Triin Jagomägi

Objective: To identify feasible and high-priority actions to improve the equitable provision of care for individuals with cleft lip and/or palate (CL/P) across Europe. Design: Participatory mixed-methods study using group concept mapping. Setting: European cleft and craniofacial care systems. Patients and Participants: Sixty-five stakeholders from 29 countries, including healthcare professionals, researchers, teachers and representatives from patient organisations involved in CL/P care. Interventions: Participants generated, sorted and rated statements in response to a structured focus prompt addressing equity in CL/P care, with ratings of importance and ease of implementation. Main Outcome Measure(s): Conceptual clusters of actions to improve equity in CL/P care and prioritisation of actions based on importance and feasibility. Results: A total of 111 statements were analysed using multi-dimensional scaling and hierarchical cluster analysis, resulting in 6 conceptual clusters: person-centred care; healthcare professional training, awareness and knowledge; resources and availability; inclusiveness and support strategies; European standardisation and governmental health policies. These clusters aligned with micro-, meso- and macro-level domains. Go-Zone analysis identified 31 actions rated as both highly important and feasible, alongside 28 actions rated as highly important but difficult to implement, reflecting longer-term structural and policy challenges. Conclusions: This study provides an empirically grounded, multi-level roadmap for advancing equitable and high-quality CL/P care across Europe. While immediate improvements can be achieved through targeted clinical and organisational actions, sustained progress requires coordinated policy and governance reform. The identified principles may provide insights for cleft care service providers beyond Europe who face similar systemic challenges.

Adenotonsillar hypertrophy (ATH) relates to airway obstruction and orofacial changes in children. Whether adenoid hypertrophy (AH), palatine tonsil hypertrophy (PTH), and combined ATH were associated with distinct patterns of hard palate morphology and tongue function in the early mixed dentition remains unclear. This cross-sectional study examined 420 schoolchildren aged 6-8 years in central Vietnam. AH was defined by the Fujioka adenoid-nasopharynx ratio (ANR > 0.6) and PTH by Brodsky grades 3-4; tongue strength was measured with the Iowa Oral Performance Instrument, and hard palate morphology by digital dental-cast analysis. Multivariable regression (adjusted for age, sex, BMI, lip-seal at rest, and school location) analyzed individual measures; modified Poisson regression analyzed a co-occurring phenotype (structural alteration plus low tongue strength). Univariable comparisons applied Benjamini-Hochberg false-discovery-rate (FDR) correction. Enlarged lymphoid tissue was present in 65.2% of children (AH only 19.3%, PTH only 32.6%, combined ATH 13.3%); tapered arch (31.0%), high-arch palate (20.0%), and low tongue strength (35.0%) were common. Nominally, AH was associated with a deeper, shorter palate, and PTH with a narrower tapered arch and lower tongue strength; but none survived FDR correction (smallest q = 0.16). In adjusted models, combined ATH was associated with a smaller anterior maxillary angle (β = -3.76°; 95% CI -6.22 to -1.29; p = 0.003) and palatal vault module (β = -0.54; -1.02 to -0.05; p = 0.032), each decreasing with adenotonsillar burden (both trends p ≤ 0.020). The co-occurring phenotype (77 children; 18.3%) became more common with burden (PTH only aPR 1.77, p = 0.040; combined ATH aPR 1.87, p = 0.048; trend aPR 1.38 per level, p = 0.020). Adenotonsillar hypertrophy was common in schoolchildren with mixed dentition. AH and PTH showed distinct patterns of palate and tongue alteration, although these did not survive FDR correction and remain exploratory. Combined ATH and greater adenotonsillar burden were consistently associated with maxillary arch narrowing; the co-occurrence alteration was also more frequent with higher burden. These findings support including palatal morphology and tongue function in orofacial screening during the mixed dentition, pending longitudinal confirmation.

To examine associations between tongue function domains and questionnaire-based high-risk sleep-disordered breathing classification across age groups, and to explore interaction effects between functional and anatomical factors. A cross-sectional study included 1,244 participants (462 children aged 6–8 years and 782 young adults aged 18–25 years). High-risk classification was defined as meeting ≥ 1 age-appropriate threshold: Pediatric Sleep Questionnaire (PSQ ≥ 8), Epworth Sleepiness Scale (ESS > 10), or Snoring Severity Scale (SSS ≥ 7) for children; Berlin Questionnaire (≥ 2 positive categories), ESS > 10, or SSS ≥ 7 for young adults. Tongue function included mobility, strength, posture, and orofacial domains. Multivariable logistic regression with backward stepwise selection was used in pooled and age-stratified models. Pre-specified interaction terms were systematically tested to explore effect modification between functional and anatomical factors. The prevalance of high-risk classification was 26.8% in children, 11.9% in young adults, and 17.5% overall. In children, low tongue resting posture (AOR = 1.69) and frequent nocturnal open-mouth posture (AOR = 2.69) were independently associated with high-risk classification. In young adults, better orofacial function (AOR = 0.79), greater posterior mobility (AOR = 0.96), and higher posterior strength (AOR = 0.98) were protective. Posterior mobility and age group moderated the association between tonsillar hypertrophy and high-risk classification (AOR = 0.53 and AOR = 2.06, respectively), though not in age-stratified models. In children, combined tonsillar hypertrophy and restricted posterior mobility were associated with substantially higher prevalence (34.5% vs. 13.8%; dose-response p=.006). Tongue function showed age-group-specific associations with questionnaire-based high-risk classification. Incorporating both anatomical and functional assessments within age-specific frameworks may improve early identification and inform future research. The online version contains supplementary material available at 10.1007/s11325-026-03666-3.

Background: Orofacial myofunctional therapy (OMT) is an emerging adjunctive treatment for obstructive sleep apnea (OSA), but its effects on upper airway structural support, particularly the hyoid complex, are not well defined. This study assessed the short-term effects of OMT on hyoid bone position and sleep-related indices in adults with mild to moderate OSA. Methods: In this assessor-blinded randomized controlled trial (ClinicalTrials.gov Identifier: NCT06079073), 13 adults with mild to moderate OSA were randomized to a 12-week web-based OMT program (n = 9) or a waitlist control group (n = 4). Cone-beam computed tomography (CBCT) and three-night home sleep testing were performed at baseline and follow-up. The primary outcome was change in axis-based cephalometric hyoid position measures; secondary outcomes included sleep parameters such as the apnea–hypopnea index (AHI). Results: No significant within- or between-group differences were observed in AHI, oxygen desaturation index, or mean nocturnal SpO₂ after 12 weeks (all p > 0.05). However, several cephalometric variables showed significant between-group differences. The waitlist group exhibited greater posterior–inferior hyoid displacement than the OMT group, with large effect sizes across multiple vector measures (all p ≤ 0.045; r = 0.56–0.66). Posterior and inferior hyoid displacement was associated with higher AHI and lower SpO₂, whereas increased lower pharyngeal airway width was associated with lower AHI. Conclusions: Short-term OMT did not improve sleep-disordered breathing indices but was associated with stabilization of hyoid bone position. These findings suggest that structural stabilization may precede functional improvement and highlight the clinical relevance of vector-based hyoid analysis.

Background: The aim of this article is to describe the protocol of a large, multicenter randomized controlled trial evaluating the effects of orofacial myofunctional therapy with auto-monitoring (OMTa) versus auto-monitoring alone on obstructive sleep apnea (OSA) assessed by the apnea–hypopnea index and other pre-specified outcomes. Method: The OMTaOSA study protocol was registered at ClinicalTrials.gov (NCT06079073) in August 2023, and data collection ended in January 2025. One hundred and four participants with mild and moderate OSA were included. Randomization was conducted in a 1:1 ratio, using sex-stratified blocks. The intervention was a standardized protocol of OMT exercises previously shown to be effective, auto-monitoring with a Withings scan watch, and feedback from self-reports. Controls received watches and access to the same application without the exercise module. Sleep was measured over three nights at baseline and after three months. The sleep scorer and researchers evaluating other outcomes were blinded to the treatment allocation. Change in the apnea–hypopnea index was defined as the primary outcome. Secondary outcomes are published on Clinicaltrials.gov. Results: The results of the trial are still in preparation. Conclusions: By addressing the limitations of previous OMT studies, this trial may clarify the effectiveness of digitally delivered OMT for patients with mild to moderate OSA.

Purpose Generating adequate tongue pressure against the hard palate requires full-range mobility of the tongue. The study aimed to (1) determine the prevalence of restricted tongue mobility and ankyloglossia and (2) determine whether, in children with restricted tongue mobility, their condition also affects tongue pressure. Methods A cross-sectional study of healthy 6–8-year-old children from primary schools in central Vietnam was conducted in 2019. Restricted tongue mobility and ankyloglossia were graded using the tongue range of motion ratio (TRMR), with the tongue-tip-to-incisive papillae (TIP) for the anterior tongue tip and lingual–palatal suction (LPS) for the posterior two-thirds of the tongue. Tongue strength and tongue endurance were measured by the Iowa Oral Pressure Instrument. Statistical analysis investigated the associations between tongue mobility and tongue pressure measurement. Results Five hundred twelve children (46.5% female, mean age 7.2 ± 0.2 years) were assessed. The prevalence of anterior ankyloglossia and restricted mobility was 17.5%, with 16.2% cases of less than 50% mobility and 1.3% cases of less than 25% mobility. The prevalence of posterior ankyloglossia and restricted mobility with less than 30% mobility was 28.9%. Anterior restricted mobility was not a predictor of reduced tongue pressure. Posterior restricted mobility in LPS was independently associated with tongue strength but not tongue endurance. Conclusion Restrictions of posterior tongue mobility in ankyloglossia are more frequent than restrictions in anterior tongue mobility. Reduced tongue strength is related to mobility and the severity of restrictions in the posterior tongue. These findings suggest that restricted posterior tongue mobility may affect tongue muscle weakness.

Orofacial myofunctional disorders (OMD) and sleep-disordered breathing (SDB) may present as comorbidities. Orofacial characteristics might serve as a clinical marker of SDB, allowing early identification and management of OMD and improving treatment outcomes for sleep disorders. The study aims to characterize OMD in children with SDB symptoms and to investigate possible relationships between the presence of various components of OMD and symptoms of SDB. A cross-sectional study of healthy children aged 6–8 from primary schools was conducted in central Vietnam in 2019. SDB symptoms were collected using the parental Pediatric Sleep Questionnaire, Snoring Severity Scale, Epworth Daytime Sleepiness Scale, and lip-taping nasal breathing assessment. Orofacial myofunctional evaluation included assessment of tongue mobility, as well as of lip and tongue strength using the Iowa Oral Performance Instrument, and of orofacial characteristics by the protocol of Orofacial Myofunctional Evaluation with Scores. Statistical analysis was used to investigate the relationship between OMD components and SDB symptoms. 487 healthy children were evaluated, of whom 46.2% were female. There were 7.6% of children at high risk of SDB. Children with habitual snoring (10.3%) had an increased incidence of restricted tongue mobility and decreased lip and tongue strength. Abnormal breathing patterns (22.4%) demonstrated lower posterior tongue mobility and lower muscle strength. Daytime sleepiness symptoms were associated with changes in muscle strength, facial appearance, and impaired orofacial function. Lower strengths of lip and tongue or improper nasal breathing were more likely to be present in children with reported sleep apnea (6.6%). Neurobehavioral symptoms of inattention and hyperactivity were linked to anomalous appearance/posture, increases in tongue mobility and oral strength. This study demonstrates a prevalence of orofacial myofunctional anomalies in children exhibiting SDB symptoms. Children with prominent SDB symptoms should be considered as candidates for further orofacial myofunctional assessment.

Multidisciplinary health professionals (HPs) are involved in supporting patients who have conditions that affect their appearance. With appearance-associated distress common in this group, acceptance and commitment therapy (ACT) and enhanced communication skills both show effectiveness in helping patients adjust to their conditions. Multidisciplinary HPs are perfectly placed to provide low-level psychological support as paraprofessionals. We present the real-world evaluation of a training programme, ACT Now, which was delivered via the train-the-trainer model to 149 multidisciplinary HPs in six European countries. Trainees completed a 16-item knowledge, attitude and practice survey covering psychoeducation on appearance concerns, ACT applied to the patient group and communication skills, at pre-training, post-training and at 3-or-6-month follow-up. Findings show that trainees’ confidence consistently improved in understanding specific facets of appearance concerns and ACT processes, with largely positive changes in other facets, skewed towards delivery nations in which psychologists delivered the training. Patient communication skills generally improved, though again these were more pronounced in psychologist-led countries. However, an absence of significant improvements in ACT comprehension suggests a challenge in transmitting the ACT model to HPs. Providing more initial training to non-psychologist trainers and embedding post-training skills practice for trainees may help reinforce the ACT component of the training.

Purpose: To determine the oral hygiene habits, levels of dental caries, and periodontal condition of patients with repaired cleft lip and/or palate (CL/P) in Central Vietnam. Materials and Methods: A total of 78 patients (1-54 years old; median: 6 years) with CL/P were examined for dental caries, gingivitis and periodontitis using the decayed, missing, and filled teeth (dmft/DMFT) index, gingival bleeding on probing and periodontal pocket depth. Data about dental visits, brushing habits and socioeconomic status were collected. Results: A majority of patients brushed their teeth at least once a day with fluoride dentifrice but did not floss. The caries prevalence was 87.2%. The dmft of patients aged <= 5 years and 6-12 years were 7.4 and 9.0. The DMFT of patients aged 6-12 years, and >= 13 years were 1.6, and 6.7; the difference was statistically significant (p < 0.05). The percentages of patients who had bleeding on probing and had periodontal pocket depth 3.5-5.5 mm were 57.7% and 5.3%, respectively. Conclusions: Patients with repaired CL/P in Central Vietnam had a very high level of caries and had signs of gingivitis but not periodontitis. It is recommended to implement dental care in the treatment protocol for patients CL/P.

Patients with repaired cleft lip and/or palate may vary in satisfaction with their treatment. The exploratory study investigated the satisfaction of patients with orofacial clefts, and their parents with cleft treatment outcomes using the Cleft Hearing, Appearance and Speech Questionnaire (CHASQ). The study included 29 Vietnamese and 27 Estonian patients aged ≥ 7 years with repaired cleft lip and/or palate. The CHASQ was translated into Vietnamese and Estonian. The questionnaire was completed independently by patients and their parents. There were nine items in the CHASQ associated with the cleft (Factor 1) and six items less associated with the cleft (Factor 2). Significant moderate positive correlations were related to Factor 1. Vietnamese patients self-rated lower than Estonian patients in most of the items except speech. The agreement between patients and parents varied from low to moderate positive correlations in the features associated with the cleft, and mainly in the Vietnam sample. Vietnamese patients were less satisfied than Estonian patients. CHASQ is an easy tool to evaluate patients' satisfaction with hearing, appearance, and speech.