Non-Instrumental Test for the Evaluation of Tongue Function

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Abstract

The tongue undergoes various negative adaptations in the presence of local or systemic pathologies, adversely its behavior within the body context. Tongue assessments to correctly diagnose its functions are carried out using instrumentation, such as ultrasonography, magnetic resonance imaging, electromyography and different intraoral devices (swallowing, strength, posture, phonesis). Currently, there is no dynamic non-instrumental test in the scientific literature to highlight any lingual dysfunctions. The article describes a non-instrumental test for the assessment of lingual function in the body context, to obtain preliminary information on the quality of the neurological activities of the tongue, with respect to the balance and muscle strength that the patient expresses. The text briefly reviews the anatomy of the tongue and describes a clinical case to better understand how to use this test. Further studies will be needed for the validation of the test.

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Development and evolution of the pharyngeal apparatus.

Paul Trainor, Aude Frisdal (2014)

The oral or pharyngeal apparatus facilitates the dual functions of respiration and feeding. It develops during embryogenesis from transient structures called pharyngeal arches (PAs), which comprise a reiterated series of outgrowths on the lateral side of the head. The PAs and their segmental arrangement are highly conserved throughout evolution from invertebrate chordates such as amphioxus, through to vertebrate agnathans including avians, squamates, and mammals. The structural organization of the PAs is also highly conserved and involves contributions from each of the three primary endoderm, mesoderm, and ectoderm germ layers. The endoderm is particularly important for PA formation and segmentation and also plays a critical role in tissue-specific differentiation. The ectoderm gives rise to neural crest cells (NCC) which provide an additional layer of complexity to PA development and differentiation in vertebrates compared to invertebrate chordates that do not possess NCC. Collectively, the PAs give rise to much of the neurovasculature and musculoskeletal systems in the head and neck. The complexity of development renders the pharyngeal apparatus prone to perturbation and subsequently the pathogenesis of birth defects. Hence it is important to understand the signals and mechanisms that govern the development and evolution of the pharyngeal complex.

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Altered connectivity of the balance processing network after tongue stimulation in balance-impaired individuals.

Yuri Danilov, Joseph C. Wildenberg, Mary E. Meyerand … (2012)

Some individuals with balance impairment have hypersensitivity of the motion-sensitive visual cortices (hMT+) compared to healthy controls. Previous work showed that electrical tongue stimulation can reduce the exaggerated postural sway induced by optic flow in this subject population and decrease the hypersensitive response of hMT+. Additionally, a region within the brainstem (BS), likely containing the vestibular and trigeminal nuclei, showed increased optic flow-induced activity after tongue stimulation. The aim of this study was to understand how the modulation induced by tongue stimulation affects the balance-processing network as a whole and how modulation of BS structures can influence cortical activity. Four volumes of interest, discovered in a general linear model analysis, constitute major contributors to the balance-processing network. These regions were entered into a dynamic causal modeling analysis to map the network and measure any connection or topology changes due to the stimulation. Balance-impaired individuals had downregulated response of the primary visual cortex (V1) to visual stimuli but upregulated modulation of the connection between V1 and hMT+ by visual motion compared to healthy controls (p ≤ 1E-5). This upregulation was decreased to near-normal levels after stimulation. Additionally, the region within the BS showed increased response to visual motion after stimulation compared to both prestimulation and controls. Stimulation to the tongue enters the central nervous system at the BS but likely propagates to the cortex through supramodal information transfer. We present a model to explain these brain responses that utilizes an anatomically present, but functionally dormant pathway of information flow within the processing network.

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Somatosensory innervation of healthy human oral tissues.

Yalda Moayedi, Stephanie Michlig, Mark Park … (2021)

The oral somatosensory system relays essential information about mechanical stimuli to enable oral functions such as feeding and speech. The neurochemical and anatomical diversity of sensory neurons across oral cavity sites have not been systematically compared. To address this gap, we analyzed healthy human tongue and hard-palate innervation. Biopsies were collected from 12 volunteers and underwent fluorescent immunohistochemistry (≥2 specimens per marker/structure). Afferents were analyzed for markers of neurons (βIII tubulin), myelinated afferents (neurofilament heavy, NFH), and Merkel cells and taste cells (keratin 20, K20). Hard-palate innervation included Meissner corpuscles, glomerular endings, Merkel cell-neurite complexes, and free nerve endings. The organization of these somatosensory endings is reminiscent of fingertips, suggesting that the hard palate is equipped with a rich repertoire of sensory neurons for pressure sensing and spatial localization of mechanical inputs, which are essential for speech production and feeding. Likewise, the tongue is innervated by afferents that impart it with exquisite acuity and detection of moving stimuli that support flavor construction and speech. Filiform papillae contained end bulbs of Krause, as well as endings that have not been previously reported, including subepithelial neuronal densities, and NFH+ neurons innervating basal epithelia. Fungiform papillae had Meissner corpuscles and densities of NFH+ intraepithelial neurons surrounding taste buds. The differing compositions of sensory endings within filiform and fungiform papillae suggest that these structures have distinct roles in mechanosensation. Collectively, this study has identified previously undescribed neuronal endings in human oral tissues and provides an anatomical framework for understanding oral mechanosensory functions.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 27 September 2021

Publication date (Electronic, collection): September 2021

Volume: 13

Issue: 9

Electronic Location Identifier: e18333

Affiliations

[1 ] Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA

[2 ] Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA

Author notes

Bruno Bordoni bordonibruno@ 123456hotmail.com

Article

DOI: 10.7759/cureus.18333

PMC ID: 8476096

SO-VID: e9fc8d17-4577-4e36-8b57-a8362512be26

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This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Non-Instrumental Test for the Evaluation of Tongue Function

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Most cited references 20

Development and evolution of the pharyngeal apparatus.

Altered connectivity of the balance processing network after tongue stimulation in balance-impaired individuals.

Somatosensory innervation of healthy human oral tissues.

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