The tongue features associated with chronic kidney disease.

BACKGROUND: Traditional Chinese medicine (TCM) tongue diagnosis plays an important role in differentiation of symptoms because the tongue reflects the physiological and pathological condition of the body. The automatic tongue diagnosis system (ATDS), which noninvasively captures tongue images, can provide objective and reliable diagnostic information. Chronic kidney disease (CKD) currently is an important global public health problem and contributor to morbidity and mortality from non-communicable diseases. Thus, it is interesting to analyze and probe the relationship between tongue examination and CKD. METHODS: This protocol is a cross-sectional, case-controlled observational study investigating the usefulness of the ATDS in clinical practice by examining its efficacy as a diagnostic tool for CKD. Volunteers over 20 years old with and without CKD will be enrolled. Tongue images will be captured and the patients divided into 2 groups: CKD group and healthy group. Nine primary tongue features will be extracted and analyzed, including tongue shape, tongue color, tooth mark, tongue fissure, fur color, fur thickness, saliva, ecchymosis, and red dots. RESULT: The results of this study will systematically evaluate tongue manifestations of patients and examine its efficacy as an early detection and diagnosis of CKD. DISCUSSION: The aim of this protocol is to investigate discriminating tongue features to distinguish between CKD and normal people, and establish differentiating index to facilitate the noninvasive detection of CKD. TRIAL REGISTRIES: ClinicalTrials.gov; Identifier: NCT04708743.

Rehabilitation Protocol for Unilateral Laryngeal and Lingual Paralysis (Tapia Syndrome): Comment About "A Challenging Case of Tapia Syndrome After Total Thyroidectomy" By Ildem Deveci, Mehmet Surmeli, and Reyhan Surmeli.

Tapia syndrome is a rare complication after surgery, with ipsilateral paralysis of vocal cord and tongue due to extracranial involvement of recurrent laryngeal and hypoglossal nerves. Tapia's case report is extremely interesting for both the rarity of the reported cases and for the importance of an early rehabilitation. In a previous work, we reported a case of Tapia syndrome after cardiac surgery for aortic aneurysm, and the protocol of logopedic rehabilitation adopted. In the postoperative period, he developed severe dyspnea and dysphagia that required a tracheostomy and a logopedic rehabilitation therapy that led to a fast and efficient swallowing without aspiration after 47 sessions (less than 4 months). The progressive recovery of the function suggests aprassic nerve damage. However, the logopedic therapy is recommended to limit the possibility of permanent functional deficits and quickly recover swallowing and phonation.

Tongue diagnosis indices for gastroesophageal reflux disease: A cross-sectional, case-controlled observational study.

Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ±â€Š0.049 and 0.615 ±â€Š0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ±â€Š18.72, 58.10 ±â€Š24.60, and 67.29 ±â€Š24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.

Neuromodulation of the lingual nerve: a novel technique.

Acute injury of the trigeminal nerve or its branches can result in posttraumatic trigeminal neuropathy (PTTN). Affected patients suffer from chronic debilitating symptoms long after they have recovered from the inciting trauma. Symptoms vary but usually consist of paresthesia, allodynia, dysesthesia, hyperalgesia, or a combination of these symptoms. PTTN of the trigeminal nerve can result from a variety of traumas, including iatrogenic injury from various dental and maxillofacial procedures. Treatments include medications, pulsed radiofrequency modulation, and microsurgical repair. Although trigeminal nerve stimulation has been reported for trigeminal neuropathy, V3 implantation is often avoided because of an elevated migration risk secondary to mandibular motion, and lingual nerve implantation has not been documented. Here, the authors report on a patient who suffered from refractory PTTN despite multiple alternative treatments. He elected to undergo novel placement of a lingual nerve stimulator for neuromodulation therapy. To the best of the authors' knowledge, this is the first documented case of lingual nerve stimulator implantation for lingual neuropathy, a technique for potentially reducing the risk of electrode migration.

Development of a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination.

INTRODUCTION: A new approach to treat obstructive sleep apnea (OSA) is upper airway stimulation therapy (UAS). Electrical pulses applied to the hypoglossal nerve induce tongue protrusion, increase airway patency and decrease the frequency of apneic and hypopneic events. Thus, the main objective of this study was to design a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. METHOD: This study has designed the Tongue Adverse Event and Satisfaction Questionnaire (TAESQ) and an endobuccal examinations divided into an endobuccal lesion examination (ELE) and an endobuccal risk factor examination (ERFE). Evaluations were conducted at month 6 post-implantation. RESULTS: The study population after implantation of UAS device consisted of ten Caucasian males with a mean age of 51.9 ± 11.8 years, and a mean BMI of 28.6 ± 3.3. The AHI of the ten participants ranged from 46.7 ± 12.2/h at baseline to 14.5 ± 8.9/h with the Inspire therapy at the 6-month follow-up. The TAESQ revealed pain (30%), followed by less tongue sensitivity (20%) and tongue weakness (10%). The ELE did not reveal any lesions. The ERFE revealed that some participants had tissue and dental risk factors but not associated to more adverse events. CONCLUSION: The TAESQ, ELE and ERFE have been designed and studied on a small number of participants. These evaluations could systematically be included in the care pathway of patients treated by UAS to better investigate tongue discomfort and tongue lesion for patients treated with this technology.

Topical application of Aloe vera and vitamin E on induced ulcers on the tongue of rats subjected to radiation: clinical and histological evaluation.

OBJECTIVE: The aim of this study is to assess the effect of two types of antioxidants, vitamin E (VE) and Aloe vera (AV), on healing of induced oral lesions after radiation in a murine model by clinical and histological analysis. METHODS: The animals were randomly divided into three groups of 12 animals each (400 mg VE, 70 % AV and control) and two time periods (5 and 7 days). They were irradiated with a single dose of 30 Gy, and after 24 h, a lesion was produced on the ventral tongue of each animal. The products were applied daily in their respective group until euthanasia. RESULTS: On clinical analysis, there was a higher frequency of lesions in the animals of the control group at both periods. The area of the lesions was also greater in the control group compared with the groups AV and VE (5 days p = 0.006; 7 days p = 0.002). On microscopic analysis, the degree of inflammation differed between the study groups and experimental periods. At 5 days, the statistical difference was not significant among the groups evaluated, but at 7 days, animals in the control group showed intense inflammation, while those in groups VE and AV exhibited mild to moderate inflammation (p = 0.002). CONCLUSION: The results suggest that VE and AV contributed to the decrease in inflammatory response and healing of the lesions induced on the tongue of rats subjected to radiation.

An epidemiologic study of tongue lesions in 1901 Iranian dental outpatients.

AIM: The aim of this study was to assess the frequency of nine tongue conditions and evaluate their relationship to oral hygiene status and personal habits in a Northern Iranian population. METHODS AND MATERIALS: This descriptive study evaluated 1901 healthy subjects (1142 women, 759 men) >12 years who were referred to the Dental Faculty of Babol University during a period from February 2005 to July 2006. A questionnaire was designed according to the aims of the study. Each subject completed the questionnaire and received a complete dental and oral examination. Statistical analysis was performed using SPSS software and Chi-square and Fisher's exact probability tests. RESULTS: Six hundred seventy-two (35.3%) of 1901 subjects had tongue lesions with a frequency of 38.6% in women and 47.7% in men which was statistically significant (P<0.0001). A strong association was found between tongue lesions and smoking (p<0.0001), black tea drinking (p=0.021), and poor oral hygiene (p<0.0001). Hairy tongue (p<0.0001), coated tongue (p<0.0001), and fissured tongue (p=0.014) conditions were significantly higher in males, while crenation of the tongue was more frequent in women (p<0.0001). CONCLUSION: This epidemiologic survey of adult dental outpatients of Northern Iran assessing tongue conditions and lesions found the frequency of these conditions in 47.7% of males and 38.6% of females in this population. Tongue conditions and lesions were more frequent among smokers, black tea drinkers, and those with poor oral hygiene. The results of this epidemiological survey can only be interpreted for the population studied and as such cannot be generalized to the wider population of Iran, but future studies should be designed to assess the frequency of these conditions on a countrywide basis. CLINICAL SIGNIFICANCE: The results of this study suggest efficient oral hygiene programs and encouraging people to drink less tea and quit smoking may reduce tongue lesions in adult dental outpatients in Northern Iran.

[Tongue coating, mouth odor, gustatory sense disorder - earlier and new treatment options by means of tongue scraper]. / Zungenbelag, Mundgeruch und Schmeckstörung - bisherige Behandlungsmethoden und neue Therapieoption durch mechanische Zungenreiniger.

The tongue is said to be the mirror of physical health. The tongue dorsum is most delicate regarding the sense of touch. Pathologic coating of the tongue accounts for paresthesia during chewing, swallowing, speaking, tasting, and also may result in mouth odor. Tongue coating can result from increased formation or decreased natural abrasion, and from xerostomia or dyschylia. In clinical otorhinolaryngology pathologic tongue coating often is idiopathic or present after surgery of the oral cavity or pharynx. Critical analysis of published studies reveals that effectivity and justification to administer xenobiotics or vitamins in that condition is doubtful. Recently, it has been shown that tongue fur was able to be reduced by an easy-to-handle mechanical tongue cleaner or tongue scraper. Due to its simple use, tongue scrapers could be a welcome supplement for the treatment of tongue fur, mouth odor, and in particular cases, to enhance gustatory sense. Preliminary results of an ongoing prospective trial showed that tongue scrapers can effectively be applied after surgery of the oral cavity or pharynx. After tonsillectomy, tongue fur seemed to be reduced and gustatory sense to be enhanced when tongue scrapers were applied during postoperative care. After confirming these promising results in further investigations, an inexpensive and simple option for the treatment of a large amount of patients in clinical otorhinolaryngology would exist.

Anquiloglosia / Ankyloglossia

En la conformación del macizo cráneofacial intervienen factores genéticos, del medio o combinación de ambos. La alteración de uno de ellos puedeproducir modificaciones en el crecimiento, por ejemplo, maloclusión de los maxilares. Parece no haber dudas sobre el rol del factor genético; las autoras hacen referencia a las influencias de los factores del medio, entre ellos el factor lingual, particularmente en el desarrollo de un frenillo lingual corto que ocasiona una anquiloglosia. Se coincide con otros autores en que se trata de un factor etiológico que actúa en el comienzo de la maloclusión y se señala la forma correcta en que la lengua debe ubicarse para que tal patología no ocurra. El tratamiento del niño debe iniciarse precozmente a los 3 años para aprovechar la respueta biológica más dócil a los requerimientos terapéuticos. Finalmente se subraya la importancia de un tratamiento interdisciplinario realizado en un equipo integrado por odontopediatría, cirugía, ortodoncia, fonoaudiología, psicología y musicoterapia, para lograr resultados morfológicos, funcionales y estéticos satisfactorios

Anquiloglosia / Ankyloglossia

En la conformación del macizo cráneofacial intervienen factores genéticos, del medio o combinación de ambos. La alteración de uno de ellos puedeproducir modificaciones en el crecimiento, por ejemplo, maloclusión de los maxilares. Parece no haber dudas sobre el rol del factor genético; las autoras hacen referencia a las influencias de los factores del medio, entre ellos el factor lingual, particularmente en el desarrollo de un frenillo lingual corto que ocasiona una anquiloglosia. Se coincide con otros autores en que se trata de un factor etiológico que actúa en el comienzo de la maloclusión y se señala la forma correcta en que la lengua debe ubicarse para que tal patología no ocurra. El tratamiento del niño debe iniciarse precozmente a los 3 años para aprovechar la respueta biológica más dócil a los requerimientos terapéuticos. Finalmente se subraya la importancia de un tratamiento interdisciplinario realizado en un equipo integrado por odontopediatría, cirugía, ortodoncia, fonoaudiología, psicología y musicoterapia, para lograr resultados morfológicos, funcionales y estéticos satisfactorios (AU)

Reduction of radiochemotherapy-induced early oral mucositis by recombinant human keratinocyte growth factor (palifermin): experimental studies in mice.

PURPOSE: To study the effect of recombinant human keratinocyte growth factor (rHuKGF or palifermin) on oral mucositis induced by radiochemotherapy in a mouse model. METHODS AND MATERIALS: Cis-diamminedichloroplatinum (cisplatin) and/or 5-fluorouracil were given before single dose irradiation, combined with palifermin before or after the treatment, or both. Daily fractionated irradiation for 2 weeks was followed by graded test doses. With additional chemotherapy in Week 1, palifermin was given before radiotherapy and at the end of the first week, or additionally at the end of Week 2. Radiochemotherapy in Week 2 was combined with palifermin at the end of Weeks 1 and 2, Weeks 1, 2, and 3, or additionally before radiotherapy. Ulceration of mouse tongue mucosa was analyzed as the endpoint. RESULTS: The dose associated with ulcer induction in 50% of the mice (ED(50)) for single-dose irradiation was 11.5 +/- 0.7 Gy. Palifermin increased the ED(50) to about 19 Gy in all protocols tested. Similar values were observed when chemotherapy was added before irradiation. With fractionated irradiation, palifermin increased the ED(50) for test irradiation from 5.7 +/- 1.5 Gy to 12-15 Gy, depending on the administration protocol. With chemotherapy in Week 1, two palifermin injections had no significant effect, but a third injection increased the ED(50) to 13 Gy. With chemotherapy in Week 2, all palifermin protocols resulted in ED(50) values of 13-14 Gy. CONCLUSION: A marked increase in oral mucosal radiation tolerance by palifermin was found, which was preserved in combinations with chemotherapy using cisplatin and/or 5-fluorouracil.

Lingual nerve injury subsequent to wisdom teeth removal--a 5-year retrospective audit from a high street dental practice.

Lingual nerve damage subsequent to lower wisdom tooth removal affects a small number of patients, sometimes producing permanent sensory loss or impairment. A number of surgical techniques have been described which are associated with low incidences of this distressing post-operative complication. When a technique is adopted by an individual clinician then a personal audit may be prudent to establish how effective it is in relation to established nerve injury rates. This audit looks at a technique involving the minimal interference of lingual soft tissues during lower wisdom tooth removal in a high street practice situation for patients having mild to moderate impacted wisdom teeth removed under local anaesthetic. It was concluded that the technique employed was associated with a low incidence of lingual nerve trauma, comparable with that reported elsewhere.

Case presentation: resolution of an oral lesion as a result of orofacial myofunctional therapy.

This case presentation examines the etiology, evaluation and treatment of a 57 year-old-female presenting with an area of irritation/chronic lesion on the anterior lingual surface. Orthodontic history and lingual and labial postures are discussed.

Oral lesions caused by habits.

Oral lesions caused by habits can be of teeth only, of teeth and the soft tissues of the mouth or may be only of the soft tissues. Lesions of teeth are permanent and may remain even when there has been total destruction of soft tissues. Recognition of lesions due to habits such as betel chewing, snuff dipping, pipe smoking and certain sexual practices may help towards establishing the sex, the ethnic grouping or even the place of origin of a person or their remains. Certain dental and gingival changes may indicate a person's working circumstances and even the type of treatment received.