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Introduction

Over 20 years have passed since the identification of ankyloglossia with deviation of the epiglottis and larynx (ADEL). The anatomical condition of ADEL is as follows: the tongue is in the forward position, the frenulum lingua is attached to the tongue or there is no frenulum, and the epiglottis and larynx are elevated and forward. This condition increases airflow resistance, thereby reducing respiratory parameters such as vital capacity and forced expiratory volume in 1 second  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>1991</Year><RecNum>2049</RecNum><DisplayText>(1)</DisplayText><record><rec-number>2049</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2049</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author></authors></contributors><titles><title>Congenital ankyloglossia with deviation of the epiglottis and larynx</title><secondary-title>Annals of Otolaryngol</secondary-title><short-title>Congenital ankyloglossia with deviation of the epiglottis and larynx</short-title></titles><periodical><full-title>Annals of Otolaryngol</full-title></periodical><pages>1-20</pages><volume>100, supple 153</volume><keywords><keyword>ADEL, tongue-tie, SIDS, sleep, suckling</keyword></keywords><dates><year>1991</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_1" \o "Mukai, 1991 #2049" 1)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>1993</Year><RecNum>2051</RecNum><DisplayText>(2)</DisplayText><record><rec-number>2051</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2051</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author></authors></contributors><titles><title>Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adult</title><secondary-title>Annals of Otolaryngol</secondary-title><short-title>Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adult</short-title></titles><periodical><full-title>Annals of Otolaryngol</full-title></periodical><pages>620-624</pages><volume>102</volume><number>102</number><keywords><keyword>adel, respiration, occlusion, Angle, teeth, tongur-tie</keyword></keywords><dates><year>1993</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_2" \o "Mukai, 1993 #2051" 2)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>2002</Year><RecNum>446</RecNum><DisplayText>(3)</DisplayText><record><rec-number>446</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">446</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S</author><author>Nitta, M</author></authors></contributors><titles><title>Correction of the glosso-larynx (CGL) and resultant positional changes of the hyoid bone and cranium</title><secondary-title>Act Otolaryngol (Sweden)</secondary-title><short-title>Correction of the glosso-larynx (CGL) and resultant positional changes of the hyoid bone and cranium</short-title></titles><periodical><full-title>Act Otolaryngol (Sweden)</full-title></periodical><pages>644-650.</pages><volume>122</volume><dates><year>2002</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_3" \o "Mukai, 2002 #446" 3)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>2002</Year><RecNum>447</RecNum><DisplayText>(4)</DisplayText><record><rec-number>447</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">447</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S</author><author>Nitta, M</author></authors></contributors><titles><title>Z-pharyngoplasty for sleep disorder and rhonchopathy</title><secondary-title>Acta Otolaryngol (Sweden)</secondary-title><short-title>Z-pharyngoplasty for sleep disorder and rhonchopathy</short-title></titles><periodical><full-title>Acta Otolaryngol (Sweden)</full-title></periodical><pages>524-530</pages><volume>122</volume><keywords><keyword>uvula, uvulopalatopharyngoplasty (UPPP), pharynx, snoring, ankyloglossia with deviation of the epiglottis and larynx (ADEL)</keyword></keywords><dates><year>2002</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_4" \o "Mukai, 2002 #447" 4)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>2004</Year><RecNum>2078</RecNum><DisplayText>(5)</DisplayText><record><rec-number>2078</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2078</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai S,</author><author>Nitta N, </author></authors></contributors><titles><title>Expansion of the vestibular oris (EVO) (In Japanese)</title><secondary-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</secondary-title></titles><periodical><full-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</full-title></periodical><pages>1-9</pages><volume>12</volume><keywords><keyword>adel, sleep, esthetics, osas. facial muscles, lip, eye</keyword></keywords><dates><year>2004</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_5" \o "Mukai S, 2004 #2078" 5)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>2009</Year><RecNum>1341</RecNum><DisplayText>(6)</DisplayText><record><rec-number>1341</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1341</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S</author></authors></contributors><titles><title>Decrease of nasal ariflow registance by expansion of the vestibular oris. (Japanese)</title><secondary-title>Ann Ankyloglossia with deviation of the epiglottis and larynx</secondary-title></titles><periodical><full-title>Ann Ankyloglossia with deviation of the epiglottis and larynx</full-title></periodical><pages>16-20</pages><volume>15</volume><dates><year>2009</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_6" \o "Mukai, 2009 #1341" 6)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai S</Author><Year>2010</Year><RecNum>2304</RecNum><DisplayText>(7)</DisplayText><record><rec-number>2304</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai S,</author><author>Yamamoto I,</author></authors></contributors><titles><title>Patial genioglossectomy leading to an increase in respiratory rate --- surgery for ankyloglossia with deviation of the epiglottis and larynx---.</title><secondary-title>Nihon Zetuyuchalusho Gakkaishi (Annals ADEL)</secondary-title></titles><periodical><full-title>Nihon Zetuyuchalusho Gakkaishi (Annals ADEL)</full-title></periodical><pages>pp25-31</pages><volume>16</volume><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_7" \o "Mukai S, 2010 #2304" 7). 
We found that respiratory distress in humans is indicated by various symptoms and signs. Those in babies are sleep apnea, harsh respiratory sounds, thumb-sucking, suckling problems, colic cry, cold extremities, swollen abdomen, protruded navel, cutis marmorata and eczema. Such babies lack eye contact and are afraid of strangers. They have a stiff body, frowned face and other symptoms  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>1991</Year><RecNum>2049</RecNum><DisplayText>(1, 8)</DisplayText><record><rec-number>2049</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2049</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author></authors></contributors><titles><title>Congenital ankyloglossia with deviation of the epiglottis and larynx</title><secondary-title>Annals of Otolaryngol</secondary-title><short-title>Congenital ankyloglossia with deviation of the epiglottis and larynx</short-title></titles><periodical><full-title>Annals of Otolaryngol</full-title></periodical><pages>1-20</pages><volume>100, supple 153</volume><keywords><keyword>ADEL, tongue-tie, SIDS, sleep, suckling</keyword></keywords><dates><year>1991</year></dates><urls></urls></record></Cite><Cite><Author>S Mukai</Author><Year>1998</Year><RecNum>3091</RecNum><record><rec-number>3091</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">3091</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S Mukai,</author></authors></contributors><titles><title>Ankuyloglossia with Deviation of the Epiglottis and Larynx (ADEL) (In Japanese)</title><secondary-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</secondary-title></titles><periodical><full-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</full-title></periodical><pages>1-53</pages><volume>8</volume><keywords><keyword>adell,</keyword></keywords><dates><year>1998</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_1" \o "Mukai, 1991 #2049" 1,  HYPERLINK \l "_ENREF_8" \o "S Mukai, 1998 #3091" 8)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>1992</Year><RecNum>425</RecNum><DisplayText>(9)</DisplayText><record><rec-number>425</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">425</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author><author>Nagasugi, S.</author></authors></contributors><titles><title>Digit sucking</title><secondary-title>Lancet</secondary-title><short-title>Digit sucking</short-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1545 -1546</pages><volume>339</volume><keywords><keyword>Digit sucking, ADEL, respiration, sleep</keyword></keywords><dates><year>1992</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_9" \o "Mukai, 1992 #425" 9)  ADDIN EN.CITE <EndNote><Cite><Author>S Mukai</Author><Year>1993</Year><RecNum>3088</RecNum><DisplayText>(10)</DisplayText><record><rec-number>3088</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">3088</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S Mukai,</author><author>C Mukai,</author><author>K Asaoka,</author><author>S Nagasugi,</author><author>M Ogiyama,</author></authors></contributors><titles><title>Near miss for SIDS seen in infants who have ankyloglossia with deviation of the epiglottis and larynx (In Japanese Iwith English abstract)</title><secondary-title>Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx</secondary-title></titles><periodical><full-title>Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx</full-title></periodical><pages>33-45</pages><volume>3</volume><keywords><keyword>adel, respiration</keyword></keywords><dates><year>1993</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_10" \o "S Mukai, 1993 #3088" 10)  ADDIN EN.CITE <EndNote><Cite><Author>Suzuki</Author><Year>1993</Year><RecNum>2306</RecNum><DisplayText>(11)</DisplayText><record><rec-number>2306</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2306</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Suzuki, H.</author><author>Nakaji, M.</author><author>S, Mukai</author></authors></contributors><titles><title>Relationship between babies with ankyloglossia and disturbance of their mother&apos;s breast (In Japanese)</title><secondary-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</secondary-title><short-title>Relationship between babies with ankyloglossia and disturbance of their mother&apos;s breast</short-title></titles><periodical><full-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</full-title></periodical><pages>74-84</pages><volume>3</volume><keywords><keyword>adel0breast feeding, sucking</keyword></keywords><dates><year>1993</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_11" \o "Suzuki, 1993 #2306" 11). In children the main signs and symptoms are shallow sleep, snoring, pallor and a tendency to whine when awakening. They are irritable, over reliant and selfish. They fall down frequently. They have week masticatory strength and tend to accumulate cerumen. Signs and symptoms in adults are sleep apnea, snoring, sleep difficulty, fatigue and persistent sleepiness. Adults may get cramps in leg muscles and other muscles, feel that the head is heavy, have bruxism and involuntarily jiggle their legs. They are irritable, selfish and dependent. 
The etiology of these symptoms is considered to be unknown.  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>1994</Year><RecNum>2054</RecNum><DisplayText>(12, 13)</DisplayText><record><rec-number>2054</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2054</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author><author>Nagasugi, S.</author><author>Djupesland, P.</author></authors></contributors><titles><title>Prevention of SIDS --- Correction of ankyloglossia with deviation of the epiglottis and larynx</title><secondary-title>Third SIDS International Conference</secondary-title><short-title>Prevention of SIDS --- Correction of ankyloglossia with deviation of the epiglottis and larynx</short-title></titles><pages>144</pages><keywords><keyword>sids, adel, correction of adel</keyword></keywords><dates><year>1994</year></dates><pub-location>Stavanger, Norway</pub-location><urls></urls></record></Cite><Cite><Author>Mukai</Author><Year>1994</Year><RecNum>2055</RecNum><record><rec-number>2055</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2055</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author><author>Nagasugi, S.</author><author>Djupesland, P.</author></authors></contributors><titles><title>Subjective and objective evaluation of crying before and after the correction of ankyloglossia with deviation of the epiglottis and larynx</title><secondary-title>Third SIDS International Conference</secondary-title><short-title>Subjective and objective evaluation of crying before and after the correction of ankyloglossia with deviation of the epiglottis and larynx</short-title></titles><pages>179</pages><keywords><keyword>cry, colic cry, adel, sids</keyword></keywords><dates><year>1994</year></dates><pub-location>Stavanger, Norway</pub-location><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_12" \o "Mukai, 1994 #2054" 12,  HYPERLINK \l "_ENREF_13" \o "Mukai, 1994 #2055" 13). Individuals with ADEL also have underdeveloped maxillo-mandibular bones, malaligned teeth, high tongue positions, etc.  ADDIN EN.CITE <EndNote><Cite><Author>S Mukai</Author><Year>2011</Year><RecNum>1523</RecNum><DisplayText>(14)</DisplayText><record><rec-number>1523</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1523</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>S Mukai,</author></authors></contributors><titles><title>New conseption about occulusion -- View from ankyloglossia with deviation of the epiglottis and larynx (ADEL) (In Japanese)</title><secondary-title>Japanse Orthodontic Society of General Practitioner</secondary-title></titles><periodical><full-title>Japanse Orthodontic Society of General Practitioner</full-title></periodical><pages>16-17</pages><volume>22</volume><keywords><keyword>adel, orthodontics, occlusion, jaw, respiration, phylogenetics</keyword></keywords><dates><year>2011</year></dates><pub-location>Tokyo</pub-location><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_14" \o "S Mukai, 2011 #1523" 14). 

Not only the tongue and the larynx but also the respiratory system in humans has evolved from the muscles of gills of fish. The transformation began from the Devonian Period, about 307 million years ago, when fish inhabited the land. The tongue and larynx of mammals evolved from the 2nd branchial arch  ADDIN EN.CITE <EndNote><Cite><Author>AS Romer</Author><Year>1977</Year><RecNum>1562</RecNum><DisplayText>(15, 16)</DisplayText><record><rec-number>1562</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1562</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>AS Romer,</author><author>TS Parsons,</author></authors><subsidiary-authors><author>M Hiramitu</author></subsidiary-authors></contributors><titles><title>The vertebrate body. 5th ed.</title></titles><pages>324-372</pages><dates><year>1977</year></dates><pub-location>Philadelphia</pub-location><publisher>W.B. Saunders Co.</publisher><label>Amazon. �20,000.-</label><urls></urls></record></Cite><Cite><Author>JA Clack</Author><Year>2000</Year><RecNum>3084</RecNum><record><rec-number>3084</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">3084</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>JA Clack,</author><author>translated by H Ikeda,</author></authors><secondary-authors><author>History of life</author></secondary-authors></contributors><titles><title>Gaining ground: The water to land adventure. (In Japanese)</title></titles><pages>31-290</pages><dates><year>2000</year></dates><pub-location>Tokyo</pub-location><publisher>Kodansha, Ltd.</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_15" \o "AS Romer, 1977 #1562" 15,  HYPERLINK \l "_ENREF_16" \o "JA Clack, 2000 #3084" 16). Thus, the condition of ADEL originates from mammalian phylogeny. As written by Charles Darwin, �Organs not in all cases are absolutely perfect.�  ADDIN EN.CITE <EndNote><Cite><Author>C.D.Darwin</Author><Year>1876</Year><RecNum>3053</RecNum><DisplayText>(17)</DisplayText><record><rec-number>3053</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">3053</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>C.D.Darwin,</author></authors></contributors><titles><title>The origin of species, 6ed.</title><secondary-title>The workds of Charles Darwin</secondary-title></titles><volume>16</volume><section>133-167</section><dates><year>1876</year></dates><pub-location>Ney York</pub-location><publisher>New York University Press</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_17" \o "C.D.Darwin, 1876 #3053" 17). It is not too much to say that ADEL was loaded onto the lives of humans like the basso continuo of baroque music.  

Surgical correction of the glosso-larynx and expansion of the vestibular oris (EVO) can greatly ameliorate symptoms of ADEL  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>2002</Year><RecNum>446</RecNum><DisplayText>(3)</DisplayText><record><rec-number>446</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">446</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S</author><author>Nitta, M</author></authors></contributors><titles><title>Correction of the glosso-larynx (CGL) and resultant positional changes of the hyoid bone and cranium</title><secondary-title>Act Otolaryngol (Sweden)</secondary-title><short-title>Correction of the glosso-larynx (CGL) and resultant positional changes of the hyoid bone and cranium</short-title></titles><periodical><full-title>Act Otolaryngol (Sweden)</full-title></periodical><pages>644-650.</pages><volume>122</volume><dates><year>2002</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_3" \o "Mukai, 2002 #446" 3)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_6" \o "Mukai, 2009 #1341" 6,  HYPERLINK \l "_ENREF_7" \o "Mukai S, 2010 #2304" 7,  HYPERLINK \l "_ENREF_12" \o "Mukai, 1994 #2054" 12,  HYPERLINK \l "_ENREF_18" \o "Susumu Mukai, 2010 #1524" 18). The EVO described in this report is based on a new concept that decreases the force of the depressor septi nasi muscle (DSN), which is positioned in the center of the face between the maxillary bone and nasal and facial muscles. The following results were observed after the EVO: widening of the opening of the nostrils, increased nasal airflow, increased activities of the oral muscles, upward movement of the angular orises, increased activities of facial muscles and increased deglutition ability. In addition, aesthetic facial changes were obtained. 

Expansion of the Vestibular Oris (EVO)
A 1% lidocaine injection is administered into the upper vestibular space between the canine teeth. The incision starts at the attachment of the upper frenulum (Figure 1-1) and is then expanded from the upper vestibular oris to the level of the junction of the nasal septum and the base of the nasal cavities, detaching the DSN from the maxillary bone between the canines (Figure 1-2). The EVO is then done and completed in the open wound (Figure 1-3).

The advantages of EVO are that it is available for all age groups, the operative area is wide and shallow and little pain is involved. Hemostasis is easy to achieve and maintain, with hemorrhage after the operation rare. Patients can breathe easier through the nose immediately after EVO and experience immediate amelioration of their complaints. The follow-up of the post-operative phase is easy. 
	
Investigation of changes achieved by EVO 
Two studies were performed to investigate the results of EVO. In Study I changes in the patients� features were investigated and in Study II changes in nasal airflow resistance were evaluated. These investigations were approved by �the Human Subjects Committee� of our clinic. Informed consent was obtained from each patient

Study I � Changes in the appearance of patients
Methods and patients
	Changes in appearance after EVO were characterized by measuring the following items (Figures 2, 3): A. height of the nose as distance from the top to the base of the nose (top of the philtrum); B. distance between the external edges of the ala nasi; C. distance between the lateral edges of the nostrils; D. length of the philtrum; E. distance between the anguli oris of the lips; F. distance between the pupils when subjects view distant objects; and G. distance from the left/right angulus oculi medialis to the angulus oris on the same side of the mouth (R-EM, right side; L-EM, left side).
Items A to E were measured in 15 subjects (5 males, 10 females; 30 y � 15.2 y (average � SD) and items F and G were measured in 8 females (37 y � 8.3 y). They received EVO between March 21 and December 13, 1996. Employing a precise industrial vernier caliper (Shinwa Sokuteiki Co., Ltd., Sanjo, Japan), distances were measured under normal calm conditions so that the facial muscles showed no tension. The vernier caliper used can measure distances of 0.01 mm and all items were measured to a level of 0.1 mm. Each item was measured three times, with the average value for each item used. StatView was used for statistical analyses.
Results 
Average changes pre and post EVO were as follows (Figure 4): distance from the top to the base of the nose increased from 18.1 mm to 18.8 mm. (p=0.0088); distance between the external edges of the ala nasi increased from 32.1 mm to 34.7 mm (<0.0001); distance between the lateral edges of the nostrils increased from 27.6 mm to 30.3 mm (<0.0001); length of the philtrum increased from 14.8 mm to 16.0 mm (<0.0001); and distance between the anguli oris increased from 54.3 mm to 56.4 mm (<0.0001). Then as shown in Figure 5, the average distance between the pupils decreased from 62.3 mm to 61.5 mm (p+0.0335) (Figure 4). Changes in the distance from the left/right angulus oculi medialis to the angulus oris on the same side of the mouth were for the R-EM from 65.8 mm to 61.5 mm (p=0.0348) and for the L-EM from 65.3 mm to 65.1 mm (p=0.3268) (Figure 5). Significant differences were observed in the measured items with the exception of L-EM.

Study II. Nasal airflow resistance.
Methods and patients
	Nasal airflow resistance was measured before and one day after the EVO by a nasal airflow meter (KOC-8900A, Chest Ltd. Tokyo, Japan). Pa/cm3/sec was employed to determine nasal airflow resistance by the posterior method  ADDIN EN.CITE <EndNote><Cite><Author>Clement PAR</Author><Year>1984</Year><RecNum>4211</RecNum><DisplayText>(19)</DisplayText><record><rec-number>4211</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4211</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clement PAR,</author></authors></contributors><titles><title>Commitee report on standardization of rhinomanometry.</title><secondary-title>Rhinology</secondary-title></titles><periodical><full-title>Rhinology</full-title></periodical><pages>151-155</pages><volume>22</volume><keywords><keyword>evo, adel</keyword></keywords><dates><year>1984</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_19" \o "Clement PAR, 1984 #4211" 19)  ADDIN EN.CITE <EndNote><Cite><Author>Cole P</Author><Year>1997</Year><RecNum>4213</RecNum><DisplayText>(20)</DisplayText><record><rec-number>4213</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4213</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cole P,</author></authors></contributors><titles><title>Nasal airflow resistance: a survey of 2500 assesment</title><secondary-title>Am J Rhinol</secondary-title></titles><periodical><full-title>Am J Rhinol</full-title></periodical><pages>415-419</pages><volume>11</volume><keywords><keyword>evo, adel</keyword></keywords><dates><year>1997</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_20" \o "Cole P, 1997 #4213" 20). StatView was used for a paired t-test. Nasal airflow resistance was measured in 28 patients (13 males and 15 females; average age 32 y (SD � 11.4)) between May 8, 2005 and April 27, 2006. All patients had complained of feelings of nasal obstruction and sleep disorders.
Results	
The average airflow resistance determined by the sum of airflow resistance by both nasal cavities at Pa/cm3/sec before and after EVO was as follows: resistance at expiration before and after EVO was 0.545 and 0.35�P��0.0005, respectively, and that of inspiration was 0.51 and 0.22 (p=0.0045), respectively. Significant differences in nasal airflow resistance were observed for both expiration and inspiration (Figure 6). 
Summary of results of Study I and Study II
In summary, results of Study I showed that the nose became higher, the nostrils and mouth became wider, the anguli oris increased and the distance between pupils decreased (Figures 4, 5). In addition to these observations, the subjects� eyes were wider after the EVO (Figure 7). The subjects also said that they could express their feelings easier after the operation. Nasal airflow resistance decreased (nasal airflow increased) (Figures 8-1, 8-2).
	
Comments from the patients
Many patients commented on improvements after undergoing EVO. A sampling of these comments is as follows.
1. �Air enters much easier.�
2. �Cold air enters deep into the nose.� 
3. �Before EVO, coughing prevented me from sleeping on my back; now I sleep on my back without coughing.�
4. �I got out of breath and my chest throbbed with pain when I went up the stairs. I was surprised that these symptoms disappeared just after the EVO.�
5. �I had wrinkles on the upper lip when I laughed. The wrinkles disappeared, and my nose was higher and wider after the operation. My expression became aesthetically more pleasing.�
6. �I have a good appetite and everything tastes good after EVO. The frequency of headache decreased significantly.�
7. �I can swallow food more easily because I hardly ever choke on a meal.� 
8. �I now have good posture.�
9. �I have more strength to do my work.�
10. �I feel I can start something new.�
11. �I can sleep well because air passes through my nose easily.�
12.  A 56-year-old male mentioned that his eyesight had improved two points on an eye test one day after EVO. 
13.  Almost all patients stated that their field of vision was brighter and clearer after EVO. 
14.  The author observed that patients had better eye contact after EVO. 
15.  The following summarizes a professional tenor�s comments after EVO:
1). The resonance of the nasal cavity became richer. The pitch of the voice increased slightly, and at the same time the low-pitch sound decreased because the ratio of nasal resonance increased and the ratio of chest resonance decreased.  
�)�Before EVO, the resonance points were discontinuous and voices were flat and nasal around C (do), Cis (#do), and D (re). After EVO, the voice maintained continuous sounds and resonances. 
3). So-called �stream of the breath� in vocalization improved after EVO.
4). In the same way the high-pitch resonance of discontinuity between As (#sol) and A (lah) was improved. 
  5. The shape of the mouth during singing was changed. �I feel both angles of the mouth (angulus oris) pulling upwards when singing after EVO. This is an example of how a tenor opens the mouth when singing. This mouth-opening method used by tenors was not easy for me before EVO.� 

DISCUSSION
The EVO is an operation that detaches the DSN muscle from the maxillary bone between the two canine teeth as high as the nasal cavities and the junction of the nasal septum and maxillary bone  ADDIN EN.CITE <EndNote><Cite><Author>Mukai S</Author><Year>2004</Year><RecNum>2078</RecNum><DisplayText>(5)</DisplayText><record><rec-number>2078</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2078</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai S,</author><author>Nitta N, </author></authors></contributors><titles><title>Expansion of the vestibular oris (EVO) (In Japanese)</title><secondary-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</secondary-title></titles><periodical><full-title>Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx</full-title></periodical><pages>1-9</pages><volume>12</volume><keywords><keyword>adel, sleep, esthetics, osas. facial muscles, lip, eye</keyword></keywords><dates><year>2004</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_5" \o "Mukai S, 2004 #2078" 5)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>2009</Year><RecNum>1341</RecNum><DisplayText>(6)</DisplayText><record><rec-number>1341</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1341</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S</author></authors></contributors><titles><title>Decrease of nasal ariflow registance by expansion of the vestibular oris. (Japanese)</title><secondary-title>Ann Ankyloglossia with deviation of the epiglottis and larynx</secondary-title></titles><periodical><full-title>Ann Ankyloglossia with deviation of the epiglottis and larynx</full-title></periodical><pages>16-20</pages><volume>15</volume><dates><year>2009</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_6" \o "Mukai, 2009 #1341" 6). Various changes are observable after EVO. Before discussing such changes, the author will discuss different aspects of maxillary and mandibular bones and the DSN muscle and provide phylogenetical explanations in order to provide a better understanding of EVO.
I. Maxillary and mandibular bones 
The growth of the cranium is divided into two parts from the level of the nose. The upper part is called the brain cranium and the lower is called the respiratory cranium. The former grows to almost adult size by the age of seven while the latter grows in proportion to physical development. The growth is not programmed within the bone itself. The occlusion and shapes of the dental arches are hardly affected by heredity (Harris and Johnson, 1991)  ADDIN EN.CITE <EndNote><Cite><Author>Staley</Author><Year>2001</Year><RecNum>623</RecNum><DisplayText>(21)</DisplayText><record><rec-number>623</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">623</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Staley, R. N.</author></authors><secondary-authors><author>Bishara, S. E.</author></secondary-authors></contributors><titles><title>Etiology and prevalence of malocclusion</title><secondary-title>Textbook of orthodontics</secondary-title><short-title>Etiology and prevalence of malocclusion</short-title></titles><pages>83-96</pages><keywords><keyword>uvo,0�ST�MR�^�b'YKbS�0respiration, upper airway</keyword></keywords><dates><year>2001</year></dates><pub-location>Phladelphia</pub-location><publisher>W.B.Saunders Co.</publisher><label>�ST�MR�^�b'YKbS�g0_(u</label><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_21" \o "Staley, 2001 #623" 21) .
The maxillary and mandibular bones develop interdependently in coordination with their functions in respiration, mastication, swallowing, phonation and even silence. The development of the two bones are controlled by forces emanating from surrounding structures such as the cranial base, respiratory tract, nasal and paranasal cavities, facial muscles, teeth, tongue, and masseter muscles  ADDIN EN.CITE <EndNote><Cite><Author>Enlow</Author><Year>1996</Year><RecNum>154</RecNum><DisplayText>(22)</DisplayText><record><rec-number>154</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">154</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Enlow, D. H.</author><author>Hans, M. G.</author></authors></contributors><titles><title>Essentials of facial growth</title><short-title>Essentials of facial growth</short-title></titles><pages>1-219</pages><dates><year>1996</year></dates><pub-location>Philadelphia</pub-location><publisher>WS Saunders Co.</publisher><label>2003/1/200��eQ�7981.-</label><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_22" \o "Enlow, 1996 #154" 22)

II. Depressor septi nasi muscle (DSN)
The anatomical name for the musculus depressor septi nasi (DSN) has changed in different years and in different anatomy textbooks. Some investigators named the DSN as musculus myritiformis  ADDIN EN.CITE <EndNote><Cite><Author>Figallo EE</Author><Year>2001</Year><RecNum>1282</RecNum><DisplayText>(23)</DisplayText><record><rec-number>1282</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1282</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Figallo EE,</author><author>Acosta JA,</author></authors></contributors><titles><title>Nose mascular dynamics: the tip trigonum</title><secondary-title>Plastic &amp; Reconstructive Surgery</secondary-title></titles><periodical><full-title>Plastic &amp; Reconstructive Surgery</full-title></periodical><pages>1118-1126</pages><volume>108</volume><number>5</number><keywords><keyword>evo, adel0;�n0K{��n0
T�y	Yw�0anatomy0craniometric points, m. procerus, m. occiptofrontaris, m. levato labii supreioris alaeque nasi, m.anomalis, m. myritiformis, m. dilator naris anterior, m.compressor narium minor, m. digastricus septi nasi labialis</keyword></keywords><dates><year>2001</year></dates><label>glabella; 	w��0<w�z
N���}n0ؚU0k0B0�0ck-N�}
Nn0M�n0g�0MR�ex0�z�QW0f0D0�0�R</label><urls></urls><access-date>2007/2/3  efigallo@clinicaelavila.com</access-date></record></Cite></EndNote>( HYPERLINK \l "_ENREF_23" \o "Figallo EE, 2001 #1282" 23). The inner muscles of the M. Myritiformis form the DSN according to Rouvi�re (1981) and Figallo (2001)  ADDIN EN.CITE <EndNote><Cite><Author>Rouvi�re H</Author><Year>2002</Year><RecNum>4193</RecNum><DisplayText>(24)</DisplayText><record><rec-number>4193</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4193</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Rouvi�re H, </author><author>Delmas A,</author></authors></contributors><titles><title>Muscle du Nez, Muscles des L�ves</title><secondary-title>Anatomie humaine, Descriptive, topographie et fonctionelle</secondary-title></titles><pages>172-179</pages><volume>tome 1, t�te et cou</volume><dates><year>2002</year></dates><pub-location>Paris</pub-location><publisher>MaSSON</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_24" \o "Rouvi�re H, 2002 #4193" 24). The name DSN is employed in this report.
The DSN originates from the incisive fossa of the maxilla, and its fibers extend upward to be inserted both into the septum and the posterior part of the ala of the nose. At its origin it lies beneath the orbicularis oris. The DSN narrows the nostrils by inhibiting the ala nasi and dilator naris muscles and shortens the length of the philtrum, resulting in a shorter distance from the nose to the upper lip. As a result, the upper lip is thinner than the lower lip  ADDIN EN.CITE <EndNote><Cite><Author>Rouvi�re H</Author><Year>2002</Year><RecNum>4193</RecNum><DisplayText>(24)</DisplayText><record><rec-number>4193</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4193</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Rouvi�re H, </author><author>Delmas A,</author></authors></contributors><titles><title>Muscle du Nez, Muscles des L�ves</title><secondary-title>Anatomie humaine, Descriptive, topographie et fonctionelle</secondary-title></titles><pages>172-179</pages><volume>tome 1, t�te et cou</volume><dates><year>2002</year></dates><pub-location>Paris</pub-location><publisher>MaSSON</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_24" \o "Rouvi�re H, 2002 #4193" 24). The length of the philtrum increased after EVO, suggesting that the strength of the DSN weakened the strength of the upper lip. The mouth became wider after EVO revealed that the inhibitory strength by the DSN on the quadratus muscles of the upper lip and on the orbicularis oris were weakened by the operation.  
The shorter distance between the pupilla when patients viewed distant objects after EVO may be due to better eye contact by the patients after EVO. The observation that the eyes were wider after EVO corresponds to the patients� comments that they can see objects more clearly and more brightly. Not only eye muscles but also optical ability might increase after EVO. This suggested that DSN was related to eye-opening muscles and/or facial nerve activities.	
That the distance from the angulus oculi medialis to the angulus oris on the same side became smaller after EVO means that the angularis oris moved upward. That is because EVO strengthens the following facial muscles: transversus nasi muscles, ala nasi muscles, m. levator labii superior, m. zygomaticus minor, m. levator anguli oris, m. zygomaticus major and minor, m. buccinator and m. risorius.
Results of the two studies described herein revealed that the DSN also inhibits the actions of muscles such as risorius, zygomaticus, caninus, buchinator, as well as deep and superficial nasal muscles. DSN inhibits the buccal muscles as well. Our results suggested that the DSN inhibits neighboring muscles as well as inhibiting growth of the maxillary and mandibular bones.
The investigations reported herein revealed that DSN inhibits growth of the respiratory cranium and that DSN has a negative effect on facial aesthetics as well.

III. Discussion of EVO
The EVO is an operation that detaches the DSN muscle from the maxillary bone, thereby weakening the inhibitory strength of the muscle on the maxillary bone. Moreover, EVO weakens the strength of the interaction between the DSN and the dilator nasi and ala nasi muscles. As a result, the nostrils become wider. Nasal height increases after EVO because the depressive strength of the DSN on the nasal septum is weakened by the operation  ADDIN EN.CITE <EndNote><Cite><Author>Hwang K</Author><Year>2006</Year><RecNum>1284</RecNum><DisplayText>(25)</DisplayText><record><rec-number>1284</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1284</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hwang K,</author><author>Kim DJ,</author><author>Hwang G,</author></authors></contributors><titles><title>Relationship between depressor septi nasi muscle and dermocartilagenous ligament; anatomic study and clinical application</title><secondary-title>J. Craniofac Surg</secondary-title></titles><periodical><full-title>J. Craniofac Surg</full-title></periodical><pages>286-290</pages><volume>17</volume><number>2</number><keywords><keyword>evo, adel, dsm,</keyword></keywords><dates><year>2006</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_25" \o "Hwang K, 2006 #1284" 25)  ADDIN EN.CITE <EndNote><Cite><Author>Lam SM</Author><Year>2002</Year><RecNum>1280</RecNum><DisplayText>(26)</DisplayText><record><rec-number>1280</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">1280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lam SM,</author><author>Williams III EF,</author></authors></contributors><titles><title>Anatomic consideration in aesthetic rhinoplasty</title><secondary-title>Facial Plast Surg</secondary-title></titles><periodical><full-title>Facial Plast Surg</full-title></periodical><pages>209-214</pages><volume>18</volume><number>4</number><keywords><keyword>evo, adel, nasal muscle,</keyword></keywords><dates><year>2002</year></dates><label>EVO0;�n0qQ�T�h0D0F0�H0�0eQ�0�002007/4/30</label><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_26" \o "Lam SM, 2002 #1280" 26). 
The most important factor in nasal airflow resistance is the nasal valve  ADDIN EN.CITE <EndNote><Cite><Author>Cole P</Author><Year>1997</Year><RecNum>4213</RecNum><DisplayText>(20)</DisplayText><record><rec-number>4213</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4213</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cole P,</author></authors></contributors><titles><title>Nasal airflow resistance: a survey of 2500 assesment</title><secondary-title>Am J Rhinol</secondary-title></titles><periodical><full-title>Am J Rhinol</full-title></periodical><pages>415-419</pages><volume>11</volume><keywords><keyword>evo, adel</keyword></keywords><dates><year>1997</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_20" \o "Cole P, 1997 #4213" 20). The nasal valve consists of the caudal border of the upper lateral cartilage, head of the inferior turbinate, floor of the nose, and nasal septum. Change in nasal airflow resistance upon inspiration was greater than that of expiration, suggesting that nasal valve widening is very effective in inspiration of air. In other words, the Benoulli effect is stronger in the inhalation of air at the nasal valve. 
Increases in nasal airflow and several comments by patients that they felt more air pass through their nasal cavities after EVO indicate that both nostrils and nasal cavities were expanded. The development of the maxillary bones continues after EVO, and the nose itself continues widening as well after EVO. The submaxillary bone also develops proportionately to the maxillary bone. The conclusion from the observations mentioned above is that EVO releases inhibitory forces exerted by facial muscles that work on the maxillary bone in every direction. 
Increases in bone mass are advantageous to the immune system. The nasal cavity is at the forefront of the respiratory immune response. Respiration via the nasal cavity is mandatory for obtaining improvements in immune systems  ADDIN EN.CITE <EndNote><Cite><Author>Nishihara K</Author><Year>1996</Year><RecNum>294</RecNum><DisplayText>(27)</DisplayText><record><rec-number>294</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">294</key><key app="ENWeb" db-id="">0</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Nishihara K,</author></authors></contributors><titles><title>Science of the face</title><short-title>Science of the face</short-title></titles><section>18-204</section><keywords><keyword>evo, adel, cgl, respiration, INV, leptorrhine, immune</keyword></keywords><dates><year>1996</year></dates><pub-location>Tokyo</pub-location><publisher>Nihon Kyobunsha</publisher><isbn>1-84426-095-X</isbn><label>��SKQbHQu�0�0�[�015/5/7</label><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_27" \o "Nishihara K, 1996 #294" 27). 
It is the author's observations that the force exerted on the maxillary bone by the DSN results in malocclusion, snaggleteeth, temporomandibular arthrosis and/or irregular movements of the temporomandibular joints. These morbid cranial conditions result in shifts of the center of gravity that affect the feet. These changes in the gravity center can cause lumbago and pain in the hip and knee joints  ADDIN EN.CITE <EndNote><Cite><Author>Tsuno H</Author><Year>1996</Year><RecNum>4214</RecNum><DisplayText>(28)</DisplayText><record><rec-number>4214</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4214</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tsuno H,</author></authors></contributors><titles><title>Standing ability of patients with ankyloglossia with deviation of the epiglottis and larynx  (In Japanese with English abstract)</title><secondary-title>Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx</secondary-title></titles><periodical><full-title>Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx</full-title></periodical><pages>8-17</pages><volume>6</volume><dates><year>1996</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_28" \o "Tsuno H, 1996 #4214" 28)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_29" \o "Mukai, 1991 #3353" 29)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai</Author><Year>1993</Year><RecNum>3332</RecNum><DisplayText>(30)</DisplayText><record><rec-number>3332</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">3332</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai, S.</author><author>Mukai, C.</author><author>Asaoka, K.</author></authors></contributors><auth-address>Mukai Clinic and Research Institute of Biology, Kanagawa, Japan.</auth-address><titles><title>Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults</title><secondary-title>Ann Otol Rhinol Laryngol</secondary-title><alt-title>The Annals of otology, rhinology, and laryngology</alt-title></titles><periodical><full-title>Ann Otol Rhinol Laryngol</full-title></periodical><pages>620-4</pages><volume>102</volume><number>8 Pt 1</number><edition>1993/08/01</edition><keywords><keyword>Adult</keyword><keyword>Epiglottis/*abnormalities</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Larynx/*abnormalities</keyword><keyword>Lingual Frenum/*abnormalities/surgery</keyword><keyword>Male</keyword><keyword>Malocclusion, Angle Class III/complications</keyword><keyword>Respiratory Insufficiency/*etiology</keyword><keyword>Tongue Diseases/complications/*congenital</keyword></keywords><dates><year>1993</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0003-4894 (Print)&#xD;0003-4894 (Linking)</isbn><accession-num>8352487</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/8352487</url></related-urls></urls><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_30" \o "Mukai, 1993 #3332" 30)  ADDIN EN.CITE <EndNote><Cite><Author>Mukai S</Author><Year>2000</Year><RecNum>2066</RecNum><DisplayText>(31)</DisplayText><record><rec-number>2066</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2066</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukai S, </author><author>Mukai C,</author><author>Nitta M,</author></authors></contributors><titles><title>Function of the uvula and Z Pharyngoplasty (Japanese with english abstract)</title><secondary-title>Acta Otolaryngol (Kyoto)</secondary-title><short-title>Function of the uvula and Z Pharyngoplasty (Japanese with english abstract)</short-title></titles><periodical><full-title>Acta Otolaryngol (Kyoto)</full-title></periodical><pages>31-38</pages><volume>93</volume><keywords><keyword>zpp, tonsilectomy, sleep, adel, cgl</keyword></keywords><dates><year>2000</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_31" \o "Mukai S, 2000 #2066" 31).
It is said that the origin of vertebrates is the lamprey, which has 7 gill slits. It is no coincidence that we humans, at the top of the vertebrates, have 7 vertebrae. Phylogenetically facial muscles originate from muscles of gills. One part of gill muscles was replaced by the tongue and another part moved down and became the diaphragm. Another part went upward to become the facial muscles. Therefore, the facial muscles have evolved from respiratory muscles.  ADDIN EN.CITE <EndNote><Cite><Author>Nishihara K</Author><Year>1996</Year><RecNum>294</RecNum><DisplayText>(27)</DisplayText><record><rec-number>294</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">294</key><key app="ENWeb" db-id="">0</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Nishihara K,</author></authors></contributors><titles><title>Science of the face</title><short-title>Science of the face</short-title></titles><section>18-204</section><keywords><keyword>evo, adel, cgl, respiration, INV, leptorrhine, immune</keyword></keywords><dates><year>1996</year></dates><pub-location>Tokyo</pub-location><publisher>Nihon Kyobunsha</publisher><isbn>1-84426-095-X</isbn><label>��SKQbHQu�0�0�[�015/5/7</label><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_27" \o "Nishihara K, 1996 #294" 27)  ADDIN EN.CITE <EndNote><Cite><Author>Miki S</Author><Year>1997</Year><RecNum>4215</RecNum><DisplayText>(32)</DisplayText><record><rec-number>4215</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4215</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Miki S,</author></authors></contributors><titles><title>Human body---phylogenic consideration (In Japanese)</title></titles><pages>12-159</pages><dates><year>1997</year></dates><pub-location>Tokyo</pub-location><publisher>Ubusuna Shoin Ltd.</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_32" \o "Miki S, 1997 #4215" 32)  ADDIN EN.CITE <EndNote><Cite><Author>Walter JG</Author><Year>1999</Year><RecNum>2366</RecNum><DisplayText>(33)</DisplayText><record><rec-number>2366</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">2366</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Walter JG, </author><author>Translated in Japanese bu Asashima M,</author></authors><subsidiary-authors><author>Em�\0���v3�,</author></subsidiary-authors></contributors><titles><title>Master control genes in development and evolution: The homeobox story (Translated in Japanese). </title><short-title>�0�0�0�0�0�0�0�0�0�0�0�0�0�b_\O�0n0z�OP[h0zvu2�S</short-title></titles><pages>pp15-298, 257-277</pages><dates><year>1999</year></dates><publisher>Tokyou Univ. Shuppan</publisher><isbn>4-13-060211-X</isbn><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_33" \o "Walter JG, 1999 #2366" 33)  ADDIN EN.CITE <EndNote><Cite><Author>Hall</Author><Year>2001</Year><RecNum>51</RecNum><DisplayText>(34)</DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">51</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Hall, Brian  K. </author><author>Translated in Japanese by Kuratani S.</author></authors></contributors><titles><title>Evolutionary developmental biology</title><short-title>2�Szvuf[</short-title></titles><section>36-723</section><dates><year>2001</year></dates><pub-location>Tokyo</pub-location><publisher>Kosakusha Co.</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_34" \o "Hall, 2001 #51" 34)  ADDIN EN.CITE <EndNote><Cite><Author>Carrol SB</Author><Year>2005</Year><RecNum>4216</RecNum><DisplayText>(35)</DisplayText><record><rec-number>4216</rec-number><foreign-keys><key app="EN" db-id="wzerrp5a2fp0wcep5rzpxr0pasdass92fzrf">4216</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Carrol SB,</author><author>Translated in Japanese by Watanabe S and Tsunehara J,0</author></authors></contributors><titles><title>Endless forms most beautiful </title></titles><section>35-339</section><keywords><keyword>evo, adel, cgl, respiration, INV, leptorrhine, phylogeny</keyword></keywords><dates><year>2005</year></dates><pub-location>Tokyo</pub-location><publisher>Kobunsha Co.</publisher><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_35" \o "Carrol SB, 2005 #4216" 35). So the human face not only expresses emotions and personality, but also has respiratory abilities. 


References
 ADDIN EN.REFLIST 1.	Mukai S, Mukai C, Asaoka K. Congenital ankyloglossia with deviation of the epiglottis and larynx. Annals of Otolaryngol 1991;100, supple 153:1-20.
2.	Mukai S, Mukai C, Asaoka K. Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adult. Annals of Otolaryngol 1993;102(102):620-24.
3.	Mukai S, Nitta M. Correction of the glosso-larynx (CGL) and resultant positional changes of the hyoid bone and cranium. Act Otolaryngol (Sweden) 2002;122:644-50.
4.	Mukai S, Nitta M. Z-pharyngoplasty for sleep disorder and rhonchopathy. Acta Otolaryngol (Sweden) 2002;122:524-30.
5.	Mukai S, Nitta N. Expansion of the vestibular oris (EVO) (In Japanese). Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx 2004;12:1-9.
6.	Mukai S. Decrease of nasal ariflow registance by expansion of the vestibular oris. (Japanese). Ann Ankyloglossia with deviation of the epiglottis and larynx 2009;15:16-20.
7.	Mukai S, Yamamoto I. Patial genioglossectomy leading to an increase in respiratory rate --- surgery for ankyloglossia with deviation of the epiglottis and larynx---. Nihon Zetuyuchalusho Gakkaishi (Annals ADEL) 2010;16:pp25-31.
8.	Mukai S. Ankyloglossia with Deviation of the Epiglottis and Larynx (ADEL) (In Japanese). Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx 1998;8:1-53.
9.	Mukai S, Mukai C, Asaoka K, Nagasugi S. Digit sucking. Lancet 1992;339:1545 -46.
10.	Mukai S, Mukai C, Asaoka K, Nagasugi S, Ogiyama M. Near miss for SIDS seen in infants who have ankyloglossia with deviation of the epiglottis and larynx (In Japanese with English abstract). Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx 1993;3:33-45.
11.	Suzuki H, Nakaji M, Mukai S. Relationship between babies with ankyloglossia and disturbance of their mother's breast (In Japanese). Annals of Ankyloglossia with Deviation of the Epiglottis and Larynx 1993;3:74-84.
12.	Mukai S, Mukai C, Asaoka K, Nagasugi S, Djupesland P. Prevention of SIDS --- Correction of ankyloglossia with deviation of the epiglottis and larynx.  Third SIDS International Conference. Stavanger, Norway; 1994. p. 144.
13.	Mukai S, Mukai C, Asaoka K, Nagasugi S, Djupesland P. Subjective and objective evaluation of crying before and after the correction of ankyloglossia with deviation of the epiglottis and larynx.  Third SIDS International Conference. Stavanger, Norway; 1994. p. 179.
14.	S Mukai. New conseption about occulusion -- View from ankyloglossia with deviation of the epiglottis and larynx (ADEL) (In Japanese). Japanse Orthodontic Society of General Practitioner 2011;22:16-17.
15.	AS Romer, TS Parsons. The vertebrate body. 5th ed. Philadelphia: W.B. Saunders Co.; 1977.
16.	JA Clack, translated by H Ikeda. Gaining ground: The water to land adventure. (In Japanese). Tokyo: Kodansha, Ltd.; 2000.
17.	C.D.Darwin. The origin of species, 6ed. Ney York: New York University Press; 1876.
18.	Mukai S. Expansion of the vestibular oris (EVO) --- Esthetic facial changes and expansion of the nasal cavity--. Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx 2010;16:32-41.
19.	Clement PAR. Commitee report on standardization of rhinomanometry. Rhinology 1984;22:151-55.
20.	Cole P. Nasal airflow resistance: a survey of 2500 assesment. Am J Rhinol 1997;11:415-19.
21.	Staley RN. Etiology and prevalence of malocclusion. In: Bishara SE, editor. Textbook of orthodontics. Phladelphia: W.B.Saunders Co.; 2001. p. 83-96.
22.	Enlow DH, Hans MG. Essentials of facial growth. Philadelphia: WS Saunders Co.; 1996.
23.	Figallo EE, Acosta JA. Nose mascular dynamics: the tip trigonum. Plastic & Reconstructive Surgery 2001;108(5):1118-26.
24.	Rouvi�re H, Delmas A. Muscle du Nez, Muscles des �\	}	�	�	�
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h�GbKHOJPJQJ^J_H	aJ"h�GbKHOJPJQJ^J_H	aJ"h{n�KHOJPJQJ^J_H	aJ"����*�0�2�D���������������������)�*�m�s�t�����������������������������������o���������\��g���8�9�l�r�t�������;�h�������������#�$�k�q�s���������������������������������������������������������������������������������h�pKaJmHnHuh�pKh�pK5�aJmHnHuh�pKh�pK6�aJmHnHuh�pKh�pKaJmHnHuN���{���������|��X���{��:��,���dx!y�y�y�zE{	|�|�|�}�}}~�����������������������������gd�~M���������)�/�1�I�q���G�p�q����������xCx�x�x
yyy>ynyoy�y�y�y�y�y�yfzgz�z�z�z�z{{5{;{>{e{�{�{�{�{u|�|�|�|�|�|4}y}�}�}�}�}D~`~���������������������������������������������������������ҵ��h<�aJmHnHuh<�h�pK5�aJmHnHuUh�pKh�pKaJmHnHuh�pKh�pK6�aJmHnHuh�pKh�pK5�aJmHnHuDL�ves.  Anatomie humaine, Descriptive, topographie et fonctionelle. Paris: MaSSON; 2002. p. 172-79.
25.	Hwang K, Kim DJ, Hwang G. Relationship between depressor septi nasi muscle and dermocartilagenous ligament; anatomic study and clinical application. J Craniofac Surg 2006;17(2):286-90.
26.	Lam SM, Williams III EF. Anatomic consideration in aesthetic rhinoplasty. Facial Plast Surg 2002;18(4):209-14.
27.	Nishihara K. Science of the face. Tokyo: Nihon Kyobunsha; 1996.
28.	Tsuno H. Standing ability of patients with ankyloglossia with deviation of the epiglottis and larynx  (In Japanese with English abstract). Annals of the Ankyloglossia with Deviation of the Epiglottis and Larynx 1996;6:8-17.
29.	Mukai S, Mukai C, Asaoka K. Ankyloglossia with deviation of the epiglottis and larynx. Ann Otol Rhinol Laryngol Suppl 1991;153:3-20.
30.	Mukai S, Mukai C, Asaoka K. Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults. Ann Otol Rhinol Laryngol 1993;102(8 Pt 1):620-4.
31.	Mukai S, Mukai C, Nitta M. Function of the uvula and Z Pharyngoplasty (Japanese with english abstract). Acta Otolaryngol (Kyoto) 2000;93:31-38.
32.	Miki S. Human body---phylogenic consideration (In Japanese). Tokyo: Ubusuna Shoin Ltd.; 1997.
33.	Walter JG, Translated in Japanese bu Asashima M. Master control genes in development and evolution: The homeobox story (Translated in Japanese). : Tokyou Univ. Shuppan; 1999.
34.	Hall BK. Evolutionary developmental biology. Tokyo: Kosakusha Co.; 2001.
35.	Carrol SB, Translated in Japanese by Watanabe S and Tsunehara J. Endless forms most beautiful. Tokyo: Kobunsha Co.; 2005.




 
Figure Legends
Figure 1. Expansion of the vestibular oris 
Figure 1-1. 
Incision starts at the attachment of the upper frenulum. 

Figure 1-2.
Then the incision expands from the upper vestibular oris to the height of the junction of the nasal septum and base of the nasal cavities detaching the depressor septi nasi muscle (DSN) from the maxillary bone between both canines.

Figure 1-3. (A. ligament of septal cartilage and maxillary bone)
The EVO is completed in the open wound.


Figure 2. Measured items I 
A. Height: Distance from top of the nose to the base of the nose (top of the philtrum).
B. Ala nasi: Distance between both external edges of the ala nasi.
C. Nostril: Distance between both lateral edges of the nostrils.
D. Philtrum: Length of the philtrum.
E. Lip: Distance between both angulus oris.  

Figure 3. Measured items II 
F. Distance between the two pupils when subjects viewed distant objects.
G. Distance from left/right angulus oculi medialis to angulus oris on the same side of the mouth. (L-EM, left side; R-EM, right side)

Figure 4. Changes in nose and lips

Figure 5. Changes in the face
Distance between pupils (R-EM, distance from right angulus oculi to angulus oris; L-EM, that of left) 

Figure 6. Airflow resistance by both nasal cavities before and after EVO
Significant differences were observed for both expiration and inspiration.

Figure 7. Features before and after EVO 
The eyes were wider after EVO. Both her nose and mouth were also enlarged. Her lips were thickened and her angulus oris had risen after EVO. She said that objects appeared brighter and sharper after EVO.
The author is very grateful for permission to present the image of this patient.

Figure 8-1. Changes in a patient�s nose after EVO. (Caucasian male aged 39 years)
Openings of the nostrils were wider after EVO. Before EVO the patient was a snorer caused by the nasal valve but after EVO he no longer snored. In Caucasians the angle between the septum and caudal border of the upper lateral nostril is acute (average 15�). This acute angle of the nostrils is also a cause of snoring. 

Figure 8-2. Changes in a patient�s nose after EVO (Japanese female aged 31 years)
The patient�s nostrils were round and narrow before EVO. After EVO her nostrils expanded laterally, and the height of the nose increased as well. She kept her mouth open before EVO and breathed through her mouth but after EVO she kept her mouth shut and breathed through her nose.

 

List of abbreviation
 ADEL; Ankyloglossia with Deviation of the Epiglottis and Larynx
 EVO; Expansion of the Vestibular Oris
 DSN; Depressor Septi Nasi muscle,

Competing interest; 
      The author declares that it has no competing interest.



Author�s information; 
 Susumu Mukai is the president of Society of Ankyloglossia with Deviation of the Epiglottis and Larynx (ADEL), as well as chief editor of the annals of ADEL.
 SM is a principal of Mukai Tennis Academy








 S Mukai; EVO 

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