Ameloblastoma of the Mandible With Carcinoma Transformation in a Young Adult.

Ameloblastic carcinoma (AC) is a rare and aggressive malignant epithelial odontogenic tumor making up less than 1% of malignant head and neck tumors. The majority of cases occur in the mandible with a minority occurring in the maxilla. Most occur de novo, while rare cases of AC have resulted from transformation from ameloblastoma. Here, we present a case in which a 30-year-old man presented with proptosis and a recurrent right temporal mass, which had been previously diagnosed as ameloblastoma on surgical pathology. CT findings demonstrated local invasion, and he was subsequently taken to the operating room for right craniotomy, infratemporal and middle cranial fossa tumor resection, and right modified radical neck dissection with reconstruction. Final pathology, which included areas of early focal necrosis, loss of peripheral palisading, and hyperchromatism, confirmed the diagnosis of ameloblastoma with transformation to AC. We further discuss radiologic and histopathological signs of this rare tumor, as well as recommended treatment modalities.

Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report.

Here, we present a case report on internal carotid artery pseudoaneurysm (ICAP) which highlights a rare but potentially life-threatening complication of transsphenoidal pituitary surgery. A 32-year-old male underwent resection of a pituitary tumor and developed a large cerebrospinal fluid (CSF) leak during surgery, which was reconstructed with a fat graft and nasoseptal flap. Postoperatively, he was recovering well and discharged without complications; however, eight days after surgery he returned with massive epistaxis and hematemesis. This was initially managed with endoscopic exploration, nasal packing, and transfusion of blood products. Imaging revealed a pseudoaneurysm on the right internal carotid artery. The patient was started on aspirin and clopidogrel, and a flow diverter stent was placed without complications. Our case emphasizes the importance of prompt recognition and management of vascular injuries such as an internal carotid pseudoaneurysm after transsphenoidal pituitary surgery to prevent catastrophic outcomes.

Work productivity and activity impairment in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery-A prospective, multi-institutional study.

BACKGROUND: Productivity loss and activity limitations due to chronic rhinosinusitis (CRS) are known to contribute to the significant economic and personal burden of disease. The purpose of this study was to assess productivity and activity impairment before and after endoscopic sinus surgery (ESS) for medically refractory CRS. METHODS: This investigation was a prospective, multi-institutional, observational cohort study. Patients diagnosed with medically refractory CRS completed the Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SHP) questionnaire before surgery and approximately 6 months after the procedure. Factors associated with minimal clinical important differences (MCIDs) for productivity and activity impairment were identified. RESULTS: A total of 279 study participants were screened for inclusion, of whom 176 (63.1%) with postoperative follow-up were included in the final cohort. Preoperative productivity and activity impairment were observed in 63.2% and 69.8% of the patients, respectively. Among these patients, postoperative improvement equaling at least 1 MCID was reported in both productivity (76.1%) and activity (76.4%) impairments. Multivariate regression identified sphenoidotomy (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.03-17.02) as the only factor associated with increased likelihood of productivity improvement, whereas septoplasty during ESS (OR, 8.45; 95% CI, 2.33-30.68) and migraine (OR, 0.35; 95% CI, 0.12-0.96) were associated with differential odds of activity improvement. CONCLUSION: CRS is associated with a substantial burden on productivity and activity that significantly improves after treatment with ESS. These data may facilitate improved patient counseling and shared decision-making regarding surgical management for CRS.

Analysis of Bending Degree of Basilar Artery Using Image Processing.

The basilar artery, which is the core of the posterior circulation, supplies blood to the brainstem and cerebellum. When basilar artery blood circulation is impaired, several symptoms can occur. In addition, the bending of the basilar artery causes stroke and infarction. Therefore, an image processing method for analyzing the bending degree of the basilar artery is introduced herein. To analyze the bending degree, the coordinates of the center points of the basilar artery are extracted using image processing techniques such as Canny edge detection, the contour technique, and the distance conversion technique. An image reconstructed using the three-dimensional scatter plot function in MATLAB and vector plots is used to calculate the vectors for each central point of the basilar artery. Meanwhile, the angle of each central point is calculated by selecting the first central point where the basilar artery begins, the central point with the greatest bending degree, and the central point at which the branching ends. The greater the bending degree of the basilar artery is, the larger the magnitude of the vector in the bending direction. The obtained results are verified by experts in the field, and the proposed algorithm demonstrates good performance.

iProm-Zea: A two-layer model to identify plant promoters and their types using convolutional neural network.

A promoter is a short DNA sequence near the start codon, responsible for initiating the transcription of a specific gene in the genome. The accurate recognition of promoters is important for achieving a better understanding of transcriptional regulation. Because of their importance in the process of biological transcriptional regulation, there is an urgent need to develop in silico tools to identify promoters and their types in a timely and accurate manner. A number of prediction methods have been developed in this regard; however, almost all of them are merely used for identifying promoters and their strength or sigma types. The TATA box region in TATA promoter influences the post-transcriptional processes; therefore, in the current study, we developed a two-layer predictor called "iProm-Zea" using the convolutional neural network (CNN) for identify TATA and TATA less promoters. The first layer can be used to identify a given DNA sequence as a promoter or non-promoter. The second layer can be used to identify whether the recognized promoter is the TATA promoter. To find an optimal feature encoding scheme and model, we employed four feature encoding schemes on different machine learning and CNN algorithms, and based on the evaluation results, we selected a one-hot encoding scheme and a CNN model for iProm-Zea. The 5-fold cross validation testing results demonstrated that the constructed predictor showed great potential for identifying promoters and classifying them as TATA and TATA less promoters. Furthermore, we performed cross-species analysis of iProm-Zea to evaluate its performance in other species. Moreover, to make it easier for other experimental scientists to obtain the results they need, we established a freely accessible and user-friendly web server at http://nsclbio.jbnu.ac.kr/tools/iProm-Zea/.

COVID-19 in the Clinic: Human Testing of an Aerosol Containment Mask for Endoscopic Clinic Procedures.

OBJECTIVE: To create an aerosol containment mask (ACM) for common otolaryngologic endoscopic procedures that also provides nanoparticle-level protection to patients. STUDY DESIGN: Prospective feasibility study . SETTING: In-person testing with a novel ACM. METHODS: The mask was designed in Solidworks and 3D printed. Measurements were made on 10 healthy volunteers who wore the ACM while reading the Rainbow Passage repeatedly and performing a forced cough or sneeze at 5-second intervals over 1 minute with an endoscope in place. RESULTS: There was a large variation in the number of aerosol particles generated among the volunteers. Only the sneeze task showed a significant increase compared with normal breathing in the 0.3-µm particle size when compared with a 1-tailed t test (P = .013). Both the 0.5-µm and 2.5-µm particle sizes showed significant increases for all tasks, while the 2 largest particle sizes, 5 and 10 µm, showed no significant increase (both P < .01). With the suction off, 3 of 30 events (2 sneeze events and 1 cough event) had increases in particle counts, both inside and outside the mask. With the suction on, 2 of 30 events had an increase in particle counts outside the mask without a corresponding increase in particle counts inside the mask. Therefore, these fluctuations in particle counts were determined to be due to random fluctuation in room particle levels. CONCLUSION: ACM will accommodate rigid and flexible endoscopes plus instruments and may prevent the leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions. LEVEL OF EVIDENCE: 2.

COVID-19 in the Clinic: Aerosol Containment Mask for Endoscopic Otolaryngologic Clinic Procedures.

OBJECTIVE: To create an aerosol containment mask (ACM) that contains aerosols during common otolaryngologic endoscopic procedures while protecting patients from environmental aerosols. STUDY DESIGN: Bench testing. SETTING: Mannequin testing. METHODS: The mask was designed in SolidWorks and 3-dimensional printed. Mannequins were fitted with a nebulizer to generate aerosols. Commercial particle counters were used to measure mask performance. RESULTS: The ACM has 2 ports on either side for instruments and endoscopes, a port for a filter, and a port that can evacuate aerosols contained within the mask via a standard suction pump. The mask contained aerosols on a mannequin with and without facial hair when the suction was set to 18.5 L/min. Other types of masks demonstrated substantial aerosol leakage under similar conditions. In a subsequent experiment, the ACM contained aerosols generated by a nebulizer up to the saturation of the particle detector without measurable leakage with or without suction. CONCLUSION: The ACM will accommodate rigid and flexible endoscopes plus instruments and prevent leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions. LEVEL OF EVIDENCE: 2.

Thermal Conductance Through the Skull Base From Endoscopic Surgery Cauterization Instruments: Cadaver and Goat Model.

OBJECTIVE: Cauterization prevents hemorrhage and optimizes the surgical field during endoscopic sinus surgery but may cause injury to nearby structures. The objective of this study is to examine thermal conductance from cauterization equipment across the skull base. STUDY DESIGN: Cadaver and animal model. SETTING: Surgical skills laboratory of an academic tertiary medical institution. METHODS: A pilot study was conducted with a deidentified cadaver head and expanded to a goat head animal model. Endoscopic dissection was performed to expose the lamina papyracea, ethmoid roof, sphenoid roof, and frontal sinus. Cautery was applied to the frontal sinus of goat heads, and temperatures were measured via thermocouple sensors placed along the intracranial skull base. Surgical instruments studied included monopolar, bipolar, and endoscopic bipolar devices at various power settings. RESULTS: Temperature increase, as averaged across all cautery powers and measurement positions, was highest for the monopolar cautery (17.55 °C) when compared with the bipolar and endoscopic bipolar devices (<2 °C for bipolar, Endo-Pen, Stammberger, and Wormald; P < .001). Monopolar cautery reached 30.86 °C at high power when averaged over all positions (P < .001) as compared with <3 °C for the other instruments. Temperatures rose as power of cautery was increased from low to medium and high. Temperatures decreased as the distance of the thermocouple sensor probe from the cautery origin increased. CONCLUSION: Thermal conductance across the skull base varies depending on equipment and power of cautery, with monopolar resulting in the largest temperature increase. Choice and implementation of cauterization instruments have implications on inadvertent transmission of thermal energy during endoscopic sinus surgery.

BrainSeg-Net: Brain Tumor MR Image Segmentation via Enhanced Encoder-Decoder Network.

Efficient segmentation of Magnetic Resonance (MR) brain tumor images is of the utmost value for the diagnosis of tumor region. In recent years, advancement in the field of neural networks has been used to refine the segmentation performance of brain tumor sub-regions. The brain tumor segmentation has proven to be a complicated task even for neural networks, due to the small-scale tumor regions. These small-scale tumor regions are unable to be identified, the reason being their tiny size and the huge difference between area occupancy by different tumor classes. In previous state-of-the-art neural network models, the biggest problem was that the location information along with spatial details gets lost in deeper layers. To address these problems, we have proposed an encoder-decoder based model named BrainSeg-Net. The Feature Enhancer (FE) block is incorporated into the BrainSeg-Net architecture which extracts the middle-level features from low-level features from the shallow layers and shares them with the dense layers. This feature aggregation helps to achieve better performance of tumor identification. To address the problem associated with imbalance class, we have used a custom-designed loss function. For evaluation of BrainSeg-Net architecture, three benchmark datasets are utilized: BraTS2017, BraTS 2018, and BraTS 2019. Segmentation of Enhancing Core (EC), Whole Tumor (WT), and Tumor Core (TC) is carried out. The proposed architecture have exhibited good improvement when compared with existing baseline and state-of-the-art techniques. The MR brain tumor segmentation by BrainSeg-Net uses enhanced location and spatial features, which performs better than the existing plethora of brain MR image segmentation approaches.

Transoral Robotic Surgery (TORS) Versus Non-TORS Tongue Resection for Obstructive Sleep Apnea.

OBJECTIVE: To compare transoral robotic surgery (TORS) versus non-TORS tongue resection procedures performed for obstructive sleep apnea from January 2010 to September 2015 using a national database, focusing on patient characteristics, performance of concurrent procedures, operative time, length of hospital stay, and postoperative complications. METHODS: A cohort of adults undergoing TORS and non-TORS tongue resection procedures was identified in the Nationwide Inpatient Sample, a publicly-available national administrative database incorporating a stratified sample of hospital discharge records. Outcomes were annual case volumes, prolonged (≥3 days) hospital stay, and complications. Statistical analyses examined potential associations between TORS and prolonged hospital stay and complications. RESULTS: From 2010 to 2015, 5709 hospital discharges included tongue resection surgery to treat obstructive sleep apnea. There was a gradual decline and stabilization in overall volumes, with the proportion of TORS use showing an initial increase, followed by a decrease and rebound increase. TORS patients were less likely to undergo concurrent nasal surgery (15% vs. 44%, P < .01), but there was no association between the use of TORS and concurrent palatal surgery. TORS use was not associated with concurrent hypopharyngeal surgery overall, but it was associated with specific types of hypopharyngeal surgery. TORS use was associated with patient age, payor, and certain hospital characteristics. TORS use was associated with an increased risk of prolonged hospital stay (33% vs. 25%, P = .045) but was not associated with complications. CONCLUSION: This study provides insight into TORS use in tongue resection surgery for obstructive sleep apnea during this period of early TORS adoption. LEVEL OF EVIDENCE: Level 3 (cohort study). Laryngoscope, 131:E1735-E1740, 2021.

CSF Leaks due to Electric Scooter Injury.

BACKGROUND: There has been a rapid increase in electric motorized scooter (e-scooter) usage after the introduction of dockless, shareable devices. METHODS: Case series from three tertiary hospitals in Los Angeles between May-September 2019. RESULTS: Five patients had skull base fractures and CSF leaks or pneumocephalus after e-scooter accident, none wore helmets. Two patients were treated with observation alone, two patients were treated with lumbar drain or external ventriculostomy placement, and one patient died of their injuries prior to definitive management. CONCLUSION: Without appropriate safety policies in place, the number of such injuries may increase as the use of e-scooters increase. Laryngoscope, 131:E1035-E1037, 2021.

Advanced Practice Providers Utilization Trends in Otolaryngology From 2012 to 2017 in the Medicare Population.

OBJECTIVE: Nurse practitioners and physician assistants form a growing advanced practice provider (APP) group. We aim to analyze the trends and types of services provided by APPs in otolaryngology. STUDY DESIGN: Cross-sectional study. SETTING: Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use Files, 2012-2017. METHODS: The Medicare database was searched for 13 commonly used otolaryngology-specific Current Procedural Terminology (CPT) codes, and 10 evaluation and management (E/M) codes were evaluated by provider type. Changes in code utilization were compared between physicians and APPs over time. RESULTS: From 2012 to 2017, there was a 51% increase in the number of otolaryngology APPs, compared to a 2.2% increase in physician providers. APPs increased their share of new and established patient visits from 4% to 7%d 11% to 15%, respectively. There was not a significant difference over time in number of patient visits performed annually per provider according to provider type. The increase in number of APP vs physician providers was significantly greater for every procedure except for balloon sinus dilation and tympanostomy tube placement. CONCLUSION: Due to increasing numbers, APPs are accounting for more patient visits and procedures over time. The physician workforce and the numbers of procedures performed per physician have remained relatively stable from 2012 to 2017. Increasing complexity of patients seen and a broader range of procedures offered by work-experienced or postgraduate-trained APPs may further improve access to health care in the face of possible physician shortages.

Association Between Olfactory Dysfunction and Mortality in US Adults.

Importance: A study of olfactory dysfunction and mortality in a large national cohort will aid in better understanding their association when accounting for multiple relevant factors and possible underlying mechanisms. Objective: To investigate the association of olfactory dysfunction with all-cause 5-year mortality in US adults. Design, Setting, and Participants: This cohort study included participants 40 years or older from the 2013-2014 National Health and Nutritional Examination Survey who had data on olfaction and mortality (n = 3503). Olfaction was assessed by self-report and objective test (8-odor Pocket Smell Test). Mortality was determined by linking with the National Death Index through February 24, 2019. Data were analyzed from July 1 to September 30, 2019. Main Outcomes and Measures: Olfaction and 5-year mortality. Cox proportional regression models were used to examine the associations between olfaction and mortality while adjusting for demographics and medical comorbidities. Multivariate models were further adjusted for depression and cognitive assessments. Results: Among the 3503 participants (1831 women [52.3%]; mean [SD] age, 59.0 [12.0] years), the prevalence of olfactory dysfunction was 13.5% (95% CI, 11.0%-16.0%) based on results of an objective smell test and 21.6% (95% CI, 18.9%-24.2%) based on self-report. Risk of mortality increased by 18% (95% CI, 7%-29%) per 1-point decrease in smell test score in a multivariate model. The association was significant among adults 65 years or older in association with binary (hazard ratio [HR], 1.95; 95% CI, 1.19-3.21) and linear (HR, 1.19; 95% CI, 1.08-1.31) measures of objective olfactory dysfunction, but not among adults aged 40 to 64 years. There was no association between self-reported olfactory dysfunction and mortality. The association between objective olfactory dysfunction and mortality remained after further adjusting for cognitive assessment battery and depression among older adults (HR, 1.18; 95% CI, 1.01-1.37). Conclusions and Relevance: These findings suggest that objective olfactory dysfunction is associated with increased mortality among older adults. In addition to its effect on quality of life, the association of olfactory dysfunction with mortality has implications for physical and cognitive health.

DNC4mC-Deep: Identification and Analysis of DNA N4-Methylcytosine Sites Based on Different Encoding Schemes By Using Deep Learning.

N4-methylcytosine as one kind of modification of DNA has a critical role which alters genetic performance such as protein interactions, conformation, stability in DNA as well as the regulation of gene expression same cell developmental and genomic imprinting. Some different 4mC site identifiers have been proposed for various species. Herein, we proposed a computational model, DNC4mC-Deep, including six encoding techniques plus a deep learning model to predict 4mC sites in the genome of F. vesca, R. chinensis, and Cross-species dataset. It was demonstrated by the 10-fold cross-validation test to get superior performance. The DNC4mC-Deep obtained 0.829 and 0.929 of MCC on F. vesca and R. chinensis training dataset, respectively, and 0.814 on cross-species. This means the proposed method outperforms the state-of-the-art predictors at least 0.284 and 0.265 on F. vesca and R. chinensis training dataset in turn. Furthermore, the DNC4mC-Deep achieved 0.635 and 0.565 of MCC on F. vesca and R. chinensis independent dataset, respectively, and 0.562 on cross-species which shows it can achieve the best performance to predict 4mC sites as compared to the state-of-the-art predictor.

Patient characteristics of suspected mast-cell activation syndrome with sinonasal obstruction: a single institution experience.

BACKGROUND: Mast-cell activation syndrome (MCAS) is increasingly recognized. Sinonasal obstruction is common among these patients. There is a paucity of literature describing the characteristics of MCAS and treatment outcomes. METHODS: Retrospective review of 192 patients with nasal congestion July 2017 to May 2019 among 3 providers (1 allergist, 2 rhinologists) was conducted. Suspected MCAS criteria were as follows: (1) at least 2 recurrent severe symptoms in addition to nasal congestion: flushing, pruritus, urticaria, angioedema, wheezing, throat swelling, headache, hypotension, diarrhea; (2) clinical response to medications that target mast cell mediators. Quality of life (QOL) outcomes were quantified using the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS: Thirty-two patients with nasal congestion were suspected of MCAS. The median age was 47 years; 24 of 32 were female; 13 of 32 had prior history of sinonasal surgery and 11 of 32 allergen immunotherapy. Out of 32, 19 had history of asthma, 10 drug allergy, 11 food allergy, and 10 anaphylaxis. The median number of medications targeting mast cell activation was 4 (range, 2-7). Eleven patients were offered surgery by a rhinologist after adequate medical management. Three of 32 patients showed elevation of serum tryptase. Fourteen completed pretreatment and posttreatment SNOT-22 (4/14 surgery, 10/14 medical management). Pretreatment score was 59.8 ± 6.2 (mean ± standard error [SEM]) and posttreatment score was 42.8 ± 6.7; the difference was statistically and clinically significant (p = 0.0015). Both groups showed a mean 17-point reduction. CONCLUSION: A multidisciplinary approach to the treatment of sinonasal symptoms using both escalation of medical therapy and surgical approaches may improve QOL of patients with suspected MCAS. Consensus criteria for MCAS, which includes elevation in tryptase over baseline during an episode, may exclude the full spectrum of individuals with MCAS from potentially beneficial treatment.

Emerging Trends in Nasal Surgery: What Is the Impact of a Bioabsorbable Nasal Implant?

BACKGROUND: A bioabsorbable nasal valve implant (NVI) was introduced in 2016 as a minimally invasive solution to nasal valve collapse. Historically the introduction of less invasive procedures performable in-office has resulted in an increase in volume. Our objective is to evaluate this trend as it relates to nasal vestibular repair, and its impact on healthcare utilization. METHODS: We interrogated the Medicare Part B national database for nasal vestibular repair (CPT code: 30465), Unlisted nasal procedure (30999) and septoplasty (30520) from 2010 to 2017. Septoplasty was used as a surrogate for overall nasal procedural rate. Linear regression modeling was used to examine the changes in reported vestibular repair rate adjusting for septoplasty rate. RESULTS: In the Medicare population, the rate of septoplasty was stable from 2010 to 2017, increasing from 26,962 to 30,194 at an annual rate of 1.5%. Coding for unlisted nasal procedure increased from 272 to 333 at an adjusted annual rate of 1.1% over this time period. Coding for nasal vestibular repair increased from 2026 to 5331 over this interval at an adjusted annual rate of 0.9% from 2010 to 2016 but significantly increased to 5% between 2016 to 2017 (P < .0001). CONCLUSION: The reported volume of nasal vestibular repair increased significantly in the year following Food and Drug Administration approval of NVIs. In the absence of a corresponding increase in septoplasty, this temporal relationship suggests that the introduction of NVIs impacted the utilization of this procedural code. LEVEL OF EVIDENCE: N/A Laryngoscope, 2020.

Adverse Events Associated with Balloon Sinuplasty: A MAUDE Database Analysis.

OBJECTIVE: Balloon sinuplasty utilization has increased significantly since its introduction over a decade ago. However, the most common associated complications are still unknown. The objective of this study was to analyze adverse events related to balloon sinuplasty. STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: Food and Drug Administration's MAUDE database (Manufacturer and User Facility Device Experience; 2008-2018). SUBJECTS AND METHODS: The MAUDE database was searched for all reports on adverse events involving balloon sinuplasty devices from the 3 leading manufacturers: Acclarent, Entellus, and Medtronic. Reported events were reviewed and categorized. RESULTS: During the study period, there were 211 adverse events from 208 reports divided into the following categories: patient related (n = 102, 48.3%), device related (n = 101, 47.9%), and packaging related (n = 8, 3.8%). Four periprocedural deaths were reported but were not clearly associated with technical complications. The most common device-related complications were guide catheter malfunction (39.6%), balloon malfunction (38.6%), and imprecise navigation (17.8%). The most common patient-related complications were cerebrospinal fluid leak (36.3%), eye swelling (29.4%), and epistaxis (11.8%). A lateral canthotomy was performed in 30.0% of eye-swelling complications. Sixty percent of eye complications occurred during balloon dilation of the maxillary sinus. The years 2014 (n = 48) and 2012 (n = 32) had the highest number of adverse events reported as compared with all other years. CONCLUSION: The most common adverse events associated with balloon sinuplasty include balloon malfunction, guide catheter malfunction, cerebrospinal fluid leak, and significant eye swelling. Health care providers should discuss these possible complications when consenting patients for balloon sinuplasty.

Use of Superelastic Nitinol and Highly-Stretchable Latex to Develop a Tongue Prosthetic Assist Device and Facilitate Swallowing for Dysphagia Patients.

We introduce a new tongue prosthetic assist device (TPAD), which shows the first prosthetic application for potential treatment of swallowing difficulty in dysphagia patients. The native tongue has a number of complex movements that are not feasible to mimic using a single mechanical prosthetic device. In order to overcome this challenge, our device has three key features, including (1) a superelastic nitinol structure that transfers the force produced by the jaws during chewing towards the palate, (2) angled composite tubes for guiding the nitinol strips smoothly during the motion, and (3) highly stretchable thin polymeric membrane as a covering sheet in order to secure the food and fluids on top of the TPAD for easy swallowing. A set of mechanical experiments has optimized the size and angle of the guiding tubes for the TPAD. The low-profile TPAD was successfully placed in a cadaver model and its mobility effectively provided a simplistic mimic of the native tongue elevation function by applying vertical chewing motions. This is the first demonstration of a new oral device powered by the jaw motions in order to create a bulge in the middle of the mouth mimicking native tongue behavior.