IN THE SHACKLES OF YOUR SILENCE 

Under your name, the night trembles within me.

In my chest, a bound flame moans.

Like a cold darkness, love stretches me upon its rack.

Your shadow drinks my breath.

My bones remember your touch.

Within me, centuries collapse without you.

Like spilled gold, my sorrow flows.

Your eyes — two abysses above my soil.

My heart bears the shackles of your silence.

My skin is a book of your wounds.

I have written you in my own blood.

I have carried you through my own ashes.

Into your voice, I placed my final peace.

And when I sink, your shadow will remain in me.

And when I fall silent, I will still long for you.

Milana Momčilović was born on April 4, 1999 in Vrbas. He currently lives in Srbobran, a place near Novi Sad in the Republic of Serbia. She published the collection of poetry TALISMAN.

She doesn’t like to talk about herself, so in the end she can describe herself through the verses of Sergei Yesenin: “What am I?” Who am I? I’m just a dreamer, whose sight fades in the fog and mist, I lived along the way, who can dream, like many other people on that earth.”

Sparrow Wars

I

Sludge water dripping

into an already clogged pipe.

Blood in my microscope, torn out

like a diary page, necessary to

analyze the ingredients.

Will the wound lift? be inverted

into a creative windstorm or

a nemesis spread,

spidery-vein spreading

until the curse is complete

and conquers?

I know love is alive,

and that hot and sudden

is the joy that stems from a miraculous shift.

I know building comes with the morning,

comes like brimming sorrow and goes

to a final destination like all things final,

temporary, broken and sliced down the centre –

undergoing a brutal mitosis.

II

Empty tables

clawed apart within

with spikes a-blazing on the edges,

and the light of the moon

high in the sky,

hardly visible.

Time is a dust heap I roll inside of,

never making a dent

or relieving my extremities from

the grim cover.

Beaten by the relentless overwhelm

and the digging dream that digs further down

more than ever before, pulled in by

gravity unspeakable and charged.

Living each day bent over, cane-walking,

repeating anguish, shooting pain and dough-bread

kneading, never baking, never

consuming.

III

When grief comes

it comes at the maximum degree

of chaos, doubt and all things

unsustainable.

Even there, in the squander and grave

disadvantage, I will surrender to trust,

protect the embryo of my new understanding

as precious as it is,

as the only intention worthy of holding,

clinging to despite the toxic smog encircling,

twirling over my extremities, nose-diving into

my internal organs, shutting me down.

It is there and its power is the past, old.

It is able to kill but I am not afraid.

I hold the jewel of this glowing budding faith

and that is all I will look at.

My heart is crushed, undone by the weight of grief

but my soul is tiny blooming. Let it be key.

Let everything be where everything needs to be.

Both are real. Only one will have authority

and receive my attention, elixir formed, a trickle,

ingested.

IV

Drum beat

no beat

I raise my arms

and scream hosana.

The drawers are empty

hunger parts my soul

into quarters. Stand up

and take account, no one

is listening.

Four months of stagnant emotion,

upheaval at the roots, planted again

somewhere less familiar and less fecund.

Faith and despair overlap, cross paths, join

together as a new entity.

Who understands? There is no understanding

to be had, only the ceramic bird on the shelf, winking,

and the air, heavy and humid one minute

and cold, oxygen-free, the next.

In my mind is an argument

existential, without possible resolution.

In my core there is shock at the terror

of disintegration, and for how long?

How much more? And still there is more.

In my being, I knew God

came with mercy, with Jesus and the peace

of infinity – washing clean, a soft joy

without degrees but only flowing, showering, eternal.

In between I wake up and I cannot see forward,

I listen, but I cannot be one with what I hear.

Holy Spirit, holy, do not escape me,

be clear, re-construct my devotion,

find me my union seed, to plant and tend to

simple devotion.

V

Jesus, you let me live.

I will sit with you

hand in hand.

I know you

in my personal crisis –

faith obliterated, reseeding

in a lucky garden.

I will trust you with all my problems,

with my anxiety like a dysfunctional

city, polluting the roadway, the airway

with its violence and indifference,

I will breathe easy, knowing you are here,

that you own it because I give it to you

and reckoning is rescue, in your hands,

miracles are coming – life changing,

a kinship with your divinity.

You are sovereign, my still-point, my doorway

into perpetual redemption.

I will collect the fruit and sit beside you,

eating together – no hunger, no hurry –

You and I, I with you, you

holding my hand.

VI

When I see the unseen

in a twisted longing

death-circle fantasy,

irresistible hope,

and drive to make that hope happen

even though

I am not a citizen of that land,

not meant to come forward

and shine with those deeds,

then I fail and live for an

illusionary future, creating a

hellish now, ripe with lack

and disappointment.

Bend on your knees, bow

to the one-name of God,

feel the slap of sobriety,

the consequences of depending

on your own wit and power

which is like a gnat trying to cross through

a tornado or a choir that sings without

glorifying.

I am learning that being conceived

and being re-conceived

is the cure for fear, the fire

that watches a greater fire,

burning enough,

releasing enough

to rejoice and just burn, a light, a warmth

transient, but elementally,

in this way, everlasting.

VII

It is hard to hold purpose

when purpose no longer holds you

when the single curtain seals the window

blocking the sun and sky,

making you blind so you only touch corners

and never a door.

All things lost their ownership, just wandered

aimless, squandering energy like tossed pebbles,

no pattern, sinking.

Governance failed, was only an imagined

corridor leading to a chaotic marketplace

that doled out meals, lacking nutrients and staying power.

Each shape to take and hold and shift from each day

was hard labour, exhausting to perform,

pretending hope existed when hope had abandoned.

I was not afraid because my fears

were pushed hard into my face,

swelling my eyes so they could only see behind.

Death won out over the light, won obedience –

the middle and opposite, smelling.

Death smells bad

smells like an inevitable succumbing

to rot, betrayal, rendering

endurance useless

and even the holiest of faith debunked.

There is a string before me,

thin and golden and unbreakable.

There is something I see I never saw.

I have collided with the consuming tyranny death,

felt it swerve and twist through

every vein, enter, break my heart,

break the truths I had before.

The string dangles,

dripping down from

of my inadequate cries

and a mangled prayer,

comes shining a faint intermittent glow.

It is small and so am I, minute,

hardly there, but there.  

VIII

If I talk again,

I will keep my end-mind twisted

so it cannot speak or formulate

a plan.

I have no constitution for plans

or wherewithal for achieving

human-made provisions.

If I talk again,

silence me into prayer,

conversing only with the angelic order,

strengthened by devotion and the power

of obedience.

If I try to be a player,

remind me of my meek capacity,

sting me with regret and slap me

into a state of surrender.

If I try to enter a world not my own,

laugh at me, call me out

and put me in my designated low-chair place,

a dreamer, advancing

no further.

IX

Falling away like before

launching water at the moon

then releasing it, scattering it

onto a lifeless surface.

Songs and singing are murderous,

selling the false business of a buffet

inspiration, and poetry, like a sober

prayer or pleading, blossoms in a place

where no one comes or looks or even cares.

Things that once stretched

with divine determination towards health,

now fall backwards into addiction and defeat.

Chaos always hovering at the entrance door,

violence a few footsteps away.

Idealism once trapped in my mind has sieved through

incrementally and now in my mind, a faint flow

of tainted possibility, mostly consumed by despair, mostly

non-existence, more hesitant than youthful,

more resigned than risking.

The days drive on the same,

and how I wish I was in a state

of conspiratorial superiority

or in a social bliss of nonchalance.

How I wish I could be like I used to be,

believing despite the odds,

calling for help and receiving it.

What is this weakness,

this futureless waste of now,

pressing on all my joints,

an aching misery perpetual?

What are these days

when I can find no hope

to master this tortuous doom?

I am removed. A thin slice everywhere

between me and reality. Only sorrow brings

me near enough to touch, only happiness lives

inside my dreams or in my memories,

stripping the peel from the fruit,

dropping it to rot in the mud-marsh with the rest

of my wearied hold on merciful possibilities.

X

I don’t see

the far-reaching joy

to build a future on,

just disappointment, false-starts,

isolation and how can-that be?

I don’t see

but I know the builders take their time

to make sure what needs to be aligned

is aligned, that broken hearts can

become hardened hearts

and hope is dangerous for those who are desperate,

perishing at the foot of the mirage.

But there is a noble prophesy to follow,

to stand by and wait for.

There is true love, love that alters bitter grief

that wraps your love in its healing balm until

it blooms and your dry throat is

finally soothed, your wounds are rewarded,

transformed into strengths exposed,

safe on the marriage altar.

XI

Time does not help

to lessen the sharp scream

of amputation, or to help gain

a way to cope, maimed as I am,

lacking resilience.

Prayer does not answer

any questions or bury the emptiness

outside of my body, allowing

room that can be filled, even with only

a faint groaning microscopic creation.

Love that sits beside me,

day-after-day, holding my hand,

stays with me – miraculous devotion –

helps while it is there,

but does not stop the welling-up of sorrow,

that will not ease or be appeased

in solitude or by distraction.

Faith is a word that sparks

but cannot ignite. I sink down again

on my broken knees. I cannot rise.

I try and I try, but

I cannot overcome.

XII

God do you love me?

Everyday I fall short

of receiving your love,

blocked and stalled and wading

knee-deep in sewage mud.

I cannot take a step. I cannot

hear you anymore or

feel your mercy move the spoke

a mile, an inch, a fraction of

a way out of this criminal sleep,

arrested every day.

I try to take a breath,

try to step but I cannot

move. Please God, show yourself

to me again. I am aching all over,

joints on fire, mind – ablaze in jet-fuel burning

heat, tired all the time, cut off

from your glory.

Cut off no matter my prayers

and my pleas.

Please God, take my hand,

recognize me as one of your own.

I long for you.

I need your grace

to lift me, now,

trumpets calling,

advancing, only with you,

loved, permitted.

XIII

A hive blasted

by poison.

A blood-letting

in crave of a cure.

Two close-together cliffs

jumped across, looking

closer than they are.

In the whirlspin of a fall –

arms broken, extremities blasted,

crying out for someone from the angelic order

to swoop down and placate the pain.

But no angel-being arrives and what is broken

remains broken, deformed and starting to heal

that way, into a permanent liability.

Even then, when stuck thigh-deep in forsaken ground,

God is close, washing our cracked bodies,

cradling our defeat, saying

My Love doesn’t always answer with a clean slate

or a put-on spell so all hurt is forgotten,

not a trace left traceable. Sometimes

My Love just sits with you, beside the pain,

lets you know I am here,

here, in the empathetic love of others,

here, in your own resilience each morning to carry on,

here, in your determination to stay close to me

as you anguish and ache,

unable to walk or fully wake,

seeing that nothing turned out

the way you saw it

in your times of highest harmonic resonance

the way

you were sure it would.

XIV

Will you speak to me again

like before death cracked my windpipe

like when death still hovered thick in the air

but you were there surrounding everything

with the weight of your love?

Will you answer me again

cooling my shape, giving back force

to my petering-out flame

so I can grow again, still tied to your mercy

and the joy of having dreams?

Will I know you again

despite my mutations

and the iron that rotates sickeningly

in my core, using my energy

for lesser aspirations?

Will you love me again

and I will know that love

igniting its current through

my every predicament,

bonding me unbreakable

to your side, inside

your privileged embrace?

XV

First thing,

you are here.

I wake up and we are talking,

merged in a matter-of-fact

conversation. My need, my only way

to take a step in the morning.

More and more, without you, I can’t

exist or comprehend a thing.

Then why this endless desert, the

hard bloated boils erupting

every time I do move?

How is it, you are here, but there

is so much pain still, so much struggle

just to keep alive?

How do I feel so close to you and need

you more than I ever have, have you

more than I ever have, with such

drought and trembling-burns burning everyday,

throughout the days, echoing – no medicine, no food,

just you and I in this high heat,

where I am barely capable,

but somehow capable.

XVI

Then the bitter defeat

was burning like a sin

committed, recognized

and unforgiveable.

Then on a hill, heavy with

weighted down legs and

an injury there, debilitating but

unexplained, the challenge came

to walk.

Walk slowly at first, walk like

I can walk even though the reins

are dropped and I have lost my mother,

lost life’s victory over death and the comfort

of an unbreakable love broken,

altered, intangible now as an angel’s skin

or a hope held for decades unrealized.

Walk with my mortal burden, stumbling without

a path, a cane or a flat plane. Twist in my ankle, twist

in my knee, swollen, bloated with a hot fever, walk.

Face a direction, walk, slowly,

commit and make it my own.

XVIII

Soak the born

in their own initial conception

to remember the pure-memory-pockets,

the truth of miracles.

Underline everything that matters

and read it again until no small word

is skimmed over or taken for granted.

Open the shelter doors and let all animals

in, wild ones, broken ones, aggressive and tame.

Free with a blessing

every dream that isn’t false,

and follow your deepest duty –

both desirous and undesirous divine commands.

Under the blanket, conspiracies are made.

They grow limbs that look like light but exclude

humility and the thumb-print of surrender.

The atmosphere is big,

the button-hole is small.

I am small when I toss

my self-determination out as wisdom

and fail at every turn.

Mercy comes with obedience,

obedience comes with trust, and then finally

freedom.

The dying are trapped in their wounds.

The living, in their success at survival,

but the gift is always

open for everyone, and changing

even without core movement.

I have a boat and that is all I own.

I see flowers on the shore, rooted in the sand.

I see yellow and sometimes, I see gold.

Allison Grayhurst has been nominated for “Best of the Net” six times. She has over 1,400 poems published in over 530 international journals, including translations of her work. She has 25 published books of poetry and six chapbooks. She is an ethical vegan and lives in Toronto with her family. She also sculpts, working with clay; www.allisongrayhurst.com

Life Bird

A life with a tree is like a bird

Floating in the wind for many years

The breath of life is mixed with the air

That image emerges clearly with every breath

Just like the bird that flutters in the sky,

Fluttering wildly in the waters, awakens

When all the sleep of the world is broken

In the gentle light of dawn

What a wonderful sweetness mixed with mountain trees and shrubs!

Transplanted before my eyes

You are intertwined with a tree for a lifetime

Years are passing by in the wind

The ants are climbing in rows.

Md. Mahbubul Alam is from Bangladesh. His writer name is Mahbub John in Bangladesh. He is a Senior Teacher (English) of Harimohan Government High School, Chapainawabganj, Bangladesh. Chapainawabganj is a district town of Bangladesh. He is an MA in English Literature from Rajshahi College under National University. He has published three books of poems in Bangla. He writes mainly poems but other branches of literature such as prose, article, essay etc. also have been published in national and local newspapers, magazines, little magazines. He has achieved three times the Best Teacher Certificate and Crest in National Education Week in the District Wise Competition in Chapainawabganj District. He has gained many literary awards from home and abroad. His English writings have been published in Synchronized Chaos for seven years.

Transient summer

The transient summer.

Restless and

weary rain are

silent and beautiful.

Deep forest near

the mountain ledge.

Unexpected rain

soundless and hazy.

The dreamy

grasses are covered with

blue light shadows

behind the mountain.

The cloudless

skies are

bright and lonely.

So beautiful was that night.

Mrinal kanti Ghosh, India He is a lyricist for All India Radio Calcutta. He has written many books of poetry, novel and short story. The names of his books are as follows: 1. Atmabairi 2.Sudhu rtis jannaya (Funded by West Bengal government) 3. jodi chole jai 4. Nairite nisarga namey 5.Ami se o somudra (novel) 6. Ekhane akash nei 7.Suranjana (English and Bengali) 8.Chayapathe saresrip bikel 9.Bideshi kobita (transcription of poetry in English and Bengali) 10.Dhupchaya nir 11.Nirjan sayanhey joytshna 12. Shely 1. Bangladesh award 2.Certificate from different countries. He has given certificate. He is a musician. He plays guitar (Indian classical). His other two books are under process. He is also an Astrologer, He believes in Astrology. He also believes in Rebirth/Regeneration. The poet also wrote a rtist poetry on Rebirth/Regeneration. His other book is going to be published on Rebirth/Regeneration.

——————————————————————————-

dying like elvis

took a shit so large this morning

i could feel my blood sugar drop

it made me laugh, reaffirm my

fears of dying like elvis

but with none of the money

or big house

had a friend wish that my poems

would make me a millionaire

i thanked her and told her i would

gladly take a fraction of that and

winning lottery numbers

and here come the holidays

here comes the depression

here comes the urge to drink

the entire bar dry

why couldn’t we evolve from

creatures that hibernated in

the winter

certainly would make christmas

easier to handle

just a thought on a random

monday

the week of thanksgiving

another test of what little

patience i have left

————————————————————————

with no soul

and you wake up from

a fever dream of a boy

who never meets the

girl yet the girl lives

happily ever after

a couple splashes of

cold water and you

know that boy is you

coming up on half

a century

still lining the walls

with loneliness

pretend someone cares

someone will save you

from yourself

in a world with no soul

no time for anyone other

than the precious mirror

torture is the morning

sun

a bird singing a song

joy on the children

down the street

your father warned

you

you were never special

and should never think

like it was even possible

sharpen the knives

still time to make

the evening news

—————————————————————-

the machines

searching for humanity

in a world that has fully

embraced the machines

before long, the humans

will be the machines

and then all hope will

be lost

somewhere, all those

science fiction writers

of my youth are asking

yet again…

still think i’m fucking

crazy?

————————————————————————-

two weeks before thanksgiving

had to drive to the store to get my pills last night

there was a number of houses with christmas

lights up already

two weeks before thanksgiving

assholes

mom is insisting the whole family gets together

this year for thanksgiving

while i’m secretly hoping she has some evil plan

to kill all of us

i think it is simply a punishment for me

but, i have never shied away from proudly

being the black sheep of the family

i’ll make a plate, place some bets, go to

my room and be by myself

punishments never worked when i was a child

they won’t work while i’m an adult either

the day after thanksgiving

i’ll put up our decorations outside

three wreaths around the three outdoor lights

which eventually will become nests for birds

that get heat from those lights at night

——————————————————————————-

figure out the truth

i haven’t shaved in weeks

the little girl that stays next

door with grandma tells all

her friends that grandma lives

next door to santa claus

it takes everything i have not

to break that little girl’s heart

but i figure, she will figure

out the truth soon enough

there’s a skeleton in the yard

across the street

i swear, when i look out

at night it is giving me

the finger

i guess the booze is working

not sleeping well yet again

i’m hoping to find a new

dealer

someone that has a decent

heart and will accept books

or baseball cards for something

that isn’t tainted with something

that will kill me

that’s for the next decade

https://evildelights.blogspot.com

J.J. Campbell (1976 – ?) is old enough to know better. He’s been widely published over the years, most recently at The Beatnik Cowboy, Crossroads Magazine, Disturb the Universe Magazine, The Rye Whiskey Review and Misfit Magazine. You can find him most days at his home in Ohio, taking care of his disabled mother and trying to hit another crazy 20 team parlay. He still has a blog, evil delights, although he rarely has the time to write on it. (https://evildelights.blogspot.com)

https://goodreads.com/jjthepoet

Effect of the Herbst Appliance on the Airway                                         

Author: Durdona Sharifovna Ro‘ziboyeva                            

Email: durdonaroziboyeva22@gmailcom                           

Address: Tashkent, Uzbekistan                     

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.

Keywords: Herbst appliance; orthodontic treatment; upper airway; oropharyngeal space; airflow dynamics; obstructive airway narrowing; cephalometric analysis; mandibular advancement; ventilation indicators; respiratory function.

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.

Cal Performances presents The 4th Witch, November 22, 2025 at Zellerbach Hall

(credit: Courtesy of Manual Cinema)

Witching Hour

The 4th Witch

Manual Cinema

Zellerbach Hall

University of California, Berkeley

Reviewed by Christopher Bernard

For (frustratingly) one lonely, tantalizing performance, Cal Performances, in co-commission and as part of its “Illuminations: Exile and Sanctuary” series, brought the bright good witches of Chicago’s Manual Cinema on a recent Saturday evening for a brew of witchery and magic that they, and they alone, are (in this apprentice wizard’s experience, anyway) uniquely qualified to provide. 

I say frustratingly because I can’t understand how this company’s brilliant toilers, who spent a year creating a compact music-filled masterpiece of puppetry, handicraft, cinema and wonder, can’t have been given a full weekend among us: the hall was packed, riveted to marvels of stagecraft and story-telling, without a pixel or a bow to “slop” in sight, and few left for the fascinated Q&A that followed. When something this fine, brave, and wondrous blazes across the Bay Area’s sky like a comet blithely visiting from a neighboring universe, one can hardly settle for a single, dazzling show – no!

It’s not as if the company were new here and on probation: they brought us a scintillating Ada/Ava in the millennium before Covid (circa 2017, to be precise). The 4th Witch is even finer, and marks one of the peaks in Bay Area performance since then. For those new to Manual Cinema, a brief description may be in order. The creative heart of the company is given to inventing live performances of puppetry, hand-crafted backgrounds, body prostheses, and props and the techniques of shadow plays projected onto large screens and accompanied by live music.

One of the most intriguing aspects of the performance is that, rather than seeing only the end result onscreen, we also see, in the background onstage, the combined actions of actors, puppets, prop managers, projectors, and musicians as they bring the final result about. It’s a bit like a combination of Bunraku puppeteering and an open kitchen at a small five-star restaurant. Far from undermining the magic, it paradoxically makes the end result seem like pure alchemy, as the mind is cast into the liminal space between the quotidian reality and the magical effect. The result is a profoundly poetic form of animation that has the high-wire thrills of live performance.  

The premise of Saturday’s show is as beautiful in its simplicity as it is timely without being brow-beating. As described by one of the members in the Q&A, they took a page from Tom Stoppard’s famous play from the 1960s, Rosencrantz and Guildenstern Are Dead, which retells the story of Hamlet through the eyes of his half-clueless, half-traitorous school fellows, and reimagined another famous play by the Bard – in this case, Macbeth , though, in keeping with sacred theatrical tradition, the tragedy is referred to onstage only as “the Scottish play”– from the point of view of one of the Thane of Cawdor’s victims. 

The story is updated to an imaginary, mid-twentieth-century war in a French-speaking country, and the victim is a young girl whose parents run a little restaurant in a town piled up a steep, isolated hill, much like Mont-Saint-Michel on the Normandy coast of France. The girl’s parents are killed in a raid by Macbeth’s air force. The town is left in ruins, and she runs away after a futile attempt to bring down the mocking, glow-eyed, gas-masked, Darth Vader-like Macbeth by striking him with her stuffed bunny rabbit, her sole possession saved from the wreckage of her home. 

Lost in  the surrounding forest, wandering for days, reduced to hunger and rags, she discovers a mysterious house, where she is met by a sinister old woman who takes her in and sets her to work. The old lady turns out, naturally, to be a witch – indeed, she is one of three, magically embodied in the one, who have a mysterious relation to Macbeth and his powers, a relation that shall not be revealed here, for those seeking spoilers. After the girl, taking a sip of a spell-casting soup, has a sorcerer’s apprentice moment in the witch’s kitchen, the old one decides to teach her witches’ ways – a fourth to add to the three.

And the powers in magic that the girl gains – black as the night, from making magic potions from mushrooms of the forest, to night flying on broomsticks, to commanding daggers to fly to the hearts of their victims – feed the dreams she cultivates of revenge against the murderer of her parents. We’ll leave it at that.

Whoever knows “the Scottish play” can guess much, but not everything: not how famous elements of the play – from floating daggers to the bitter washing of hands, from the assassinations of kings to the executions of assassins – are mixed and blended, with imagination and wit, nor how the amalgam of the imaginary, the remembered, and the hoped for is finally annealed into a satisfying whole – a Gesamtkunstwerk (forgive my German) held light and bright, from acting as rich as a puppet’s to puppetry as nuanced as a great actor’s, to potently low-tech sound design and music from a trio of instrumentalists seconding as vocalists, to world-creating as lyrical and witty as it is suggestive of its own self-contained universe.

Play on, Manual Cinema! And blessed be those Who bring ye back for more than one more show!

Christopher Bernard is an award-winning poet, novelist, playwright, and essayist. His most recent book is The Beauty of Matter: A Pagan’s Verses for a Mystic Idler. 2025 is the twentieth anniversary of the publication of his celebrated debut novel, A Spy in the Ruins.