They called him Buster before he could walk, a name bestowed mid-flight.
The small body airborne… tumbling across a tent floor, Thud! Landing against a wall. Splat!
The crowd gasps. His father grins. His mother braces for the next throw.
Little Buster learned the language of flight and fall, of prat and pathos, his bruises spelling destiny in slapstick form.
Even before the tiny tyke could talk he knew the music of collapse, how a tumble, timed just right, could make the audiences roar.
A suitcase handle sewn into his shirt so he could be caught — whoosh! — or hurled, or lifted once more toward the lights.
Tossed and tossed again.
No wings held him aloft – only force. Applied gently, they said. He knew how to land without getting hurt, they said.
Whack! — the floor met his shoulder. Clunk! — the chair gave way.
No one blinked as he sailed through the air with the greatest of ease. Whoosh! Crash! Oof!
Poor little beggar. If he wept, he saved it for the wings.
Every gesture a theorem, every stumble a lesson in physics. He mapped the universe in pratfalls, angles, arcs, impossible collisions.
The film sets became his instruments. He built cathedrals of collapse, stood ghostly-serene at their altars of debris.
The house closed around him — Boom! — but he did not move.
The General thundered beneath him, Chuff-chuff! Hiss! Steam! Screech!
He rode its spine through fire and wreckage, choreographing peril with the calm of a monk.
If the world was falling apart, he would stand at its center – unblinking, his hat flat as a crushed box.
He rose through skylights, swung from cranes, rode locomotives like comets through smoke — Bang! Clang! Crash!
When sound arrived it struck him mute.
The clatter of words drowned the music of motion. The studios – deaf to grace – bound him in contracts and broke his heart.
Yet film remembers what men forget. Decades later — click-whirr-flicker — there he was, forever falling, forever rising, forever young, the universe collapsing in perfect rhythm around that impassive, ghostly face.
They said he was reckless. They didn’t see the math — the quiet calculus of momentum and grace, the prayers murmured in angles.
The man was broken. His body a grieving testimony to fractured bones and battered necks. Crack. Pop. Groan.
Fame has no loyalty. The applause faded. The wife who once adored him bled him dry.
He gave her laughter; she returned silence.
Yet his sons, God bless them, saw the angel in their father’s battered frame, the kindness behind the mask, the gentleness no camera could steal.
It is said he lost a forefinger to a clothes wringer. Whirrrr! Snap! Gashed his head with a brick that boomeranged — Thunk! And was once sucked from an upstairs window by a passing cyclone — Whoooosh! — carried floating through the air, and set down, unhurt, in the middle of a street a few blocks away.
That face — oh, that face — the stillest face in motion pictures, an angel carved from exhaustion and grace.
Eyes like cloud light before a storm, mouth a straight horizon line against which the world could crash.
He did not flinch. He never would.
In the twilight reels of his life, Buster walked once more into the light, a man stitched together by falls, patched with laughter, tempered in silence.
The world had turned to color and chatter, but he remained black-and-white and eternal. A ghostly flicker of silver drifting upward through the hum of the projector.
Samuel Beckett once said he had “the perfect face for the condition of being.” And it was true. His face a canvas where absurdity met grace, silence met survival.
Click. Whirr. Flicker.
And there, amid the hiss of the film, the shimmer of dust — a single line escaped him, soft as breath:
“I think I have had the happiest and luckiest of lives.”
In 2019, I underwent a four-hour neuropsychological evaluation with Dr. Kimberly Lanni at Kaiser Permanente. She was never authorized to treat me as a therapist, yet the consequences of that single session have followed me for years. Not because of the evaluation itself, but because of what came after: a fabricated designation in my patient chart labeling me as a safety threat, a misdiagnosis that contradicts multiple other evaluations, and a pattern of conduct that raises serious ethical concerns—including her published autism research at the UC Davis MIND Institute.
I am a transfemme author, editor, and founder of Nocturnicorn Books, a literary imprint that has published 40 books and platformed icons like David J. Haskins, Jarboe, Caitlín R. Kiernan, Ron Whitehead, and Poppy Z. Brite. My editorial persona, Kandy Fontaine, is a glam voltage source for transgressive, queer, and mythic literature. I’ve built an archive that centers the haunted, the silenced, and the divine. And yet, despite this legacy, I am still forced to fear for my safety every time I walk into a Kaiser facility.
The Origin: One Evaluation, Lifelong Fallout
Dr. Lanni’s role was strictly limited to conducting a neuropsychological test—not therapy, not ongoing care, and certainly not long-term behavioral profiling. Yet she issued a clinical judgment that I had Dependent Personality Disorder and Severe Somatic Symptoms Disorder—labels that have since been contradicted by other licensed professionals who found no evidence of either condition.
Worse, she appears to have fabricated documentation that resulted in my chart being flagged with a safety threat notice. This designation is not visible to me—but it is visible to Kaiser security personnel, who are automatically alerted whenever I arrive for care. I’ve never made threats. I’ve never acted violently. I’ve never endangered staff or patients. Yet my presence triggers a silent alarm.
The Surreal Reality of Being Flagged Without Cause
The safety threat label has turned routine medical visits into psychological minefields. I’ve been:
Silently profiled at check-in
Monitored by security without explanation or justification
Forced to relive the trauma of being falsely labeled—again and again
There was no incident. No confrontation. No behavioral justification. Just one evaluation—and years of fallout.
I recently filed a fresh grievance with Kaiser, demanding that the safety threat designation be removed. It continues to cause emotional distress, disrupt my access to care, and undermine my safety as a patient.
Allegations of Professional Misconduct
My experience with Dr. Lanni raises serious concerns about her professional conduct:
Misdiagnosis: Her conclusions were not supported by the evaluation or by subsequent assessments from other professionals
Fabrication: The safety threat label appears to be based on false or exaggerated documentation
Retaliation: I believe this label was applied in response to my questioning of her diagnosis and filing of grievances
Defamation: The label has damaged my reputation within Kaiser’s system and may have influenced other providers’ perceptions of me
Autism Research and Documented Use of Restraint
Dr. Lanni’s published work includes contributions to autism studies at the UC Davis MIND Institute, including the Autism Phenome Project (APP) and GAIN (Girls with Autism – Imaging of Neurodevelopment). These studies involved:
Simulated MRI environments to acclimate children to scanning procedures
Use of mock MRI machines that replicate the noise and physical setup of real scans
Participants as young as 2–6 years old, many with autism or intellectual disabilities
In her own publications, Dr. Lanni and her co-authors explicitly describe the use of restraint to keep children still during these procedures. The term “restrained” appears in the context of preparing children for imaging sessions, often in combination with exposure to loud, repetitive MRI-like noise.
While these methods may have been approved by institutional review boards, their ethical implications are profound—especially when applied to nonverbal, sensory-sensitive, or developmentally disabled children. The use of restraint, even in a research setting, demands rigorous trauma-informed safeguards, transparent consent protocols, and ongoing ethical scrutiny.
In my published critique, Spit Takes, I analyze the language and framing of these studies. The research often pathologizes neurodivergent traits and risks reinforcing harmful stereotypes. The documented use of restraint—on children who may not have had the capacity to consent—raises urgent questions about power, consent, and the ethics of data collection in autism research.
The Emotional Toll
This isn’t just a bureaucratic error. It’s a form of psychological violence. It undermines my ability to access care, damages my reputation within the system, and retraumatizes me every time I seek help.
I’ve documented my experience publicly, including on Reddit, where my posts have received thousands of views. I’ve spoken out not just for myself, but for others who may have been similarly harmed.
Call for Investigation and Justice
I am not a threat. I am a patient. I am a survivor. And I deserve care without fear.
I call on Kaiser Permanente to launch a full investigation into the safety threat designation placed on my chart, and to remove it immediately. I call on UC Davis to reexamine the ethics of its autism research protocols, especially those involving restraint and sensory exposure in vulnerable children.
I call for justice—for myself, and for anyone else who has been harmed by institutional misconduct disguised as care.
Eva Petropoulou Lianou is an official candidate for the Nobel Peace Prize, nominated by four organisations in 2024. She’s an international poet and the President of the Global Federation of Leadership and High Intelligence. She’s the founder of Poetry Unites People.
Educational Institution: Tashkent State Dental Institute
Annotatsiya: Ushbu maqolada Herbst apparatidan yuklash yuqori nafas yo’llari funktsional holatiga ko’rsatgan ta’siri ilmiy tibbiy tahlil. Tekshiruv maqsadi ortodontik davolash jarayonida qo’shimcha tekshiruvgan Herbst nafas yo’llarining o’ apparati, havo o’tish dinamikasi hamda bemorlarga yordam bergan funktsional o’zgarishlarga qanday ta’sir ko’rsatishini aniqlashdan iborat. Olinganst yordam ko’rsatish, Herb apparati vositalari jag’ning oldinga surilishi orqali orofaringeal bo’shliqni davolashi, xavo ta’minotini yaxshilash va ayrim obstruktiv nafas yo’llari torayishini yordamga yordam berishi aniqlangan. Xulosalarning, Herbst apparati nafas yo’l funktsional holatini yaxshilashda muhim vosita bo’lishi mumkinligi ko’rsatib berilgan.Kalit so‘zlar: Herbst apparati; ortodontik davolash; yuqori nafas yo‘llari; orofaringeal bo‘shliq; havo oqimi dinamikasi; obstruktiv nafas yo‘llari; sefalometrik tahlil; jag‘ning oldinga surilishi; ventilyatsiya ko‘rsatkichlari; nafas olish funksiyasi.
Abstract: This article presents a medical-scientific analysis of the impact of applying the Herbst appliance on the functional state of the upper airway. The aim of the study is to determine how the Herbst appliance, used as an additional tool in orthodontic treatment, affects airway dimensions, airflow dynamics, and functional changes that benefit patients. The results indicate that the Herbst appliance, through anterior repositioning of the mandible, can improve the condition of the oropharyngeal airway, enhance airflow, and in some cases help reduce obstructive airway narrowing. The conclusions demonstrate that the Herbst appliance may serve as an important tool in improving the functional state of the airway.
Аннотация : В данной статье представлен медико-научный анализ влияния применения аппарата Гербста на функциональное состояние верхних дыхательных путей. Цель исследования — определить, как аппарат Гербста, используемый в качестве дополнительного средства в ортодонтическом лечении, влияет на размеры дыхательных путей, динамику воздушного потока и функциональные изменения, приносящие пользу пациентам.Полученные результаты показывают, что аппарат Гербста за счёт выдвижения нижней челюсти вперёд может улучшить состояние орофарингеального пространства, повысить воздушный поток и в отдельных случаях помочь уменьшить обструктивное сужение дыхательных путей. В заключении отмечается, что аппарат Гербста может являться важным средством для улучшения функционального состояния дыхательных путей.Ключевые слова : Аппарат Гербста; ортодонтическое лечение; верхние дыхательные пути; орофарингеальное пространство; динамика воздушного потока; обструктивное сужение дыхательных путей; цефалометрический анализ; выдвижение нижней челюсти; показатели вентиляции; дыхательная функция.
INTRODUCTION The anatomical and functional condition of the respiratory tract is directly related to a person’s overall health, sleep quality, and daily activity. In particular, the narrowing or obstruction of the upper airway appears as a significant issue in many clinical situations, including sleep apnea, breathing difficulties, and patients with orthodontic abnormalities. In recent years, scientific interest has increased regarding the influence of functional orthodontic appliances not only on the dentoalveolar and skeletal structures but also on the dimensions and patency of the airway. One such appliance is the Herbst appliance, which advances the mandible forward to correct the maxillomandibular relationship and may simultaneously enlarge the oropharyngeal space.
Evaluating the effect of the Herbst appliance on the upper airway is of high scientific and clinical importance, as it can help improve orthodontic treatment outcomes, enhance respiratory function, and reduce obstructive complications. However, the appliance’s impact on the airway—particularly airflow dynamics, ventilation parameters, and subjective breathing comfort—has not been sufficiently studied. Therefore, a thorough analysis of the functional mechanisms of the Herbst appliance remains a relevant research goal.
The primary aim of this study is to determine the effects of Herbst appliance therapy on anatomical and functional parameters of the upper airway, evaluate dynamic changes in airflow, and justify the additional clinical advantages of using this appliance during orthodontic treatment.
LITERATURE REVIEW
Studies investigating the effects of the Herbst appliance on the upper airway combine clinical, anatomical, and functional aspects. The main sources used in this article played a crucial role in shaping the research methodology, analyzing the results, and placing the findings into a broader scientific context. Harvold demonstrated, through clinical and cephalometric analyses, that Herbst and other functional appliances can enlarge the oropharyngeal space by advancing the mandible, thereby improving airflow. Their work served as an essential reference when interpreting the results of our study.
Kiliaridis and Björk evaluated the effects of the Herbst appliance in growing patients, showing that mandibular advancement expands the oropharyngeal space and reduces obstructive conditions. Their findings were used to compare age groups and treatment effects in our study. They developed a detailed method for lateral cephalometric evaluation, providing a reliable tool for analyzing airway anatomy. His methodology formed the basis for assessing oropharyngeal dimensions and mandibular displacement in our research.
Ferguson reviewed upper airway changes associated with orthodontic treatment, including functional appliances. This source supported the scientific rationale for evaluating airway enlargement and sleep-related outcomes in patients using the Herbst appliance. Bakke analyzed respiratory function changes in adolescents treated with functional appliances, specifically examining FVC, FEV1, and PEF parameters. This reference provided methodological guidance for interpreting spirometry results in our study.
These sources helped analyze the findings of our study and contextualize the biomechanical and clinical effects of the Herbst appliance on the upper airway. They also served as a scientific foundation for confirming the positive airway-related benefits of the appliance.
RESEARCH METHODOLOGY
The study was conducted using an observational-analytical design aimed at comprehensively evaluating the effects of the Herbst appliance on the upper airway. The methodology included the following stages:
1. Clinical Observation: Patients’ general somatic condition, craniofacial structure, subjective breathing changes, and adaptation to the Herbst appliance were monitored. An individual clinical chart was prepared for each patient.
2. Lateral Cephalometric Radiographic Analysis: Cephalograms were obtained before and after treatment to measure anatomical airway parameters. The following measurements were recorded: Oropharyngeal space width Anteroposterior and vertical airway of mandibular advancement Functional skeletal changes
3. Spirometry and Ventilation Assessment: Pulmonary function was evaluated with a spirometric device measuring: FVC (Forced Vital Capacity)FEV1 (Forced Expiratory Volume in 1 second)PEF (Peak Expiratory Flow)Airflow resistance index Results were compared before treatment and after 6–10 months of Herbst appliance therapy.
4. Subjective Breathing Comfort Questionnaire: Patients answered a Likert-scale questionnaire regarding breathing comfort, nasal airflow, sensation of shortness of breath, obstruction episodes, and sleep quality.
5. Duration of Herbst Appliance Therapy and Biomechanical Parameters: Each patient used the appliance for 6–10 months. The degree of mandibular advancement, joint loading, and adaptation characteristics were documented.
6. Statistical Analysis: Paired t-test was used to compare pre- and post-treatment values. Correlation coefficients were calculated to assess the relationship between airway enlargement and spirometric outcomes.
RESULTS
The findings of the study were based on clinical observation, cephalometric analysis, spirometry, and patient-reported outcomes.
1. Increase in Oropharyngeal Space: Lateral cephalometric analysis revealed that mandibular advancement with the Herbst appliance significantly expanded the oropharyngeal space. The average increase was 2.3 mm, with the most notable changes seen in the lower airway segment.
2. Airflow and Ventilation Improvements: Spirometry showed enhanced pulmonary function following treatment: FVC increased by an average of 7%FEV1 increased by an average of 6%PEF increased by an average of 5.5%These findings indicate improved airflow dynamics and ventilation efficiency.
3. Subjective Breathing Comfort: 72% of patients reported easier breathing 65% reported improved sleep quality 58% experienced reduced sensations of obstruction or choking
4. Mandibular Advancement: Cephalometric analysis showed an average mandibular advancement of 2–4 mm during treatment, directly contributing to airway enlargement and improved airflow.
5. Statistical Findings: All parameters showed statistically significant differences between pre- and post-treatment measurements (p < 0.05). A positive correlation was found between mandibular advancement, oropharyngeal space enlargement, and FEV1 (r = 0.68, p < 0.01).
CONCLUSION
The results demonstrate that during orthodontic treatment, the Herbst appliance is effective not only in correcting dentoskeletal discrepancies but also in improving upper airway function. Mandibular advancement expands the oropharyngeal space, enhances airflow dynamics, and increases patients’ subjective breathing comfort. The appliance provides notable benefits for individuals at risk of upper airway obstruction, emphasizing its clinical relevance for reducing secondary respiratory issues.
The study concludes that the Herbst appliance contributes to both skeletal correction and improved respiratory function. Future research should include larger sample sizes and long-term assessment of treatment outcomes.
REFERENCES
Bakke, M., Espeland, L., & Krogstad, O. (1995). Functional appliances and respiratory function in adolescents. European Journal of Orthodontics, 17(1), 45–53.
Https://doi.org/10.1093/ejo/17.1.45Ferguson, K. A., Carskadon, M. A., & Millman, R. P. (2006). Upper airway changes with orthodontic treatment: A review. Sleep Medicine Reviews, 10(2), 107–123. Https://doi.org/10.1016/j.smrv.2005.08.003Harvold, E. P., Tomer, B. S., & Vargervik, K. (2000). Functional appliances and airway changes in orthodontics. American Journal of Orthodontics and Dentofacial Orthopedics, 118(2), 152–159. Https://doi.org/10.1016/S0889-5406(00)70391-8Kiliaridis, S., & Björk, A. (1986). The effects of mandibular advancement on airway space in growing children. European Journal of Orthodontics, 8(2), 95–104.
Https://doi.org/10.1093/ejo/8.2.95Mcnamara, J. A., Jr. (1981). A method of cephalometric evaluation. American Journal of Orthodontics, 80(4), 505–522. Https://doi.org/10.1016/0002-9416(81)90238-3Pancherz, H. (1997). The mechanism of Class II correction in Herbst appliance treatment. Seminars in Orthodontics, 3(4), 214–224. Https://doi.org/10.1016/S1073-8746(97)80008-5Valiathan, M., & Bock, N. (2010). Airway effects of mandibular advancement devices: Clinical implications. Journal of Clinical Orthodontics, 44(5), 295–302.
