New Perspectives on Posterior Tongue-Tie: Anatomical Clarity, Diagnostic Precision, and Standardized Terminology – Soroush Zaghi, MD; Chad Knutsen; Lesley Kupiec, RDH, MS; and Leyli Norouz-Knutsen

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Abstract

Posterior tongue-tie remains a topic of debate due to inconsistencies in terminology, diagnosis, and clinical assessment. This article seeks to clarify anatomical misconceptions and refine diagnostic criteria by introducing the term “mid-tongue restriction” to more accurately describe the condition previously labeled as posterior tongue-tie. Through analysis of functional limitations, compensatory mechanisms, and the Floor of Mouth (FOM) hold maneuver, the study provides a standardized approach for identifying tongue mobility restrictions. The proposed framework enhances interdisciplinary communication and clinical decision-making, aiming to improve diagnostic precision and treatment outcomes. Standardizing terminology and assessment methods will facilitate more effective management of tongue-tie and its impact on oral function and airway health.

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About the Authors

Soroush Zaghi, MD
The Breathe Institute, Los Angeles, CA

Dr. Zaghi graduated from Harvard Medical School, completed a residency in ENT (Otolaryngology- Head and Neck Surgery) at UCLA, and Sleep Surgery Fellowship at Stanford University. The focus of his sub-specialty training is on the comprehensive treatment of nasal obstruction, snoring, and obstructive sleep apnea. He is very active in clinical research relating to sleep-disordered breathing with over 80+ peer-reviewed research publications in the fields of neuroscience, head and neck surgery, and sleep-disordered breathing. Dr. Zaghi practices in Los Angeles, CA as Medical Director of The Breathe Institute, which provides comprehensive functional and structural treatment options for pediatric and adult sleep and breathing issues. Dr. Zaghi is particularly interested in how tethered-oral tissues (such as tongue-tie) and oral myofascial dysfunction impact maxillofacial development, upper airway resistance syndrome, and obstructive sleep apnea. He is an invited lecturer, author, and journal reviewer for topics relating to sleep-disordered breathing and tongue-tie disorders.

Chad Knutsen
The Breathe Institute, Los Angeles, CA

Chad Knutsen, Founder and Chief Innovation Officer of The Breathe Institute, is an award-winning Los Angeles-based filmmaker and producer with over a decade of industry experience. As an expert generalist, he excels at assimilating new knowledge and developing creative solutions across diverse fields such as sustainable technology, agriculture, construction, security, and intelligence. Chad has led and consulted on successful projects for organizations like MIT, the International Association of Science Parks (IASP), the Moscow Agency of Innovation, and SXSW, earning accolades and speaking invitations at international conferences. His diverse background and relentless curiosity have been instrumental in keeping The Breathe Institute at the forefront of technological innovation.

Lesley Kupiec, RDH, MS
The Breathe Institute, Los Angeles, CA

Lesley is a registered dental hygienist with over a decade of experience, balancing part-time clinical practice with roles as an educator and researcher at The Breathe Institute in Los Angeles. She holds a BS in Sport Management from UMass Amherst, an AS in Dental Hygiene from Middlesex Community College, and an MSDH from the University of Southern California (2014). Lesley is furthering her expertise in orofacial myology, focusing on health promotion and prevention through a functional approach while collaborating with dedicated medical professionals. She is a member of the American Academy of Physiological Medicine & Dentistry and the International Association of Orofacial Myology, and has served on the boards of the Los Angeles Dental Hygienists’ Society, the Academy for Sports Dentistry, and the National Center for Dental Hygiene Research & Practice.

Leyli Norouz-Knutsen
The Breathe Institute, Los Angeles, CA

Leyli Norouz-Knutsen is the Co-Founder and Managing Director of The Breathe Institute, recognized for her exceptional ability to streamline organizational structures, enhance collaboration and communication, drive impactful media and branding campaigns, and inspire innovation and entrepreneurship. With over a decade of experience in higher education, non-profit management, and operations, Leyli has held director roles at the University of California Los Angeles (UCLA) and San Diego State University (SDSU). Since leaving UCLA’s Anderson School of Management in 2007, her extensive expertise in healthcare consulting and corporate strategy has been pivotal in co-founding The Breathe Institute. Additionally, she serves on the Board of the American Academy of Physiological Medicine & Dentistry (AAPMD), further demonstrating her commitment to advancing the field.

Additional information

# of Pages

8

Page Size

8 1/2 x 11 inches

File Format

PDF

Published

January 2025