion, the AW started widening first. Time sequence of these reversals during drinking was similar to that during chewing, but RT/LT thickening was behind RL/LL lengthening. These results suggested that during natural feeding, regional tongue deformations are rhythmic and stereotypical similar to jaw movement. The reversals of expansion-contraction of various dimensions are not synchronous, but occur in a sequential manner in timing. Tongue internal deformations are task-specific in both timing and amplitude. The dimensional expansions-contractions are dominant in the transverse and sagittal planes during chewing and ingestion, respectively, but are smaller and more symmetrically distributed across various dimensions during drinking.

Limited expression of slow tonic myosin heavy chain in human cranial muscles

Recent reports of slow tonic myosin heavy chain (MHCst) in human masticatory and laryngeal muscles suggest that MHCst may have a wider distribution in humans than previously thought. Because of the novelty of this finding, we sought to confirm the presence of MHCst in human masticatory and laryngeal muscles by reacting tissue from these muscles and controls from extraocular, intrafusal, cardiac, appendicular, and developmental muscle with antibodies (Abs) ALD-58 and S46, considered highly specific for MHCst. At Ab dilutions producing minimal reaction to muscle fibers positive for MHCI, only extraocular, intrafusal, and fetal tongue tissue reacted with Ab S46 had strong immunoreaction in an appreciable number of muscle fibers. In immunoblots, Ab S46, but not Ab ALD-58, labeled adult extraocular muscles; no other muscles were labeled with either Ab. We conclude that, in humans, Ab S46 has greater specificity for MHCst than does Ab ALD-58. We suggest that reports of MHCst in human masticatory and laryngeal muscles reflect false-positive identification of MHCst due to cross-reactivity of Ab ALD-58 with another MHC isoform.

Roles of intrinsic and extrinsic tongue muscles in feeding: electromyographic study in pigs

The performance of tongue muscles in various feeding behaviours is not well defined. This study was undertaken to examine the role of the intrinsic and extrinsic tongue muscles during natural drinking, food ingestion and chewing. Ten 12-week-old Yucatan miniature pigs (5 in each gender) were used. Under anesthesia, fine-wire electrodes were inserted into three intrinsic (verticalis and transversus [V/T]; superior and inferior longitudinalis [SL and IL]) and two extrinsic (genioglossus [GG] and styloglossus [SG]) tongue muscles and two jaw muscles (masseter [MA] and anterior digastricus [DI]). Electromyogram (EMG) and jaw movement were recorded and synchronized when pigs were drinking water, ingesting and chewing food freely. Chewing frequency (CF), onset of activation, burst duration and integrated activity (IEMG) were assessed quantitatively, and EMG activities during drinking and ingestion were examined qualitatively. Results indicate that during chewing, the V/T and GG had one phase of activity starting at early jaw opening, and the V/T activity lasted through late of jaw closing. The SL, IL and SG had double phases with the first starting at jaw opening and the second at late jaw closing phases. The three intrinsic tongue muscles and the SG were active during 35-48% of the chewing cycle. IEMG values of the SL, IL and SG of both sides were significantly greater compared to the other muscles (p<0.05-0.01). Both the SL and the IL showed significantly higher activities in the contralateral than ipsilateral sides (p<0.05). The timing sequences of both extrinsic and intrinsic muscles were similar between ingestion and chewing, but amplitudes of the GG and IL were greatly enhanced and those of the MA and SL were reduced during ingestion. The simultaneous activation of the MA, GG and V/T were seen during drinking, along with major activity in the GG and V/T. These results suggested that the majority of activity in the intrinsic and extrinsic tongue muscles occurred during jaw opening and the occlusal phases of chewing. The activity of the GG and IL played a major role during ingestion, whereas simultaneous activation of jaw, extrinsic and intrinsic tongue muscles and major activity in the GG and V/T occurred during drinking.

What is orofacial fatigue and how does it affect function for swallowing and speech?

Speech-language pathologists are likely to encounter patients who report symptoms of fatigue, but there are few clinical procedures to assess this phenomenon. Furthermore, it is difficult to determine whether fatigue contributes to a patient's dysphagia or dysarthria. This article reviews orofacial muscles, including the muscles of the tongue, lips, and cheeks, highlighting in particular their role in swallowing and speaking. It provides definitions of fatigue and describes assessment procedures. The author's research has focused on assessing fatigue, especially of the tongue, and elucidating the effects of exercising the tongue on speech and nonspeech tasks. Most of this work involves people who have Parkinson's disease and neurologically normal adults; results generally support heightened fatigue in Parkinson's disease. However, the effect of fatigue on functional activities remains unclear. Literature regarding the effects of orofacial fatigue on swallowing and speaking is notably sparse, but preliminary evidence indicates that these functions are rather robust.