NA.

Objectives/Hypothesis: Use of the Muller maneuver (MM) in the evaluation of patients with obstructive sleep apnea is controversial. One criticism of this test is that it is somewhat subjective. Our objective is to explore the reliability of this technique and its association with sleep-disordered breathing. Study Design: Prospective study performed in an academic tertiary care center. Methods: An analysis of MM scores from 180 consecutive patients obtained independently by two examiners was completed. These scores were compared with each other and with the apnea-hypopnea index (AHI) obtained from polysomnographic studies. Results: Collapse of the soft palate (PAL), lateral pharyngeal wall (LPW), and base of the tongue (BOT) was rated on a five-point scale (0 -4). The mean scores determined by the faculty examiner were 2.47, 2.06, and 1.58, respectively; the mean scores determined by the resident examiner were 2.34, 2.25, and 1.48, respectively. The scores of the two examiners correlated to within ؎1 unit 83.9% of the time at the PAL, 91.1% at the LPW, and 85.0% at the BOT. The degree of correlation was not influenced by year of training of the resident. When the AHI was converted to a four-point scale based on severity, the score correlated within ؎1 of the average MM score 72.1% of the time. Conclusions: Despite the subjective nature of the MM, the five-point scale can be used by independent examiners to achieve an evaluation of the upper airway that is reproducible. The preoperative severity of sleep-disordered breathing based on the AHI is moderately correlated with the MM score. Key Words: Sleep-disordered breathing, obstructive sleep apnea, Muller maneuver, inter-rater reliability.

No abstract

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