From Tongue-Tie to Tongue Base Collapse: The Missing Adult Airway Conversation

Ankyloglossia is widely discussed in infants and children, yet its potential impact on adult health remains largely absent from both the tongue-tie and sleep medicine literature. At the same time, obstructive sleep apnea (OSA), upper airway resistance syndrome (UARS), and snoring affect hundreds of millions of adults worldwide, driving significant cardiovascular, metabolic, cognitive, and quality-of-life consequences. Could restricted tongue mobility represent an overlooked contributor to airway dysfunction in a subset of these patients?

This lecture challenges attendees to reconsider ankyloglossia through the lens of adult airway health.

The session will explore how tongue mobility, tongue posture, and tongue-base collapse intersect in adults with sleep-disordered breathing. Drawing on their collaborative clinical experience in Dubai, UAE, the speakers will demonstrate how multidisciplinary assessment can reveal functional contributors to airway obstruction that may otherwise go unrecognized.

Central to the discussion is Drug-Induced Sleep Endoscopy (DISE), currently regarded as the gold-standard dynamic assessment of upper airway collapse. While DISE is commonly used to guide surgical procedures, hypoglossal nerve stimulation (HNS), and oral appliance therapy, it also provides a unique opportunity to observe the role of the tongue in airway obstruction. The presenters will share DISE findings illustrating patterns of tongue-base collapse and discuss how these observations have influenced their understanding of restricted tongue mobility in selected adult patients.

The lecture will examine an important paradox in contemporary sleep medicine. One of the most effective surgical treatments for OSA—hypoglossal nerve stimulation—works by advancing and stabilizing the tongue. Yet the potential impact of a tongue that is anatomically restricted and functionally compromised has received remarkably little attention.

Emerging evidence suggests that tongue mobility restrictions may influence tongue posture, swallowing mechanics, oral function, and upper airway stability, warranting greater investigation within adult airway care.
Attendees will review recent landmark research by the primary author himself demonstrating improvements in tongue-base collapse following myofunctional therapy, confirmed during DISE evaluation, and will explore how these findings may reshape current thinking about functional airway rehabilitation. Clinical cases will illustrate how myofunctional therapy, objective strength assessment using the Iowa Oral Performance Instrument (IOPI), digital platforms such as Airway Gym®, and, when appropriate, tongue-tie release can be integrated into comprehensive treatment pathways which may include Nasal and Upper Airway Surgery.

Importantly, this session is not intended as an advocacy lecture for frenotomy. Rather, it offers a balanced, evidence-informed examination of a controversial topic. The speakers will critically evaluate the current literature, identify gaps in evidence, discuss patient selection, and highlight the need for prospective research exploring the relationship between tongue mobility and airway function in adults.

For a conference largely focused on pediatric populations, this lecture expands the conversation into a rapidly growing and underserved area of clinical practice. Attendees will leave with a practical framework for assessing adult ankyloglossia within the context of sleep-disordered breathing and a deeper appreciation of how collaboration between surgery, dentistry, sleep medicine, and myofunctional therapy may improve patient outcomes.