Figure 4

The piercing procedure: (A) Penetration of the tongue from the upside by the Venflon needle; (B) After removal of the needle, the plastic tube remains in situ while the valve section is cut off and discharged; (C) The metal rod is guided through the tissue by means of the plastic tube; (D) The balls are tigthened onto the rod of the piercing by a needle holder while holding the tongue with the forceps; (E) Relaxed tongue muscles immidiately after the insertion, where the piercing is loosely attachted to the tongue; and (F) Contraction of the tongue muscles causes the piercing to become more firmly embedded (written consent for publication of these photos was obtained from the participant).