The following is a list of scientific articles, case studies, opinion articles, and other resources that correspond to the airway health, myofunctional therapy, sleep disordered breathing, and dental modalities that address these airway challenges. None of these articles reflect Dr. Trino‘s opinions or MiBöca Dentistry‘s opinions, but they are important to read and understand these articles for the evidence-based practitioner. You may click on the links to go directly to the source, and you are encouraged to do so.
The Research : Airway & Sleep Studies
Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.
Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep. 2015 May 1;38(5):669-75. doi: 10.5665/sleep.4652. PMID: 25348130; PMCID: PMC4402674.
Objective: To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data.
Yoon A, Zaghi S, Weitzman R, Ha S, Law CS, Guilleminault C, Liu SYC. Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects. Sleep Breath. 2017 Sep;21(3):767-775. doi: 10.1007/s11325-016-1452-7. Epub 2017 Jan 17. PMID: 28097623.
Objective: Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility.
Chirag Govardhan, Janine Murdock, Leyli Norouz-Knutsen, Sanda Valcu-Pinkerton, Soroush Zaghi. Lingual and Maxillary Labial Frenuloplasty with Myofunctional Therapy as a Treatment for Mouth Breathing and Snoring. https://doi.org/10.1155/2019/3408053. 2019 March;10
Objective: Chronic mouth breathing may adversely affect craniofacial development in children and may result in anatomical changes that directly impact the stability and collapsibility of the upper airway during sleep. Mouth breathing is a multifactorial problem that can be attributed to structural, functional, and neurological etiologies, which are not all mutually exclusive. While therapeutic interventions (myofunctional, speech and swallowing, occupational, and craniosacral therapy) may address the functional and behavioral factors that contribute to mouth breathing, progress may sometimes be limited by restrictive lingual and labial frenum that interfere with tongue and lip mobility. This case report explores the case of a three-year-old girl with mouth breathing, snoring, noisy breathing, and oral phase dysphagia that was successfully treated with lingual and labial frenuloplasty as an adjunct to myofunctional therapy. Within four days of the procedure, the patient had stopped snoring and demonstrated complete resolution of open mouth breathing. The patient was also observed to have increased compliance with myofunctional therapy exercises. This report highlights the effectiveness of surgical interventions to improve the efficacy of myofunctional therapy in addressing open mouth posture and low tongue resting position.
Camacho M, Noller MW, Del Do M, et al. Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis. Otolaryngology–Head and Neck Surgery. 2019;160(4):580-593. doi:10.1177/0194599818815158
Objective: To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA).
Changing practice: Trends in skeletal surgery for obstructive sleep apnea
Michael Awad, Christopher Gouveia, Soroush Zaghi, Macario Camacho, Stanley Yung-Chan Liu. Changing practice: Trends in skeletal surgery for obstructive sleep apnea, Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8, 2019, Pages 1185-1189, ISSN 1010-5182, https://doi.org/10.1016/j.jcms.2018.11.005.
Objective: The objective of this study was to systematically review the English literature for articles that have described skeletal surgeries in the treatment of obstructive sleep apnea in both adults and children. From these articles trends and patterns in the treatment of OSA with skeletal procedures are described.
Yoon AJ, Zaghi S, Ha S, Law CS, Guilleminault C, Liu SY. Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional – morphological study. Orthod Craniofac Res. 2017; 20: 237–244. https://doi.org/10.1111/ocr.12206
Objective: To characterize associations between restricted tongue mobility and maxillofacial development.
Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases
Zaghi, S., Valcu-Pinkerton, S., Jabara, M., Norouz-Knutsen, L., Govardhan, C., Moeller, J., Sinkus, V., Thorsen, R.S., Downing, V., Camacho, M., Yoon, A., Hang, W.M., Hockel, B., Guilleminault, C. and Liu, S.Y.-C. (2019), Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases. Laryngoscope Investigative Otolaryngology, 4: 489-496. https://doi.org/10.1002/lio2.297
Objective: Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility.
Speech production in young children with tongue-tie
olly Salt, Mary Claessen, Timothy Johnston, Sharon Smart, Speech production in young children with tongue-tie, International Journal of Pediatric Otorhinolaryngology, Volume 134, 2020, 110035, ISSN 0165-5876, https://doi.org/10.1016/j.ijporl.2020.110035.
Objective: Tongue-tie, or ankyloglossia, occurs in 4–10% of the population. Treatment of tongue-tie has increased by 420% in Australia between 2006 and 2016 and 866% in the United States between 1997 and 2012. Despite limited evidence, it has been suggested that tongue-tie can result in speech sound disorder (SSD). This study aimed to investigate tongue mobility and speech production outcomes in children with and without tongue-tie diagnoses.
Clinical Consensus Statement: Ankyloglossia in Children
Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 May;162(5):597-611. doi: 10.1177/0194599820915457. Epub 2020 Apr 14. PMID: 32283998.
Objective: To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements.
Yoon A, Guilleminault C, Zaghi S, Liu SY. Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor. Sleep Med. 2020 Jan;65:172-176. doi: 10.1016/j.sleep.2019.06.002. Epub 2019 Jun 13. PMID: 31606311.
Objective: This study correlates objective and subjective measurements associated with obstructive sleep apnea (OSA) to define the efficacy of Distraction Osteogenesis Maxillary Expansion (DOME) to treat adult OSA patients with narrow maxilla and nasal floor.
Assessment of Nasal Breathing Using Lip Taping: A Simple and Effective Screening Tool
Zaghi, Soroush et al. “Assessment of Nasal Breathing Using Lip Taping: A Simple and Effective Screening Tool.” International Journal of Ophthalmology 6 (2020): 10.
Objective: Objectively testing whether a subject can breathe through the nose with the lips and mouth taped for three minutes can identify patients at risk of mouth breathing and is a simple and effecting screening tool to distinguish organic nasal obstruction from functional mouth breathing habit and or nasal resistance.
Chen, Y.F., Ko, E.C., Zaghi, S. et al. Optimizing mandibular sagittal split of large maxillomandibular advancements for obstructive sleep apnea: patient and surgical factors. Clin Oral Invest 24, 1359–1367 (2020). https://doi.org/10.1007/s00784-019-03017-5
Objective: Maxillomandibular advancement (MMA) confers consistent and high rates of surgical success for obstructive sleep apnea (OSA). In the era of value-based medicine, identifying factors that affect the stability of rigid fixation and allow rapid return to function are important targets for improvement. The aim of this study was to identify patient and surgical factors associated with mandibular sagittal split outcomes associated with optimal postoperatively skeletal stability.
Lacking Consensus: The Management of Ankyloglossia in Children
Ghaheri BA, Tylor DA, Zaghi S. Lacking Consensus: The Management of Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 Nov;163(5):1064. doi: 10.1177/0194599820937299. PMID: 33137275.
Objective: We would like to commend the authors on their effort to develop a Clinical Consensus Statement (CCS) on ankyloglossia in children. 1 It was necessary and important for the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) to recognize ankyloglossia as a significant medical condition that otolaryngologists should diagnose, treat, and study. The CCS is a description of the opinions of an invited expert panel of pediatric otolaryngologists, but it suffers from a high degree of confirmation bias. We are concerned that most will come away with a skeptical view of a very real issue, much to the detriment of vulnerable mother-infant dyads and other patients who look to us for help and healing.
Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis
Burgos-Sanchez C, Jones NN, Avillion M, et al. Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery. 2020;163(6):1078-1086. doi:10.1177/0194599820931087
Objective: To systematically review the international literature for studies evaluating the effect of alcohol consumption on the occurrence and severity of snoring and obstructive sleep apnea and to use the available data to perform a meta-analysis.
James S. Oh, Soroush Zaghi, Nora Ghodousi, Cynthia Peterson, Daniela Silva, Gilles J. Lavigne, Audrey J. Yoon, Determinants of probable sleep bruxism in a pediatric mixed dentition population: a multivariate analysis of mouth vs. nasal breathing, tongue mobility, and tonsil size, Sleep Medicine, Volume 77, 2021, Pages 7-13, ISSN 1389-9457, https://doi.org/10.1016/j.sleep.2020.11.007.
Objective: This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of ‘probable’ sleep bruxism in children.
The Value of Oxygen Desaturation Index for Diagnosing Obstructive Sleep Apnea: A Systematic Review
Rashid, N.H., Zaghi, S., Scapuccin, M., Camacho, M., Certal, V. and Capasso, R. (2021), The Value of Oxygen Desaturation Index for Diagnosing Obstructive Sleep Apnea: A Systematic Review. The Laryngoscope, 131: 440-447. https://doi.org/10.1002/lary.28663
Objective: Intermittent hypoxemia is a risk factor for developing complications in obstructive sleep apnea (OSA) patients. The objective of this systematic review was to identify articles evaluating the accuracy of the oxygen desaturation index (ODI) as compared with the apnea–hypopnea index (AHI) and then provide possible values to use as a cutoff for diagnosing adult OSA.
Zaghi S, Shamtoob S, Peterson C, et al. Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia. J Oral Rehabil. 2021; 48: 692–700. https://doi.org/10.1111/joor.13144
Objective: A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one-third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two-thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual-palatal suction (LPS). This study aims to explore the utility and normative values of TRMR-LPS as an adjunct to functional assessment of tongue mobility using TRMR-TIP.
Oh, James S.; Zaghi, Soroush; Peterson, Cynthia; Law, Clarice S.; Silva, Daniela; Yoon, Audrey J.; Pediatric Dentistry, Volume 43, Number 4, July-August 2021, pp. 262-272(11) American Academy of Pediatric Dentistry
Objective: The purpose of this study was to identify patterns of functional, extraoral, and intraoral examination characteristics that correlate with increased risk of sleep disturbances and develop a functional airway screening tool to help clinicians for early diagnosis of pediatric sleep-disordered breathing.
Richard T. Baxter, Soroush Zaghi, Ashley P. Lashley, Safety and efficacy of maxillary labial frenectomy in children: A retrospective comparative cohort study, International Orthodontics, Volume 20, Issue 2, 2022, 100630, ISSN 1761-7227, https://doi.org/10.1016/j.ortho.2022.100630.
Objective: Maxillary frenectomy in children is a common procedure, but concerns about scar tissue affecting diastema closure prevent many clinicians from treating prior to orthodontics. To determine if maxillary frenectomy is safe and if diastema size is affected by early treatment.
Summersgill, I., et al. (2023). Muscle tension dysphonia in singers and professional speakers with ankyloglossia: Impact of treatment with lingual frenuloplasty and orofacial myofunctional therapy. International Journal of Orofacial Myology and Myofunctional Therapy, 49(1), 1-8.
Objective: Muscle tension dysphonia (MTD) describes a condition affecting the feeling or quality of the voice due to increased muscle tension in and/or around the neck and larynx. Ankyloglossia is a condition of restricted tongue mobility that has been shown to be associated with increased muscle tension. This case series explores outcomes for voice users with MTD who have been treated for ankyloglossia.
Does Head and Neck Posture Affect Cone-Beam Computed Tomography Assessment of the Upper Airway?
Kevin Coppelson, Isabella Summersgill, David Hatcher, Gloria Nguyen, Hilary Pada, Hal Stewart, Tim Herre, Michael Hansen, Soroush Zaghi, Does Head and Neck Posture Affect Cone-Beam Computed Tomography Assessment of the Upper Airway?, Journal of Oral and Maxillofacial Surgery, Volume 81, Issue 6, 2023, Pages 721-733, ISSN 0278-2391, https://doi.org/10.1016/j.joms.2023.01.016.
Objective: Radiographic analysis is often used as a screening tool to assess for risk of sleep-related breathing disorders. This study aimed to address 2 questions: (1) Does head posture significantly affect the minimum cross-sectional area (MCA)? and (2) Is the NBC3 (nasion-basion-C3) angle a reliable measurement to control for alteration of head position in cone-beam computed tomography (CBCT) scans?
Baxter R, Merkel-Walsh R, Lahey L, Knutsen C, Zaghi S. The buccal frenum: Trends in diagnosis and indications for treatment of buccal-ties among 466 healthcare professionals. J Oral Rehabil. 2024; 51: 369-379. doi:10.1111/joor.13609
Objective: The buccal frenum is connective tissue that adheres the mucosa of the cheek to the alveolar process. When restricted, this condition is commonly known as a buccal- or cheek-tie. Restrictive buccal frena are often treated during tongue- and lip-tie procedures, yet widely accepted classification, diagnostic and treatment guidelines are lacking. Provide a scoping review on the evaluation and management of buccal-ties, including diagnosis, classification, symptoms and treatment, by surveying healthcare providers with experience evaluating and managing oral restrictions.
