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Objective: Compare fasciculation rates between amyotrophic lateral sclerosis (ALS) patients and healthy controls in body regions relevant for diagnosing ALS using motor unit MRI (MUMRI) at baseline and 6 months follow-up, and relate this to single-channel surface EMG (SEMG)., Methods: Tongue, biceps brachii, paraspinals and lower legs were assessed with MUMRI and biceps brachii and soleus with SEMG in 10 healthy controls and 10 patients (9 typical ALS, 1 primary lateral sclerosis [PLS])., Results: MUMRI-detected fasciculation rates in typical ALS patients were higher compared to healthy controls for biceps brachii (2.40 ± 1.90 cm -3 min -1 vs. 0.04 ± 0.10 cm -3 min -1 , p = 0.004), paraspinals (1.14 ± 1.61 cm -3 min -1 vs. 0.02 ± 0.02 cm -3 min -1 , p = 0.016) and lower legs (1.42 ± 1.27 cm -3 min -1 vs. 0.13 ± 0.10 cm -3 min -1 , p = 0.004), but not tongue (1.41 ± 1.94 cm -3 min -1 vs. 0.18 ± 0.18 cm -3 min -1 , p = 0.556). The PLS patient showed no fasciculation. At baseline, 6/9 ALS patients had increased fasciculation rates compared to healthy controls in at least 2 body regions. At follow-up every patient had increased fasciculation rates in at least 2 body regions. The MUMRI-detected fasciculation rate correlated with SEMG-detected fasciculation rates (τ = 0.475, p = 0.006)., Conclusion: MUMRI can non-invasively image fasciculation in multiple body regions and appears sensitive to disease progression in individual patients., Significance: MUMRI has potential as diagnostic tool for ALS., Competing Interests: Conflict of interest The authors report no conflict of interests., (Copyright © 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Objective: Obstructive sleep apnea (OSA) is a common risk factor for stroke, and dysphagia and pneumonia are both well-known complications of stroke. The development of these conditions is related to the oropharyngeal structures. We investigated whether specific structural features of the tongue may lead to the development of these complications., Methods: Patients with ischemic stroke who required admission and community-dwelling elderly controls were enrolled. The participants underwent tongue measurements by received hand-held ultrasound, and received questionnaires to evaluate sleep quality and daytime sleepiness. The patient group also underwent objective sleep measurement by actigraphy and the 3-Step Swallowing Test (3-SSS). Sleep parameters and outcomes were analyzed., Results: Patient with ischemic stroke had significantly thicker tongue than controls (6.53 cm v. 6.05 cm, p = 0.002). Multiple logistic regression analysis revealed that the anatomical parameters of the tongue in patients with stroke were significantly correlated with parameters of OSA, and the thickness of the tongue was positively correlated with the development of OSA (p = 0.024) and pneumonia (p = 0.048)., Conclusions: A thicker-than average tongue may be a risk factor for OSA and pneumonia in patient with stroke. Hand-held ultrasound can be used to identify these anatomical features. Further studies are warranted to clarify the role of the tongue in these post-stroke complications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Clinical airway assessment parameters differ significantly between pregnant and non-pregnant patients, however literature comparing their ultrasound (US) airway parameters is limited. We planned a prospective cohort study to compare US-assessed airway parameters between pregnant and non-pregnant women., Methods: We enrolled 82 pregnant females scheduled for elective cesarean section under neuraxial anesthesia and 80 age-matched non-pregnant females scheduled for elective surgery. Pre-operative clinical airway assessment was performed in both groups. The US airway assessment was done pre-operatively in non-pregnant and postoperatively in pregnant patients. Our primary objective was to compare US-assessed parameters, and secondary objectives included a comparison of clinical airway assessment parameters and investigating a relationship between a difficult airway (defined as a modified Mallampati grade (MMG) ≥ 3) and other airway assessment parameters., Results: Among several US airway parameters, pregnant patients had significantly higher hyomental distance, anterior neck soft tissue thickness at the hyoid and vocal cord level, and oral cavity height, while the tongue thickness and mandibular condylar movements were significantly lower than in non-pregnant patients. Similarly, for the clinical airway assessment, pregnant patients had significantly higher MMG and upper lip bite test scores, mentohyoid distance, and neck circumference. Pregnancy, the ratio of pre-epiglottic space and epiglottis-to-vocal cords distance (Pre-E/E-VC), and hyoid bone visibility were independent predictors of a difficult airway., Conclusion: The US airway assessment parameters differ significantly between pregnant and non-pregnant patients. Pregnancy, hyoid bone visibility, and Pre-E/E-VC ratio were independent predictors of the difficult airway in female patients., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: In China, diabetes is a common, high-incidence chronic disease. Diabetes has become a severe public health problem. However, the current diagnosis and treatment methods are difficult to control the progress of diabetes. Traditional Chinese Medicine (TCM) has become an option for the treatment of diabetes due to its low cost, good curative effect, and good accessibility., Objective: Based on the tongue images data to realize the fine classification of the diabetic population, provide a diagnostic basis for the formulation of individualized treatment plans for diabetes, ensure the accuracy and consistency of the TCM diagnosis, and promote the objective and standardized development of TCM diagnosis., Methods: We use the TFDA-1 tongue examination instrument to collect the tongue images of the subjects. Tongue Diagnosis Analysis System (TDAS) is used to extract the TDAS features of the tongue images. Vector Quantized Variational Autoencoder (VQ-VAE) extracts VQ-VAE features from tongue images. Based on VQ-VAE features, K-means clustering tongue images. TDAS features are used to describe the differences between clusters. Vision Transformer (ViT) combined with Grad-weighted Class Activation Mapping (Grad-CAM) is used to verify the clustering results and calculate positioning diagnostic information., Results: Based on VQ-VAE features, K-means divides the diabetic population into 4 clusters with clear boundaries. The silhouette, calinski harabasz, and davies bouldin scores are 0.391, 673.256, and 0.809, respectively. Cluster 1 had the highest Tongue Body L (TB-L) and Tongue Coating L (TC-L) and the lowest Tongue Coating Angular second moment (TC-ASM), with a pale red tongue and white coating. Cluster 2 had the highest TC-b with a yellow tongue coating. Cluster 3 had the highest TB-a with a red tongue. Group 4 had the lowest TB-L, TC-L, and TB-b and the highest Per-all with a purple tongue and the largest tongue coating area. ViT verifies the clustering results of K-means, the highest Top-1 Classification Accuracy (CA) is 87.8%, and the average CA is 84.4%., Conclusions: The study organically combined unsupervised learning, self-supervised learning, and supervised learning and designed a complete diabetic tongue image classification method. This method does not rely on human intervention, makes decisions based entirely on tongue image data, and achieves state-of-the-art results. Our research will help TCM deeply participate in the individualized treatment of diabetes and provide new ideas for promoting the standardization of TCM diagnosis., Competing Interests: Declaration of competing interest The authors declare that there is no duality of interest associated with this manuscript., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Biomechanical relationships involving lingual myoanatomy, contractility, and bolus movement are fundamental properties of human swallowing. To portray the relationship between lingual deformation and bolus flow during swallowing, a weakly one-way solid-fluid finite element model (FEM) was derived employing an elemental mesh aligned to magnetic resonance diffusional tractography (Q-space MRI, QSI) of the human tongue, an arbitrary Lagrangian-Eulerian (ALE) formulation with remeshing to account for the effects of lingual surface (boundary) deformation, an implementation of patterned fiber shortening, and a computational visualization of liquid bolus flow. Representing lingual tissue deformation in terms of its 2D principal Lagrangian strain in the mid-sagittal plane, we demonstrated that the swallow sequence was characterized by initial superior-anterior expansion directed towards the hard palate, followed by sequential, radially directed, contractions of the genioglossus and verticalis to promote lingual rotation (lateral perspective) and propulsive displacement. We specifically assessed local bolus velocity as a function of viscosity (perfect slip conditions) and observed that a low viscosity bolus (5 cP) exhibited maximal displacement, surface spreading and local velocity compared to medium (110 cP, 300 cP) and high (525 cP) viscosity boluses. Analysis of local nodal velocity revealed that all bolus viscosities exhibited a bi-phasic progression, with the low viscosity bolus being the most heterogeneous and fragmented and the high viscosity bolus being the most homogenous and cohesive. Intraoral bolus cohesion was depicted in terms of the distributed velocity gradient, with higher gradients being associated with increased shear rate and bolus fragmentation. Lastly, we made a sensitivity analysis on tongue stiffness and contractility by varying the degree of extracellular matrix (ECM) stiffness through effects on the Mooney-Rivlin derived passive matrix and by varying maximum tetanized isometric stress, and observed that a graded increase of ECM stiffness was associated with reduced bolus spreading, posterior displacement, and surface velocity gradients, whereas a reduction of global contractility resulted in a graded reduction of obtainable accommodation volume, absent bolus spreading, and loss of posterior displacement. We portray a unidirectionally coupled solid-liquid FEM which associates myoarchitecture-based lingual deformation with intra-oral bolus flow, and deduce that local elevation of the velocity gradient correlates with bolus fragmentation, a precondition believed to be associated with aspiration vulnerability during oropharyngeal swallowing., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Non-invasive multi-disease detection is an active technology that detects human diseases automatically. By observing images of the human body, computers can make inferences on disease detection based on artificial intelligence and computer vision techniques. The sublingual vein, lying on the lower part of the human tongue, is a critical identifier in non-invasive multi-disease detection, reflecting health status. However, few studies have fully investigated non-invasive multi-disease detection via the sublingual vein using a quantitative method. In this paper, a two-phase sublingual-based disease detection framework for non-invasive multi-disease detection was proposed. In this framework, sublingual vein region segmentation was performed on each image in the first phase to achieve the region with the highest probability of covering the sublingual vein. In the second phase, features in this region were extracted, and multi-class classification was applied to these features to output a detection result. To better represent the characterisation of the obtained sublingual vein region, multi-feature representations were generated of the sublingual vein region (based on color, texture, shape, and latent representation). The effectiveness of sublingual-based multi-disease detection was quantitatively evaluated, and the proposed framework was based on 1103 sublingual vein images from patients in different health status categories. The best multi-feature representation was generated based on color, texture, and latent representation features with the highest accuracy of 98.05%., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Nonalcoholic fatty liver disease (NAFLD), a leading cause of chronic hepatic disease, can progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, it is extremely important to explore early diagnosis and screening methods. In this study, we developed models based on computer tongue image analysis technology to observe the tongue characteristics of 1778 participants (831 cases of NAFLD and 947 cases of non-NAFLD). Combining quantitative tongue image features, basic information, and serological indexes, including the hepatic steatosis index (HSI) and fatty liver index (FLI), we utilized machine learning methods, including Logistic Regression, Support Vector Machine (SVM), Random Forest (RF), Gradient Boosting Decision Tree (GBDT), Adaptive Boosting Algorithm (AdaBoost), Naïve Bayes, and Neural Network for NAFLD diagnosis. The best fusion model for diagnosing NAFLD by Logistic Regression, which contained the tongue image parameters, waist circumference, BMI, GGT, TG, and ALT/AST, achieved an AUC of 0.897 (95% CI, 0.882-0.911), an accuracy of 81.70% with a sensitivity of 77.62% and a specificity of 85.22%; in addition, the positive likelihood ratio and negative likelihood ratio were 5.25 and 0.26, respectively. The application of computer intelligent tongue diagnosis technology can improve the accuracy of NAFLD diagnosis and may provide a convenient technical reference for the establishment of early screening methods for NAFLD, which is worth further research and verification., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

By affecting the tongue position and oropharyngeal airway volume, torus mandibularis is an anatomical factor associated with obstructive sleep apnea (OSA). This study aimed to investigate the influence of torus mandibularis on the surgical outcomes of multilevel upper airway surgery with tongue base resection (TBR) in patients with OSA. Patients with OSA who underwent palatal surgery and TBR were retrospectively analyzed. The patients were divided into two groups according to the presence or absence of torus mandibularis upon physical examination or on computed tomography images. The anatomical characteristics of the upper airway and pre/postoperative polysomnography were analyzed. The control and torus mandibularis groups comprised 69 and 35 patients, respectively, with all of them showing improved sleep quality after surgery. Apnea-hypopnea index (AHI) scores decreased from 42.1 ± 22.2 preoperatively to 23.9 ± 21.4 postoperatively in the control group (p < 0.001), and from 45.2 ± 19.9 to 22.5 ± 13.5 in the torus mandibularis group (p < 0.001). Comparing the postoperative changes in AHI, the AHI of the torus mandibularis group improved by 22.7 ± 23.4, whereas that of the control group improved by 18.1 ± 19.6 (p = 0.296). Sleep efficiency improved from 90.0 ± 7.5 to 92.8 ± 6.8 in the control group, and from 90.3 ± 8.7 to 93.6 ± 6.5 in the torus mandibularis group; however, there was no statistical difference between the two groups (p = 0.816). The presence of torus mandibularis did not appear to significantly affect the surgical results in OSA patients, but it did elicit significant changes in polysomnographic parameters compared with the control group. Therefore, following the identification of torus mandibularis in OSA patients, TBR should be considered as part of planning, as it may help to predict surgical outcomes., Competing Interests: Declaration of competing interest The authors have no financial or personal conflicts of interest to declare., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Intelligible speech is produced by creating varying internal local muscle groupings-i.e., functional units-that are generated in a systematic and coordinated manner. There are two major challenges in characterizing and analyzing functional units. First, due to the complex and convoluted nature of tongue structure and function, it is of great importance to develop a method that can accurately decode complex muscle coordination patterns during speech. Second, it is challenging to keep identified functional units across subjects comparable due to their substantial variability. In this work, to address these challenges, we develop a new deep learning framework to identify common and subject-specific functional units of tongue motion during speech. Our framework hinges on joint deep graph-regularized sparse non-negative matrix factorization (NMF) using motion quantities derived from displacements by tagged Magnetic Resonance Imaging. More specifically, we transform NMF with sparse and graph regularizations into modular architectures akin to deep neural networks by means of unfolding the Iterative Shrinkage-Thresholding Algorithm to learn interpretable building blocks and associated weighting map. We then apply spectral clustering to common and subject-specific weighting maps from which we jointly determine the common and subject-specific functional units. Experiments carried out with simulated datasets show that the proposed method achieved on par or better clustering performance over the comparison methods.Experiments carried out with in vivo tongue motion data show that the proposed method can determine the common and subject-specific functional units with increased interpretability and decreased size variability., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Nutritive sucking is a complex process, essential to proper growth and development. The complexity of this oral sensorimotor activity includes movements of the tongue and jaw. Tongue movements during nutritive sucking can only be visualized with instrumented methods such as ultrasound. Until now, studies using ultrasound during nutritive sucking performed measurements on each individual ultrasound image frame, which was quite time-consuming. The aim of this pilot study was to automatically process ultrasound video recordings in healthy infants during bottle feeding to measure teat compression and tongue movements. Tongue movements and teat compression during bottle feeding were visualized and recorded using 2D dynamic ultrasound imaging. A custom-made semi-automated analysis-routine was developed. Teat compression was expressed as the median difference in teat diameter during the recording. Tongue movements were expressed as the displacement of the tongue along four evenly distributed image lines and the corresponding time-shifts between those lines. The recordings of 12 out of 14 participants were adequate for the analysis of tongue movements. Teat compression could be analysed in the recordings of 6 participants. The reliability of our analysis-routine was considered to be good, and the analysis-routine was more time-efficient than manual frame-by-frame analysis. This quantitative analysis-routine is a promising tool, that can be used efficiently and accurately in the future to collect normative data that can serve as reference values to distinguish normal from abnormal tongue movements in infants with feeding difficulties., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: To investigate age and other factors related to the deterioration of the muscles used for swallowing, including the tongue and suprahyoid muscles., Design: Cross-sectional study., Setting and Participants: This study included 146 participants: 47 younger adults (23 men and 24 women; age range 23-44 years) recruited from a dental hospital and 99 community-dwelling older adults (37 men and 62 women, age range 65-86 years)., Methods: Age (<65 years or ≥65 years), body mass index (BMI), skeletal muscle mass index (SMI), and tooth loss (Eichner classification) were measured. The cross-sectional areas (CSAs) of the tongue, geniohyoid muscle, and anterior belly of the digastric muscle were measured using an ultrasonic diagnostic apparatus. The correlation between each muscle's CSA and strength was examined. Multiple regression analyses were performed separately for each sex using each muscle CSA as the dependent variable and age, BMI, SMI, and the Eichner classification as explanatory variables., Results: Older men had a significant positive correlation between tongue pressure and CSA (r = 0.35, P = .031). Jaw opening force was positively correlated with geniohyoid muscle CSA (r = 0.41, P = .001) in older women. In the multiple regression analysis, age, BMI, and SMI were significantly associated with tongue CSA in men. Age was significantly and inversely associated with suprahyoid muscle CSA in both men and women. No explanatory variables were significantly associated with geniohyoid muscle CSA except age., Conclusions and Implications: The tongue increased in volume, and the suprahyoid muscles underwent atrophy with age. The study results suggest that interventions to prevent dysphagia associated with aging should be tailored toward specific muscles. Direct muscle training is required for the suprahyoid muscles, whereas the maintenance of tongue muscle mass and function, as well as training for the tongue, requires attention to ensure optimal nutritional status and whole-body skeletal muscle mass., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To learn if quantitative ultrasound (QUS) distinguishes the tongues of healthy participants and amyotrophic lateral sclerosis (ALS) patients by echo intensity (EI) and to evaluate if EI correlates with measures of bulbar function., Methods: Ultrasound was performed along the midline of the anterior tongue surface in 16 ALS patients and 16 age-matched controls using a linear hockey stick 16-7 MHz transducer. A region of interest was manually drawn and then EI was determined for the upper 1/3 of the muscle. For patients, the ALS functional rating scale - revised (ALSFRS-R) was used to calculate bulbar sub-scores and the Iowa Oral Performance Instrument (IOPI) was used to measure tongue strength., Results: EI was significantly higher in ALS patients than in healthy participants (49.8 versus 37.8 arbitrary units, p < 0.01). In the patient group, EI was negatively correlated with ALSFRS-R bulbar sub-score (R S  = -0.65, p < 0.01). An inverse correlation between EI and tongue strength did not reach significance (R S  = -0.34, p = 0.28)., Conclusions: This study suggests that EI can differentiate healthy from diseased tongue muscle, and correlates with a standard functional measure in ALS patients., Significance: Tongue EI may represent a novel biomarker for bulbar dysfunction in ALS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

A few systematic imaging studies employing ultrasound (HRUS) and magnetic resonance imaging (MRI) have suggested tongue measures to aid in diagnosis of amyotrophic lateral sclerosis (ALS). The relationship between structural tongue alterations and the ALS patients' bulbar and overall motor function has not yet been elucidated. We here thus aimed to understand how in-vivo tongue alterations relate to motor function and motor function evolution over time in ALS. Our study included 206 ALS patients and 104 age- and sex-matched controls that underwent HRUS and 3T MRI of the tongue at baseline. Sonographic measures comprised coronal tongue echointensity, area, height, width and height/width ratio, while MRI measures comprised sagittal T1 intensity, tongue area, position and shape. Imaging-derived markers were related to baseline and longitudinal bulbar and overall motor function. Baseline T1 intensity was lower in ALS patients with more severe bulbar involvement at baseline. Smaller baseline coronal (HRUS) and sagittal (MRI) tongue area, smaller coronal height (HRUS) and width (HRUS) as well as more rounded sagittal tongue shape predicated more rapid functional impairment - not only of bulbar, but also of overall motor function - in ALS. Our results suggest that in-vivo sonography und MRI tongue measures could aid as biomarkers to reflect bulbar and motor function impairment., Competing Interests: Declaration of Competing Interests None of the authors have potential conflicts of interest to be disclosed., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Magnetic resonance (MR) images with both high resolutions and high signal-to-noise ratios (SNRs) are desired in many clinical and research applications. However, acquiring such images takes a long time, which is both costly and susceptible to motion artifacts. Acquiring MR images with good in-plane resolution and poor through-plane resolution is a common strategy that saves imaging time, preserves SNR, and provides one viewpoint with good resolution in two directions. Unfortunately, this strategy also creates orthogonal viewpoints that have poor resolution in one direction and, for 2D MR acquisition protocols, also creates aliasing artifacts. A deep learning approach called SMORE that carries out both anti-aliasing and super-resolution on these types of acquisitions using no external atlas or exemplars has been previously reported but not extensively validated. This paper reviews the SMORE algorithm and then demonstrates its performance in four applications with the goal to demonstrate its potential for use in both research and clinical scenarios. It is first shown to improve the visualization of brain white matter lesions in FLAIR images acquired from multiple sclerosis patients. Then it is shown to improve the visualization of scarring in cardiac left ventricular remodeling after myocardial infarction. Third, its performance on multi-view images of the tongue is demonstrated and finally it is shown to improve performance in parcellation of the brain ventricular system. Both visual and selected quantitative metrics of resolution enhancement are demonstrated., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Tracking the tongue in ultrasound images provides information about its shape and kinematics during speech. Current methods for detecting/tracking the tongue require manual initialization or training using large amounts of labeled images. In this article, we propose a solution to convert a semi-automatic tongue contour tracking system to a fully-automatic one. This work introduces a new method for extracting tongue contours in ultrasound images that requires no training nor manual intervention. The method consists in an image enhancement step based on phase symmetry, followed by skeletonization and clustering steps, leading to a set of candidate points that can be used to fit an active contour to the image and subsequently initialize a tracking algorithm. Two novel quality measures were also developed that predict the reliability of the segmentation result so that an image with a reliable contour can be chosen to confidently initialize fully automated tongue tracking. This is achieved by automatically generating and choosing a set of points that can replace the manually segmented points for a semi-automated tracking approach. This paper also improves the accuracy of tracking by incorporating two criteria to reset the tracking algorithm from time to time. Experiments show that fully automated and semi-automated methods result in very similar mean sum of distances errors, respectively, indicating that the proposed automatic initialization does not significantly alter accuracy. Moreover, further results show that tracking accuracy is improved when using the new segmentation technique within the proposed re-initialization scheme., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Quality of life in tumour patients following combined ablative and reconstructive head and neck surgery varies significantly. This is at least partially due to differences in speech and swallowing function. A tool to objectively evaluate articulation by magnetic resonance imaging (MRI) has now been tested alongside ultrasound examination., Patients and Methods: A standardized sequence of phonemes from the German language was established in 20 healthy volunteers and recorded in different planes by MRI and ultrasound. Phonemes were identified through recognition of typical tongue configurations by two different observers. An algorithm for metric analysis of articulation in terms of distances and angles for five extreme points on the tongue (anterior, posterior, cranial and two basal corners) was designed. The findings in these volunteers were subsequently compared with the results of an examination of a tumour patient., Results: Physiological articulation was visualized and evaluated both by MRI and ultrasound. There was a high intra-class correlation coefficient for measurements between independent observers. Tongue position for certain phonemes was mostly constant in healthy patients of different age groups, with gender-specific differences. In a first comparison, tongue position in a patient with tongue cancer differed significantly from this position, both pre- and postoperatively. In agreement with clinical articulation quality, the tongue position of the patient returned to almost normal within 12 months postoperatively., Conclusion: Both ultrasound and MRI are appropriate instruments for visualization of articulation and objective measurements to evaluate speech in tumour patients. Whilst MRI is more precise and can identify more subtle differences, ultrasound is a valid alternative due to its wider availability and broader applicability., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: In this study, we aimed to determine the usefulness of diffusion kurtosis imaging (DKI) as a noninvasive method for evaluation of the histologic grade and lymph node metastasis in patients with oral carcinoma., Materials and Methods: Twenty-seven patients with oral carcinoma were examined with a 3-T MR system and 16-channel coil. DKI data were obtained by a single-shot echo-planar imaging sequence with repetition time, 10,000 ms; echo time, 94 ms; field of view, 250 × 204.25 ms; matrix, 120 × 98; section thickness, 4 mm; four b values of 0, 500, 1000, and 2000 s/mm 2 ; and motion-probing gradients in three orthogonal directions. Diffusivity (D) and kurtosis (K) were calculated using the equation: S = S 0 ∙ exp(-b ∙ D + b 2 ∙ D 2 ∙ K/6). Conventional apparent diffusion coefficient (ADC) was also calculated. The MR images were compared with the histopathologic findings., Results: Relative to the histologic grades (Grades 1, 2, and 3) of the 27 oral carcinomas, D values showed a significant inverse correlation (r = -0.885; P < 0.001) and K values showed a significant positive correlation (r = 0.869; P < 0.001), whereas ADC values showed no significant correlation (r = -0.311; P = 0.115). When comparing between metastatic and non-metastatic lymph nodes, significant differences in the D values (P < 0.001) and K values (P < 0.001), but not the ADC values (P = 0.110) became apparent., Conclusions: In patients with oral carcinoma, DKI seems to be clinically useful for the evaluation of histologic grades and lymph node metastasis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: A decreased flap volume can be an obstacle to proper phonation and swallowing. In this study we verified the proportion of volume decrease using 3D reconstructed images and identified the contributors to flap volume loss., Methods: We retrospectively analyzed all patients who underwent radical excision of tongue cancer and reconstructive surgery in our institution from January 2003 to October 2016. Segmentation of the DICOM images, 3D rendering of the neotongue flap, and analysis of the reconstructed images were performed using SPlanner V1 ® software., Results: The first postoperative imaging work-up was performed within an average of 22 days (T1). The last follow-up images were taken at an average of 6.25 months (T2). The mean flap volume at T2 was reduced to 82.99 per cent compared with T1, and flap height was reduced to 91.85 per cent, giving mean volume and height decreases of 17.01 per cent and 8.15 per cent, respectively. Neither the volume/height difference between T1 and T2 nor the flap volume/height discrepancy compared with the preoperative tongue affected speech or feeding function. The difference between the flap and preoperative tongue volumes was significantly related to the presence of complications (p = 0.0153). Initial flap volume was significantly related to the flap volume reduction (p = 0.0159)., Conclusions: The mean flap volume reduction is the only factor significantly related to initial flap volume. Our realistic 3D reconstructed image and novel software enables us to more precisely predict the flap volume of the postoperative state and preoperatively evaluate the required flap size for covering defects., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine reader performance in evaluating oropharyngeal anatomy on ultrasonography., Materials and Methods: Ultrasound images of the oropharynx comprising normal and malignant anatomic variants were organized into slideshows. Slideshows were administered to 6 readers blinded to participant tumor status and with varying experience reading oropharyngeal sonograms. A training slideshow oriented readers to images of the oropharynx with and without malignant lesions. Readers then evaluated images in a test slideshow for tumor presence and marked orthogonal long and short dimensions of the tumor. Results were analyzed for accuracy, sensitivity, specificity, inter-reader agreement, and measurement error relative to prospectively-identified reference measurements., Results: Eighty-seven percent of base of tongue (BOT) sonograms were identified correctly by a majority of readers. In identifying BOT tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 79%, 73%, 85%, and 0.51, respectively. Median measurement error in the long and short axes for BOT tumors was -2.6% (range: -40% to 29%) and -2.6% (range: -56% to 156%), respectively. Eighty-four percent of palatine tonsil sonograms were identified correctly by a majority of readers. In identifying tonsil tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 77%, 74%, 78%, and 0.41, respectively. Median measurement error in the long and short axes for tonsil tumors was 3.8% (range: -45% to 32%) and -6.5% (range: -83% to 42%), respectively., Conclusions: Overall, US has clinically useful sensitivity for identification of oropharyngeal carcinoma among readers of diverse clinical backgrounds and experience. US may be useful for the evaluation of features such as tumor dimensions., (Copyright © 2017. Published by Elsevier Ltd.)

Characterizing tongue shape and motion, as they appear in real-time ultrasound (US) images, is of interest to the study of healthy and impaired speech production. Quantitative anlaysis of tongue shape and motion requires that the tongue surface be extracted in each frame of US speech recordings. While the literature proposes several automated methods for this purpose, these either require large or very well matched training sets, or lack robustness in the presence of rapid tongue motion. This paper presents a new robust method for tongue tracking in US images that combines simple tongue shape and motion models derived from a small training data set with a highly flexible active contour (snake) representation and maintains multiple possible hypotheses as to the correct tongue contour via a particle filtering algorithm. The method was tested on a database of large free speech recordings from healthy and impaired speakers and its accuracy was measured against the manual segmentations obtained for every image in the database. The proposed method achieved mean sum of distances errors of 1.69 ± 1.10 mm, and its accuracy was not highly sensitive to training set composition. Furthermore, the proposed method showed improved accuracy, both in terms of mean sum of distances error and in terms of linguistically meaningful shape indices, compared to the three publicly available tongue tracking software packages Edgetrak, TongueTrack and Autotrace., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Preeclampsia is associated with greater narrowing of the airway than normal pregnancy, but it is not known if these changes worsen during labor and delivery. The aim of the study was to evaluate the airway during and after labor in women with or without preeclampsia., Methods: Twenty-five normal and 25 severely preeclamptic pregnant women in early labor were recruited in this single-center, prospective, case-control study. Airway assessment was performed (a) before active labor (b) within one hour of delivery and (c) 24-48 h postpartum. The Mallampati grade was the primary outcome. Sonographic measurements of tongue thickness, anterior neck soft tissue at the level of the hyoid bone and the vocal cords, thyromental distance, and neck circumference, were secondary outcomes., Results: The Mallampati score increased from the pre-labor to the post-labor period in both preeclamptic and normotensive patients (P=0.001 and P=0.002 respectively). A significant difference in tissue thickness at the hyoid level was observed between preeclamptic and normotensive patients pre-labor (P=0.035), post-labor (P=0.05) and postpartum (P=0.05). There was no significant difference in thyromental distance or neck circumference between groups at any time. The total duration of labor and a Mallampati change by one grade correlated (Spearman correlation coefficient 0.473)., Conclusion: Airway sonography may provide useful bedside anatomical information for prediction of difficult laryngoscopy. The change in airway dimensions and the Mallampati score during labor may persist for 48 h postpartum in both groups. Those with prolonged labor are more susceptible to changes in airway dimensions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Combined ablative and reconstructive oral maxillofacial surgery involves a multitude of anatomical and functional structures for speech and swallowing. Although there are a few methods to objectively examine swallowing function, this is not true for speech. We describe the development of an objective visualization and measurement tool for magnetic resonance imaging (MRI) to evaluate speech and its first application in a patient., Material and Methods: A total of 20 healthy patients and one patient with squamous cell carcinoma localized in the anterior floor of the mouth were included in the study. Examination included an MRI examination of a paced, defined set of fictive words representing all sounds of the German language. The patient underwent MRI preoperatively and 1, 3, 6 and 12 months postoperatively. MRI findings were correlated with speech intelligibility., Results: In sagittal planes, the correct identification of vowels and consonants was feasible and showed a high accordance between two independent observers and repetitions. Measurements for the patient showed significant deviations 1 month postoperatively but gradually decreased over time. Aberrant values were persistent for sound /s/. Findings correlated with clinical findings of speech intelligibility., Conclusion: The presented tool seems to be promising for evaluating articulation in (tumor) patients., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Hypoglossal neurinomas are very rare intracranial tumors. The management choices include surgery, as the gold standard, and radiosurgery or a combination of both. Little is known about this condition and the behavior of this tumor., Case Description: A 54-year-old woman presented with a right 12th nerve neurinoma with ipsilateral hemiatrophy of the tongue and spontaneous regression after 1 year of follow-up., Conclusions: Our case highlights the importance of considering careful observation and diligent follow-up as a treatment option, as these lesions can show spontaneous regression with no invasive approaches., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background.: Increased tongue thickness is likely to be associated with difficult airways. However, no methods to evaluate tongue thickness were available. Currently, tongue thickness can be measured by ultrasonography. The present study investigated the predictive value of tongue thickness to predict difficult tracheal intubation., Methods.: Adult patients undergoing tracheal intubation and general anaesthesia were enrolled in the study. Tongue thickness was assessed using submental ultrasonography in the median sagittal plane before anaesthesia. Airway assessments were conducted. Ratios of tongue thickness to thyromental distance were calculated to investigate the potential predictive value of their combination. The primary outcome was difficult tracheal intubation. A multivariable logistic regression and receiver operating characteristic curve analysis were used., Results.: In total, 2254 patients were analysed. One hundred and forty-two (6.3%) patients experienced difficult laryngoscopy, and 51 (2.3%) patients experienced difficult tracheal intubation. Increased tongue thickness (>6.1 cm) was an independent predictor for difficult tracheal intubation [sensitivity 0.75, 95% confidence interval (CI) 0.60-0.86; specificity 0.72, 95% CI 0.70-0.74]. An area under the curve of 0.78 (95% CI 0.77-0.80) for predicting difficult tracheal intubation was calculated. Increased ratios of tongue thickness to thyromental distance (>0.87) presented a considerable area under the curve (0.86, 95% CI 0.84-0.87), sensitivity (0.84, 95% CI 0.71-0.93), and specificity (0.79, 95% CI 0.77-0.81)., Conclusions.: Tongue thickness measured by ultrasonography and its ratio to thyromental distance present significant capacities to predict difficult tracheal intubation., Clinical Trial Registration.: ChiCTR-RCS-14004539., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

Background: Currently, up to 85% of the oral resection specimens have inadequate resection margins, of which the majority is located in the deeper soft tissue layers. The prognosis of patients with oral cavity squamous cell carcinoma (OCSCC) of the tongue is negatively affected by these inadequate surgical resections. Raman spectroscopy, an optical technique, can potentially be used for intra-operative evaluation of resection margins., Objective: To develop in vitro Raman spectroscopy-based tissue classification models that discriminate OCSCC of the tongue from (subepithelial) non-tumorous tissue., Materials and Methods: Tissue classification models were developed using Principal Components Analysis (PCA) followed by (hierarchical) Linear Discriminant Analysis ((h)LDA). The models were based on a training set of 720 histopathologically annotated Raman spectra, obtained from 25 tongue samples (11 OCSCC and 14 normal) of 10 patients, and were validated by means of an independent validation set of 367 spectra, obtained from 19 tongue samples (6 OCSCC and 13 normal) of 11 patients., Results: A PCA-LDA tissue classification model 'tumor' versus 'non-tumorous tissue' (i.e. surface squamous epithelium, connective tissue, muscle, adipose tissue, gland and nerve) showed an accuracy of 86% (sensitivity: 100%, specificity: 66%). A two-step PCA-hLDA tissue classification model 'tumor' versus 'non-tumorous tissue' showed an accuracy of 91% (sensitivity: 100%, specificity: 78%)., Conclusion: An accurate PCA-hLDA Raman spectroscopy-based tissue classification model for discrimination between OCSCC and (especially the subepithelial) non-tumorous tongue tissue was developed and validated. This model with high sensitivity and specificity may prove to be very helpful to detect tumor in the resection margins., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The determination of the number of fungiform papillae (FP) on the human tongue is important for taste sensitivity studies. Most of the time, the counting of the FP is done manually. In this paper we propose a novel algorithm to count the FP using shape characteristics measured by cross-correlation. The accuracy of the algorithm is evaluated by counting the FP manually on the same images and then doing a statistical analysis. A Poisson regression model is fitted using maximum likelihood. The result is that the algorithm counts are very similar to the human experts. Another advantage of the algorithm is its facility of use, velocity and that it can work on a plain tongue image, without the need to stain the tongue as is usual in manual counting., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Data from diffusion magnetic resonance imaging (dMRI) can be used to reconstruct fiber tracts, for example, in muscle and white matter. Estimation of fiber orientations (FOs) is a crucial step in the reconstruction process and these estimates can be corrupted by noise. In this paper, a new method called Fiber Orientation Reconstruction using Neighborhood Information (FORNI) is described and shown to reduce the effects of noise and improve FO estimation performance by incorporating spatial consistency. FORNI uses a fixed tensor basis to model the diffusion weighted signals, which has the advantage of providing an explicit relationship between the basis vectors and the FOs. FO spatial coherence is encouraged using weighted ℓ1-norm regularization terms, which contain the interaction of directional information between neighbor voxels. Data fidelity is encouraged using a squared error between the observed and reconstructed diffusion weighted signals. After appropriate weighting of these competing objectives, the resulting objective function is minimized using a block coordinate descent algorithm, and a straightforward parallelization strategy is used to speed up processing. Experiments were performed on a digital crossing phantom, ex vivo tongue dMRI data, and in vivo brain dMRI data for both qualitative and quantitative evaluation. The results demonstrate that FORNI improves the quality of FO estimation over other state of the art algorithms., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objectives: The aim of this study was to evaluate whether a new method using quantitative light-induced fluorescence-digital (QLF-D) was appropriate for the diagnosis of oral malodor by quantifying the fluorescence of tongue coating., Methods: This study examined 103 healthy subjects who have an oral malodor as a main complaint. The levels of oral malodor were measured by organoleptic scores (OLS) and volatile sulfur compound (VSC) levels. The fluorescent tongue coating images captured by QLF-D were quantified as the integrated fluorescence score (IF score) by multiplying the intensity and area of fluorescence. The correlations between the fluorescence parameters and OLS as well as VSC levels and the diagnostic accuracy of the IF score were evaluated., Results: The IF score of tongue coating showed a significant positive correlation with the OLS (r=0.54, p<0.01) and the VSC levels (r=0.49, p<0.01). This score was significantly differed with the level of oral malodor (p<0.001), and its AUC was 0.72 in identifying the patient with definite oral malodor (≥OLS 2)., Conclusions: A new method quantifying tongue coating fluorescence detected by QLF-D can be used to diagnose oral malodor and assess its severity in the clinical practice., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: OSA pathogenesis is complex and may vary according to ethnicity. The anatomic component predisposing to OSA is the result of the interaction between bony structure and upper airway soft tissues and can be assessed using passive critical closing pressure (Pcrit). We hypothesized that Japanese-Brazilians and whites present different predictors of upper airway collapsibility, suggesting different causal pathways to developing OSA in these two groups., Methods: Male Japanese-Brazilians (n = 39) and whites (n = 39) matched for age and OSA severity were evaluated by full polysomnography, Pcrit, and upper airway and abdomen CT scans for determination of upper airway anatomy and abdominal fat, respectively., Results: Pcrit was similar between the Japanese-Brazilians and the whites (-1.0 ± 3.3 cm H2O vs -0.4 ± 3.1 cm H2O, P = .325). The Japanese-Brazilians presented smaller upper airway bony dimensions (cranial base, maxillary, and mandibular lengths), whereas the whites presented larger upper airway soft tissue (tongue length and volume) and a greater imbalance between tongue and mandible (tongue/mandibular volume ratio). The cranial base angle was associated with Pcrit only among the Japanese-Brazilians (r = -0.535, P < .01). The tongue/mandibular volume ratio was associated with Pcrit only among the whites (r = 0.460, P < .01). Obesity-related variables (visceral fat, BMI, and neck and waist circumferences) showed a similar correlation with Pcrit in the Japanese-Brazilians and the whites., Conclusions: Japanese-Brazilians and whites present different predictors of upper airway collapsibility. Although craniofacial bony restriction influenced Pcrit only in the Japanese-Brazilians, an anatomic imbalance between tongue and mandible volume influenced Pcrit among the whites. These findings may have therapeutic implications regarding how to improve the anatomic predisposition to OSA across ethnicities., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objective: Dysphagia is a critical issue in amyotrophic lateral sclerosis (ALS) patients. An evaluation of swallowing function is important for assessing the risk of aspiration. We investigated the validity of tongue sonography compared with videofluoroscopic examination for ALS patients., Methods: We investigated 18 ALS patients. Nine subjects underwent repeated investigations. All of the subjects underwent tongue sonography and videofluoroscopic examination. Additionally, tongue sonography was evaluated in 18 age- and sex-matched healthy volunteers. To determine tongue thickness, we measured the vertical distance from the surface of the mylohyoid muscle to the tongue dorsum using ultrasonography., Results: In the ALS patients, the tongue was significantly thinner than in healthy subjects. Tongue thickness was associated with body mass index and onset type in the ALS patients (p=0.006). Temporal analyses of videofluoroscopy revealed that tongue thickness was associated with oral preparatory and transit time (p=0.032) but not with pharyngeal transit time. Repeated measurement data revealed a decrease in tongue thickness over the course of the measurements (p=0.002)., Conclusions: In ALS patients, reduced tongue thickness suggests disease progression and tongue dysfunction., Significance: Tongue sonography is a useful modality for the non-invasive and quantitative evaluation of tongue thickness and dysphagia in ALS patients., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Swallowing is an essential function in our daily life; nevertheless, stroke or other neurodegenerative diseases can cause the malfunction of swallowing function, ie, dysphagia. The objectives of this review are to understand the neural and cortical basis of swallowing and tongue, and review the latest techniques on the detection of motor imagery of swallow (MI-SW) and motor imagery of tongue movements (MI-TM), so that a practical system can be developed for the rehabilitation of poststroke dysphagia patients. Specifically, we firstly describe the swallowing process and how the swallowing function is assessed clinically. Secondly, we review the techniques that performed the neural and cortical analysis of swallowing and tongue based on different modalities such as functional magnetic resonance imaging, positron emission tomography, near-infrared spectroscopy (NIRS), and magnetoencephalography. Thirdly, we review the techniques that performed detection and analysis of MI-SW and MI-TM for dysphagia stroke rehabilitation based on electroencephalography (EEG) and NIRS. Finally, discussions on the advantages and limitations of the studies are presented; an example system and future research directions for the rehabilitation of stroke dysphagia patients are suggested., (© 2016 Elsevier B.V. All rights reserved.)

Background: This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted., Methods: An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging., Result: Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients., Conclusion: Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate upper airway diameter differences before and after placement of custom made mandible protruding devices (MPD) in OSAS group and to compare with control group using computerized tomography., Methods: The OSAS group was composed of 15 patients aged from 25 to 45 years with mild-moderate OSAS and the control group included 15 healthy volunteers, aged from 25 years to 44 years. On coronal and sagittal reformated CT images, anteroposterior (AP) and lateral (LAT) diameters at three levels (passing through soft palate [level 1], 5 mm above uvula [level 2] and 1 cm above the tip of epiglottis [level 3]) were measured before and after MPD placement in both groups., Results: LAT diameters at level 1, level 2 and AP diameter at level 2 in OSAS group were significantly lower than in control group before MPD placement. Only LAT diameters at level 2 in OSAS group were significantly lower than in control group after MPD placement. When we compared upper airway diameters before and after placement of the MPD within each group, statistically significant increase in diameters at all levels were observed., Conclusion: MPD is a cheap, easily usable device providing increase in upper airway diameters., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Our objective was to assess the intraexaminer and interexaminer reliabilities of upper airway linear, area, and volumetric measurements in cone-beam computed tomography., Methods: Cone-beam computed tomography scans of 12 subjects were randomly selected from a pool of 132 orthodontic patients. An undergraduate student, an orthodontist, and a dental radiologist independently made linear, area, and volumetric measurements. Linear anteroposterior and transversal measurements, cross-sectional area, sagittal area, minimum axial area, and volume measurements were made. The intraclass correlation coefficient (ICC) was used to assess intraexaminer and interexaminer reliabilities, and measurement errors were assessed. Agreement was further assessed with the Bland-Altman method and 95% limits of agreement., Results: Overall, the ICC values indicated good reliability for the measurements assessed. The ICC values were greater than 0.9 (excellent) for 93% of intraexaminer and 73% of interexaminer assessments. Transversal width measurements and cross-sectional area at the level of the vallecula, however, had only moderate reliability (minimum ICC, 0.63), large 95% limits of agreement, and the greatest mean measurement errors (as high as 16% and 13% of the mean measurements, respectively). Linear anteroposterior measurements; cross-sectional areas at the levels of the palatal plane, soft palate, and tongue; and sagittal area and volume were reliable measurements, with a minimum ICC of 0.93 and more restricted limits of agreement., Conclusions: Based on these results, airway assessments by examiners with different backgrounds might have reliable anteroposterior linear measurements; cross-sectional areas at the levels of the palatal plane, soft palate, and tongue; and sagittal area and volume. The unreliable measurements were linear width, cross-sectional area at the level of the vallecula, and minimum axial area., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: Whether infants use suction or peristaltic tongue movements or a combination to extract milk during breast-feeding is controversial. The aims of this pilot study were 1] to evaluate the feasibility of using 3D ultrasound scanning to visualise infant tongue movements; and 2] to ascertain whether peristaltic tongue movements could be demonstrated during breast-feeding., Methods: 15 healthy term infants, aged 2 weeks to 4 months were scanned during breast-feeding, using a real-time 3D ultrasound system, with a 7 MHz transducer placed sub-mentally., Results: 1] The method proved feasible, with 72% of bi-plane datasets and 56% of real-time 3D datasets providing adequate coverage [>75%] of the infant tongue. 2] Peristaltic tongue movement was observed in 13 of 15 infants [83%] from real-time or reformatted truly mid-sagittal views under 3D guidance., Conclusions: This is the first study to demonstrate the feasibility of using 3D ultrasound to visualise infant tongue movements during breast-feeding. Peristaltic infant tongue movement was present in the majority of infants when the image plane was truly mid-sagittal but was not apparent if the image was slightly off the mid-sagittal plane. This should be considered in studies investigating the relative importance of vacuum and peristalsis for milk transfer., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: The aim of this prospective study was to use cone-beam computed tomography to assess the dimensional changes of the upper airway in orthodontic patients with maxillary constriction treated by rapid maxillary expansion., Methods: Fourteen orthodontic patients (mean age, 12.9 years; range, 9.7-16 years) were recruited. The patients with posterior crossbite and constricted maxilla were treated with rapid maxillary expansion as the initial part of their comprehensive orthodontic treatments. Before and after rapid maxillary expansion cone-beam computed tomography scans were taken to measure the retropalatal and retroglossal airway changes in terms of volume, and sagittal and cross-sectional areas. The transverse expansions by rapid maxillary expansion were assessed between the midlingual alveolar bone plates at the maxillary first molar and first premolar levels. The measurements of the before and after rapid maxillary expansion scans were compared by using paired t tests with the Bonferroni adjustment for multiple comparisons., Results: After rapid maxillary expansion, significant and equal amounts of 4.8 mm of expansion were observed at the first molar (P = 0.0000) and the first premolar (P = 0.0000) levels. The width increase at the first premolar level (20.0%) was significantly greater than that at the first molar level (15.0%) (P = 0.035). As the primary outcome variable, the cross-sectional airway measured from the posterior nasal spine to basion level was the only parameter showing a significant increase of 99.4 mm(2) (59.6%) after rapid maxillary expansion (P = 0.0004)., Conclusions: These results confirm the findings of previous studies of the effect of rapid maxillary expansion on the maxilla. Additionally, we found that only the cross-sectional area of the upper airway at the posterior nasal spine to basion level significantly gains a moderate increase after rapid maxillary expansion., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Analyses of the human tongue motion as captured from 2D dynamic ultrasound data often requires segmentation of the mid-sagittal tongue contours. However, semi-automatic extraction of the tongue shape presents practical challenges. We approach this segmentation problem by proposing a novel higher-order Markov random field energy minimization framework. For efficient energy minimization, we propose two novel schemes to sample the solution space efficiently. To cope with the unpredictable tongue motion dynamics, we also propose to temporally adapt regularization based on contextual information. Unlike previous methods, we employ the latest optimization techniques to solve the tracking problem under one unified framework. Our method was validated on a set of 63 clinical data sequences, which allowed for comparative analyses with three other competing methods. Experimental results demonstrate that our method can segment sequences containing over 500 frames with mean accuracy of 3mm, approaching the accuracy of manual segmentations created by trained clinical observers., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: The objective of this study was to compare the incidental radiographic findings in the maxillofacial structures and the pharyngeal airway between subjects with moderate/severe obstructive sleep apnea (OSA) and mild OSA/healthy subjects using cone-beam computed tomography (CBCT) scans., Study Design: A total of 53 subjects with moderate/severe OSA (with a Respiratory Disturbance Index [RDI] ≥ 15 events/h) and 33 mild OSA/healthy subjects (RDI < 15), based on ambulatory somnographic assessment, were recruited. Supine CBCTs were taken and sent for radiological report. The incidental findings were compared between the 2 groups., Results: Moderate/severe subjects had larger prevalence of conchae bullosa, hypertrophic turbinates, hypertrophic tonsils, elongated or posteriorly placed soft palate, narrower airway, enlarged tongue, and focal calcifications, although no significant differences were found., Conclusions: CBCT is useful in identifying maxillofacial and airway anomalies that could interfere with normal breathing; however, no significant difference was found in prevalence of incidental findings between subjects with moderate/severe OSA and mild OSA/healthy subjects. Further studies are necessary to generalize our results., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: To evaluate fresh blood imaging (FBI), a magnetic resonance imaging technique that does not use contrast, for identifying hemangiomas and feeding arteries in the oral and maxillofacial regions., Study Design: For 16 patients with hemangiomas, FBI visualizations of hemangiomas and feeding arteries in the oral and maxillofacial regions were compared with those from 3-dimensional (3D) phase-contrast magnetic resonance angiography (PC-MRA). Comparisons were based on the conspicuities of blood vessels and the 3D relationships of hemangiomas with the surrounding blood vessels., Results: The conspicuity of hemangiomas, feeding arteries, and blood vessels were significantly better with FBI than with PC-MRA. After differentiating arteries from veins, 3D visualizations of hemangiomas and arteries or veins could be performed with FBI., Conclusions: FBI is a useful method in oral and maxillofacial regions for identifying the relationships between hemangiomas and the surrounding arteries or veins., (Crown Copyright © 2012. Published by Mosby, Inc. All rights reserved.)

Introduction: In this study, using a cone-beam computed tomography system, we evaluated the airways of 30 adults., Methods: The shapes of the 3-dimensional volume of the airway were analyzed and compared among the subjects by using surface superimposition software techniques., Results: The airway had the greatest variability in the hypopharynx, in the region below the epiglottis, and above the vocal folds. Moderate variation was apparent at the nares, behind the soft palate, and at the base of the tongue. Conservation of form was seen at the central portion of the nasal airway surrounding the inferior turbinate., Conclusions: The potential for comparing the shape of the airway among subjects is possible., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The purpose of this study was to examine whether the pharyngeal airway volume in adults with skeletal Class III malocclusion is greater than in subjects with Class I occlusion and whether the pharyngeal airway volume correlated with facial morphology., Methods: Cone-beam computed tomography scans were obtained from 60 subjects, who were assigned to 2 groups. The skeletal Class III malocclusion group consisted of 31 subjects (16 men, 15 women) who had planned on orthodontic treatment with orthognathic surgery. The Class I malocclusion group consisted of 29 subjects (14 men, 15 women). The pharyngeal airway volumes and areas were measured and compared with cephalometric variables., Results: The cross-sectional areas of the lower part of the pharyngeal airway and the volume of the upper part of the pharyngeal airway were greater in skeletal Class III malocclusion patients than in Class I malocclusion patients. The volume of the upper part of the pharyngeal airway showed negative correlations with ANB angle and the Wits appraisal, and positive correlations with SNB, APDI, pogonion to N-perp, gonial angle, and FMA., Conclusions: The volume of the upper part of the pharyngeal space was greater in patients with skeletal Class III malocclusion, and the increased volume of the upper part of the pharyngeal airway showed significant correlations with measurements characterizing the anterior position of mandible., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: The therapeutic value of transcutaneous electrical stimulation of the genioglossus muscle in patients with obstructive sleep apnea (OSA) to reduce sleep-disordered breathing is unclear., Methods: Contraction of the genioglossus muscles during transcutaneous stimulation was investigated using ultrasonography in 11 healthy subjects (seven men, mean [SD] age 30 [6] years; BMI, 24.2 [3.5] kg/m(2)). Esophageal and gastric pressures were measured with balloon catheters, and transesophageal diaphragm electromyogram (EMGdi) was recorded during polysomnography in 11 patients with OSA (eight men, aged 51 [16] years; BMI, 42.0 [9.7] kg/m(2)) while transcutaneous electrical stimulation of the genioglossus was applied in non-rapid eye movement sleep (stage N2)., Results: Ultrasonography measurements showed a significant increase in tongue diameter during stimulation (sagittal: 10.0% [2.8%]; coronal: 9.4 % [3.7%]). The measurements were reproducible and repeatable. In patients with OSA, snoring decreased during stimulation (P < .001) and oxygenation improved (P = .001); the respiratory disturbance index (RDI) fell from 28.1 (26.3) to 10.2 (10.2) events per hour during stimulation (P = .002), returning to 26.6 (26.0) events per hour after stimulation was stopped. Transdiaphragmatic pressure swing decreased from 24.1 (13.5) cm H(2)O to 19.7 (7.1) cm H(2)O (P = .022), increasing to 24.2 (10.8) cm H(2)O afterward, and EMGdi fell from 23.8% max (12.6% max) to 15.7% max (6.4% max) (P < .001), rising to 22.6% max (10.4% max) post stimulation., Conclusions: Continuous transcutaneous electrical stimulation of the genioglossus contracts the genioglossus muscle and reduces ventilatory load and neural respiratory drive in patients with OSA.

For cancers of the head and neck, the combination of (18)F-fluorodeoxy-glucose positron emission tomography (FDG-PET)/computed tomography (CT) gains wide acceptance, especially if the primary tumor is unknown (CUP). A patient underwent FDG-PET/CT for squamous cell CUP with cervical lymph node metastases. FDG-PET/CT showed uptake in the right side of the tongue, rendering this area a possible location for the primary tumor. However, clinical examination revealed a deviation of the tongue toward the left side indicating affection of the left hypoglossal nerve, causing the increased FDG uptake. This case illustrates the interpretive pitfalls of unspecific FDG uptake in PET/CT imaging of the head and neck., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: Incorrect tongue posture on the mouth floor is considered an important factor in the etiology of unilateral posterior crossbite. The aim of this study was to objectively assess tongue posture in children with unilateral posterior crossbite and those with normal deciduous dentition by using 3-dimensional (3D) ultrasonography., Methods: First, referential 3D ultrasound images for differently postured tongues were acquired and reconstructed in 10 adults. Second, 27 children with unilateral posterior crossbite (mean age, 5.4 ± 1 years) and 23 children with normal deciduous dentition (mean age, 6.2 ± 0.4 years) were examined by using the 3D ultrasound technique. The referential 3D ultrasound reconstructions were used for the assessment of tongue posture in each child., Results: The characteristic 3D reconstruction of the tongue postured on the palate displays distinctive convexity of the tongue dorsum, whereas, in the 3D reconstruction with the tongue postured on the mouth floor, the dorsum is characterized by a central groove and expressed concavity. Posture on the mouth floor was demonstrated by 81.5% of the children with unilateral posterior crossbite and by only 34.8% of those with normal deciduous dentition. The difference was statistically significant (Fisher exact test: P = 0.0012)., Conclusions: Three-dimensional ultrasonography enables objective assessment of tongue posture and could become in the future an important part of functional diagnostics before, during, and after orthodontic treatment., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)