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AUTHORS: Richard Baxter | Robyn Merkel‐Walsh | Lisa Lahey | Chad Knutsen | Soroush Zaghi
HIGHLIGHTS: 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.
Date Published: October 12, 2023

AUTHORS: Isabella Summersgill | Gloria Nguyen | Cullen Grey | Leyli Norouz-Knutsen | Robyn Merkel-Walsh | Christine Katzenmeir | Benjamin Rafii | Soroush Zaghi

HIGHLIGHTS: 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.

Date Published: 2023

AUTHORS: James S Oh | Soroush Zaghi | Cynthia Peterson | Clarice S Law | Daniela Silva | Audrey J Yoon

HIGHLIGHTS: 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. Methods: From March 2018 until March 2019, a cross-sectional study was conducted of 96 mixed dentition children during dental examinations at the UCLA pediatric dental clinic. Outcome measures included a sleep index score by the Sleep Disturbance Scale for Children (SDSC) completed by parents. Clinical assessment tool measurements assessing functional, extraoral, intraoral soft tissue, and intraoral hard tissue determinants were recorded during a routine dental examination by pediatric dental residents. Results: The mean age was 8.9 years (±1.9 years standard deviation), with 46 males and 50 females …

Date Published: July 15, 2021

AUTHORS: Nur HA Rashid | Soroush Zaghi | Marcelo Scapuccin | Macario Camacho | Victor Certal | Robson Capasso

HIGHLIGHTS: 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.

Date Published: January 2, 2021

AUTHORS: James S Oh | Soroush Zaghi | Nora Ghodousi | Cynthia Peterson | Daniela Silva | Gilles J Lavigne | Audrey J Yoon

HIGHLIGHTS: This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of ‘probable’ sleep bruxism in children.

Date Published: January 1, 2021

AUTHORS: Bobak A Ghaheri | Dale A Tylor | Soroush Zaghi

HIGHLIGHTS: 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.

Date Published: November 2020

AUTHORS: Yu Feng Chen | Edward Chengchun Ko | Soroush Zaghi | Audrey Yoon | Ryan Williams | Robert Riley | Stanley Yung-Chuan Liu

HIGHLIGHTS: 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.

Date Published: March 2020

Assessment of Nasal Breathing Using Lip Taping: A Simple and Effective Screening Tool

AUTHORS: Soroush Zaghi | Cynthia Peterson | C Shamtoob | Brigitte Fung | DKK Ng | Triin Jagomagi | Nicole Archambault | Bridget O’Connor | Kathy Winslow | Zahra Peeran

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

Date Published: February 24, 2020

AUTHORS: Holly Salt | Mary Claessena | Timothy Johnsto | Sharon Smart

HIGHLIGHTS: 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.

Date Published: July 2020

AUTHORS: AJ Yoon | S Zaghi | S Ha | CS Law | C Guilleminault | SY Liu

HIGHLIGHTS: We eat and speak with them, but our tongues may be even more important than we think. In a condition called ankyloglossia, also known as tongue-tie, the tongue is tethered more tightly than normal to the bottom of the mouth by the lingual frenulum. While this is usually considered relatively harmless, new work from dental and sleep experts at UCLA and Stanford suggests tongue mobility is critical for proper development of the jaw and facial tissues … In the study, researchers evaluated tongue mobility in 302 patients using the Tongue Range of Motion Ratio and the Kotlow free tongue measurement. All measurements were performed in triplicate to ensure consistency and accuracy. Each participant also had dental casts made and X-rays taken to capture anatomical features of the teeth, mouth, and face.

Date Published: September 20, 2019

AUTHORS: Michael Awad | Christopher Gouveia | Soroush Zaghi | Macario Camacho | Stanley Yung-Chan Liu

HIGHLIGHTS: 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.

Date Published: August 1, 2019

Lingual And Maxillary Labial Frenuloplasty With Myofunctional Therapy As A Treatment For Mouth Breathing And Snoring

AUTHORS: Chirag Govardhan | Janine Murdock | Leyli Norouz-Knutsen | Sanda Valcu-Pinkerton

| Soroush Zaghi

HIGHLIGHTS: 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.

Date Published: March 10, 2019

AUTHORS: Chirag Govardhan | Janine Murdock | Leyli Norouz-Knutsen | Sanda Valcu-Pinkerton

AUTHORS: Macario Camacho, MD, 1 Victor Certal, MD, 2 Jose Abdullatif, MD, 3 Soroush Zaghi, MD, 4 Chad M. Ruoff, MD, RPSGT, 1 Robson Capasso, MD, 5 and Clete A. Kushida, MD, PhD1

HIGHLIGHTS: 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.

Date Published: May 1, 2015

| Soroush ZaghiDate Published: March 10, 2019

AUTHORS: Kevin Coppelson | Isabella Summersgill | David Hatcher | Gloria Nguyen | Hilary Pada | Hal Stewart | Tim Herre | Michael Hansen | Soroush Zaghi

HIGHLIGHTS: 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?

Date Published: June 1, 2023

AUTHORS: Richard T Baxter | Soroush Zaghi | Ashley P Lashley


  • Early treatment of a lip-tie does not form scar tissue that prevents diastema closure.

  • Treating lip-tie in the primary dentition yields present and future cosmetic benefits.

  • Treatment of a maxillary frenum provides benefits to families with minimal risks.

  • Providers should consider treating a lip-tie for oral hygiene or cosmetic concerns.

  • Treatment of a frenum can occur before or after orthodontics if it causes a problem.

Date Published: June 1, 2022

AUTHORS: Soroush Zaghi | Shayan Shamtoob | Cynthia Peterson | Loree Christianson | Sanda Valcu‐Pinkerton | Zahra Peeran | Brigitte Fung | Daniel Kwok‐keung Ng | Triin Jagomagi | Nicole Archambault | Bridget O’Connor | Kathy Winslow | Miche’ Lano | Janine Murdock | Lenore Morrissey | Audrey Yoon

HIGHLIGHTS: 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).

Date Published: January 1, 2021

AUTHORS: Joy L Moeller | Cynthia Peterson | Licia Coceani Paskay | Samantha D Weaver | Soroush Zaghi

HIGHLIGHTS: Patients who undergo maxillary mandibular advancement surgery often develop swelling, facial numbness, oral incompetence, drooling, difficulty with mouth opening, and nasal obstruction. Myofunctional and physical therapy can be used before surgery to identify and eliminate potential barriers to successful outcomes, work to identify hurtful habits, educate and empower the patient, and begin to establish healthy habits, postures, and movement patterns. Post-surgical therapy helps maximize the benefits of surgery by restoring motion, strength, and establishing healthy postures, habits, and normal oral and masticatory function, as well as to re-pattern the stomatognathic functions of the oral facial muscles. Rehabilitation by a skilled team of professionals is critical to optimizing long-term success and can significantly improve airway patency, functional, orthodontic, and aesthetic outcomes after surgery. This …

Date Published: 2021

AUTHORS: Christian Burgos-Sanchez | Nolan N Jones | Michael Avillion | Steven J Gibson | Jagatkumar A Patel | John Neighbors | Soroush Zaghi | Macario Camacho

HIGHLIGHTS: 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.

Date Published: December 2020

AUTHORS: Weitao Wang, Aurora Vincent, Jason Cohn, Sameep Kadakia, Yadranko Ducic, T Reuther, T Schuster, U Mende, A Kübler, J Thorn, H Hansen, L Specht, L Bastholt, A Vissink, F Burlage, F Spijkervet, J Jansma, R Coppes, B Jereczek-Fossa, R Orecchia, S Delanian, J Lefaix, B Beadle, K Liao, M Chambers, N Rice, I Polyzois, K Ekanayake, O Omer, L Stassen, B Raggio, R Winters, R Marx, M Buglione, R Cavagnini, F Di Rosario, J Dhanda, D Pasquier, L Newman, R Shaw, R Marx, R Johnson, S Hao, H Chen, F Wei, C Chen, A Yeh, J Su, A Shaha, P Cordeiro, D Hidalgo, Y Chang, E Santamaria, F Wei, N Celik, F Wei, H Chen, O Coskunfirat, F Wei, W Huang, M Cheng, W Yang, Y Chang, A Lyons, N Ghazali, S Delanian, J Lefaix, A Lyons, P Brennan, D Costa, T Costa, E Netto, L Levi, R Lalla, T Wang, C Liu, T Chao, T Chen, Y Hu, S Nabil, N Samman, J Rivero, O Shamji, A Kolokythas, C Powell, C Chang, S Naguwa, G Cheema, M Gershwin, B Goldwaser, S Chuang, L Kaban, M August, P Brennan, K Bradley, M Brands, F Caparrotti, S Huang, L Lu, F De Felice, D Musio, V Tombolini, F Butler Jr, C Hagan, H Murphy-Lavoie, J Dhanda, T Hall, A Wilkins, V Mason, J Catling, A Kanatas, D Lowe, J Harrison, S Rogers, M Bennett, J Feldmeier, N Hampson, R Smee, C Milross, A Sultan, G Hanna, D Margalit, S Cheng, J Lee, L Ting, H Gavriel, E Eviatar, R Abu Eta, R Shaw, L Forner, C Butterworth, H Fan, S Kim, Y Cho, M Eo, S Lee, K Woo, S Delanian, C Chatel, R Porcher, J Depondt, J Lefaix, S Delanian, R Porcher, S Balla-Mekias, J Lefaix, S Delanian, J Depondt, J Lefaix, J Suh

HIGHLIGHTS: The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primary site of malignancy. Osteoradionecrosis (ORN) of the facial bones, in particular the maxilla, is a debilitating complication of radiation therapy. Exposure to ionizing radiation results in devitalization of underlying bone with necrosis of adjacent soft tissue. Controversy surrounding appropriate early intervention in ORN persists and no consensus for clinical treatment has been established. In the present article, we review the pathophysiology of maxillary ORN and discuss the role of both conservative medical therapy and reconstruction.

Date Published: May 1, 2020

AUTHORS: Audrey Yoon | Christian Guilleminault | Soroush Zaghi | Stanley Yung-Chuan Liu

HIGHLIGHTS: 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.

Date Published: January 1, 2020

AUTHORS: Anna H Messner | Jonathan Walsh | Richard M Rosenfeld | Seth R Schwartz | Stacey L Ishman | Cristina Baldassari | Scott E Brietzke | David H Darrow | Nira Goldstein | Jessica Levi | Anna K Meyer | Sanjay Parikh | Jeffrey P Simons | Daniel L Wohl | Erin Lambie | Lisa Satterfield 

HIGHLIGHTS: 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.

Date Published: April 14, 2020

AUTHORS: Soroush Zaghi MD | Sanda Valcu‐Pinkerton RDH‐AP | Mia Jabara BS | Leyli Norouz‐Knutsen BA | Chirag Govardhan BS | Joy Moeller RDH | Valerie Sinkus PT | Rebecca S. Thorsen MS, CCC‐SLP | Virginia Downing RDH | Macario Camacho MD | Audrey Yoon DDS, MS | William M. Hang DDS, MSD | Brian Hockel DDS | Christian Guilleminault DM, MD | Stanley Yung‐Chuan Liu MD, DDS

HIGHLIGHTS: 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

Date Published: August 2019

AUTHORS: Macario Camacho | Michael W Noller | Michael Del Do | Justin M Wei | Christopher J Gouveia | Soroush Zaghi | Scott B Boyd | Christian Guilleminault

HIGHLIGHTS: 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).

Date Published: April 2019

AUTHORS: Audrey Yoon | Soroush Zaghi | Rachel Weitzman | Sandy Ha | Clarice S Law | Christian Guilleminault | Stanley Y C Liu

PURPOSE: 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.

Date Published: January 2017

Migraine Patients Find Pain Relief in Electrical Brain Stimulation

AUTHORS: Soroush Zaghi

Date Published: April 19, 2012

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