Background 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. Methods Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient‐reported outcome measures. Results In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue‐tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications. Conclusion Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited. Level of Evidence 3

Background 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). Objective 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. Study Design Cross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population. Methods Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate. Results There was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R2 0.31 vs 0.05, P < .0001). Conclusions This study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility.

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.

Objectives: Subjective assessment of nasal obstruction with patient-reported outcome measures such as visual analogue scale and NOSE score may be limited in chronic mouth breathing subjects who are not consciously aware of nasal breathing difficulties. This study investigates a simple objective screening tool to assess the capacity for comfortable nasal breathing that is based on sealing the lips and mouth with tape and assessing whether the subject can breathe comfortably through the nose for up to three minutes. Method: Cross-sectional, multi-center cohort study with 663 participants (ages: 3-83 years, 50.5% female). Lips were gently sealed using MicroPore paper tape; timer was used to assess how long the participants were able to breathe comfortably through the nose for up to 180 seconds. Other measures included subjective rating of perceived difficulty with nasal breathing (VAS, 0-100) as well as self-assessed reports of mouth breathing. Results: There were 9.3% of patients with subjective reports of moderate to severe nasal obstruction (VAS> 50) and 17.2% of patients with predominance of self-reported mouth breathing in this series. Overall, 93.4% of participants successfully passed the nasal breathing test. Among patients with habitual mouth breathing, 83.5% (91/109) were able to breathe comfortably through the nose when instructed to do so for the entire 3-minute duration tested. Similarly, there were 67% (40/59) patients with VAS score >50 who could breathe comfortably through the nose for >180 seconds despite subjective reports of moderate to severe nasal obstruction. Participants unable to breathe exclusively through the nose for 180 seconds had increased likelihood of mouth breathing while awake (OR 4.12, 95% confidence interval 2.14-7.89, p<.0001) as well as increased odds of mouth breathing while asleep (OR 3.05, 95% confidence interval 1.61-5.72, p=0.0003). Conclusion: 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.