Head and neck
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
The lip is split in the midline with an incision curving around the chin – this is the most aesthetic and best preserves sensation and motor control. The osteotomy site can be Symphyseal.Paramedian – split anterior to mental foramen (MF) and provides good exposure. It allows genioglossus and geniohyoid muscles to remain attached to the mandible helping to maintain tongue stability.Lateral – posterior to the MF. This divides the inferior alveolar (IA) neurovascular bundle.
Drug-induced acute upper airway obstruction
Philippe Camus, Edward C Rosenow in Drug-induced and Iatrogenic Respiratory Disease, 2010
Patients with OSA have a structurally smaller pharyngeal airway than non-apnoeic patients. The genioglossus is of great importance in the pathophysiology of sleep apnoea as it contracts during inspiration and increased phasic activity of the genioglossus is seen during the awake state in patients with OSA. The phasic activity of genioglossus and tensor veli palatini decreases with sleep onset. Sleep deprivation and use of alcohol, sedatives and anaesthetic agents such as propofol also reduce the activity of the genioglossus.75–79 The loss of genioglossus muscle activity is associated with a decrease in airway patency and collapse of the pharyngeal airway. Hypoglossal nerve stimulation contracts the genioglossus and has been studied for maintaining upper airway patency in OSA.80 Continuous positive airway pressure (CPAP) acts as a pneumatic splint of the upper airway and is used for the management of OSA.
Introductory Aspects of Head and Neck Cancers
Loredana G. Marcu, Iuliana Toma-Dasu, Alexandru Dasu, Claes Mercke in Radiotherapy and Clinical Radiobiology of Head and Neck Cancer, 2018
Tongue: The tongue is a mobile sort of muscular tissue, which can be divided into two parts. The most mobile part, corpus linguae, is situated in the oral cavity while the rest of the tongue, the base of tongue or radix linguae, is situated in the oropharynx. This latter part of the tongue belongs together with tissues in the soft palate and in the tonsils to the Waldeyer’s ring. The anterior two-thirds of the tongue, the oral tongue, extends from the circumvallate papillae to the undersurface of the tongue at the junction of the floor of mouth. A fibrous septum divides the tongue into right and left halves. The oral tongue is commonly demarcated into four anatomic areas: (1) the tip, (2) lateral borders, (3) dorsal surface, and (4) undersurface (ventral surface). There are six pairs of muscles that form the oral tongue: three of these are extrinsic and the rest are intrinsic. The external muscles are m. genioglossus, m. hyoglossus and m. styloglossus, and are those muscles that can move the tongue in the oral cavity, prevent it from falling backwards, etc. The intrinsic muscles are situated in the depth of the tongue and include the lingual, vertical, and transverse muscles. These muscles can alter the form of the tongue during speech and swallowing. The base of the tongue, belonging to oropharynx is bordered ventrally by the so-called sulcus terminalis. Caudally the base of tongue is bounded by the most cranial part of the supraglottic larynx, i.e. the epiglottis. The base of tongue is characteristically composed by an abundance of lymphoid tissue, constituting together with the tonsils and the soft palate what is called the Ring of Waldeyer.
Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology
Published in Expert Review of Respiratory Medicine, 2022
Brandon Nokes, Jessica Cooper, Michelle Cao
Skeletal surgery includes 1) hyoid advancement 2) genioplasty/genioglossus advancement 3) maxillary expansion 4) maxillomandibular advancement 5) mandibular distraction and 6) maxillomandibular expansion. The two most common are maxillomandibular advancement (MMA) and genioglossus advancement (GGA), which are often described as tongue base surgery [91]. Predictors of success for skeletal surgery are complete concentric collapse (CCC) and lateral pharyngeal wall collapse (LPW) on DISE, or congenital dentofacial deformity on physical exam [91]. Previously, MMA was used as a salvage surgical therapy for OSA, but now has more predictable clinical outcomes through visualizing the pattern of collapse at the velum during DISE [91]. The OSA cure rate for MMA is approximately 38%, but again can be optimized through careful patient selection [92].
Noninvasive electrical stimulation of oropharyngeal muscles in obstructive sleep apnea
Published in Expert Review of Respiratory Medicine, 2021
Juan Luis Rodríguez Hermosa, Myriam Calle, Ina Guerassimova, Baldomero Fernández, Víctor Javier Montero, José Luis Álvarez-Sala
The upper airways lack rigid bony support to perform these important functions, and the muscles surrounding them are responsible for their patency; therefore, the upper airways are susceptible to collapse. There are at least 20 dilator muscles, and among them, the genioglossus muscle (GG) plays a very important role in upper airway patency during sleep [13]. It is the principal tongue protrusor and various studies have shown that its contraction is more important in reducing pharyngeal resistance and collapsability in comparison with other upper airway dilators [14,15,16,17]. The contraction of the genioglossus muscle stabilizes and lengthens the upper section of the upper airways; this section is the most vulnerable to collapse (Figure 1). The moment the genioglossus, geniohyoid, and palatal veil-tensor muscles relax, the probability of apnea episodes occurring during sleep is greater. This is the reason for the continuing attempts of GG stimulation. Different approaches have been used: transcutaneous, intraoral and intramuscular electrodes placement and, lately, the direct hypoglossal nerve stimulation (HNS) via implantable devices. Despite the extensive work done by the HNS researchers and the promising first results, there is still insufficient evidence for consistent recommendation. It is also asurgical procedure requiring general anesthesia and risks and complications of the procedure have been documented.
Analysis of fiber strain in the human tongue during speech
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Arnold D. Gomez, Maureen L. Stone, Jonghye Woo, Fangxu Xing, Jerry L. Prince
With correlation analysis, we were able to observe patterns of mechanical cooperation evidenced by simultaneous action of muscles within each subject, and we determined whether these patterns persist across subjects. Globally, the strongest correlation patterns, that is, the ones with the most significant correlations of the same sign, involved the T muscle, whose action serves as a primary driver of tongue elevation, resulting in simultaneous extension of the GGA, HG, and SL muscle fibers (note that these last three muscles were positively correlated to each other). Negative correlation was also detected between the T and V muscles, indicating antagonistic action stemming from the elevation mechanism (because vertical and radial fibers in the GGA muscle have similar directionality). Relative motion or bending via antagonistic deformation of the GGA and GGP can also be observed, but is not as consistent across participants as the strongest interactions. Despite their physical proximity, GGP and HG muscles are not correlated; instead, the HG is strongly correlated to the GGA, most likely because these two muscles are influenced by GGP. Evidence for this type of synchrony within the genioglossus has been found via electromyography and numerically (Vranish and Bailey 2015; Harandi et al. 2017). Other correlations are weaker in terms of the number of subjects in which significant correlations are observed or their signs are in agreement.
Related Knowledge Centers
- External Carotid Artery
- Geniohyoid Muscle
- Hyoid Bone
- Hypoglossal Nerve
- Lingual Artery
- Mandible
- Rapid Eye Movement Sleep
- Tongue
- Mental Spine
- Palatoglossus Muscle