The modified Mallampati (MM) grade and Friedman tongue position (FTP) are commonly used scales that assess the oropharynx during evaluation for obstructive sleep apnea (OSA). Though used by many ...practitioners, there is controversy in the literature regarding their practical utility. The goal of this review will be to review the history of how the MM and FTP were developed, to discuss current evidence for their usefulness in the workup of OSA, and to provide future direction to better understand their utility in the workup of OSA.
We searched the literature (PubMed) for the terms "modified Mallampati" and "Friedman tongue position." Articles were selected based on our study objectives emphasizing articles discussing the utility of MM and FTP in managing OSA.
MM and FTP have the potential to be useful assessment tools in the evaluation of OSA. When performing this examination, it is important for physicians and other medical providers to understand the pitfalls of the MM and FTP including the potential difficulty in performing the exam and the lack of consistency between examiners in both the terminology and execution of this physical exam finding. Better methods to standardize the assessment are necessary to ensure consistent evaluation among individual examiners while at the same time keeping the method simple and convenient for wide use as a clinical screening tool.
•An ultrasound study of English and Brazilian Portuguese stops was conducted.•Tongue position is one of articulatory correlates of laryngeal contrasts.•Two languages show similar tongue position ...differences.•Two languages share a similar articulatory gesture despite VOT differences.
Many languages make a two-way laryngeal contrast in obstruents, but the phonological and phonetic characterization of these contrasts continues to be controversial. In English, utterance-initial /b d ɡ/ stops are often phonetically voiceless. Languages like Brazilian Portuguese, however, exhibit phonetic voicing for /b d ɡ/ stops utterance-initially. This study focuses on tongue position as an articulatory correlate of laryngeal contrasts. Results of an ultrasound study show that tongue position differences are similar for English and Portuguese despite VOT differences, although English speakers show more variation. Tongue root advancement/tongue body lowering is found in both English and Portuguese /b d ɡ/ stops, compared to /p t k/ counterparts. In addition to VOT, which reflects the timing of the oral and laryngeal gestures, the tongue position during closure may be an integral part of the articulatory properties of laryngeal contrasts. Results imply that these languages have different laryngeal gestures but share a similar supralaryngeal articulatory gesture, which may be necessary to distinguish between /b d ɡ/ and /p t k/ stops with respect to supralaryngeal cavity volume.
A comprehensive understanding of how vocal tract dimensions vary among different types of loud voice productions has not yet been fully formed. This study aims to expand the existing knowledge on the ...topic.
Three trained professional singers together practiced the vocal techniques underlying Opera and Kulning singing styles for one hour and, afterwards, phonated using these techniques on vowel iː at pitch C5 (523 Hz), while their vocal tracts were scanned via MRI. One of the participants also produced the samples in the Edge vocal mode using ɛː. Several dimensional vocal tract measurements were calculated from the MRIs. Spectral analysis was conducted on the filtered audio recorded during the MRI.
The Operatic technique demonstrated a lower larynx, a larger tongue–palate distance, and larger epilaryngeal and pharyngeal tube diameters compared to Kulning. Edge showed the highest laryngeal position, narrowest pharynx and epilarynx tubes, and the least forward-tilted larynx out of the styles studied. The spectra of Opera and Kulning showed a dominant first harmonic, while in Edge, the second harmonic was the strongest.
The results shed light on the magnitude of vocal tract changes necessary for genre-typical vocal projection. This information can be pedagogically helpful.
BackgroundClass II malocclusion is one of the most common malocclusion with varied prevalence. Functional therapy with appliances like Twin Block or Fixed functional appliances forms the mainstay of ...treatment in growing Class II patients. These patients might demonstrate narrow airway due to the retrognathic position of the mandible. This study investigated the effects of twin block and fixed functional appliance therapy (Forsus™ FRD) on the pharyngeal airway space in skeletal Class II patients. MethodsForty patients with Class II malocclusion were selected and divided into two equal groups of 20 patients each for both Twin block and Forsus group. Lateral cephalograms were obtained before and after the functional appliance therapy. Evaluation was done for changes in hyoid bone position, pharyngeal airway dimensions and tongue position. ResultsThe variables of the study showed better hyoid position in both the groups. In Twin Block group, an increase in hy-apw2 and hy-PoFH suggested anterior positioning of hyoid and a decrease in H-MP and hy-ML indicated superior positioning. In Forsus group an increase in H-H', hy-FH, hy-ML, hy-NL, hy-NSL and hy-OL suggested inferior positioning of hyoid, while an increase in hy-apw2, hy-CVT, hy-PoFH, hy-RL and hy'-tgo indicated anterior positioning of hyoid bone after functional therapy. ConclusionBoth the twin block and Forsus™ FRD improved the position of the hyoid bone after the functional appliance therapy however the changes were not statistically significant. Twin block and Forsus™ had similar effect on the hyoid bone position, pharyngeal dimensions and the tongue position.
ObjectiveThis study aimed to evaluate the association between low tongue position (LTP) and the volume and dimensions of the nasopharyngeal, retropalatal, retroglossal, and hypopharyngeal segments of ...the upper airway. MethodsA total of 194 subjects, including 91 males and 103 females were divided into a resting tongue position (RTP) group and a LTP group according to their tongue position. Subjects in the LTP group were divided into four subgroups (Q1, Q2, Q3, and Q4) according to the intraoral space volume. The 3D slicer software was used to measure the volume and minimum and average cross-sectional areas of each group. Airway differences between the RTP and LTP groups were analyzed to explore the association between tongue position and the upper airway. ResultsNo significant differences were found in the airway dimensions between the RTP and LTP groups. For both retropalatal and retroglossal segments, the volume and average cross-sectional area were significantly greater in the patients with extremely low tongue position. Regression analysis showed that the retroglossal airway dimensions were positively correlated with the intraoral space volume and negatively correlated with A point-nasion-B point and palatal plane to mandibular plane. Males generally had larger retroglossal and hypopharyngeal airways than females. ConclusionsTongue position did not significantly influence upper airway volume or dimensions, except in the extremely LTP subgroup.
To assess the association between the Mallampati classification and Friedman tongue position for obstructive sleep apnea severity as determined by apnea-hypopnea index and to determine which method ...is most closely correlated with prediction of obstructive sleep apnea severity.
English-language searches of PubMed, MedLine, and the Cochrane database. Reference sections of identified studies were examined for additional articles.
Databases through December 2011 were searched, combined with review of relevant article bibliographies, and assessed by 4 reviewers. Systematic review and random-effects meta-analysis of studies evaluating tongue position and obstructive sleep apnea severity were performed. Outcomes were reported as correlations.
Ten studies met inclusion criteria and had data for pooling (2513 patients). Friedman tongue position and Mallampati classification were significantly associated with obstructive sleep apnea severity, with a correlation of 0.351 (0.094-0.564, P = .008). Analysis of the correlation of tongue position with obstructive sleep apnea severity reveals correlations of 0.184 (0.052, 0.310, P = .006) and 0.388 (0.049, 0.646, P = .026) for the Mallampati classification and Friedman tongue position, respectively. Publication bias does not yield a significant Egger regression intercept; however, 4 imputed values to the right of the mean were found using Duval and Tweedie's trim-and-fill method, yielding an overall correlation of 0.498 (confidence interval = 0.474-0.521).
The Mallampati classification and Friedman tongue position assessment techniques are significantly correlated with predicting obstructive sleep apnea severity. Publication bias does not significantly affect our results. The strength of this correlation is higher for Friedman tongue position, although 95% confidence intervals for the respective correlation coefficients overlap.
Introduction: The Modified Mallampati (MM) grading and Friedman’s Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current ...descriptions of performing these scores do not specify the route of breathing taken by the patient during the examination. The dynamic changes in the tongue and palate, in relation to the route of breathing, may contribute to the high interobserver variability in MM scoring. Aim: To explore the differences in MM scores and Friedman’s scores obtained during mouth breathing and nose breathing in order to standardise the scoring system. Materials and Methods: A community-based cross-sectional study was conducted at the Departments of Anaesthesiology and Community Medicine at Believers Church Medical College Hospital in Central Kerala, India between April 2022 and October 2022, on 702 adults. MM scores and FTP scores were recorded separately for each person during mouth breathing and nose breathing. Socio-demographic variables such as age, gender, and Body Mass Index (BMI) were also collected. The data was analysed using the Z-test for proportions. Results: The mean age of the study participants was 3.58±16.42 years. The majority of the participants were females (69.2%), and more than half (59%) were above 50 years of age. Out of the 135 participants with an MM Score-1 during mouth breathing, 99 (73.3%) had higher scores during nose breathing. For the 196 individuals with an MM Score-2 during mouth breathing, 87 (44.3%) had higher scores during nose breathing. Similarly, out of the 220 people with an MM score of -3 during mouth breathing, 106 (48.2%) had a Score-4 during nose breathing. A similar pattern was observed for the FTP scores. Conclusion: The present study demonstrates significant variability in MM and FTP scores obtained during oral and nasal breathing, highlighting the need to standardise the route of breathing during examination. The study suggests that advising patients to breathe through the mouth may relax the tongue and improve the predictive value of MM grading.
We hypothesize that the control of tongue position using a newly developed tongue position retainer, where the tongue is held in a protruded position (i.e., intervention A) or in its resting position ...(i.e., intervention B), is effective for maintaining upper airway patency in obstructive sleep apnea (OSA) compared with no control of tongue position. This is a randomized, controlled, non-blinded, crossover, and two-armed trial (i.e., sequence AB/BA) in 26 male participants (i.e., sample size) who are scheduled to undergo a dental operation under intravenous sedation with OSA (10 ≤ respiratory event index < 30/h). Participants will be randomly allocated into either sequence by a permuted block method, stratified by body mass index. Under intravenous sedation, participants will undergo two interventions, separated by a washout period after receiving intervention A or intervention B using a tongue position retainer after baseline evaluation, before each intervention is provided. The primary outcome is the abnormal breathing index of apnea as determined by the frequency of apnea per hour. We expect that, compared with no control of tongue position, both intervention A and intervention B will improve the abnormal breathing events with superior effects achieved by the former, offering a therapeutic option for OSA.
Purpose
The aim of this prospective study was to investigate associations between nasal/oropharyngeal structures and a range of factors including age, gender, daytime sleepiness, and body mass index ...(BMI).
Methods
Patients with OSA were prospectively selected as research participants in rhinomanometric analysis as well as for otolaryngological evaluation. Participants were grouped as follows according to their apnea/hypopnea index (AHI) scores: no OSA (AHI < 5), mild OSA (5 ≤ AHI ≤ 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). One-way analysis of variance (ANOVA), Kruskal–Wallis
H
, and Mann–Whitney
U
tests were performed to assess OSA severity in terms of the relationships between nasal resistance (NR) and anthropometric indices (body mass index (BMI), Friedman tongue position (FTP)), age, and gender.
Results
The study cohort of 177 men and 81 women ranged in age between 21 and 76 years, with BMI ranging from 23 to 45. In total, 37 patients were simple snorers (AHI < 5), and 221 patients were diagnosed with OSA. There was no significant difference among the AHI groups in terms of nasal volume (Vol05) (
p
= 0.952), mean flow (
p
= 0.778), and mean NR total (
p
= 0.723). A statistically significant difference was found between the AHI groups in terms of mean BMI and median FTP scores (
p
< 0.001).
Conclusion
This study provides evidence that that the oropharyngeal region (oropharynx, tongue, and vallecula) is a more important determinant of OSA severity than the nasal region.
Obstructive Sleep Apnea Syndrome (OSAS) is a relevant public health problem; dentists can play an important role in screening patients with sleep disorders by using validated tools and referring ...patients to a specialist, thereby promoting an interdisciplinary approach. The aim of the study is to identify if the OSAS severity, measured by the apnea-hypopnea index (AHI), and some anthropometric measurements are associated with the Friedman Tongue Position (FTP) within a population with dysmetabolic comorbidities.
A questionnaire containing information about clinical data including height, weight, Body Mass Index (BMI), neck circumference, waist circumference, hip circumference and FTP was administered. The AHI value was measured by means of an unattended home polysomnography device. Pearson correlation coefficients were calculated, and Kruskal-Wallis, Kolmogorov-Smirnov (both nonparametric) and independence tests were performed to probe the possible relationships. The significance was set at
≤ 0.05.
A total of 357 subjects were analyzed. The association between the FTP and AHI was not statistically significant. On the contrary, the AHI showed a positive correlation with BMI and neck circumference. A statistically significant association between the number of subjects with a larger neck and an increasing FTP class was found. BMI, neck, hip and waist circumference was associated with the FTP scale.
although the FTP was not directly associated with OSAS severity, there was also evidence that an FTP increase is associated with an increase in the considered anthropometric parameters, and FTP can be a clinical tool used in the assessment of risk for OSAS risk factors.
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