Auswahl der wissenschaftlichen Literatur zum Thema „Anatomy of tongue“

This study compared the anatomical features of the tongue in nine pairs of twins — six monozygotic and three dizygotic. The aim of the project was to determine if tongues, like any other anatomical structure, could be used to reliably predict relatedness given that tongue shape, presentation and surface can be influenced by environment. Using the method of forced choice, 30 subjects were asked to match the photographs of tongues from twins. Our data indicate that, based on visual assessment, monozygotic twins have highly similar tongues (60% matches); similarly, dizygotic twins were matched 31% of the time, which is a higher probability than would be expected from random selection. This study should help identify baseline and control data in future behavioral studies of taste, which has a genetic basis.

Frogs are well known to capture fast-moving prey by flicking their sticky tongues out of the mouth. This tongue projection behaviour happens extremely fast which makes frog tongues a biological high-speed adhesive system. The processes at the interface between tongue and prey, and thus the mechanism of adhesion, however, are completely unknown. Here, we captured the contact mechanics of frog tongues by filming tongue adhesion at 2000 frames per second through an illuminated glass. We found that the tongue rolls over the target during attachment. However, during the pulling phase, the tongue retractor muscle acts perpendicular to the target surface and thus prevents peeling during tongue retraction. When the tongue detaches, mucus fibrils form between the tongue and the target. Fibrils commonly occur in pressure-sensitive adhesives, and thus frog tongues might be a biological analogue to these engineered materials. The fibrils in frog tongues are related to the presence of microscopic papillae on the surface. Together with a layer of nanoscale fibres underneath the tongue epithelium, these surface papillae will make the tongue adaptable to asperities. For the first time, to the best of our knowledge, we are able to integrate anatomy and function to explain the processes during adhesion in frog tongues.

Problem We investigated the topographic anatomic characteristics of the human tongue in order to determine the safest location for Coblation® (ArthroCare Corp., Sunnyvale, CA) tongue treatment in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to provide detailed anatomic data to facilitate the surgery. Methods We dissected 16 lateral tongues from human cadavers and studied the distribution of the hypoglossal nerve and lingual artery and their respective distances. The ratios of those distances to the length and width of the tongue were calculated to establish the safest locations for Coblation tongue treatment. Results The vertical distance from the hypoglossal nerve and lingual artery to the surface of the tongue was invariant near the foramen caecum. The ratio of the horizontal distance from the hypoglossal nerve and lingual artery to the midline of the tongue to its length and the vertical distance to the surface at the foramen caecum and at 10 mm and 25 mm from the apex was obtained. Analysis of the data using ANOVA (analysis of variance) revealed statistically significant differences (p<0.05). Conclusion Low-temperature radiofrequency tongue treatment (Coblation) offers a safe and effective treatment for patients with retroglossal OSAHS. Recognizing the topographic anatomic characteristics of the tongue and applying the concepts of ratio and individualization, in which consideration is given to each patient's unique anatomy, promotes greater safety and optimal patient outcomes. Significance The data could extend the area of surgery in tongue from before or after caecum to the whole tongue. It could facilitate the coblation tongue treatment which is different from those surgeries in the base of tongue. And coblation tongue channeling (CTC) is very useful to treat hypertrophic tongue in obstructive sleep apnea syndrome (OSAS). We have performed many CTC on the patients with OSAS and give the relative area by proportional view in the tongue based on the data.

Abstract There is a huge demand for electronic tongues in the food and pharmaceutical industries for chemical detection and flavor analysis. The lack of availability of robots with electronic tongues has motivated us to investigate, design, and simulate a human tongue’s complex motions. Human anatomy was studied in detail to modify the standard design of the human tongue, with the addition of 32 embedded chambers at strategic locations, to replicate various 3D motions (rolling, groove, twist, and elongation) of the human tongue necessary for improving the biochemical sensing capabilities. The FEM (Finite element method) simulations showed the relation between pressure and deformation range for various kinds of motions in a human tongue, including the mechanical properties from the stress versus strain response.

The tongue is an integral and functional part of the oral cavity. This article reviews and describes various disorders of the tongue. A comprehensive description of diagnosis and management of tongue problems is included. A review of the anatomy related to the tongue is described.

Objective The authors hypothesize that floor-of-mouth and tongue base anatomy can be visualized with ultrasound and that ultrasound can be used to accurately guide needle placement and dye injection into the tongue base, serving as a surrogate for fine-needle aspiration. Study Design Observation of experimental intervention. Setting Medical school cadaver anatomy laboratory. Subjects and Methods Ultrasound imaging was performed on human cadaveric specimens to visualize the anatomy of the floor of mouth and base of tongue in a midline transcervical approach. Methylene blue dye was injected under ultrasound guidance into the base of tongue. Specimens were dissected, and results were counted and analyzed. Results Twenty-five of 32 (78%) cadaver specimens were found to have correct placement of dye within the posterior genioglossus and intrinsic tongue musculature. Seven cadavers did not have correct placement of dye. Of these, 3 had dye staining the walls of the oropharynx and epiglottis. Two specimens had dye injected erroneously into the geniohyoid muscles. One patient was found to have had a partial glossectomy. Difference in neck circumference was not significant between those with correct (mean, 37.9 cm) and incorrect (mean, 37.4 cm) dye placement ( P = .75). Conclusion Anatomy of the floor of mouth and tongue base can be readily depicted with ultrasonography. After reasonable success of injecting dye into cadaver tongue bases, the authors conclude that there appears to be a future clinical role for ultrasound-guided fine-needle aspiration of the tongue base for tongue base lesions.

Abstract Introduction: The Six-banded armadillo (Euphractussexcintus) belongs to Cigunlata order, has diverse feeding habits and masticatory apparatus developed. The tongue, one of the major components of this equipment, has the mucosa papillae, taste buds and tongue glands. Materials and Methods: Six-banded armadillo were submitted to an anesthetic protocol with Tiletamine and zolazepan (Telazol®, Fortdotge, Brazil) and Sodium Thiopental (Thiopentax®, Cristália, Brazil), we proceeded to euthanasia using Potassium Chloride 19.1%, to then fix them in a 10% formaldehyde solution. The tongues were dissected and identified structures. For microscopic processing, segments from different parts of the tongue were subjected to histological routine and stained with hematoxylin-eosin and Masson. Results: The tongue of the six-banded armadillo presents three types of papillae: filiform, fungiform and vallate, with no conical buds and foliate. Still in the tongue mucosa, was observed mucous glands and various taste corpuscles. Some data differ from those same found in other wild animals that have been studied, but are similar to those of the same phylogenetic. Conclusion: The morphological characteristics of the six-banded armadillo's tongue are adapted to the difficulties faced by him during chewing, requiring the tongue, structures that provide you mobility, strength and sensitivity.

The mobility of the primate tongue allows for the manipulation of food, but, in addition, houses both general sensory afferents and special sensory end organs. Taste buds can be found across the tongue, but the ones found within the fungiform papillae on the anterior two thirds of the tongue are the first gustatory structures to come into contact with food, and are critical in making food ingestion decisions. Comparative studies of both the macro and micro anatomy in primates are sparse and incomplete, yet there is evidence that gustatory adaptation exists in several primate taxa. One is the distally feathered tongues observed in non-destructive nectar feeders, such as Eulemur rubriventer. We compare both the macro and micro anatomy of three lemurid species who died of natural causes in captivity. We included the following two non-destructive nectar feeders: Varecia variegata and Eulemur macaco, and the following destructive flower feeder: Lemur catta. Strepsirrhines and tarsiers are unique among primates, because they possess a sublingua, which is an anatomical structure that is located below the tongue. We include a microanatomical description of both the tongue and sublingua, which were accomplished using hematoxylin–eosin and Masson trichrome stains, and scanning electron microscopy. We found differences in the size, shape, and distribution of fungiform papillae, and differences in the morphology of conical papillae surrounding the circumvallate ones in all three species. Most notably, large distinct papillae were present at the tip of the tongue in nectar-feeding species. In addition, histological images of the ventro-apical portion of the tongue displayed that it houses an encapsulated structure, but only in Lemur catta case such structure presents cartilage inside. The presence of an encapsulated structure, coupled with the shared morphological traits associated with the sublingua and the tongue tip in Varecia variegata and Eulemur macaco, point to possible feeding adaptations that facilitate non-destructive flower feeding in these two lemurids.

A complete understanding of the feeding structures is fundamental in order to study how animals survive. Some birds use long and protrusible tongues as the main tool to collect their central caloric source (e.g., woodpeckers and nectarivores). Hummingbirds are the oldest and most diverse clade of nectarivorous vertebrates, being a perfect subject to study tongue specializations. Their tongue functions to intraorally transport arthropods through their long bills and enables them to exploit the nectarivorous niche by collecting small amounts of liquid, therefore it is of vital importance to study its anatomy and structure at various scales. I focused on the portions of the hummingbird tongue that have been shown to be key for understanding their feeding mechanisms. I used histology, transmission and scanning electron microscopy, microCT, andex-vivoexperiments in order to advance the comprehension of the morphology and functioning of the hummingbird feeding apparatus. I found that hummingbird tongues are composed mainly of thin cornified epithelium, lack papillae, and completely fill the internal cast of the rostral oropharyngeal cavity. Understanding this puzzle-piece match between bill and tongue will be essential for the study of intraoral transport of nectar. Likewise, I found that the structural composition and tissue architecture of the tongue groove walls provide the rostral portion of the tongue with elastic properties that are central to the study of tongue-nectar interactions during the feeding process. Detailed studies on hummingbirds set the basis for comparisons with other nectar-feeding birds and contribute to comprehend the natural solutions to collecting liquids in the most efficient way possible.

The aim of this study was to quantify the density of taste pores on the anterior region of the tongue, in adult males and 8 to 9 year old boys. Earlier studies had shown that, although 8 to 9 year olds were poorer than adults at sensing the tastant sucrose using a whole mouth procedure, localised regions of the tongue in male children were more sensitive than equivalent regions in adults. This study aims to detemine whether the age differences in sensitivity is related to a difference in taste pore density. Two areas of the tongue, for which children had previously been shown to have higher sensitivity than adults, were examined using a videomicrosocpy technique and the number and diameter of taste pores were measured. Children were found to have a greater density of taste pores, however the number of taste pores per papilla were similar in children and adults. It was found to be likely that the greater sensitivity of localised areas on the children's tongue is due to a greater taste pore density. The reduced sensitivity reported using whole mouth stimulation may be due to a reduced capacity to assimilate taste input from the whole mouth or due to different relative contributions to whole-mouth taste from the various receptive fields in the mouth.
Master of Science (Hons)

The aim of this study was to quantify the density of taste pores on the anterior region of the tongue, in adult males and 8 to 9 year old boys. Earlier studies had shown that, although 8 to 9 year olds were poorer than adults at sensing the tastant sucrose using a whole mouth procedure, localised regions of the tongue in male children were more sensitive than equivalent regions in adults. This study aims to detemine whether the age differences in sensitivity is related to a difference in taste pore density. Two areas of the tongue, for which children had previously been shown to have higher sensitivity than adults, were examined using a videomicrosocpy technique and the number and diameter of taste pores were measured. Children were found to have a greater density of taste pores, however the number of taste pores per papilla were similar in children and adults. It was found to be likely that the greater sensitivity of localised areas on the children's tongue is due to a greater taste pore density. The reduced sensitivity reported using whole mouth stimulation may be due to a reduced capacity to assimilate taste input from the whole mouth or due to different relative contributions to whole-mouth taste from the various receptive fields in the mouth.

L'objectif de cette thèse est l'étude des interactions mécaniques entre la langue et le palais dans la production de parole et la déglutition. Cette interaction est cruciale car elle détermine la morphologie de la langue et son évolution dans le temps avant et après les contacts. Elle ne peut cependant pas être étudiée avec des approches cinématiques conventionnelles, car l'amplitude des mouvements est trop faible. La première partie de la thèse est consacrée à la conception d'un dispositif expérimental permettant de mesurer ces interactions sans perturber l'appareil vocal. La première particularité est que le dispositif est utilisé sur des patients édentés appareillés. Nous utilisons un duplicata de la prothèse complète maxillaire pour insérer des capteurs miniatures à jauges de contrainte dont les caractéristiques de réponse sont optimisées et qui permettent de mesurer la pression mécanique exercée par la langue sur le palais. La seconde particularité est qu’il existe une procédure d'étalonnage, associée aux capteurs, qui utilise une Colonne d’Eau Sèche. Elle applique une pression sur le capteur via une membrane en latex déformable, capable de simuler le comportement visco-élastique de la langue sur le palais. La deuxième partie de la thèse décrit le protocole de recherche clinique visant à (1) caractériser l'interaction langue-palais au cours de la prononciation et de la déglutition normales sur des individus édentés que nous considérons adaptés à leur prothèse complète (Cohorte 1), (2) observer l'adaptation dans une étude longitudinale des patients édentés nouvellement appareillés (Cohorte 2). Ce projet comprend, pour les deux cohortes, la description des objectifs, le protocole expérimental, la description fine des paramètres pertinents et la méthode statistique de traitement des données. Toutefois, le processus de rédaction et de soumission de ce protocole à un Comité de Protection des Personnes (CPP) a été plus long que prévu et l’étude clinique n’a pu être menée dans le cadre de cette thèse. C’est pourquoi, dans la troisième partie de la thèse, nous avons utilisé les données enregistrées dans l’étude de faisabilité, auprès d'un adulte édenté francophone. Les résultats montrent que notre dispositif permet d'explorer des hypothèses théoriques cruciales dans la parole comme l'existence de cibles virtuelles au-dessus du palais ou le rôle du palais dans la mise en forme du conduit aérien des consonnes fricatives. Les résultats des données enregistrées lors de la déglutition sont moins clairs, mais l'enchaînement temporel précis des contacts peut être décrit, ce qui permet de préciser comment les mouvements ondulatoires de la langue pendant la phase orale de la déglutition exploitent les contacts avec le palais. Les retombées cliniques de cette thèse permettent une meilleure connaissance du rôle fonctionnel des prothèses complètes et d’envisager la conception de prothèses qui seraient adaptées aux spécificités de chaque patient, notamment pour la rééducation des sujets traités chirurgicalement après des cancers de la langue, dans le cadre des taches de production de parole et de déglutition
The aim of the thesis is the study of the mechanical interaction between tongue and palate in speech production and swallowing. This interaction is crucial since it determines the shape of the tongue and its time evolution before and after contacts occur. Yet it cannot be studied with conventional kinematic approaches, since magnitude of movements is too small. The first part of the thesis was devoted to the design of an experimental setup to measure this interaction without perturbing the vocal tract. The first specificity is that the setup is used on subjects who are edentulous and wear a complete denture. We use a duplicate of the complete denture to insert miniature strain gauge sensors with enhanced response characteristics, that enable the measure of the mechanical pressure exerted by the tongue in different locations of the palate, without altering the shape of the palatal arch. The second specificity is that the calibration procedure uses a Dried Water Column (DWC) that applies pressure on the sensor via a deformable latex membrane, that simulates the way tongue touches the palate. The second part of the thesis enabled the design of an experimental protocol aiming at (1) providing a characterization of the tongue-palate interaction in normal speech production and swallowing based on edentulous subjects whom we consider to have adapted to their complete denture (cohort 1), (2) observing the adaptation process in a longitudinal study of edentulous subjects who are new users of complete denture (cohort 2). This work includes for two cohorts the design of the subject inclusion criteria, the motor tasks and the statistical method for the data analysis. However, unforeseen long delays were faced in the application process for the ethical approval and no data were collected in this context. Hence the third part of the thesis used data recorded in our most recent pilot study, with a French speaking edentulous adult. It is shown that our setup makes possible to tackle crucial theoretical questions in speech production such as the existence of virtual targets above the palate in stops or the role of the palate in the air channel shaping in fricatives. Results of swallowing tasks are less clear, but it is shown that precise time sequencing of contacts can be described, making possible the specification of how the ondulatory movements of the tongue in the oral phase of swallowing takes advantage of palatal contacts. In conclusion implications of this thesis are presented for a functional assessment of complete dentures, and the design of dentures that would be adapted to each subject’s specificities

Comprendre et mieux définir la pathophysiologie de l'asthme est essentiel au développement de traitements plus efficaces. L'hyperréactivité bronchique et le tonus élevé du muscle lisse entourant les voies respiratoires sont deux caractéristiques majeures de l'asthme. Si une causalité existe entre ces caractéristiques, elle demeure encore inconnue. Le travail présenté dans ce Mémoire décrit comment un tonus, induit par un spasmogène, affecte la réactivité bronchique à une bronchoprovocation in vivo chez la souris. La capacité contractile de trachées murines excisées a aussi été mesurée afin d'évaluer si la réponse obtenue in vivo implique le muscle lisse. Les résultats présentés dans ce mémoire démontrent qu'in vivo, les souris exposées à un tonus voient leur réactivité bronchique augmenter en réponse à une dose d'un spasmogène, comparées aux souris contrôles. Les résultats démontrent également que la réponse obtenue est causée, du moins en partie, par une augmentation de la capacité contractile du muscle lisse. Suite à ces résultats, les mécanismes moléculaires possiblement impliqués dans le gain de force induit par le tonus ont été investigués. L'hypothèse est que les voies de signalisation en aval de l'activation des récepteurs couplés aux protéines G sont responsables de l'augmentation de la capacité contractile du muscle lisse. L'inhibition de la polymérisation de l'actine, l'activation de la chaîne légère de myosine, l'activation de protéines G et l'inhibition des protéines kinases activées par les mitogènes ont donc été évaluées. Les résultats démontrent qu'aucune des voies de signalisation étudiées est impliquée dans le gain de force du muscle lisse provoqué par un tonus induit par la présence continue d'un spasmogène. Ces résultats démontrent la complexité que représente la recherche des mécanismes moléculaires du gain de force et que cette recherche doit être plus approfondie.
To understand and better define the pathophysiology of asthma is essential for the development of more effective treatments. Airway hyperresponsiveness and an elevated airway smooth muscle tone are two common features of asthma. Whether causality exists between these two characteristics is unknown. The work presented in this Master's thesis describes how a tone induced by a spasmogen affects airway responsiveness in vivo in mice to a spasmogenic challenge. The contractile capacity of excised murine tracheas was also measured to evaluate whether the obtained response in vivo involved airway smooth muscle. The results presented in this Master's thesis demonstrate that mice exposed to tone in vivo have an increased response to a high dose of a spasmogen, compared to control mice. The results also show that this response is caused, at least partly, by an increase in airway smooth muscle contractile capacity. Following these results, molecular mechanisms possibly involved in the gain in force induced by tone were investigated. It was hypothesized that signaling pathways downstream of G protein-coupled receptors were responsible for the increase in airway smooth muscle contractile capacity. Therefore, the inhibition of actin polymerization, the activation of myosin lightchain, the activation of G proteins, and the inhibition of mitogen-activated protein kinases were evaluated to assess whether they mediate the gain in force induced by tone. The results show that none of the pathways studied were implicated in the gain in force induced by tone elicited by the continuous presence of a spasmogen. These latter results demonstrate that the mechanisms leading to a gain in airway smooth muscle force following an induced tone are complex and will require further investigation.

INTRODUÇÃO: A apneia obstrutiva do sono (AOS) é um problema de saúde pública, com grande prevalência e graves consequências. O tratamento considerado padrão-ouro para AOS grave é a aplicação do aparelho de pressão positiva aérea contínua (CPAP) durante o sono. Porém a adesão ao CPAP é baixa, em especial nos pacientes com ronco primário e AOS leve. Estudo prévio do nosso laboratório demonstrou que a terapia miofuncional orofacial (TMO) é efetiva em pacientes com AOS moderada (Guimaraes et. al, AJRCCM 2009:(179);962-966). No entanto, no trabalho inicial o número de pacientes foi relativamente pequeno (n=31), avaliou-se apenas pacientes com AOS moderada. Adicionalmente, a quantidade de exercícios orofaríngeos realizados foi relativamente grande (n=10) dificultando a adesão ao tratamento e os potenciais mecanismos de ação da terapia não foram elucidados. OBJETIVO: O objetivo primário do trabalho é avaliar a efetividade na redução da gravidade da AOS de um programa com um número reduzido de exercícios de TMO (6 exercícios) em pacientes com ronco primário, AOS leve, moderada e grave. Os objetivos secundários foram avaliar o impacto da TMO no índice de apneia hipopneia (IAH) em pacientes estratificados pelo IAH basal, a anatomia da via aérea superior (VAS) por meio da ressonância magnética (RM), a fisiologia da VAS por meio da força e fadiga da língua e a pressão crítica de fechamento (Pcrit). METODOLOGIA: Foram incluídos pacientes de ambos os sexos, com idade entre 20 e 65 anos, recentemente diagnosticados com ronco primário, AOS leve, moderada ou pacientes com AOS grave que se recusaram a utilizar o CPAP. Foram excluídos pacientes com índice de massa corpórea (IMC) >= 35 kg/m2, malformações craniofaciais, desdentados, uso regular de medicação hipnótica, doença obstrutiva nasal grave, pacientes já submetidos a outros tipos de tratamentos e pacientes com indisponibilidade de comparecimento semanal durante o estudo. Os pacientes foram avaliados no início e final do estudo por questionário de sonolência (Epworth, variando de 0 a 24 pontos), qualidade de sono (Pittsburgh, variando de 0 a 21 pontos), avaliação fonoaudiológica específica para AOS (variando de 0 a 20 pontos), RM da via aérea superior, força e fadiga de língua, Pcrit e polissonografia. Os pacientes foram sorteados para 3 meses de TMO (6 exercícios) ou controle (dilatador nasal durante o sono e exercícios respiratórios inespecíficos). Todos os pacientes foram acompanhados semanalmente por uma fonoaudióloga e orientados a realizar os exercícios três vezes por dia. Foi realizada ANOVA de dois caminhos para medidas repetidas para avaliar a eficácia dos tratamentos nos diferentes desfechos. Secundariamente também avaliamos o efeito dos tratamentos por meio do teste t pareado. RESULTADOS: Inicialmente 251 pacientes foram avaliados, e após avaliação dos critérios de inclusão e exclusão, 60 pacientes entraram no estudo, sendo que 30 foram randomizados para TMO e 30 para o grupo Controle. Os dois grupos foram semelhantes para todos os parâmetros na entrada. Finalizaram o estudo 58 pacientes (58,6% do sexo masculino, média de idade 45,9 ± 12,2 anos, IMC 28,8 ± 4,3 kg/m2, IAH=18,4 ± 12,6 eventos/h e saturação mínima de oxigênio 84,6 ± 6,4%). O grupo Controle não teve modificações em nenhuma das variáveis ao longo do estudo. O grupo TMO não modificou o IMC e não apresentou mudança significativa nos questionários Epworth e Pittsburgh. Em relação ao início do estudo, o grupo TMO apresentou uma redução significativa na circunferência cervical (38,8±3,3 vs 38,4±4 cm), índice de despertar (21,3±10,9 vs 16,9±7,9 despertares/h), IAH (19,5 ± 14,2 vs 15 ± 10,2 eventos/h) e avaliação fonoaudiológica específica para AOS (9,3 ± 2,9 vs 3,6 ± 2,4). O efeito da TMO sobre o IAH foi significativo somente nos pacientes que apresentavam na entrada AOS moderada (23,8 ± 5,2 vs 17,7 ± 5,2) e grave (43,9 ± 19,5 vs 24,7 ± 21,4). Não foram observadas modificações significativas quando avaliado por meio do teste de ANOVA de duas vias para medidas repetidas na RM da via aérea superior em 24 pacientes (10 Controle e 14 TMO) e fisiologia avaliados por força e fadiga de língua em 38 pacientes (19 Controle e 19 TMO) e Pcrit em 17 pacientes (7 Controle e 10 TMO). No entanto, observamos uma redução significativa (teste t pareado) com diminuição do volume da língua (p=0.031), quantidade de gordura da língua (p=0.008) e aumento significativo da força da língua (p=0,046) no grupo TMO. CONCLUSÃO: Um programa reduzido de TMO é efetivo e capaz de reduzir a gravidade da apneia do sono em pacientes com AOS moderada e grave. A tendência ao aumento da força de língua e redução da gordura de língua podem auxiliar a explicar os efeitos benéficos da TMO em pacientes com AOS
INTRODUCTION: Obstructive sleep apnea (OSA) is a public health problem, with high prevalence and severe consequences. The gold standard treatment for severe OSA is the application of continuous positive airway pressure (CPAP) during sleep. However, adherence to CPAP is low, especially in patients with primary snore and mild OSA. A previous study from our laboratory demonstrated that oropharyngeal exercises are effective in patients with moderate OSA (Guimaraes et. al, AJRCCM 2009:(179);962-966). Nonetheless, in this first study the number of patients included in the randomized trial was relatively small (n=31) and evaluated only patients with moderate OSA. Moreover, the number of oropharyngeal exercises the patients had to do 3 times a day was large (n=10) and raised doubt about the compliance to treatment, and the mechanism by which the therapy was effective was not elucidated. OBJECTIVE: The primary objective was to evaluate the effectiveness to reduce OSA severity of a short program of oropharyngeal exercises (6 exercises) in patients with primary snore, mild, moderate and severe OSA. The secondary objective was to evaluate the impact of reduced oropharyngeal exercises program on apnea hypopnea index (AHI) in patients stratified by baseline AHI, the anatomy of upper airway by magnetic resonance (MR), strength and fatigue of the tongue and critical closing pressure (Pcrit). METHODOLOGY: Patients of both sexes, with age between 20 and 65 years old, recently diagnosed with primary snore, mild, moderate or severe OSA who refused to use CPAP were included. Patients with body mass index (BMI) >= 35kg/m2, craniofacial deformities, edentulous, regular use of hypnotic medication, severe nasal obstruction, patients undergoing other treatments for OSA and patients with unavailability to comply with the protocol were excluded. The patients were evaluated at the beginning and end of the study by questionnaire of daytime sleepiness (Epworth, ranging from 0 to 24 points), quality of sleep (Pittsburgh, ranging from 0 to 21 points), oral myofunctional evaluation for OSA (ranging from 0 to 20 points), MR of the upper airway, tongue strength and fatigue, critical closing pressure (Pcrit) and polysomnography. The patients were randomized to 3 months of oropharyngeal exercises (6 exercises) or Control (use of nasal dilator strip and respiratory non specific respiratory exercises). All patients were instructed to perform the exercises 3 times a day and evaluated by a speech pathologist once a week. The primary endpoints were evaluated primarily by two-way repeated-measures ANOVA. A paired t test was also used as a secondary evaluation. RESULTS: A total of 251 patients were evaluated and 60 patients were randomized. The 2 groups (n=30) were similar at study entry for all the parameters and 58 patients completed the study (58.6% males, age: 45.9±12.2 years, BMI: 28.8±4.3 kg/m2, AHI=18.4±12.6 events/h and minimum saturation84.9±6.4%). All variables remained unchanged in the Control group. There were no changes in Epworth and Pittsburgh questionnaires as well as BMI in patients randomized to oropharyngeal exercises. As compared to study entry, there was a significantly reduction on neck circumference (38.8 ± 3.3 vs 38.4±4.4cm), arousals index (21.3 ± 10.9 vs 16.9 ± 7.9 arousals/h), AHI (19.5 ± 14.2 vs 15 ± 10.2 events/h), oral myofunctional evaluation for OSA (9.3 ± 2.9 vs 3.6 ± 2.4) in the patients randomized for oropharyngeal exercises. Oropharyngeal exercises only reduced AHI significantly among patients with moderate OSA (23.8 ± 5.2 vs 17.7 ± 5.2) and severe OSA (43.9 ± 19.5 vs 24.7 ± 21.4) at study entry. No significantly changes as evaluated by two-way repeated-measures ANOVA were observed on upper airway MR anatomy (10 Control and 14 oropharyngeal exercises), tongue force and fatigue (19 Control and 19 oropharyngeal exercises) and Pcrit (7 Control and 10 oropharyngeal exercises). As compared to study entry there was a significant reduction as evaluated by paired T test on tongue volume (p=0.031), tongue fat (p=0.008) and a significant increase of tongue strength (p=0.046) of patients randomized to oropharyngeal exercises. CONCLUSION: A short program of oropharyngeal exercises is effective to reduce OSA severity in patients with moderate and severe OSA. The trend to increase tongue strength and reduce tongue fat may explain the beneficial effects of oropharyngeal exercises

Le système langue-palais est capable de détecter de fines variations de texture en bouche là où le meilleur des rhéomètres est essentiellement aveugle. Une hypothèse pour expliquer cette remarquable sensibilité repose sur la présence de myriades de papilles filiformes sur la surface de la langue et de mécanorécepteurs à leur base. Pendant cette thèse, nous avons adopté une approche biomimétique reproduisant le fonctionnement de la cavité orale. La langue est un bloc d’élastomère décoré de cylindres assimilés à des papilles filiformes. Elle est placée sur une cellule de rhéoscope, combinaison d’un rhéomètre et d’un microscope. L’outil rotatif du rhéomètre joue le rôle du palais rigide, et impose l’écoulement du liquide testé. Nous avons imagé sous cisaillement de fluides simples la déflexion d’une papille et montré que celle-ci est proportionnelle aux contraintes visqueuses, en accord avec un modèle élastohydrodynamique récent. Nous avons sondé la déflexion d’une papille en présence de suspensions granulaires, modélisant des émulsions alimentaires. Nous avons montré que la présence de particules dans la phase continue modifie peu la déformation moyenne d’une papille, mais fortement son écart-type, surtout à cause des collisions particules/papille. Enfin, nous avons étudié l’effet des interactions entre papilles en variant leur densité surfacique. Cette déflexion diminue avec la densité. Un modèle phénoménologique, qui traite le tapis de papilles comme un milieu poreux effectif, décrit avec succès nos données sur toute la gamme de densité
The tongue-palate system is able to detect fine texture variations in the mouth where the best rheometers are essentially blind. One hypothesis to explain this remarkable sensitivity is the presence of myriads of filiform papillae on the surface of the tongue and mechanoreceptors at their base. During this thesis, we developed a biomimetic approach reproducing the functioning of the oral cavity. The tongue is an elastomer block decorated with elongated cylinders assimilated to filiform papillae. It is placed on the bottom of the cell of a rheoscope, a combination of a rheometer and a microscope. The rotating rheometer tool plays the role of the rigid palate, and imposes the flow of the tested liquid. We have imaged while shearing simple fluids the deflection of a papilla and showed that it is proportional to the viscous stresses, in perfect agreement with a recent elastohydrodynamics model. We probed the deflection of a papilla in the presence of granular suspensions as models of food emulsions. We have shown that the presence of particles in the continuous phase slightly modifies the average deformation of a papilla, but strongly changes the standard deviation around this deformation, mainly because of particle/papilla collisions. Finally, we studied the effect of papillae interactions by varying their surface density. This deflection decreases with density. A phenomenological model that treats the papillae as an effective porous medium successfully describes our data across the entire density range

Background: Ramsay Hunt syndrome or herpes zoster oticus is a disorder caused by the reactivation of the varicella zoster virus in the geniculate ganglion, a bundle of nerve cells in the facial nerve. Symptoms include acute facial nerve palsy, otalgia, loss of taste in the anterior 2/3 of the tongue, dry mouth and eyes, and erythematous vesicular rash in the ear canal, tongue and / or palate. Objectives and Methods: Describe the case of a male patient, 26 years old, with complete Ramsay Hunt syndrome, reporting pain in the right ear with tinnitus, difficult to close his right eye, odynophagia and pain in the anterior 2/3 of the tongue at right side. Results: On examination, the presence of vesicles with erythema was observed in the region of the right external auditory canal and the ear, as well as on the right palate and tongue. Upon inspection, he had peripheral facial paralysis on the right, associated with loss of taste in the anterior 2/3 of the tongue. The patient was treated with antiviral and corticosteroids, followed for 3 months, obtaining partial recovery from facial paralysis. The anatomy of the facial nerve and its pathophysiology due to the involvement of herpes zoster will be discussed. Conclusion: Ramsay Hunt syndrome is often described as the presence of peripheral facial paralysis and vesicles in the auditory canal and the ear. However, this rare case presented the complete condition with the presence of vesicles on the palate and the tongue.

Human occupant responses in motor vehicle collisions (MVCs) are commonly predicted and evaluated in a laboratory using surrogates including human volunteers, anthropomorphic test devices (ATDs), and post mortem human surrogates (PMHSs) [1]. The ultimate goal of these surrogates is to demonstrate a similar response to humans in MVCs that can be used to evaluate human tolerance and enhance vehicle design and safety. The distinguishing attribute of human volunteers that non-human surrogates do not currently possess is the combination of identical human anthropometry, anatomy, and physiologic response of the target population, including resting muscle tone and active bracing capabilities. All human volunteer laboratory testing must be performed at sub-injurious levels due to ethical constraints, while non-human surrogates can be used to examine injurious or traumatic events. Given the capabilities and shortcomings of each surrogate in automobile safety research, performing matched tests with these surrogates can aid in the understanding of the biomechanical response of humans in an impact environment, leading to improvements in ATD design and increased efficacy of safety devices. Therefore, the purpose of this study was to investigate volunteer, ATD, and PMHS occupant kinematic responses in matched low-speed frontal sled tests.