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MATRIX RELOADEDMATRIX RELOADED
B+M mode echomyography ofB+M mode echomyography of
tongue – A new technique withtongue – A new technique with
ultra sonogramultra sonogram
www.indiandentalacademy.com

AIM OF THE STUDY:AIM OF THE STUDY:
 To assess the relationship of movement of
tongue during swallowing in different
dentofacial forms.
 To evaluate the applicability of B+M mode
ultrasonography in studying the above two
To understand the amplitude of
tongue movements during swallowing
and its relationship to vertical facial
disproportions.www.indiandentalacademy.com

The tongue is a muscular organ and forms an important
aspect of the neuromuscular balance.
Deglutition:
Phases of swallow:
Oral phase: When the food is ready for swallowing, it is
voluntarily squeezed or rolled posteriorly in the mouth
by pressure of the tongue upwards and backwards
against the palate.
Thus the tongue forces the bolus of
food into the pharynx.This is the
phase which is being studied in
ultrasonography technique.

Oral Phase: On the basis of M mode echomyography images, the
swallowing phase is interpreted and divided into three phases.
I phase – Shovel phase – When the tip of tongue is resting on the
palate
II phase – Transport phase – When the body of the tongue is on
the palate.
III phase – Final phase - When the base of tongue is on the
palate

Historical Perspective of
Ultrasound
 PIERRE CURIE, 1880 -PIEZOELECTRIC EFFECT-
When mechanical stress is applied to a quartz crystal , it
produced electric potential. REVERSE PIEZOELECTRIC
EFFECT-By applying silver to the face of the crystal and
inducing pressure, mechanical changes occurs in the crystal
producing sound waves

Historical Perspective of
Ultrasound
 This effect is the basis for the function of “ULTRA-
SONOGRAM” .
 “TRANSDUCERS”or “SOFT TISSUE PROBES”produce
this effect by coating silver on synthetic ceramic crystals.

Physics Of Sound
What are sound waves and how do
they propagate…?

Physics Of Sound
 Sound waves are mechanical disturbances
propagating through a medium , by virtue of vibrating
the molecules in the medium and henceforth, moving
forwards.
 The speed at which the sound waves travel, depends on
the property of the medium ( Elastic, Rigid or Dense).
 Sound waves travel in different ways
-Parallel ---- Longitudinal waves
-Perpendicular---- Transverse
waves www.indiandentalacademy.com

Physics Of Sound
 Audible range of the sound waves is between 15Hz &
20KHz , the “AUDIBLE FREQUENCY”
 If the frequency is below 15Hz, it is “INFRASONIC
FREQUENCY”
 If the frequency is more than 20KHz, it is
ULTRASONIC FREQUENCY

Physics Of Ultrasound
 Ultrasound primarily functions using the principle
of sound wave propagation.
 Ultrasound uses a range between 1 & 10 MHz by
longitudinal sound wave propagation.
 There are 4 types of modes
1. A-- Mode (Amplitude Mode):the sweep
and amplitude are assessed on the
oscilloscope or screen.www.indiandentalacademy.com

2. B- Mode - Brightness mode : the
brightness of the sound wave is assessed on the
oscilloscope or screen.
3. M-Mode -Motion mode : it is used to
correlate the position & the time of the object in
motion - primarily used in Cardiac structures .
4. G-Mode -Gray scale mode : it is used mainly
to find the soft-tissue structures.

ATL – Advanced Technologies
Limited – USA
HDI – High definition image
1500
Transducer – 5 – 12 Mhz
Linear– soft tissue probe
Printer – Sony thermal printer -
Japan
Materials and Methods:

Subjects of age group 22 to 28 yrs were
selected.
No craniofacial deformities.
Grouped under three categories: ( sample size
of 5 each ).
High angle – More than 30 degrees FMA
Low angle - Less than 20 degrees FMA
Average FMA subjects.

Cephalometric values
Average Low High
FMA 25 19 32
GoGnSn 31 25 40
ANS - Me 61 51 68
Bjorks sum
of angles
395 380 405

Results:
Average
FMA
Resting Contraction Amplitude
Phase I 24.4mm 32.3mm 7.9mm
Phase II 32.3mm 38.7mm 6.4mm
Phase III 25.8mm 20.2 mm 5.6mm

Low
FMA
Phase III 11.1mm 9.1mm 2mm
Results:

High
FMA
Phase III 23.7mm 10.9mm 12.8mm
Results:

0
2
4
6
8
10
12
14
AVG LOW HIGH
I
II
III

Inference:
Results suggest the following trends:
•Subjects with high FMA have greater
amplitude of contractions of tongue
musculature .
•Subjects with low FMA have lesser
amplitude of contractions of tongue
musculature.

Subjects with high amplitude of contractions
during swallow tend to have deeper palatal
vaults, increased mandibular lengths , long
lower faces, increased mandibular planes ,
raised anterior lower facial heights.
Subjects with low amplitude of
contractions during swallow have shallow
palatal vaults, decreased lower anterior
facial heights and short lower faces.

Uses of echomyography of tongue :
For Evaluation of abnormal muscular contraction in patients
with altered neuromuscular balance.
Anterior Open Bite
 Increased or diminished Lower anterior facial height
To assess neuromuscular imbalance in post orthognathic
patients where facial heights are altered.
Sagittal and transverse correction of maxilla and mandible
by growth modulation or surgery in Class II or Class III
subjects.
In Asymmetry patients with dentofacial deformities.

The role of intrinsic control mechanism in the outcome of
functional appliance treatment was mentioned by BIMLER
with the tongue being a major player in it.
The role of the tongue (forming a part of the neuro muscular
environment) in relapse is widely accepted
The above two reasons do underline the importance of this
study’s observation which definitely has to be followed up with
studies
to observe the relationship between the amplitude of tongue
contractions with
1) the outcome of the treatment and
2) stability of the result

This technique could be recommended as
a valuable tool for differential diagnosis
and etiological studies of tongue
dysfunctions, understanding the
physiology of swallowing and speech and
related research.
Conclusion

YYOUOU

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