#lingual anomaly

[velveteencryptid]

Why is it that space vessels are ships and not planes? It's always spaceSHIP, starSHIP, rocketSHIP. Never plane.

There's an easy, obvious argument that they move more like planes, navigating in 3 dimensions, not 2. Using engines not sails.

Still, they're always ships. Always sailing, never flying.

Is it just the romance? The twin magic of adventure mirroring sailing the seas and... sailing the stars? Ships passing in the night, figuratively and literally?

My brain is obsessing over this little language anomaly lately

[ishipgenfics]

You and Your Human: Part 6

Part 1

Part 2

Part 3

Part 4

Part 5

You gently peel your human away from you, limb by limb. It makes a soft whining noise.

"I am sorry," you say, edging away from your human. "I need to go."

Your human seems to collect itself, nodding firmly. "Right. Sorry."

"Captain?" the pilot calls. "You really should come look at this."

You wish you could stay. Your human is breathing heavily, and it looks tense as it shifts along the ground, as if any wrong movement might make it fall over and shatter. But this, whatever it is, is important.

You follow your pilot up to the bridge, where your engineer and scientist are both standing. They nod as you approach. You note vaguely that it is funny, how easy it is to pick up on human quirks.

"We got a messsssssage a few minutesss ago," your engineer explains. Her Pyricese is getting very good. "It is the same word... wordsss?"

"Do you mean phrase?"

"Yes. The same phrase, over and over. Many languages, but same phrase, I think."

"What is it?" you say. There is no voice echoing through the bridge, so your engineer must have shut off the message for now. Unless perhaps the message written, and sent through the controls. You can't really say.

"Do you have a human?" the Sirviles quotes. "That is all."

You stiffen, thinking over all the sentients you have encountered so far. Could one of them have figured out your secret, your human?

Or maybe it is someone you haven't met before. After all, your former customers would know what language you speak.

So. Who is this, and what does it want with a human?

"Do you want me to answer their hail?" the engineer asks.

"Yes, thank you," you say. "Please do."

The big screen that usually shows nothing but blank space and the flicker of stars lights up. A human appears on the screen.

It looks young, probably around the same age as your human, if you had to guess. Its hair is the color of dirty sand, and it is wearing a gray shirt that is definitely too big for it.

Its eyes meet yours, and he says, in pitch-perfect Pyricese, "Do you have a human?"

It starts to repeat it in another pronoun variant, but you hold up a hand and it stops. "I am captain of this vessel, and use she/her pronouns," you say in your native tongue, all lilts and rolls. "What are your pronouns, and what do you want with us?"

The human says nothing.

You frown. "My name is Rhy'cd," you say. You had not gotten the impression that names were of much importance to humans, considering your human's behavior, but perhaps it was simply an anomaly. "Please state your intentions."

The human stayed quiet for a moment longer and then repeated, "Do you have a human?"

You stare. "... that's the only sentence in Pyricese you know, isn't it?"

"Do you have a--"

"Yeah, yeah," you wave your hand and the human stops talking. With a sigh, you switch languages. "Do you speak English?"

The human startles. "Yes, I do. Why do you speak English?"

"I have an personal interest in languages," you reply, which is not technically inaccurate.

"Do you have a human?" the human says again, falling back on its weird catchphrase. You try very hard to focus on the words and not just the way this humans speaks. It is different then your human, faster and smoother, with more heavily accented vowels. A dialect, perhaps? Or could English be this human's second language? The books had implied that Earth was a multi-lingual planet...

"Well?' the human demands, shocking you out of your thoughts. Your ears shoot up, and your fur bristles.

"Why do you want a human?" you ask.

The human does something with its lips, like a smile, but not all the way. "Let's just say... I have a personal interest."

Snarky little-- "I will not give up a member of my crew," you say. "Not without a reason."

The human points at you. "Aha! You do have a human!"

Shit. Shit shit shit shit shit. You try to pull yourself together and deliver some kind of eloquent plea to continue diplomatic talks but what comes out of your mouth is instead, "It wants to be here!"

The human's face shuts down. Completely. You aren't all that good at reading human facial expressions at the best of times(void, you have trouble with it among your own species) but right now you are getting nothing. Except the eyes. Those are filled with cold hard anger. You shiver.

You know humans are predators. But this is the first time you've ever really felt it.

"Wait," you say. "We can talk about this--"

"Will you give me my human?"

... you've had a bad day. You've been a little stressed ever since you woke up, and you really haven't been sleeping enough ever since you started cramming for your human's surprise, and now you're in the middle of a direct confrontation and you're a prey animal, damnit! You aren't meant for this.

And all these things, piled one on top of the other, are slowly wearing down your restraint and making it so that--

Well. When you hear that possessive adjective, your instincts scream.

"Mine."

The human nods, stiffly. "Right then." The screen turns off.

You sink into your chair, wrapping yourself in your tail. No one says anything.

Your engineer is the one to finally break the silence. "Captain? They're charging weapons."

That little tidbit breaks you out of your haze of instincts and failure. Your claws retract and reveal again, scraping against metal. You take a deep breath.

"Pull up the star charts," you order your scientist.

"But--"

"Pull them up!"

"Yes, Captain!"

The screen changed, a sea of empty black appearing. You must have stumbled your way into a dead zone. Damnit. Out of the corner of your eye, you see your engineer frantically fiddling with the controls. The shields around the ship glow brighter, blocking out the first volley of attack. The human's ship pauses, waiting to see what you do. They must not have much ammunition.

"Expand," you order.

There's a slight pause as your engineer taps frantically at the controls before the screen expands wider. You search the void, sharp eyes scanning every inch and-- there!

"My pilot," you say. "Set a course for the star."

There's a flash of bright light, and as your pilot springs to action, feathers rustling, you turn to see your scientist flickering anxiously.

"Can't--danger-- star-- fire,"

"I'm sorry," you say as gently as you can, as the ship hums and starts flying. "We don't really have a choice."

Your scientist growls.

"Captain?" your pilot says. Their voice is ever so slightly higher-pitched than normal, indicating a hint of hysteria, but they seem to be holding together well. "The other ship is following us."

"Are they charging weapons?"

Your engineer snorts. "At this speed? In that ship? No."

The star map comes down, and you see the star quickly approaching. Your ship slows down/

"Shall I stop the ship?" your pilot asks. "We're going to hit the star."

You nod. "That's the point. Keep going."

You fly into the star. Instantly, the ship starts shaking.

"Shields are down!" your engineer yells. "Shields are down!"

"The other ship has stopped following us!" your pilot says.

There is another flash of bright light and your scientist is gone. You look around, but can't see it anywhere.

"Captain?" your engineer says. "The shields are... coming back up. 10 percent... 20 percent... 30 percent... 40 percent... holding steady at 40 percent!"

You peer at the screen. "My scientist?" you say, feeling stupid. "Is that you?"

A shining face appears and nods at you before vanishing, presumably back into the wiring.

Your engineer coughs. "Captain. We are safe for now, but this ship was not made to enter stars. We will need to do repairs before we can continue safely."

You nod numbly. Your ears are low. You think you might be in shock. Or no.

Adrenaline crash, my old friend.

"Captain?" your engineer says. "What do you want me to do?"

Your head feels floaty. "The other ship isn't coming after us."

"That is correct."

You stand up, and wave a paw at everyone. "You all can... do whatever you want then. I'm going to go find my human."

[first-digi-add]

The Rise Of AI in Digital Market: How Artificial Intelligence is Transforming the Industry

In the world of Digital Marketing Services, AI has emerged as a significant game-changer, influencing every aspect of the market and its components. Whether it's optimizing simple email campaigns or developing complex software, AI is a transformative force. This technology plays a crucial role in reshaping the digital marketing landscape, and businesses need to harness its power to stay competitive and effective in reaching their target audience. Explore how AI is shaping the future of digital marketing and discover the many advantages it offers.

Content Categorization and Generation: 

AI carries great potential to select and generate optimal content and it makes it easier for businesses to comprehend target audiences and create personalized content for them according to their taste.  

AI has the ability to  categorize users and their and their preferences according to their demographic, lingual identity  and by their recent activities too for instance people in north india. Get suggestions in their local language and people with English speaking reasons get advertisements in english and a guy recently moved to another city automatically gets suggestions with offers about better stay and dining options in his nearby place. 

Concentrated Digital Advertising: 

AI makes it smooth for businesses to get a clearer insight about the expectations, needs and behavioral patterns of their target customers. AI can easily understand the nature of consumers and how they can be influenced.

Without technology businesses had very limited and outdated ways to reach out to customers like dore to dore marketing by utmost human efforts, but with the help of AI we can get the closest idea to reach out to if a person uses instagram he will get the information about product or services there if he watch videos he can get to know about it there and like that we have numerous options to catch potential buyers with the simple help of AI tools. 

Bettering Customer Relationship Management: 

With the help of access to a huge data set that contains user’s preferences, feedback and other records, AI gets the edge in terms of pleasing customers by offering them what they want. With the help of that business get an idea of what they have to offer very easily. 

This can also help someone who wants to expand their business in a certain area or in a certain group of people, better CRM can give them genuine insight about the quantity of potential buyers with their preferences and expectations.  

By Reducing Cost and Time Complexity:

With the assistance of AI, we can significantly reduce workforce costs from over 1000 employees to just one, and in certain areas, we can effectively eliminate the need for human resources altogether.

Organizations had to put tones of effort to conduct survey and make strategy accordingly and testing their feasibility, this all process drains time and effort and by inclusion of human factor risk of getting anomalies is also a factor, but with the help of AI all of this effort and time cut very optimal extent and that is the measure positive of it. 

This advancement of technology makes many complex jobs very smooth like understanding customers' expectations and their behavior but there's one thing that we have to always keep in mind that AI comes with a disclaimer that it upgrades and improves its operation day by day so if we want to reap all the benefits from it we too should improve our concepts about AI and its modus operandi.  

Conclusion

The advent of AI in digital marketing guarantees a lot of benefits but indicates that after all of this advancement digital marketing services won with the assistance of AI, we can significantly reduce workforce costs from over 1000 employees to just one, and in certain areas, we can effectively eliminate the need for human resources altogether, and it showing us glimpses that the future of digital marketing with inclusion of AI will not be this inexpensive anymore.

[thorntonkrell-blog-blog]

According to legend, Otis Blackwell claimed that he could write a hit song in five minutes. Al Statnton took the dare and shook a bottle of Pepsi Cola. Otis grabbed the challenge and the inspiration and wrote a song about the ancient, primitive, atavistic emotion of sudden love. They threw in a catchy melody and rhythm and the result was "All Shook Up"

They pitched the song to Elvis. He recorded the song on Jan 12, 1957. The session was laid back and the musicians were enjoying themselves. Elvis hiccupped his way through the song with simian sounds like Mm mm oh, oh, yeah, yeah, yeah!

He sings about being a man sitting in a fuzzy tree where he is acting like a shaky wild bug who can't even stand up because his knees are shaking even as he shivers while near a volcano which renders him unable to speak because he's tongue tied and his insides like the leaves on the fuzzy tree and his hands and knees are shaking beyond control and they ain't gonna stop til he gets a kiss from his butter cup.

Yay...Yay

Where once I was quite loquacious and smooth in conversation, I have noticed that I'm beginning to stammer and hiccup and ya know more than I used to when I speak and I might even be swearing more. I'm pretty sure I'm not ankyloglossiac as my frenulum receded correctly in the womb and later on I managed to play Oh Sussanah on the clarinet.

As a teacher,parent and husband, I became accustomed to interruptions while speaking and now on top of all that I'm getting used to contradiction and fact checking as well which compound the challenge of speaking about complex insights. And if I finally connect with the flow of my ideas, I can stumble as my thoughts run faster than my articulation.

All of this is why I write whether I'm falling in love or looking out the window or looking out the window and trying to figure out how our species started talking in the first place and why my mouth feels dry which explains why I need another beer before I write anymore even though I'm not actually speaking but rather typing and thirsty and wanting to be fully prepared in case somebody calls me on the phone and I decide to answer which I tend not to do unless I'm properly hydrated so I'm gonna quit this typing for now and attend to the hydration problem in case somebody calls in the next ten minutes of hour which is far more likely than anybody reading this for at least the next six months and maybe forever etc.

And it took more than five minutes to write.

Speaking about an unfamiliar or complex topic can cause hesitation and difficulty finding the right words, leading to temporary tongue-tiedness. Rapid Thought Processing:

When thoughts are racing faster than one can articulate them, it can cause stumbling over words or pauses to catch up with the flow of ideas. High Stakes or Pressure:

Situations perceived as high-stakes, such as job interviews, important presentations, or confrontational conversations, can increase pressure and lead to hesitant speech. Physical Factors: Fatigue:

Being tired or sleep-deprived can affect cognitive functions, including speech processing and articulation, causing temporary speech difficulties. Dehydration or Dry Mouth:

Lack of adequate hydration can lead to dry mouth, making it harder to speak smoothly and clearly.

The condition known as "tongue-tied," or ankyloglossia, is a congenital anomaly characterized by an unusually short, thick, or tight lingual frenulum — the band of tissue that connects the underside of the tongue to the floor of the mouth. This can restrict the movement of the tongue, leading to difficulties with various oral functions.

Physiological Causes: Lingual Frenulum Development: The lingual frenulum typically recedes and thins during fetal development. However, in individuals with ankyloglossia, this process is incomplete, resulting in a frenulum that remains short, tight, or thick. Genetic Factors: There is evidence to suggest that ankyloglossia can be hereditary. If a family member has the condition, there is a higher likelihood that it will occur in other family members. Effects on Oral Functions: Speech:

Limited tongue mobility can affect the ability to articulate certain sounds, particularly those that require the tongue to touch the roof of the mouth or the back of the teeth, such as 't,' 'd,' 'l,' and 'r.' Feeding:

In infants, ankyloglossia can cause breastfeeding difficulties, as the baby may struggle to latch properly or generate the necessary suction. Oral Hygiene:

Restricted tongue movement can make it difficult to sweep food debris from the teeth and gums, potentially leading to oral hygiene issues. Other Functions:

Activities such as licking, playing wind instruments, and kissing can also be affected due to reduced tongue mobility. Treatment: Surgical Intervention:

Frenotomy: A simple surgical procedure where the frenulum is snipped to release the tongue. Frenuloplasty: A more complex surgery that may be required if the frenulum is particularly thick or if there are additional structural issues. Speech Therapy:

Post-surgery or as an alternative treatment, speech therapy can help improve articulation and oral functions. Assessment:

Early assessment by healthcare providers can help determine the severity of ankyloglossia and the appropriate course of action. Pediatricians, lactation consultants, and speech-language pathologists are often involved in the evaluation and management process. Ankyloglossia can vary significantly in severity, and not all individuals with the condition require treatment. The decision to intervene often depends on the degree to which the restricted tongue movement impacts daily functions and quality of life.

short of ankloglossia what causes temporary tongue tied ness in relation to hesitant speech ChatGPT Temporary tongue-tiedness in relation to hesitant speech is often caused by psychological and situational factors rather than physiological issues like ankyloglossia. Here are some common causes:

Psychological Factors: Anxiety:

When people are anxious or nervous, such as during public speaking, important meetings, or social interactions, they may experience temporary tongue-tiedness. The anxiety can cause physical symptoms like dry mouth, increased heart rate, and muscle tension, affecting speech fluency. Stress:

High levels of stress can lead to cognitive overload, making it difficult to process thoughts quickly and articulate them clearly. This can result in stumbling over words or hesitating while speaking. Self-Consciousness:

Being overly aware of one’s speech, especially in front of an audience or when trying to make a good impression, can cause self-doubt and hesitation, leading to temporary tongue-tiedness. Situational Factors: Unfamiliarity with the Topic:

Speaking about an unfamiliar or complex topic can cause hesitation and difficulty finding the right words, leading to temporary tongue-tiedness. Rapid Thought Processing:

When thoughts are racing faster than one can articulate them, it can cause stumbling over words or pauses to catch up with the flow of ideas. High Stakes or Pressure:

Situations perceived as high-stakes, such as job interviews, important presentations, or confrontational conversations, can increase pressure and lead to hesitant speech. Physical Factors: Fatigue:

Being tired or sleep-deprived can affect cognitive functions, including speech processing and articulation, causing temporary speech difficulties. Dehydration or Dry Mouth:

Lack of adequate hydration can lead to dry mouth, making it harder to speak smoothly and clearly. Medications:

Some medications can have side effects that affect speech, such as causing dry mouth or reducing cognitive sharpness. Strategies to Overcome Temporary Tongue-Tiedness: Relaxation Techniques:

Deep breathing, mindfulness, or other relaxation exercises can help reduce anxiety and stress before speaking. Preparation:

Being well-prepared and familiar with the material can boost confidence and reduce the likelihood of hesitant speech. Practice:

Rehearsing speeches or conversations can help improve fluency and reduce anxiety. Pacing:

Speaking more slowly and deliberately can help manage racing thoughts and improve articulation. Hydration:

Staying well-hydrated can prevent dry mouth and aid in clear speech. Positive Self-Talk:

Encouraging oneself with positive affirmations can help reduce self-consciousness and build confidence in speaking situations.

[govindhtech]

Applications of Generative AI in Digital Twins

A digital twin is the identical copy of a physical item that exists only in the digital realm. It does this by combining data from the real environment (both in real time and from the past) with engineering, simulation, or machine learning (ML) models in order to improve operations and assist with human decision-making.

Conquer obstacles to maximize the benefits of the digital twin

It is necessary to have a data and logic integration layer in addition to a role-based presentation in order to reap the benefits of having a digital twin. In any asset-intensive business, such as the energy and utility industries, you are required to integrate a variety of data types, as shown in Figure 1. These data sets include things like:

OT (real-time data from equipment, sensors, and the internet of things)

Information technology solutions such as enterprise asset management (like Maximo or SAP, for instance)

Management of the plant’s lifecycle systems

ERP in addition to a variety of other unstructured data types, including P&ID, visual pictures, and auditory data

For the presentation layer, you can leverage various capabilities, such as 3D modeling, augmented reality and various predictive model-based health scores and criticality indices. At IBM, we strongly believe that open technologies are the required foundation of the digital twin.

When leveraging traditional ML and AI modeling technologies, you must carry out focused training for siloed AI models, which requires a lot of human supervised training. This has been a major hurdle in leveraging data—historical, current and predictive—that is generated and maintained in the siloed process and technology.

As illustrated in Figure 2, the use of generative AI increases the power of the digital twin by simulating any number of physically possible and simultaneously reasonable object states and feeding them into the networks of the digital twin.

he current status of the physical item may be continually determined with the use of these skills. For instance, heat maps may be used to highlight where potential bottlenecks in the power network may arise as a result of an anticipated heat wave that is induced by intensive use of air conditioning (and how these bottlenecks could be alleviated by intelligent switching). In addition to the requirement for an open technical basis, it is essential that the models be reliable and geared toward the business domain.

Use applications for generative artificial intelligence and digital twins in asset-intensive sectors

When generative AI is leveraged for digital twin technologies in an asset-intensive business, such as energy and utilities, several use cases become a reality. Take a look at some of the following use cases that were submitted by our customers in the industry:

1.A look behind the scenes: We are able to make use of the neural network architectures by first developing a fundamental model of a number of different utility asset classes, such as towers, transformers, and lines; then, by using large scale visual pictures; and last, by adapting to the client configuration. We may make use of this to scale the application of artificial intelligence in the identification of abnormalities and damages on utility assets as an alternative to manually evaluating the image.

2.Management of the performance of assets: We build large-scale fundamental models for anomaly detection based on time series data and its co-relationship with other types of data, such as work orders, event prediction, health ratings, criticality index, user manuals, and other types of unstructured data. We make use of the models to construct individual twins of assets, and these twins contain all of the historical knowledge that is relevant to the functioning of the asset in the present and the future.

3.Services in the field: We construct a question-answer feature or multi-lingual conversational chatbot (based on documents or dynamic material from a large knowledge base) that gives field service support in real time by utilizing retrieval-augmented generation activities to create the feature. This technology has the potential to have a significant influence on the performance of field services crews as well as an increase in the dependability of energy services. It does this by providing answers to asset-specific inquiries in real time, without the need to send the end user to documentation, links, or a human operator.

The area of artificial intelligence (AI) faces new challenges as a result of the development of generative AI and large language models (LLMs), and we do not pretend to have all the answers to the concerns that these new solutions raise. IBM is aware that fostering trust and openness in artificial intelligence is not a technological barrier, but rather a socio-technology challenge. This is something that the company is well aware of.

We see a high percentage of artificial intelligence initiatives become stalled in the proof of concept phase for a variety of reasons, including misalignment with business strategy and lack of faith in the model’s outcomes. IBM combines a large amount of experience in the field of transformation with industry expertise as well as proprietary and partner technology. IBM ConsultingTM is in a position to assist organizations in developing the strategy and capabilities necessary to operationalize and scale trusted AI in order to achieve their goals because of the mix of expertise it possesses and the partnerships it maintains.

At the moment, IBM is one of the very few companies on the market that not only offers solutions based on artificial intelligence (AI), but also has a consulting practice that is dedicated to assisting customers in the ethical and responsible application of AI. The Center of Excellence for Generative AI at IBM helps clients build ethically acceptable generative AI solutions and operationalize the whole AI lifecycle.

The process of using generative AI should, among other things: a) be driven by open technologies; b) ensuring that AI is accountable and managed in order to establish confidence in the model; and c) empower those who use your platform. As energy and utility companies work to upgrade their digital infrastructure in preparation for the transition to renewable energy, we think that generative artificial intelligence has the potential to help turn the digital twin promise into a reality. You can become an AI value generator by partnering with IBM Consulting, which gives you the ability to train, deploy, and administer data and AI models on your own.

https://govindhtech.com/applications-of-generative-ai-in-digital-twins/

[kidstoothdocparker]

Making Smiles Better: The Efficiency of Braces and Orthodontics

A merry, playful grin can do ponders for your confidence and generally speaking appearance. However, a lot of people's crowded, crooked, or misaligned teeth can make them feel self-conscious about their smile. Luckily, orthodontic treatment can help with changing these grins and supporting confidence. The transformative power of orthodontics and braces will be the subject of this blog.

What exactly are braces and orthodontics?

Braces are orthodontic appliances that gently press on the teeth with wires, brackets, and bands to move them into the right positions. Overcrowding, undercrowding, misaligned teeth, overbites, and other dental and facial irregularities are the primary areas of orthodontics, a subfield of dentistry. Orthodontists are dentists who have the training and experience necessary to identify, prevent, and treat various skeletal and dental anomalies.

Benefits of Orthodontics and Supports

Worked on Oral Wellbeing: Both your oral health and the appearance of your smile are enhanced by orthodontic treatment. Gum disease, tooth decay, and other dental issues are less likely to occur in people with straight teeth because they are easier to clean and maintain.

Boosted self-assurance: Misaligned teeth can affect your confidence and self-esteem. These issues can be settled with orthodontic treatment, which can work on your ability to talk and grant.

Speech improvement: A misaligned set of teeth can affect how you speak and make it difficult to pronounce. These issues can be settled with orthodontic treatment, which can work on your ability to talk and grant.

Acceptable bite: Misaligned teeth can make eating difficult and painful. Adjusting your teeth and jaws with orthodontic treatment can make eating more pleasant and less uncomfortable.

Types of Braces

Metal Braces: The most prevalent type of supports is conventional metal supports. They reach the teeth by way of flexible groups and metal sections joined together by wires. They are very good at treating all kinds of teeth and face irregularities.

Ceramic pillars: Ceramic braces are like metal braces in that they use clear or tooth-colored brackets that blend in with the teeth to be less noticeable. They are a well known decision for grown-ups who need a treatment choice that is more private.

Lingual backings: Similar to traditional metal braces, the brackets and wires of lingual braces are attached to the back of the teeth rather than visible from the front. They are an excellent option for patients who require careful treatment selection.

Straight braces: A popular alternative to traditional braces is clear aligners. They comprise of various straightforward, removable plate that shift the teeth bit by bit. Grown-ups and youths looking for a treatment choice that is more private regularly pick them.

How Orthodontic Treatment Is Performed

A consultation with an orthodontist typically marks the beginning of the orthodontic treatment process. During the insight, the orthodontist will take a gander at your teeth, take x-radiates and photographs, and encourage a therapy plan custom fitted to your specific necessities. Once the treatment plan is finalized, the orthodontist will use braces or clear aligners. They will also keep regular appointments to make any necessary changes to the plan.

Keeping up with great oral cleanliness during orthodontic treatment

To keep away from dental issues like cavities, gum infection, and tooth rot, keeping up with great oral cleanliness during orthodontic treatment is fundamental. During orthodontic treatment, keeping up with great oral wellbeing requires customary brushing and flossing, staying away from tacky and sweet food varieties, and standard dental visits.

Conclusion

Orthodontic treatment has the power to change people's smiles and help them shine. Because there are a variety of orthodontic and braces options, there is a treatment option.

[lupine-publishers-sjo]

Ankyloglossia, A Case Report: Untying the Tongue Tie in the Family Tree

Abstract

Ankyloglossia or ‘Tongue-tie’ is a congenital oral anomaly characterized by the persistence of the lingual frenulum as an anatomical abnormality. It has a prevalence of 0.1 – 10.7 % as reported in the literature with affection more towards males. I hereby present a case report to have come across an Isolated Ankyloglossia in a family of 4 members, in whom 3 are affected with this condition.

Keywords:Ankyloglossia/Tongue tie; inheritance; familial; congenital; syndrome

Read More About This Article Click on Below Link: https://lupinepublishers.com/otolaryngology-journal/fulltext/ankyloglossia-a-case-report-untying-the-tongue-tie-in-the-family-tree.ID.000247.php Read More about Lupine Publishers Google Scholar Articles: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=dMOUw-wAAAAJ&cstart=20&pagesize=80&citation_for_view=dMOUw-wAAAAJ:M0j1y4EgrScC

[lupinepublishers]

Lupine Publishers|Eruptive Guidance of Permanent Teeth and Education of Oro-Facial Functions: Indications of Early Trainer Treatment

Abstract

The eruption of the permanent teeth is done in a harmonious way when the conditions of development of the dento-alveolar arches are all united. This is not always the case, obstacles to growth as lingual or orofacial dysfunctions, parafunctions or early extractions of temporary teeth can disrupt the eruptive process in permanent dentition. Functional education using trainer treatment can stimulate the development of the arches for proper teeth placement.

Keywords: Permanent teeth; Obstacles to growth; Eruptive process; Trainer treatment

Introduction

Functional orthodontic trainer use depends on its various indications. It allows the interception of orthodontic malocclusions, the contributions are numerous: It allows not only the functional education in case of orofacial dysfunctions (atypical swallowing, oral breathing and disorders of the mastication) but also the guidance of the eruption of permanent teeth by maintaining the space, stimulating the growth of the dentoalveolar arches and guiding teeth to a harmonious and balanced occlusion [1,2].

Studies have shown that these positive effects can be observed from the first months of wearing the device if the patient’s compliance is complete [3-5]. Indeed, the best results depend on certain conditions of use. A daily wear is necessary for more than one year associated to a rigorous oral hygiene and breathing exercises.

The treatment should preferably be early during growth just before or at the time of the evolution of permanent teeth and maturation of orofacial functions. However, any anatomical or functional obstacle to breathing must be treated by otorhinolaryngologist before orthodontic treatment [6,7].

Materials and Methods

Functional orthodontic trainer Multi T was used during 15-18 months. Its Characteristics are single size, dental silicone positioner, tongue tag, lip bumper, tooth channels and labial bows guide the erupting/ developing dentition into correct alignment.

Children were 9 years old in the mixed dentition with: dysfunctional habits (digital suction, swallowing problem, oral breathing), perimeter deficiency, narrow dental arches and disorders of dental eruption.

The Diagnosis was based on

a) Anamnese data

b) Examination of orofacial functions

c) Occlusal examination

d) Etiological analysis

e) Dental casts measurements

f) Photographic and radiographic analysis

g) Otolaryngology assessment

Patients with breathing problems were referred to the otolaryngologist for a medical report before orthodontic treatment. Indeed, the device is contraindicated when breathing is severely disrupted. It can aggravate the respiratory gene instead of improving it.The patients were told to use the appliance two hours and overnight during sleep associated to breathing exercises during daytime: nasal breathing, joined lips and swallowing the tongue guided by the appliance 10 to 15 times intermittently along the two hours.

Results and Discussion

After 15 months of treatment using a trainer the results showed:

a) Lingual repositioning;

b) Improvement of orofacial functions, in particular swallowing and breathing;

c) Deletion of digital suction

d) Improved shape and dimensions of the alveolar arches;

e) Eruptive guiding of permanent teeth;

f) Improvement of dental relationship (incisor inclination, overbite, molar relationship);

g) Improvement of alveolar malocclusions;

After lingual repositioning, orofacial functions were improved, lip contact allowed nasal breathing and so, rapid effects on the shape, dimensions and relationships of the dento-alveolar arches in the three planes of space. The disturbed dental eruption [4,13] before treatment has been reduced, results showed a correct alignment concerning both anterior and posterior teeth (Figure 1 & 2).

The trainer allowed the interception of functional and dentoalveolar anomalies in a relatively short time in compare with the devices usually used. Moreover, in most cases, it wasn’t necessary to use another device to improve the results; this has reduced the costs of treatment. Previous studies in Picaud [10] reported same positive effects on growth and dental eruption but there is a limitation when using the appliance, it concerns the lack of compliance in some cases. This must be taken into account from the beginning of treatment in order to decide whether to use or not a myofunctional appliance. It seemed important to us to highlight the possibilities offered by this device to correct orthodontic malocclusions before their aggravation, the ideal is to act quickly and when possible on several anomalies at the same time. The goal is to optimize treatment as much as possible as showed by Usumez et al. [11] and Tallgren et al. [12].

During the phases of temporary and mixed dentition and therefore active growth, orofacial functions play a major role in the development of the dentoalveolar arches [8,9,14]. Screening and early diagnosis as well as the use of adapted devices helps to restore the necessary balance in case of dysfunctions for a correct placement of the permanent teeth. The usual devices usually have only one function and must be replaced as the treatment progresses, as opposed to the trainer device that can correct several anomalies simultaneously, thus reducing the duration and the cost of the treatment.

Conclusion

The various orofacial dysfunctions have been until very recently supported by devices that are inefficient or limited action, with no significant effects on growth and dental eruption. The trainer is a good alternative, it is preformed but in different shapes and sizes according to the age and the anomaly. It can be used associated to a fixed therapy but its action during temporary or mixed dentition gives impressive results. It is the best device for prevention and interception of malocclusions. The positive effects are also expressed both on the duration and on the costs of treatment provided.

[thedivinedemom]

This has literally been in my wallet for a few days waiting for me to transcribe it. It's not great but hopefully it'll kick off my writing habit again.

Working title: Blue Eyes

As strange as it may have seemed Steve had never been upstate. Not really. Albany, sure. There and every other State capital and major city of his day.

Shipped cross country, from city to city, to be paraded about like some circus chimp to sell warnings. Never allowed to explore the cities outside the theaters.  Not without an appointment and full escort at least. He was the "property of the United States government" after all. They could not risk losing such a valuable asset because he wanted to go sightseeing. Much less taking a look outside them.

Sealed away in a train car, rushing to show after show, he rarely had the chance to take in the countryside. To enjoy the greenery or the scenery. He could honestly say that he had seen more of France and Germany then he had his own country.

Easing his bike down the turnpike he found that the early afternoon made the roads deceptively quiet. There were only a handful of vehicles out at the hour, mostly big rigs, and it gave an almost serene feeling to the drive. The silence of it gobbled up and ate away at the muffled roar of his engine. Though not enough to avoid startling some poor deer as he rode past. A chuckle bubbled out of Steve at that. How long had it been since he had last seen a deer? Decades? It all  depended on how one counted the years.

Making his way down an exit he caught the first glimpse of his destination. The greenhouses of the Gardens were gleaming in the sunlight. A series of crystal heels arranged across a thick pasture. A small field surrounded the buildings, filled with apple orchards and raspberry bushes.

Beautiful, likely to be more so on the inside. The Gardens were home to a number of rare, exotic, and even mutated plants from across the globe. Tony claimed that the Fantastic Four had donated a few of their more benign experiments to the facility. Sparking the interests of more than just Steve.

Locking his helmet away in his bike's compartment he walked in, his either art bag strapped tight to his back. The lobby was as fancy and sophisticated as one would imagine; filled sleek plastic, flat screens, and linoleum tiles. Even the ticket booth was digital.

Everything seemed to be electric nowadays. It was helpful, amazingly so. There should be ballads written about the wonders of the internet. Yet it was all so different. He was in the same country but it had a different feel to it. Like a teen who was growing into a man. Still going through the growing pains but becoming all the finer from it.

But Steve could barely recognize the land he was born in. Everyone spoke differently, they dressed differently, and there was even a change in the way they walked. It was all so radically different and Steve couldn't be prouder, for the most part.

Easing himself passed the ticket booth he found himself in the middle of a controlled jungle. Thick bushes of deep and vivid color lined the paths. Leading people deeper into the greenhouse filled with tropical flowers and temperate trees. How both could be in the same room he hadn't a clue, another wonder of the future surely, but it was all wonderfully arranged.

Casting his eyes about he looked.forma place to set up. A task easier said than done as what few benches he could see were occupied, taken before he had even arrived. He had hoped by coming in the middle of the week he would have avoided the crowds. A vein wish as it turned out to be.

After a moment, once his eyes finished their second lap of the area, he decided to change his plans. With how crowded things were he would not be able to sketch out the Gardens section by section as he planned. Instead he would have to treat it as a puzzle, taking it one area at a time as.he worked for the full image.

Up along the path he finally found a place to sit, deeper than he would have liked but he had to start somewhere. He did not fancy drawing standing up, he could do it but it would be annoying. The first bench he found put him firmly in the 'Mutated' section. It was an area filled with genetic anomalies ranging from crossbreeds to lab experiments to ability generated. The plant in front of him, according to its placard, was of the last category. The ever shifting colors of the petal was a fairly large hint for that.

Steve would have preferred to have started with something a little more mundane. Something familiar and simple that he could have warmed up on. Something that did not sway on its own or tangle its vines along anything within reach. It would be a challenge, especially so early into his day, but as with most challenges he jumped in feet first.

Eyeing the plant he began. Carefully he started with an outline of the stem. He made it sway on the page, letting it curve in three separate places before moving onto the creeping vines. These he only gave the vaguest of outlines, a matter to fill in later. Once the focus of his drawing was done.

Being as engaged as he was with his work he barely noticed someone approaching his bench. She took a seat without so much as a word, sipping at her coffee as Steve gave her a quick glance.

Lacking for better words Steve could only describe the woman beautiful. To do more would have left his tongue tied and his face red. It was a sensation he was intimately familiar with from his youth, not something he wanted to experience again. Still, he took a second look.

Amused, she caught him staring. Her blue eyes dancing as they met his own. She gave him a small indulgent smile and an inclination of her chin worthy of a queen. And Steve would know, he had met more than a few members of royalty in his time. She even gestured like one, giving a grand arch of her arm as she waved towards the plant he was sketching.

"Cassandra, one of my students, made this." She said, her voice accented and her smile more genuine. "She is very proud."

Keeping his head on his shoulders Steve managed to smile back. "She's not the only one who sounds proud."

Letting out a laugh she nodded. "I suppose. She worked very hard to get the colors just so. All semester in fact. She would be happy to know someone drove all the way to the Gardens to sketch them." She said, her accent twisted through her words and niggled at his brain. It was familiar to him. The curve of her words struck a chord in his memory. The way her vowels weaved away from her words in incriminates and popped away was throwing him off. He knew he had heard it before, and he did have an ear for these things, but he just could not place it.

"If you want she can have this when it's done." He offered, tilting the half finished sketch towards her. "It would just be gathering dust in my portfolio anyway."

"Very well." She said after a moment and a long searching look. "I think she would enjoy that." She paused for a moment longer. "Would you mind if I waited here until it is done? If it wouldn't be a bother."

Eyeballing his drawing Steve gave it another ten to fifteen minutes until he was finished, more or less. It wouldn't be his best work, not when it was his first sketch of the day, but it would still be up to his usual quality. Which he would modestly admit was exceptional.

So, Steve nodded his head. "It shouldn't take too long, Miss -"

"Monroe." She introduced, offering him another smile. This one was bright and full of genuine warmth, unlike her first smile. "But please, call me Ororo. Hearing Miss Munroe makes me think I'm back at the Institute."

"Ah, " he said, finally realizing how.rude.he was being. Once he wiped it free of pencil smudges he offered her his hand to shake. "Steve, please. It's a pleasure to meet you. Though if you don't mind me asking, where are you from? I can't seem to place your accent."

Taking his hand she gave him a firm shake, little callouses scraping against his palm as she pulled away. "I'm not surprised. I had a… diverse childhood. Though I am fairly certain my accent is some combination of Manhattan, Cario, and rural Kenya." Her tone lost some of its warmth, her voice worn as she answered. Likely because she answered that question in some form a thousand times before.

Though Steve barely noticed this. Instead, he felt a pang of excitement as things clicked into place. "<Ah! I knew your accent sounded familiar! The Manhattan in your consonants must have been what threw me off but I can hear it now.>"

Eyes wide Ororo leaned in, her voice excited as she asked, "<You can speak Arabic?>"

"<Roughly>," he said, shifting in his seat. "<I spent a few months in Egypt on my tour and some of the locals taught me. I'm sure my grammar is horrible. My French and German is much better but my Cantonese is barely passable.>"

Though Steve was fairly sure his grammatical and structural errors were more due to the lingual shift of the better part of a century passing by. He had a few missteps in his first months after the thaw with English. Steve could not imagine his secondary languages faired any better.

Ororo, unaware of his thoughts, simply nodded his head. Completely agreeing with his assessment. "<A few words do seem off. Perhaps they taught you a different dialect? You are speaking very well." She paused here, considering him for a long moment. Longer than before, as if she was only then getting the full picture of him. "<If you would like we could practice your language skills while we are here. Walk around the Gardens, perhaps a bite to eat. It has been so long since I've spoken Arabic with someone."

"Ororo, " He said, enjoying the feel of her name, "<It would be my genuine pleasure.>"

An:

Again, not happy with it. I've been reading a lot of high/sword & sorcery fantasy lately and I think it has an effect on my prose. I'm likely to just redo the entire snip.

I honestly like the pairing of Ororo and Steve, largely because they have each have been called the 'perfect person' as well as being strong leaders in their own rights even if they have different styles. Plus I can see them bonding over nature and trying things neither are familiar with, as well as her constantly making him blush (see swimsuits of the 1940s and compare to Storm's preferred swimwear).

And yes, I like the idea of neither putting two and two together for a while. Adds spice/grounds the relationship. Part of my handmade is that while Steve has worked with the XMen before the was the Original 5 and he hasn't met the new team yet. For Ororo Steve wasn't part of her history books besides a brief mention before the earthquake happened, and Steve is a common white boy name.

Oh, and before I forget, the first letter of every paragraph. Donate to your preferred cause.

[klaraudnt]

BASIC INFORMATION :

name:  luisa rivera

age:   31

birthdate:   september 3rd

alias:  luisa,   lu,  rivera

gender:  cis female

sexuality:  pansexual

height:  5′3″

MBTI:  tbd.

astrological sign:  virgo

skills:  cellist,  bi - lingual

abilities:   clairaudience  ( able to pick up on other people based on sounds + reading other people based on their sound,  similar to an aura )

occupation:  music therapist

CONNECTIONS :

immediate family:  mother,  alive.   father,  alive.   older sister,  alive.  younger sister,  alive.

partner / lover:   emil kindell

HISTORY :

luisa grew up in a loving family full of life,  and she was happy.    while she had the anomaly gene,   there wasn’t anything that stood out in her parents minds.  luisa was a normal, average girl.    the only difference was that she would constantly hear more than the average person,   and it only became stronger the older she got.  her parents began to worry,  but doctors passed it off as neuro - divergence,  rather than a direct result from the anomaly gene.   she was given medication to stop the sounds,  but despite everyone’s efforts, nothing changed.   there wasn’t a clear explanation given and it eventually led to her being admitted into a psychological ward for further observation.  for almost two years,  she was observed before she finally learned how to conceal and lie her way out.  just before turning sixteen,  luisa was released and she returned home,  not telling her family it had actually gotten worse.  she thought adding music would help calm the noise,  and so she began to learn the cello and would do what she could to study and learn.  her parents,  fully accepting of this area of self - care,  saw it as a better outlet for her and did whatever they could to support her.  

she eventually goes to college to pursue music and concentrate on becoming a therapist as well,   wanting to find a way to combine the music with healing,   as it was something that helped her focus less on the noise.  she graduated with a double major in psychology and music theory with a concentration in the cello,   and eventually opened her own studio where she helps others heal by music,  which was a huge success.   she still can hear more than the average human,  yet she’s able to control the sounds and dull them when needed.    she eventually runs into emil,    learning about tantalus slowly.  she was never recruited up until this point,   and she turns it down,  claiming she wants no part in the government and the shady ideals they had.   still,  she keeps running into him ( and there’s a sound in him that she can’t put her finger on and while it infuriated her in the beginning,  it’s something she’s grown more and more fond of. )   

[minervastation]

AGE: 60 FACECLAIM: Jeff Goldblum

Scientific curiosity. And, hah!, y'know. A little bit of professional envy. At ten years old Shelby got to watch Neil Armstrong land on the moon and, boy, who didn’t dream about ending up in his big space shoes some day when they saw that? Shelby never exactly qualified to be an astronaut, he was just never physically fit enough for it, but as long as they’re sending people up into the space-and hey, this time, no physical requirements!–he’s eager to go.

August 22, 1959, Morristown, New Jersey. Lydia and Myron Bronstein give birth to a healthy baby boy, their second of three–well, of two, since the last would be a daughter. Shelby Walter Bronstein would grow up happily in his middle-class bubble: he and his siblings could walk to school and back, walk to the corner store and back, walk to the park, the playground, the neighbor’s house, even the bike shop and back!

But that was before “helicopter parenting” really took off, right?

The Bronsteins had a long family history–on both sides, really, the Bronstein and the Roseberg–of raising independent, strong-minded children who were outspoken, at the least, if not always filial or. Y'know. Smart. Joshua was the jock of the family. He was big and strong, but felt the need to protect Shelby, who was always a real string bean of a kid. Joshua would go on to play college ball and graduate, but never make a big to-do of himself. Sports are hard like that. He’s got a lovely family, though, or had one until lung cancer took him away. (Shelby still goes by to visit the wife and family whenever he’s in town, and he’s very punctual with gifts for them.)

Talia was the baby of the family, loved by everyone. There’s an artist in every family, and Talia’s was theirs. A smart girl, expressive, loving, good at creating things, hell of a dancer. Talia never quite settled down, but then, she never quite came out of the closet to their parents until it was too late. She’d told Shelby first. Shelby’d known all along. And despite some rough patches involving well-intended blind dates when he was doing his doctorate–hey, his sister’s a nice girl, she shouldn’t be single forever!–they’ve always been on solid footing.

Between two such upstanding individuals, it would have been understandable for Shelby to get lost to the middle child syndrome, especially since he wasn’t the oldest boy or the oldest girl. But he didn’t get lost. He might’ve lacked Talia’s artistic talents and Joshua’s athletic ones, but Shelby–he was one smart cookie. Always had been. His passions were in the sciences and mathematics, and it showed.

Gangling, string-bean Shelby who never managed to put much meat on his bones became the scientific community’s equivalent of a rockstar when, during his post-graduate career, he cracked the code on astrophysical anomaly at the edge of the Milky Way that scientists had been stumbling over for years.

Shelby took up a position, first at NASA and later at the Massachusetts Institute of Technology, where he worked on various and sundry research and taught–much to everyone’s surprise–introduction to physics, astronomy, and a section on current events in science which was really his personal excuse to learn and then teach about any topic that caught his eye.

He was hardly shaken by the announcement of impending planetary doom, having been among the circles debating the exact length of time for several years prior to the moment, but the length was still a real punch to the gut. He’d always erred on the side of a few hundred, long enough to get things back on track if they could get world governments on board, but–twenty years. Maximum. Shelby knows he probably won’t live to see those twenty years up close and personal, but he’s eager to help with any endeavour that will help the human race into the future. It’s been his guiding principle for years, the reason he never went into private corporations or funded studies, and he intends to see that through until his dying breath. Shelby is probably best defined as eccentric, followed by open-minded, kind-hearted, and exceedingly peculiar. A bachelor even in his twilight years, he’s very much enthralled with the idea of love–especially true love and young love–and is always happy to help a lover in need, although it’s pretty rare that that lover is his own. He is a charitable and generous man, respectful though not deeply pious, trusting but not entirely. He finds he shields most information in large groups. He is very charming, witty, and warm, but lacks a certain social grace which can make him seem awkward, forceful, or sometimes bumbling in normal social circles. He is a humanitarian and philanthropist first and foremost, a scientist second, and a global citizen third. Well-read and multi-lingual, Shelby spends a little of his time outside of the lab dabbling in…well, everything! He embodies the idea of being a jack of all trades but a master of none, which–in combination with his eclectic hobbies–would certainly explain his recent lack of scientific discoveries and advancements prior to joining the Minerva Station. He’s not accomplished in it or praised for it, but he’s an excellent pianist and amateur gourmand. He speaks 6 languages (English and Hebrew, the first two he learned, as well as ASL, Spanish, and a smattering of Mandarin and German) and when asked how he learned all these things, he likes to joke that he gave up on pursuing romance to pursue knowledge instead. “It’s much easier to woo than another person!”

[oneorthodontics]

What treatment facilities are provided by a best Orthodontist in Brooklyn?

Orthodontic problems require highly professional treatments by qualified orthodontists. The level of expertise of the orthodontist, modern treatment facilities and high-grade orthodontic appliances are the main features of the best orthodontic clinics.

One Love Orthodontics is the Best Orthodontist in Brooklyn due to several reasons. Some have been discussed here.

Comprehensive treatment services

Both major and minor orthodontic anomalies are treated in the clinic. All kinds of bite problems such as open bite, overbite, crossbite and underbite are treated effectively. Crowding, spacing and other problems are also treated expertly. Complex procedures to treat cleft lip and cleft palate, abnormal jaw growth, temporomandibular joint or TMJ disorders and many more are also treated.

Interceptive procedures to detect and treat orthodontic problems in the early stages are carried out in the clinic. Orthodontic treatments are also provided to both adolescents and adults.

Best modern Braces Brooklyn

One Love Orthodontics provides conventional metal, clear, lingual and self-ligating Braces in Brooklyn. The modern alternative to braces called Invisalign is also offered to the patients.

Conventional metal braces made of brackets, elastic bands and brackets slowly align the teeth by moving elastic band and archwire. Lingual braces are not visible because they are placed behind the teeth. Clear braces are also not visible because of their transparent appearance. Self-ligating braces use a sliding mechanism to align the teeth instead of elastic bands.

Invisalign sits on the teeth and is transparent. A series of removable Invisalign is worn to move the teeth into correct positions.

Insurance facility

Dental insurance is provided to cover the costly procedures. For instance, 1199 Orthodontist in Brooklyn means the insurance provider is 1199 SEIU National Benefit Fund.

[bolgs]

What is a Functional Frenectomy?

A functional frenectomy is a procedure designed to alleviate tension caused by the frenum, which are muscular attachment strips in the mouth. These segments of tissue connect the lips to the upper and lower gums (referred to as the superior or inferior labial frenulum, respectively), as well as the tongue to the floor of the mouth (called the lingual frenulum). The size and degree of restriction levied by the frenum can have an array of physiological effects on orofacial function and other parts of the body. For example, a large labial frenulum can prevent the two front teeth in either the upper or lower dental arches from coming together, creating a gap between teeth. A frenulum that is too short and restrictive can also cause gum recession, as well as speech issues in the case of an irregularly shaped lingual frenulum. As these muscular attachments contain tiny fibers that run through the chest and spine, frenal anomalies can even affect posture and cause pain in the shoulders and neck.

A functional frenectomy is a relatively simple, in-office procedure offered by Encino dentist Martin Gorman, DDS to release the constraints caused by problematic frenum and restore proper function of the oral structures. Using a local anesthesia or sedation techniques, treatment involves freeing the frenulum with an incision or laser. This can improve speech impediments, prevent further gum recession, relieve physiological impacts on the shoulders and neck, and allow proper alignment of the teeth when performed in complement to orthodontic treatment. Furthermore, myofunctional therapy both before and after a functional frenectomy can help patients establish better patterns of facial muscle movement. This comprehensive approach can optimize speaking, chewing, and breathing function—ultimately ensuring the long-term success of the procedure.

For more information about the indications for a functional frenectomy, or to schedule a consultation with Dr. Gorman, please contact our practice today.

Courtesy: What is a Functional Frenectomy? (mgormandental.com)

Sleep Apnea Doctor Los Angeles

[lupine-publishers-sjo]

Lupine Publishers | Transoral Robotic Resection of Lingual Thyroid

Lupine Publishers | Journal of Otolaryngology

Introduction

Surgical removal of ectopic lingual thyroid is indicated in symptomatic patients or in cases of suspected malignancies. An external approach is most often used but is associated with morbidity and visible scar on cervical region. In this case we utilized Transoral Robotic surgery [TORS] to excise ectopic lingual thyroid tissue. Ectopic thyroid refers to the presence of thyroid tissue in locations other than the normal anterior neck region between the second and fourth tracheal cartilages. It is the most frequent form of thyroid dysgenesis, accounting for 48-61% of the cases [1]. Lingual thyroid is a rare developmental anomaly originating from aberrant embryogenesis during the passage of the thyroid gland through the neck. Prevalence of this condition is reported to be between 1 per 100,000-300,000 persons and occur one in 4,000- 8,000 patients with thyroid disease [2]. To date, about 500 cases have been reported in the English literature mainly from Europe, Asia and America, with a small number of reports coming from Africa. Sixty-five to eighty percent of cases occurred in females [2]. Although it is difficult to detect asymptomatic thyroid ectopy, postmortem studies have suggested that 7-10% of adults may harbor asymptomatic thyroid tissue along the path of the thyroglossal duct [3]. In 1869, Hickman reported the first case of ectopic thyroid tumour of the base of the tongue, pressing down the epiglottis on the larynx and causing death by suffocation sixteen hours after birth [4]. In 1999, da-Vinci robot was developed by intuitive company in USA. It contains high magnification 3-D endoscope, endo-wristed instruments with motion scaling and tremor filtration function that help surgeons to perform endoscopic surgery with more precision, dexterity and control. conventional transoral approach has the disadvantages of limited exposure and difficulty in manipulation and hemostasis [5]. In this paper we report a case of 16 years old lady from Nepal who presented to our hospital with choking symptoms which are more during night since years. She was treated as an asthmatic and had no improvement with bronchodilators. She was referred to our center for further evaluation to rule out any ENT cause. Fiberoptic laryngoscopy lead to provisional diagnosis of lingual thyroid. She underwent excision of ectopic thyroid tissue by Da Vinci robotic surgical system. Histopathological examination confirmed lingual thyroid (Figure 1).

Figure 1: Photomicrograph of histology section, Hematoxylin Eosin stain, 10 X magnification, showing covering of normal squamous epithelium of tongue, with many variable sized colloids filled thyroid follicles in the subepethelium.

Case Report

A 16-year-old female presented with dyspnoea especially at night and foreign body sensation throat. The patient also had complaints of dysphagia. She had no history of either past or present thyroid disease. Upon examination, the patient presented a solid, pink, spherical mass, covered with intact mucosa, located at the base of the tongue. Examination of the neck revealed no palpable thyroid gland in the normal pre-tracheal position and no cervical adenopathy. Thyroid hormone tests showed normal thyroid-stimulating hormone (TSH) concentrations and normal FT3 and FT4 concentrations. Patient was clinically euthyroid. Ultrasonography (US) revealed a mass 5x4cm in size with distinct margins restricted to the base of the tongue and absence of the thyroid gland. A thyroid scan with technetium Tc-99m sodium was performed showing marked isotope uptake in the area of the tongue and no uptake in the neck (Figure 2).

Figure 2: Photomicrograph of histology section, H & E stain, 20 X, with similar features as in slide 1.

Method

Patient was taken up for transoral robotic surgical excision of lingual thyroid tissue under general anesthesia. The da Vinci Si surgical system (Intuitive Surgical, Sunnyvale, CA) used. a) Patient position is like Rose’s position of tonsillectomy. Neck is extended by sandbag under the shoulders and the head is supported on a ring. b) Painting & draping done. c) Docking of the robot done. Mass base of tongue visualized using 30 degree up endoscope. 4mm instruments used for dissection. d) Maryland dissector at left hand side and spatula tip electro-cautery at right hand side. e) Resection carried out from the anterior border of the lingual thyroid along the capsule f) of ectopic thyroid tissue. Mass excised in toto. Hemostasis confirmed. g) Undocking of robot done. GA withdrawn. h) Excised tissue sent for histopathological examination. i) Pt. kept in hospital overnight for observation. No postoperative complications. j) Post operatively substitutive thyroid hormone replacement therapy was given.

Gross description: Multiple mucosa covered tissue pieces altogether measure 5x2x0.5cm. No ulcer or mass lesion is identified on the surface. The cut surface shows a brownish, colloid like appearance.

Microscopic description: Sections show unremarkable stratified squamous epithelial lining. The subepithelial stroma shows islands of normal thyroid follicles and few seromucinous salivary glands, with mild lymphoid cell infiltrate. There is no evidence of malignancy (Figure 3).

Figure 3: Docking of the robot for transoral surgery.

Conclusion: Excised swelling base of tongue - LINGUAL THYROID.

Results

TORS of ectopic lingual thyroid tissue was successfully performed with excellent functional outcomes and with decreased operating time than conventional tongue base surgeries. Less than 5 ml blood loss during surgery and stay in the hospital was less than 24 hours (Figure 4).

Figure 4: Intraoperative picture of mass.

Discussion

Lingual thyroid is reported to be a rare congenital anomaly in the population. Asymptomatic ectopic thyroid tissue becomes symptomatic in periods of puberty, pregnancy, menopause, inflammation, and stress. Thyroid requirement increasing in these periods leads TSH level to increase and hypertrophy in the thyroid gland [8]. Approach to lingual thyroid tissue may vary according to clinical findings, but it is still debatable. Although asymptomatic cases can be followed without management for probable complications, in symptomatic cases, there are alternative treatment methods. Even though thyroid suppressive treatment conducted with the administration of exogenous thyroid hormone is a method that can be preferred in patients with minimal symptoms, it is not preferred in that it requires long term treatment. Radioactive iodine treatment and surgery are other treatment alternatives. As it is in a region difficult to access, open surgical approaches have been used in surgical treatment [9]. These surgical approaches may lead morbidity rates to increase according to the method used since they require lip, tongue, and mandibular splitting or lateral, suprahyoid pharyngotomy and long operation times and feeding with nasogastric tube, they run the risk of the development of suprahyoid pharyngotomy, hospitalization is prolonged, and there are skin scars. In order to avoid these morbidities, transoral resection techniques including Co2 laser, electrocautery, and harmonic technologies are used. Terris et al. [10] reported that transoral minimal invasive lingual thyroid resection decreased morbidity and duration of hospitalization compared to other open approaches. Coblation assisted lingual thyroid and lingual tonsil resection techniques were used and successful results were reported [11-13]. Leitzbach et al. [12] reported successful results and low complication rates in 108 patients undergoing coblation assisted resection due to tongue root and lingual tonsil hypertrophy. However, transoral resection techniques have limited point of view and lead to difficulty in resection owing to difficulty in manipulation, which restricts their use [6]. Studies have demonstrated that as the size of the mass increases, transoral respectability of the mass decreases. The basic principles of avoiding complications in transoral tongue root resections are careful dissection in accordance with imaging methods and adequate anatomic evaluation in order to prevent lingual artery injury [14]. Transoral robotic surgery decreases the technical difficulties encountered in other transoral approaches in that it has a three-dimensional larger point of view, and manipulation is easier thanks to robotic instruments, leading to its larger use in oropharyngeal and tongue root operations [7]. Transoral robotic surgery is used in many different regions in surgical otolaryngology [15,16]. Three robotic arms, 0-degree and 30-degree high definition and 3-dimensional video instruments make it possible to overcome restriction of visualization of regions with difficult access and difficulty of manipulation. Lingual thyroid excision using this method has been described in previous studies [17,18]. The absolute local contraindication is related to the difficult exposition of the oropharynx, due to a limited opening of the mouth or the patient’s habitus. TORS for treatment of ectopic lingual goiter is feasible, requires a short learning curve, and appears to be safe [19]. In addition, the robotic surgery also has been adopted to do esthetic neck surgery with better cosmetic outcomes by hiding the scar [20].

Conclusion

TORS assisted excision of ectopic lingual thyroid is minimally invasive, feasible method. It is a safe technique with minimum morbidity and decreased operative time. In experienced hands it should be offered as valid treatment for this pathology. Studies with larger case series and longer duration of follow-up are required in order to reach a definitive conclusion on this issue.

For more Otolaryngology Journals please click on below link https://lupinepublishers.com/otolaryngology-journal/

For more Lupine Publishers Please click on below link https://lupinepublishers.com/

[jesawyer]

Who translated POE 1? Do you have members of the team who do it or do you hire people specifically for translation?

We/Paradox used a localization house, S&H Entertainment Localization.  Members of the development team don’t have time to work on the localizations, but I do encourage some of the multi-lingual devs to play the game in non-English languages to do spot checks.  E.g. Jorge Salgado is a native Spanish speaker so he can sometimes catch weird anomalies in the Spanish text.

We also know that there are dedicated fans who do their own translations.  Kaz Aruga, who grew up in Japan, discovered that someone had made a full Japanese localization of Pillars of Eternity on their own, which is pretty crazy.

[azapofinspiration]

That was an amazing response to 'Rin meets the Stan twins'. I originally had the idea to combine that scenario with the 'better world' au and have Rin end up on Stan's boat after Stan finds him wandering around looking lost and upset and decided to offer him a job. Due to language barriers it is months or years later that they finally discuss what happened and contact his family. In the mean time, many adventures, treasure, babes, anomalies, and Rin mastering every cuisine in the world.

Ah, that’s a good idea too.

Though personally, I don’t think there would be as much of a language barrier as there could be. I headcanon that Stan is multi-lingual due to his dealings with the underground world and trying to avoid getting killed by mobsters. I think he’s fluent in Spanish, but is also pretty good with Russian, Japanese, and Chinese.

Therefore, I think he’d be able to communicate okay with Rin.

Besides, even if he didn’t, I would bet that there’s a translation spell in the Journal, or in the case I talked about before, that Ford has a universal translator.

Still, yeah, I’d totally be up for Stan picking up Rin in the Better World AU, with them being able to understand each other a little and getting better as they travel.

Shiro and Yukio would still end up the same though.