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Preedeewong C, Chirakalwasan N, Kaboosaya B. Impact of frenectomy on the oral exercise in patients with ankyloglossia and obstructive sleep apnea: double-blind randomized controlled clinical trials. Clin Oral Investig 2024; 28:566. [PMID: 39365358 DOI: 10.1007/s00784-024-05932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 09/14/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVE This study compares the efficacy of oral exercise alone to oral exercise with frenectomy in improving obstructive sleep apnea (OSA) symptoms and quality of life (QOL) in patients with ankyloglossia. MATERIALS AND METHODS A prospective, controlled, double-blind clinical study enrolled fifteen adults (20-60 years) newly diagnosed with mild to moderate OSA and ankyloglossia. Participants were randomly assigned to either oral exercise alone (control group; n = 8) or oral exercise with frenectomy (intervention group; n = 7). Outcomes were assessed after a 3-month therapy period using polysomnography, the Epworth Sleepiness Scale (ESS), tongue strength (measured in kPa), and QOL questionnaires. RESULTS Both control (-2.88 ± 1.73; p = 0.02) and intervention (-4.00 ± 3.65; p = 0.03) groups showed a significant reduction in ESS scores, indicating both improved sleepiness. Although the apnea-hypopnea index (AHI) increased in both groups after treatment, these changes were not statistically significant (control 4.73 ± 15.55; p = 0.48, intervention 10.42 ± 14.66; p = 0.12). Tongue strength significantly increased in both groups: control group (p = 0.04) and intervention group (p = 0.03). Satisfaction rates with the overall treatment process were 100% in the control group and 57.1% in the intervention group. Furthermore, 75.0% and 57.1% of participants in the respective groups reported an improvement in QOL. CONCLUSION Frenectomy improved tongue mobility and the ability to perform oral exercises in individuals with OSA and ankyloglossia. However, these exercises did not significantly improve OSA-related symptoms or QOL. CLINICAL RELEVANCE While frenectomy enhances tongue mobility, thereby enabling better engagement in oral exercises. These exercises alone did not significantly improve OSA-related symptoms or QOL. This suggests that oral exercises focusing solely on tongue mobility may not be sufficient for managing OSA. TRIAL REGISTRATION The Thai Clinical Trials Registry was TCTR20220429002.
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Affiliation(s)
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Lichnowska A, Gnatek A, Tyszkiewicz S, Kozakiewicz M, Zaghi S. A Prospective Randomized Control Trial of Lingual Frenuloplasty with Myofunctional Therapy in Patients with Maxillofacial Deformity in a Polish Cohort. J Clin Med 2024; 13:5354. [PMID: 39336841 PMCID: PMC11432234 DOI: 10.3390/jcm13185354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
Introduction: There are few publications concerning ankyloglossia in mixed-aged groups utilizing myofunctional therapy and frenuloplasty in patients undergoing orthodontic treatment and maxillofacial surgery. While it is well known that ankyloglossia is mainly diagnosed in babies, research on functional and structural disorders in different age groups is less common. Thus, there is a high need for specific information about the influence and effectiveness of frenuloplasty with myofunctional therapy on the stomatognathic function and final treatment outcome for a wider variety of patients, especially those with maxillofacial deformities. Aim: This paper aims to evaluate the impact of lingual frenuloplasty as an adjunct to myofunctional therapy for the treatment of ankyloglossia in children and adults with maxillofacial deformity. Methods: Prospective randomized control trial with 155 subjects. Methods were based on visual observation and examination of the oral cavity. There were two groups: myofunctional therapy vs. myofunctional therapy and lingual frenuloplasty. Patients were randomized based on order of entry into the study. χ2 test, Kruskal-Wallis, ANOVA, Student's t-test and others were used for statistical analyses. Results: The presented protocol with myofunctional therapy and surgical procedures proved to be significantly more effective in improving tongue mobility and stomatognathic functions such as swallowing, breathing, and oral resting postures as compared to the reference group who underwent myofunctional therapy only. Conclusions: Lingual frenuloplasty with myofunctional therapy is highly effective in restoring the equilibrium of the orofacial muscles and the skeleton, which is often disturbed and may lead to unstable functional effects among patients considering orthodontic and orthognathic treatments for maxillofacial deformities.
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Affiliation(s)
- Anna Lichnowska
- Private Psychological and Pedagogical Clinic Land of Imagination i, 32 Bardowskiego Str., 95-200 Pabianice, Poland
| | - Adrian Gnatek
- Panaceum Center for Aesthetic Dentistry, 114 Piotrkowska Str., 90-006 Łódź, Poland
| | - Szymon Tyszkiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego, 90-549 Lodz, Poland
| | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego, 90-549 Lodz, Poland
| | - Soroush Zaghi
- The Breathe Institute, 10921 Wilshire Blvd Suite 912, Los Angeles, CA 90024, USA
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Hoang DA, Nguyen TM, Jagomägi T. Restricted tongue mobility and ankyloglossia in 6-8-year-old Vietnamese school children: prevalence and association with tongue strength and endurance. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00938-y. [PMID: 39207660 DOI: 10.1007/s40368-024-00938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Generating adequate tongue pressure against the hard palate requires full-range mobility of the tongue. The study aimed to (1) determine the prevalence of restricted tongue mobility and ankyloglossia and (2) determine whether, in children with restricted tongue mobility, their condition also affects tongue pressure. METHODS A cross-sectional study of healthy 6-8-year-old children from primary schools in central Vietnam was conducted in 2019. Restricted tongue mobility and ankyloglossia were graded using the tongue range of motion ratio (TRMR), with the tongue-tip-to-incisive papillae (TIP) for the anterior tongue tip and lingual-palatal suction (LPS) for the posterior two-thirds of the tongue. Tongue strength and tongue endurance were measured by the Iowa Oral Pressure Instrument. Statistical analysis investigated the associations between tongue mobility and tongue pressure measurement. RESULTS Five hundred twelve children (46.5% female, mean age 7.2 ± 0.2 years) were assessed. The prevalence of anterior ankyloglossia and restricted mobility was 17.5%, with 16.2% cases of less than 50% mobility and 1.3% cases of less than 25% mobility. The prevalence of posterior ankyloglossia and restricted mobility with less than 30% mobility was 28.9%. Anterior restricted mobility was not a predictor of reduced tongue pressure. Posterior restricted mobility in LPS was independently associated with tongue strength but not tongue endurance. CONCLUSION Restrictions of posterior tongue mobility in ankyloglossia are more frequent than restrictions in anterior tongue mobility. Reduced tongue strength is related to mobility and the severity of restrictions in the posterior tongue. These findings suggest that restricted posterior tongue mobility may affect tongue muscle weakness.
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Affiliation(s)
- D A Hoang
- Faculty of Odonto-Stomatology, Hue University, Hue University of Medicine and Pharmacy, Hue, Vietnam
- Faculty of Medicine, Institute of Dentistry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - T M Nguyen
- Department of Family Medicine, Hue University, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - T Jagomägi
- Faculty of Medicine, Institute of Dentistry, Faculty of Medicine, University of Tartu, Tartu, Estonia.
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Camañes-Gonzalvo S, Montiel-Company JM, Paredes-Gallardo V, Puertas-Cuesta FJ, Marco-Pitarch R, García-Selva M, Bellot-Arcís C, Casaña-Ruiz MD. Relationship of ankyloglossia and obstructive sleep apnea: systematic review and meta-analysis. Sleep Breath 2024; 28:1067-1078. [PMID: 38478208 PMCID: PMC11196303 DOI: 10.1007/s11325-024-03021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Recent studies have highlighted the potential role of a short lingual frenulum as a risk factor for pediatric obstructive sleep apnea syndrome. A shortened frenulum may contribute to abnormal orofacial development, leading to increased upper airway resistance and susceptibility to upper airway collapsibility during sleep. Recognizing early indicators, such as a short lingual frenulum, is crucial for prompt intervention. This systematic review aims to evaluate the association between a short lingual frenulum and the risk of obstructive sleep apnea syndrome in children. METHODS This systematic review adheres to PRISMA criteria for a quantitative analysis. A comprehensive search was conducted on five databases until January 2024 to identify relevant studies. The selected articles underwent rigorous analysis, considering study design, sample characteristics, lingual frenulum characterization, sleep assessment methods, and key findings. RESULTS A total of 239 references were initially identified. Finally, six studies were included in the qualitative synthesis, with four studies eligible for the quantitative synthesis. The Newcastle-Ottawa scale was employed to assess study quality. Meta-analysis, supported by a moderate evidence profile according to the GRADE scale, revealed statistically significant differences, with odds ratios of 3.051 (confidence interval: 1.939 to 4.801) for a short frenulum and 12.304 (confidence interval: 6.141 to 24.653) for a high-arched palate. CONCLUSION This systematic review and meta-analysis provide evidence supporting the association between ankyloglossia and obstructive sleep apnea in children. Nevertheless, it is crucial to consider additional factors such as tongue mobility and the presence of a high-arched palate in further evaluations.
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Affiliation(s)
- Sara Camañes-Gonzalvo
- Sleep Unit. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Montiel-Company
- Senior Lecturer. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
| | - Vanessa Paredes-Gallardo
- Senior Lecturer. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Francisco Javier Puertas-Cuesta
- Sleep Unit, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, Valencia, Spain
| | - Rocío Marco-Pitarch
- Sleep Unit. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Marina García-Selva
- Sleep Unit. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Carlos Bellot-Arcís
- Senior Lecturer. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - María Dolores Casaña-Ruiz
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Cordray H, Raol N, Mahendran GN, Tey CS, Nemeth J, Sutcliffe A, Ingram J, Sharp WG. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis. Pediatr Res 2024; 95:34-42. [PMID: 37608056 DOI: 10.1038/s41390-023-02784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial. METHODS Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores. RESULTS Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5-10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5-15 days (SMD -1.10 [CI: -1.49, -0.70; P < 0.001]) and 1 month (SMD -1.23 [CI: -1.79, -0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD -0.63 [CI: -0.95, -0.31; P = 0.008]), with continued improvement at 1 month (SMD -0.41 [CI: -0.78, -0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5-7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01). CONCLUSIONS Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties. PROTOCOL REGISTRATION PROSPERO identifier CRD42022303838 . IMPACT This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia. Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Geethanjeli N Mahendran
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ching Siong Tey
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Alastair Sutcliffe
- Population, Policy, and Practice Department, Institute of Child Health, University College London, London, UK
| | | | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
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Frezza A, Ezeddine F, Zuccon A, Gracco A, Bruno G, De Stefani A. Treatment of Ankyloglossia: A Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1808. [PMID: 38002899 PMCID: PMC10670877 DOI: 10.3390/children10111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
AIM The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy. MATERIALS AND METHODS A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: "lingual", "frenulectomy", "frenulotomy", "frenulum", "ankyloglossia", and "laser." RESULTS A total of 14 articles were included in this review, including four prospective observational studies, one case-control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table. CONCLUSIONS In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period.
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Affiliation(s)
- Alessandro Frezza
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Fatima Ezeddine
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Andrea Zuccon
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Antonio Gracco
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
| | - Giovanni Bruno
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
- Department of Industrial Engineering, University of Roma Tor Vergata, 00133 Roma, Italy
| | - Alberto De Stefani
- Department of Neuroscience, School of Dentistry, University of Padova, 35122 Padova, Italy; (A.F.); (F.E.); (A.Z.); (A.G.); (G.B.)
- Department of Pharmacological Sciences, University of Padova, 35122 Padova, Italy
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Cordray H, Mahendran GN, Tey CS, Nemeth J, Raol N. The Impact of Ankyloglossia Beyond Breastfeeding: A Scoping Review of Potential Symptoms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:3048-3063. [PMID: 37606583 DOI: 10.1044/2023_ajslp-23-00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo tongue-tie release (frenotomy) during infancy. DATA SOURCES This study contains data from PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar (1961-January 2023). REVIEW METHOD The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Experimental and observational studies were eligible if they reported baseline outcomes associated with ankyloglossia in children above a year of age. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded. CONCLUSIONS Twenty-six of 1,568 screened studies (> 1,228 patients) were included. Six studies were high quality and 20 were medium quality. Studies identified various symptoms that may be partially attributable to ankyloglossia after infancy, including speech/articulation difficulties, eating difficulties, dysphagia, sleep-disordered breathing symptoms, dental malocclusion, and social embarrassment such as oral hygiene issues. Multiple comparative studies found associations between ankyloglossia and risk factors for obstructive sleep apnea; a randomized controlled trial found that frenotomy may attenuate apnea severity. Ankyloglossia may also promote dental crowding. IMPLICATIONS FOR PRACTICE Ankyloglossia may be associated with myriad effects on children's quality of life that extend beyond breastfeeding, but current data regarding the impact are inconclusive. This review provides a map of symptoms that providers may want to evaluate as we continue to debate the decision to proceed with frenotomy or nonsurgical therapies in children with ankyloglossia. A continuing need exists for controlled efficacy research on frenotomy for symptoms in older children and on possible longitudinal benefits of early frenotomy for maxillofacial development. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23900199.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Ching Siong Tey
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Psychology, University of Georgia, Athens
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Scarano A, Di Giulio R, Gehrke SA, Tagariello G, Romano F, Lorusso F. Atmospheric Plasma Lingual Frenectomy Followed by Post Operative Tongue Exercises: A Case Series. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010105. [PMID: 36670655 PMCID: PMC9857210 DOI: 10.3390/children10010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
The lingual frenulum is a submucosal component significantly involved in the mobility of the tongue. In the case of short lingual frenulum, different surgical approaches have been proposed. Atmospheric plasma is a thermal technique of vaporization or sublimation of the superficial tissues, without going deep, and the resulting fine carbonized layer avoids bleeding. The aim of the present investigation was to evaluate the effectiveness of atmospheric plasma (voltaic arc dermabrasion) for the frenectomy of a short lingual frenulum. A total of 30 patients with an age range between 6−11 years old and a class III/IV Kotlow’s ankyloglossia classification were included in the study. The Kotlow’s free-tongue, maximal interincisal mouth opening (MIO, mm) and interincisal mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP, mm) were calculated at the baseline, immediately postoperatively (T0), at one week (T1), one month (T2) and two months (T3). A significant increase of Kotlow’s measurements, MOTTIP and MIO were detected when comparing the baseline and the T0 (p < 0.05). No significant difference was detected between the T0, T1 and T2 (p > 0.05). The atmospheric plasma demonstrated a very minimal invasive approach for frenectomy, without important or fibrotic complications and with very low recurrence rates.
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Affiliation(s)
- Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy
- Correspondence: ; Tel.: +39-08713554084; Fax: +39-08713554099
| | - Rosanna Di Giulio
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy
| | | | | | | | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti–Pescara, 66100 Chieti, Italy
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Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? Case Report and Systematic Review. J Clin Med 2022; 12:jcm12010201. [PMID: 36615001 PMCID: PMC9821269 DOI: 10.3390/jcm12010201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Ankyloglossia (tongue-tie) is a condition of the oral cavity in which an abnormally short lingual frenulum affects the tongue's mobility. Literature on the correlation between ankyloglossia and obstructive sleep apnea (OSA) is scarce. The main objective of this study was to report our preliminary experience in adult OSA patients before and after ankyloglossia treatment, using drug-induced sleep endoscopy (DISE) to evaluate the upper airway modifications resulting after treatment, and to present a systematic review of the impact of ankyloglossia and its treatment on OSA adults. We found that, after frenotomy, regarding the DISE findings, and according to the VOTE classification, two of the three patients showed an improvement in tongue level, from 2A-P (complete anteroposterior collapse) to 1ap (partial anteroposterior collapse). The third patient showed no changes in his UA after frenotomy, neither worsening nor showing improvement. Thus, the results of this study suggest that frenotomy in OSA patients with ankyloglossia could reduce tongue collapse, probably by allowing the tongue to take into the physiological position in the oral cavity. These patients should undergo speech therapy and oropharyngeal exercises prior to any surgical procedure, in order to avoid glossoptosis and to improve the quality of life and sleep apnea results.
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Arena M, Micarelli A, Guzzo F, Misici I, Jamshir D, Micarelli B, Castaldo A, di Benedetto A, Alessandrini M. Outcomes of tongue-tie release by means of tongue and frenulum assessment tools: a scoping review on non-infants. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:492-501. [PMID: 36654515 PMCID: PMC9853103 DOI: 10.14639/0392-100x-n2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/17/2022] [Indexed: 01/18/2023]
Abstract
Objective To evaluate outcomes of the surgical and rehabilitative procedures devoted to release the tongue-tie in non-infants when implementing the most commonly used quantitative/qualitative structured tools for tongue and frenulum assessment. Methods A scoping review and meta-analysis were conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. Results The systematic search retrieved 603 (Pubmed), 893 (Scopus), and 739 (ISI Web of Science) articles from January 2011 to December 2021. A total of 50 articles were retrieved for full-text review of which 7 were selected and included based on inclusion criteria. The majority of treatment options have been found to significantly improve the anatomical limitation of the tongue with clear benefits on descending functionality. Conclusions The review highlights an overall improvement in terms of clinical and functional outcomes when using validated tongue assessment tools both before and after frenulum release. This highlights the need for their rigorous implementation in research and clinical practice.
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Affiliation(s)
- Martina Arena
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy
| | - Alessandro Micarelli
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy,Correspondence Alessandro Micarelli Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy E-mail:
| | - Federico Guzzo
- Unit of Dentistry and Oral Health, UNITER ONLUS, Rome, Italy
| | - Ilaria Misici
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy
| | - Diana Jamshir
- Unit of Dentistry and Oral Health, UNITER ONLUS, Rome, Italy
| | - Beatrice Micarelli
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy
| | | | - Adriano di Benedetto
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy, Occupational Therapy Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, ENT Unit, University of Rome Tor Vergata, Rome, Italy
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Cruz PV, Souza-Oliveira AC, Notaro SQ, Occhi-Alexandre IGP, Maia RM, De Luca Canto G, Bendo CB, Martins CC. Prevalence of ankyloglossia according to different assessment tools. J Am Dent Assoc 2022; 153:1026-1040.e31. [DOI: 10.1016/j.adaj.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
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González Garrido MDP, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of Myofunctional Therapy in Ankyloglossia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12347. [PMID: 36231647 PMCID: PMC9566693 DOI: 10.3390/ijerph191912347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Ankyloglossia is a pathology of the tongue in which the frenulum appears anchored to the floor of the mouth. The treatment of choice for this pathology is frenectomy, but myofunctional therapy is emerging in recent years as a complement to surgical intervention. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of myofunctional therapy in ankyloglossia. The Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Pubmed, Web of Science and Scopus were searched. Study quality was determined using the PEDro scale, STROBE statement and single-case experimental design scale. Eleven studies were selected. Based on the studies included in this review, surgery is more effective than myofunctional therapy, although better results are achieved if both are combined. Improvements have been found in maternal pain, weight gain of babies, duration of breastfeeding, tongue mobility, strength and endurance, sleep apnea, mouth breathing and snoring, quality of life, clenching teeth, myofascial tension, pain after surgery and speech sound production. These findings must be taken with caution because of the small number of articles and their quality. Future clinical trials using larger sample sizes and with higher methodological quality are needed.
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Affiliation(s)
| | | | - Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, University of Cadiz, 11003 Cadiz, Spain
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006 Cadiz, Spain
| | | | - Gloria Gonzalez-Medina
- Department of Nursing and Physiotherapy, University of Cadiz, 11003 Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, 11003 Cadiz, Spain
- CTS-986 Physical Therapy and Health (FISA), University Institute of Research in Social Sustainable Development (INDESS), 11003 Cadiz, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, 11003 Cadiz, Spain
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006 Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, 11003 Cadiz, Spain
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Craniofacial Sleep Medicine: The Important Role of Dental Providers in Detecting and Treating Sleep Disordered Breathing in Children. CHILDREN 2022; 9:children9071057. [PMID: 35884041 PMCID: PMC9323037 DOI: 10.3390/children9071057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.
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Calvo-Henríquez C, Neves SM, Branco AM, Lechien JR, Reinoso FB, Rojas XM, O’Connor-Reina C, González-Guijarro I, Martínez Capoccioni G. Relationship between short lingual frenulum and malocclusion. A multicentre study. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:177-183. [DOI: 10.1016/j.otoeng.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/29/2021] [Indexed: 10/18/2022]
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Murias I, Grzech-Leśniak K, Murias A, Walicka-Cupryś K, Dominiak M, Golob Deeb J, Matys J. Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review. Life (Basel) 2022; 12:life12040558. [PMID: 35455049 PMCID: PMC9031639 DOI: 10.3390/life12040558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.
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Affiliation(s)
- Iwona Murias
- EMDOLA, Wroclaw Medical University, 50-425 Wroclaw, Poland;
| | - Kinga Grzech-Leśniak
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Correspondence:
| | - Anna Murias
- Faculty of Medicine, Pavel Jozef Šafárik University, Trieda SNP 1, 040 11 Košice, Slovakia;
| | - Katarzyna Walicka-Cupryś
- Institute of Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland;
| | - Marzena Dominiak
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
| | - Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Jacek Matys
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
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Abstract
Snoring can be harmless (primary) or a symptom of sleep-disordered breathing (secondary) and should alert the physician to evaluate the patient for risks thereof. Phenotypes of snoring and sleep-disordered breathing (SDB) are anatomic and nonanatomic and identifying these phenotypes and their interrelationships are critical to effective therapy. Mouth breathing alerts the physician to nasal airway obstruction, signals orofacial growth changes in children, and heralds the progression of SDB. Systematic evaluation to establish phenotypes includes assessing sleep habits, comorbidities, upper airway examination, polysomnography, and drug-induced sleep endoscopy. Strategies for treatment should be personalized and precise to the phenotype(s) to achieve the most benefit.
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Affiliation(s)
- Yoke-Yeow Yap
- KPJ Johor Specialist Hospital, 39b Jalan Abdul Samad, Johor Bahru 80100, Malaysia.
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Cho H, Noh JS, Park J, Park C, Park ND, Ahn JY, Park JW, Choi YH, Chun SM. Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients. Ann Rehabil Med 2022; 45:440-449. [PMID: 35000369 PMCID: PMC8743842 DOI: 10.5535/arm.21126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients. Methods Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS). Results The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%. Conclusion There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.
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Affiliation(s)
- Hyunchul Cho
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jeong Se Noh
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Junwon Park
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Changwook Park
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - No Dam Park
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jun Young Ahn
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Woong Park
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seong-Min Chun
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Bussi MT, Corrêa CDC, Cassettari AJ, Giacomin LT, Faria AC, Moreira APSM, Magalhães I, Cunha MOD, Weber SAT, Zancanella E, Machado Júnior AJ. Is ankyloglossia associated with obstructive sleep apnea? Braz J Otorhinolaryngol 2021; 88 Suppl 1:S156-S162. [PMID: 34895868 PMCID: PMC9734261 DOI: 10.1016/j.bjorl.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To investigate the evidence on the association between ankyloglossia and obstructive sleep apnea. METHODS An integrative literature review was carried out in the databases. Observational and interventional studies that assessed the lingual frenulum in children with sleep-disordered breathing were included. As exclusion criteria: studies in animals, in vitro, letters to the editor, expert opinions, other reviews. The selected articles were analyzed regarding the study design, sample, characterization of the lingual frenulum and sleep assessment, in addition to the main results and conclusions. RESULTS Ninety-seven articles were identified, but only 4 met the inclusion criteria. Two retrospective studies concluded that the untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea. A prospective study concluded that there was an improvement in speech and deglutition after lingual frenectomy, in addition to improved sleep. A retrospective cohort concluded that lingual frenuloplasty combined with myofunctional therapy is effective in the treatment of snoring and mouth breathing. CONCLUSION The studies included in this review contribute to corroborate the association between ankyloglossia and obstructive sleep apnea.
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Affiliation(s)
- Marieli Timpani Bussi
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil,Corresponding author.
| | - Camila de Castro Corrêa
- Centro Universitário Planalto do Distrito Federal (UNIPLAN), Brasília, DF, Brazil,Universidade de Brasília (UnB), Brasília, DF, Brazil
| | - Arthur Justi Cassettari
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Lorena Torres Giacomin
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ana Célia Faria
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | | | - Itamá Magalhães
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Mila Oliveira da Cunha
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Silke Anna Theresa Weber
- Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina, Botucatu, SP, Brazil
| | - Edilson Zancanella
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Almiro José Machado Júnior
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
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Yuen HM, Au CT, Chu WCW, Li AM, Chan KCC. Reduced Tongue Mobility: An Unrecognised Risk Factor of Childhood Obstructive Sleep Apnoea. Sleep 2021; 45:6357667. [PMID: 34432065 DOI: 10.1093/sleep/zsab217] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Childhood obstructive sleep apnoea (OSA) is an important and prevalent disease. A short lingual frenulum is a risk factor for OSA, but whether tongue mobility also plays a role in OSA aetiology remains unknown. This study aimed to examine tongue mobility in children with and without OSA. We hypothesized that reduced tongue mobility was associated with OSA. We also evaluated the relationship between tongue mobility and craniofacial profile. METHODS This was a cross-sectional case-control study. Prepubertal Chinese children aged 5-12 years, suspected to have OSA were recruited from our sleep disorder clinic. All subjects underwent overnight polysomnography (PSG). The lingual frenulum was evaluated based on tongue mobility and free tongue length. Craniofacial measurements were assessed by lateral cephalometry. RESULTS Eighty-two subjects (mean age: 8.32 ± 1.70 years, 57 males) were recruited. The mean tongue mobility was 58.2 (±19)% and 67.4 (±15)% (p=0.019) in subjects with and without OSA, respectively. Tongue mobility was inversely correlated with OAHI (r=-0.218, p=0.049). In multivariate logistic regression, low tongue mobility was independently associated with a higher risk of OSA after adjustment for age, sex, BMI z-score, presence of large tonsils and turbinates and nocturnal oral breathing (odds ratio=3.65, 95% CI= 1.22-11.8). Tongue mobility was found to correlate with the cranial base angle (Ba-S-N) (r=0.262, p=0.018), which determines the relative position of the mandible. CONCLUSIONS In pre-pubertal children, reduced tongue mobility is associated with the occurrence and severity of OSA. Assessing tongue mobility is recommended in childhood OSA management.
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Affiliation(s)
- Hoi Man Yuen
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chun Ting Au
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albert Martin Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kate Ching-Ching Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Visconti A, Hayes E, Ealy K, Scarborough DR. A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:349-358. [PMID: 33501864 DOI: 10.1080/17549507.2020.1849399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: The primary objective of this systematic review was to determine if frenotomy for ankyloglossia improves breastfeeding or speech outcomes in infants and children ages birth to 12.Method: Literature selection focussed on the presence of ankyloglossia, reported as either posterior or submucosal, and the impact of surgical treatment. The two populations that were included involve infants who were breastfeeding and children with speech delays. Six search engines were utilised (PubMed, Medline, Cochrane Database, CINHAL Plus, ERIC and PsychINFO). The selected articles critically examined study characteristics, measurement tools, outcome measures, design, and summary of results, and bias.Result: Five articles met the inclusion criteria related to infants who had undergone a frenotomy and who were examining changes in breastfeeding outcomes and two articles met the inclusion criteria for changes in speech production following a frenotomy.Conclusion: Research supports the use of frenotomy in children with ankyloglossia to reduce nipple pain and improve maternal self-efficacy during breastfeeding. The classification of ankyloglossia, assessment tools used, age and timing of frenotomy, in terms of breastfeeding improvements were inconsistent across the studies. Ankyloglossia release for children with speech delays is currently inconclusive due to lack of objective data and research quality. Overall, the review also revealed inconsistent definitions of ankyloglossia severity, standardised outcome measures and research protocols.
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Affiliation(s)
- Alison Visconti
- Department of Speech Pathology and Audiology, Miami University, Oxford, UK
| | - Emily Hayes
- Department of Speech Pathology and Audiology, Miami University, Oxford, UK
| | - Kristen Ealy
- Department of Speech Pathology and Audiology, Miami University, Oxford, UK
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Calvo-Henríquez C, Neves SM, Branco AM, Lechien JR, Reinoso FB, Rojas XM, O'Connor-Reina C, González-Guijarro I, Martínez Capoccioni G. Relationship between short lingual frenulum and malocclusion. A multicentre study. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00031-5. [PMID: 34301375 DOI: 10.1016/j.otorri.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Ankyloglossia is characterized by an abnormally short lingual frenulum, which impairs tongue movement. Ankyloglossia has been related to craniofacial growth disturbances and dental malocclusion. But even though there is a clear biological plausibility for this hypothesis, available evidence is scarce. METHODS A case-control design was followed. Patients between 4 and 14 years old were routinely screened for short lingual frenulum and recruited from the pediatric Otolaryngology consultation of 3 Spanish tertiary referral hospitals. Lingual frenulum was assessed with the Marchesan system. A cohort of cases with short lingual frenulum and a cohort of healthy controls matched for sex and age were included. Both cases and controls had pictures of occlusion. Occlusion was evaluated by an expert in orthodontics, blinded for the frenulum assessment. RESULTS A total of 100 participants were included, 70 males and 30 females. The proportion of malocclusion in the short lingual frenulum group was 48%, while it was 24% in the normal frenulum group. The odds ratio of malocclusion for the short lingual frenulum patients was 2.92 (CI 95% 1.15-7.56). The difference was statistically significant (p=.012). This difference was significant for patients with class III occlusion (p=.029). There was no difference for patients with class II (p=.317). CONCLUSIONS This work supports the hypothesis that relates class III malocclusion with a short lingual frenulum.
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Affiliation(s)
- Christian Calvo-Henríquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Ana María Branco
- College of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Foch Hospital, University of Paris Saclay, Paris, France
| | - Frank Betances Reinoso
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain
| | - Xenia Mota Rojas
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - Isabel González-Guijarro
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Martínez Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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22
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Tome W, Moon W. The prevalence of posterior tongue tie in patients with transverse maxillary deficiency. AUSTRALASIAN ORTHODONTIC JOURNAL 2021. [DOI: 10.21307/aoj-2021.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Abstract
Objectives
To investigate the prevalence of posterior tongue tie in orthodontic patients using numerical and clinical assessment methods in order to identify an association between posterior tongue tie and transverse maxillary deficiency.
Materials and methods
Seventy-nine participants from an orthodontic clinic were divided into two groups. The first group of 44 patients exhibited a skeletally narrow maxilla and required maxillary skeletal expansion (MSE group) and 35 patients without a transverse discrepancy comprised a control group. Posterior tongue tie was examined by the Kotlow tongue tie classification, tongue range of motion ratio (TRMR) and via a clinical assessment. The prevalence of posterior tongue tie was compared between the two groups.
Results
There was no significant difference in the level of the Kotlow classification grade between the two groups (p > 0.05) and the overall majority was diagnosed as normal. However, a higher proportion of posterior tongue tie was found in the MSE group than in the control group by clinical assessment (MSE group, 72.7%; control group, 42.9%; p = 0.005). The proportion of TRMR grade 2 was also higher in the MSE group than in the control group (p = 0.001). Of the subjects diagnosed with posterior tongue tie by clinical findings, approximately 94% showed TRMR grades 2 or 3.
Conclusions
A clinical assessment of posterior tongue tie was found to be simple and accurate, whereas a numerical assessment alone provided diagnostic difficulty. Considering the high prevalence of observed posterior tongue tie in the MSE group, there was a significant association between posterior tongue tie and transverse maxillary deficiency.
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Affiliation(s)
- Wakako Tome
- Department of Orthodontics Oral Structure, Function, and Development School of Dentistry, Asahi University , Gifu , Japan
| | - Won Moon
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California , Los Angeles , USA
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The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116112. [PMID: 34204017 PMCID: PMC8200995 DOI: 10.3390/ijerph18116112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023]
Abstract
This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients. Background: Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum. Methods: Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%). Results: In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe. Conclusion: The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.
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Brożek-Mądry E, Burska Z, Steć Z, Burghard M, Krzeski A. Short lingual frenulum and head-forward posture in children with the risk of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2021; 144:110699. [PMID: 33823467 DOI: 10.1016/j.ijporl.2021.110699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children. METHODS Children from pre-, primary, secondary, and high school, aged 3-17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups. RESULTS A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58-15.94]). CONCLUSIONS The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters.
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Affiliation(s)
- Eliza Brożek-Mądry
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland.
| | | | - Zuzanna Steć
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland
| | | | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland
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Zaghi S, Shamtoob S, Peterson C, Christianson L, Valcu-Pinkerton S, Peeran Z, Fung B, Kwok-Keung Ng D, Jagomagi T, Archambault N, O'Connor B, Winslow K, Lano M, Murdock J, Morrissey L, Yoon A. Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia. J Oral Rehabil 2021; 48:692-700. [PMID: 33386612 PMCID: PMC8247966 DOI: 10.1111/joor.13144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022]
Abstract
Background A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one‐third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two‐thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual‐palatal suction (LPS). Objective This study aims to explore the utility and normative values of TRMR‐LPS as an adjunct to functional assessment of tongue mobility using TRMR‐TIP. Study Design Cross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population. Methods Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate. Results There was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R2 0.31 vs 0.05, P < .0001). Conclusions This study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility.
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Affiliation(s)
| | | | | | | | | | - Zahra Peeran
- The Breathe Institute, Los Angeles, CA, USA.,Happy Kids Dental Planet, Agoura Hills, CA, USA
| | | | | | - Triin Jagomagi
- Institute of Dentistry and Unimed United Clinics, University of Tartu, Tartu, Estonia
| | | | | | | | - Miche' Lano
- South County Pediatric Speech, Mission Viejo, CA, USA
| | | | | | - Audrey Yoon
- Division of Growth and Development, Section of Pediatric Dentistry, UCLA School of Dentistry, Los Angeles, CA, USA
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Determinants of probable sleep bruxism in a pediatric mixed dentition population: a multivariate analysis of mouth vs. nasal breathing, tongue mobility, and tonsil size. Sleep Med 2020; 77:7-13. [PMID: 33291022 DOI: 10.1016/j.sleep.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of 'probable' sleep bruxism in children. METHODS From March 2018 until March 2019, a cross-sectional clinical study was performed with ninety-six healthy children ages 6-12 years who presented for routine dental examination at the UCLA pediatric dental clinic. Variables of interest included: (1) assessment of probable bruxism based on parental awareness on the frequency of tooth grinding during sleep and clinical signs of bruxism based on tooth wear; (2) parental reports of mouth breathing while awake and asleep, snoring during sleep, difficulty breathing and/or gasping for air during sleep; (3) parental reports of psychosocial distress; (4) assessment of tonsil hypertrophy, tongue mobility, and nasal obstruction. Three pediatric dental residents were calibrated to perform the clinical data collection. All dental residents were graduated dentists with licensure and at least one year of experience examining children. The methodology to take the specific measurements administered in the manuscript were calibrated between the data-collectors under the supervision of a board-certified pediatric dentist and orthodontist (AY). RESULTS The mean age of individuals was 8.9 (SD = 1.9) years with a gender distribution of 46 males and 50 females. There were 23 out of the 96 (24%) individuals who met the diagnostic criteria for probable sleep bruxism (PSB). Sleep Disturbance Scale for Children (SDSC) scores were significantly elevated among children positive for PSB, indicating that they are at higher risk for sleep disturbances (PSB-positive: 45.1 ± 13.0, PSB-negative: 34.8 ± 5.5; p < 0.0001). Impaired nasal breathing, parental reports of mouth breathing when awake or asleep, restricted tongue mobility, and tonsillar hypertrophy were found to be significant risk factors for PSB. Exploratory analysis further suggests a synergistic effect between tonsil hypertrophy, restricted tongue mobility, and nasal obstruction. The incidence of probable sleep bruxism among individuals without any of the exam findings of tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction was 5/58 (8.6%), whereas the incidence of PSB among individuals with all three exam findings was 10/11 (90.9%), p < 0.0001. Among the 23 individuals with PSB, however, there were n = 5 (21.7%) who did not have any of the three exam findings, suggesting an additional role of psychosocial distress, postural maladaptation, malocclusion, or other factors in the etiology of sleep bruxism. CONCLUSION This study shows that tonsil hypertrophy, restricted tongue mobility, and nasal obstruction may have a synergistic association on the presentation of PSB. Dentists should evaluate for tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction in the evaluation of PSB, as these exam findings are highly prevalent in the majority of cases.
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Baxter R, Merkel-Walsh R, Baxter BS, Lashley A, Rendell NR. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study. Clin Pediatr (Phila) 2020; 59:885-892. [PMID: 32462918 DOI: 10.1177/0009922820928055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.
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Affiliation(s)
| | - Robyn Merkel-Walsh
- TalkTools, Charleston, SC, USA.,Ridgefield Board of Education, Ridgefield, NJ, USA
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Unger C, Chetwynd E, Costello R. Ankyloglossia Identification, Diagnosis, and Frenotomy : A Qualitative Study of Community Referral Pathways. J Hum Lact 2020; 36:519-527. [PMID: 31835960 DOI: 10.1177/0890334419887368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Researchers and practitioners continue to debate the most appropriate assessment, diagnostic, and treatment practices for ankyloglossia (tongue-tie). Health care workers struggle to provide evidence-based care in the absence of consistent standards. RESEARCH AIM The aims of this pilot study were to qualitatively (a) evaluate the knowledge of, and attitudes toward tongue-tie and (b) describe how they shaped referral pathways and the establishment of practice patterns of frontline practitioners (pediatric dentists, speech-language pathologists, pediatric chiropractors, and International Board Certified Lactation Consultants). METHODS We recruited clinicians (N = 9) using nonprobability purposive sampling. Participants were interviewed using survey schedules adjusted to reflect their specialty area. Semistructured interviews were transcribed and coded using manual and inductive coding techniques common in grounded theory. Themes were iteratively developed using memoing techniques, in which observations and potential concepts were recorded using the aforementioned codes. RESULTS Participants were familiar with a variety of protocols and assessment tools, but did not consistently use them. No formal training about the management of tongue-tie was received through their degree programs. Instead they pursued self-guided study. Interprofessional consensus guided opinions about tongue-tie best practices, and referral pathways reflected these consensuses. International Board Certified Lactation Consultants were viewed as pivotal to the care of infants with tongue-tie while primary care physicians-primarily pediatricians-were omitted from referral pathways. CONCLUSION Lack of formalized training, professional consensus about best practices, and insufficient resources for assessing and treating tongue-tie led participants to incomplete referral pathways and personal interpretations of the data through the lens of anecdotal evidence.
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Affiliation(s)
| | - Ellen Chetwynd
- College of Agriculture and Life Sciences, Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA.,2331 Department of Public Health Education School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
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Filfilan RO, Almazrooa SA. Double lingual frenulum: a case report. J Med Case Rep 2020; 14:116. [PMID: 32711574 PMCID: PMC7382814 DOI: 10.1186/s13256-020-02440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background The lingual frenulum is a mucous membrane fold found underneath the tongue. It helps the tongue to perform its function. There are few anomalies that can affect the lingual frenulum, such as ankyloglossia and absence of the lingual frenulum. We report a case of two lingual frenula to educate practitioners about the presence of such an anomaly. Case presentation A 10-year-old healthy Saudi girl came to our dental clinic complaining of “malpositioned frontal teeth.” Upon intraoral examination, two lingual frenula were found connecting the tongue with the floor of the mouth. Intraoral examination revealed no other abnormalities. Conclusion Double lingual frenulum is an existing frenulum anomaly that did not affect normal function of our patient. A search of the literature revealed that this may well be the first reported case of such a condition.
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Affiliation(s)
- Reham O Filfilan
- King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia.
| | - Soulafa A Almazrooa
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
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Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg 2020; 162:597-611. [PMID: 32283998 DOI: 10.1177/0194599820915457] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements. METHODS An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. CONCLUSION This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
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Affiliation(s)
- Anna H Messner
- Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | | | | | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Scott E Brietzke
- Nemours Specialty Care, Wolfson Children's Hospital, St. Johns, Florida, USA
| | | | | | - Jessica Levi
- Boston University and Boston Medical Center, Boston, Massachusettes, USA
| | - Anna K Meyer
- UCSF School of Medicine, San Francisco, California, USA
| | - Sanjay Parikh
- University of Washington Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey P Simons
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel L Wohl
- Pediatric Otolaryngology Associates, LLC, Jacksonville, Florida, USA
| | - Erin Lambie
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa Satterfield
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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31
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Martinelli RLDC, Marchesan IQ, Berretin-Felix G. Tongue position for lingual frenulum assessment. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/20202210120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to compare the movements of elevation and protrusion of the tongue in order to determine which position provides better lingual frenulum assessment. Methods: a database of 92 audiovisual recordings of subjects over six-years of age diagnosed with ankyloglossia was used to verify the shape of the tip of the tongue during tongue elevation and protrusion. The Chi-Square Test for Proportion was applied to verify possible differences between the postures of elevation and protrusion. The significance level of 5% (p<0.05) was adopted. Results: the statistical analysis demonstrated that both shapes, i.e., the V-shaped one and the heart-shaped one are more visible during tongue elevation than during tongue protrusion. Conclusion: elevation is the position that allows the best observation of the shape of the tip of the tongue.
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Guilleminault C, Hervy-Auboiron M, Huang YS, Li K, Amat P. [Obstructive sleep-disordered breathing and orthodontics. An interview with Christian Guilleminault, Michèle Hervy-Auboiron, Yu-Shu Huang and Kasey Li]. Orthod Fr 2019; 90:215-245. [PMID: 34643512 DOI: 10.1051/orthodfr/2019038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Yu-Shu Huang
- Department of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, No. 5, Fusing St, Kwei-Shan Township, Taoyuan Country, 333, Taiwan
| | - Kasey Li
- 1900 University Ave #105, East Palo Alto, CA 94303, États-Unis
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Abstract
This narrative review surveys current research demonstrating how oral dysfunction can escalate into malocclusion, acquired craniofacial disorder and contribute to generational dysfunction, disorder and disease. INTRODUCTION Baseline orthodontic consultations are generally recommended beginning age seven. However, the dysmorphic changes that result in malocclusion are often evident years earlier. Similarly, following orthodontic treatment, patients require permanent retention when the bite is not stable, and without such retention, the malocclusion can return. SETTING AND POPULATION Narrative review article including research on infants, children and adults. MATERIALS AND METHODS This review is a brief survey of the symptomology of orofacial myofunctional disorder and outlines 10 areas of oral function that impact occlusal and facial development: breastfeeding, airway obstruction, soft tissue restriction, mouth breathing, oral resting posture, oral habits, swallowing, chewing, the impact of orofacial myofunctional disorder (OMD) over time and maternal oral dysfunction on the developing foetus. CONCLUSION Malocclusions and their acquired craniofacial dysmorphology are the result of chronic oral dysfunction and OMD. In order to achieve long-term stability of the face, it is critical to understand the underlying pathologies contributing to malocclusion, open bite and hard palate collapse.
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Affiliation(s)
- Linda D'Onofrio
- Oregon Health and Sciences University School of Dentistry, Portland, Oregon
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34
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Villa MP, Evangelisti M, Barreto M, Cecili M, Kaditis A. Short lingual frenulum as a risk factor for sleep-disordered breathing in school-age children. Sleep Med 2019; 66:119-122. [PMID: 31874353 DOI: 10.1016/j.sleep.2019.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent evidence has emphasized the role of a short lingual frenulum in the pathogenesis of sleep-disordered breathing (SDB) in childhood. The oral dysfunction induced by a short frenulum may promote oral-facial dysmorphism, decreasing the size of upper airway lumen and increasing the risk of upper airway collapsibility during sleep. The aim of this study was to evaluate the presence of a short lingual frenulum as risk factor for SDB in children of school age, with and without snoring, who were recruited from the community. METHODS Children aged 6-14 years were recruited from a school in Rome. For all participants, the previously described Sleep Clinical Record (SCR) was completed, and orthodontic evaluation and measurement of lingual frenulum were performed. Tongue strength and endurance were evaluated in all participants using the Iowa Oral Performance Instrument (IOPI). SDB was defined as positive SCR (≥6.5). RESULTS We assessed 504 children with mean age of 9.6 ± 2.3 years, and in 114 of them (22.6%) a short frenulum was identified. Children with a short lingual frenulum were at significantly higher risk for a positive SCR compared to those with a frenulum of normal length (odds ratio = 2.980, 95% confidence interval = 1.260-6.997). Participants with positive or negative SCR did not differ in tongue strength or endurance. CONCLUSION Short lingual frenulum is a risk factor for SDB. An early multidisciplinary approach and screening for SDB are indicated when this anatomical abnormality is recognized.
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Affiliation(s)
- Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
| | - Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mario Barreto
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Manuela Cecili
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Athanasios Kaditis
- Division of Pediatric Pulmonology, Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Guilleminault C, Huang YS, Quo S. Apraxia in children and adults with obstructive sleep apnea syndrome. Sleep 2019; 42:5580770. [DOI: 10.1093/sleep/zsz168] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/20/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
Early in life impairment of orofacial growth leads to sleep-disordered breathing (SDB). Normal lingual gnosis and praxis are part of this early development related to the normal sensorimotor development of the tongue and surrounding oral musculature. The aim of this retrospective study was to explore if lingual praxia is impaired in both SDB children and adults and if there is an association to craniofacial morphology.
Methods
The ability to perform simple tongue maneuvers was investigated in 100 prepubertal SDB children and 150 SDB adults (shown with polysomnography). All individuals had a clinical investigation by specialists to assess any orofacial growth impairment and the elements potentially behind this impairment. In a subgroup of individuals both able and unable to perform the maneuvers, we also performed a blind recognition of forms placed in the mouth.
Results
A subgroup of pediatric and adult SDB patients presented evidence not only of orofacial growth impairment, but also apraxia independent of age and severity of OSA.
Conclusions
By 3 years of age, children should be able to perform requested tongue maneuvers and have oral form recognition. Abnormal gnosis–praxis was noted, independent of age in SDB children and adults, demonstrating that an abnormal functioning of the tongue in the oral cavity during early development can be detected. Both children and adults with SDB may present similar absences of normal oral development very early in life and a similar presentation of apraxia, suggesting that the distinction of SDB in children versus adults may not be relevant.
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Affiliation(s)
| | - Yu-Shu Huang
- Pediatric Psychiatry and Sleep Center, Chang Gung Hospital and Medical College, Taoyuan, Taiwan
| | - Stacey Quo
- Division of Orthodontics, University of California San Francisco School of Dentistry, CA
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36
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Zaghi S, Valcu‐Pinkerton S, Jabara M, Norouz‐Knutsen L, Govardhan C, Moeller J, Sinkus V, Thorsen RS, Downing V, Camacho M, Yoon A, Hang WM, Hockel B, Guilleminault C, Liu SY. Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases. Laryngoscope Investig Otolaryngol 2019; 4:489-496. [PMID: 31637291 PMCID: PMC6793603 DOI: 10.1002/lio2.297] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/02/2019] [Accepted: 07/09/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility. METHODS Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient-reported outcome measures. RESULTS In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue-tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications. CONCLUSION Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Soroush Zaghi
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- UCLA HealthSanta MonicaCaliforniaU.S.A.
| | | | - Mia Jabara
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
| | | | | | - Joy Moeller
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- Academy of Orofacial Myofunctional TherapyPacific PalisadesCaliforniaU.S.A.
| | | | - Rebecca S. Thorsen
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- Long Beach Speech PathologyLong BeachCaliforniaU.S.A.
| | - Virginia Downing
- The Breathe InstituteLos AngelesCaliforniaU.S.A.
- Orofacial IntegrityOaklandCaliforniaU.S.A.
| | | | - Audrey Yoon
- Section of Pediatric Dentistry, Division of Growth and DevelopmentUCLA School of DentistryLos AngelesCaliforniaU.S.A.
- Division of Sleep Surgery, Department of Otolaryngology‐Head & Neck SurgeryStanford University School of MedicineStanfordCaliforniaU.S.A.
| | - William M. Hang
- William M Hang, DDS, MSD ‐ A Prof CorpAgoura HillsCaliforniaU.S.A.
| | - Brian Hockel
- Life Dental and OrthodonticsWalnut CreekCaliforniaU.S.A.
| | - Christian Guilleminault
- Department of Psychiatry, Sleep Medicine DivisionStanford Hospital and ClinicsRedwood CityCaliforniaU.S.A.
| | - Stanley Yung‐Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology‐Head & Neck SurgeryStanford University School of MedicineStanfordCaliforniaU.S.A.
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Behrents RG, Shelgikar AV, Conley RS, Flores-Mir C, Hans M, Levine M, McNamara JA, Palomo JM, Pliska B, Stockstill JW, Wise J, Murphy S, Nagel NJ, Hittner J. Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper. Am J Orthod Dentofacial Orthop 2019; 156:13-28.e1. [DOI: 10.1016/j.ajodo.2019.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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Govardhan C, Murdock J, Norouz-Knutsen L, Valcu-Pinkerton S, Zaghi S. Lingual and Maxillary Labial Frenuloplasty with Myofunctional Therapy as a Treatment for Mouth Breathing and Snoring. Case Rep Otolaryngol 2019; 2019:3408053. [PMID: 31001444 PMCID: PMC6437727 DOI: 10.1155/2019/3408053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/18/2022] Open
Abstract
Chronic mouth breathing may adversely affect craniofacial development in children and may result in anatomical changes that directly impact the stability and collapsibility of the upper airway during sleep. Mouth breathing is a multifactorial problem that can be attributed to structural, functional, and neurological etiologies, which are not all mutually exclusive. While therapeutic interventions (myofunctional, speech and swallowing, occupational, and craniosacral therapy) may address the functional and behavioral factors that contribute to mouth breathing, progress may sometimes be limited by restrictive lingual and labial frenum that interfere with tongue and lip mobility. This case report explores the case of a three-year-old girl with mouth breathing, snoring, noisy breathing, and oral phase dysphagia that was successfully treated with lingual and labial frenuloplasty as an adjunct to myofunctional therapy. Within four days of the procedure, the patient had stopped snoring and demonstrated complete resolution of open mouth breathing. The patient was also observed to have increased compliance with myofunctional therapy exercises. This report highlights the effectiveness of surgical interventions to improve the efficacy of myofunctional therapy in addressing open mouth posture and low tongue resting position.
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Affiliation(s)
| | | | | | | | - Soroush Zaghi
- The Breathe Institute, Los Angeles, CA, USA
- UCLA Health, Santa Monica, CA, USA
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Alexander N, Boota A, Hooks K, White JR. Rapid Maxillary Expansion and Adenotonsillectomy in 9-Year-Old Twins With Pediatric Obstructive Sleep Apnea Syndrome: An Interdisciplinary Effort. J Osteopath Med 2019; 119:126-134. [DOI: 10.7556/jaoa.2019.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Pediatric obstructive sleep apnea is known to cause neurocognitive problems, yet it often goes undetected or mistreated. The authors describe 9-year-old twins with snoring, enlarged tonsils, and excessive daytime sleepiness whose symptoms had been previously disregarded by health care professionals. At presentation, a dentist found the patients to be midface deficient and symptomatic. A home sleep test, prescribed by the dentist, revealed apnea-hypopnea index readings of 74/h and 16/h, respectively. The children were referred to an otolaryngologist, and a continuous positive airway pressure therapy trial resulted in improved cognition and temperament. Rapid maxillary expansion was then performed at the dentist office, followed by adenotonsillectomy by an ear, nose, and throat specialist and myofunctional rehabilitation with a speech pathologist for both patients. After treatment, results mimicked those reported during the continuous positive airway pressure trial, with substantially reduced apnea-hypopnea index of 0.9/h and 1.6/h. This case highlights the interdisciplinary nature of pediatric obstructive sleep apnea management and the need for all health care professionals to receive comprehensive sleep medicine training for proper diagnosis and treatment.
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Space Maintenance in the Primary Dentition. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yoon AJ, Zaghi S, Ha S, Law CS, Guilleminault C, Liu SY. Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional - morphological study. Orthod Craniofac Res 2017; 20:237-244. [PMID: 28994495 DOI: 10.1111/ocr.12206] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To characterize associations between restricted tongue mobility and maxillofacial development. SETTING AND SAMPLE POPULATION Cross-sectional cohort study of 302 consecutive subjects from an orthodontic practice. MATERIAL AND METHODS Tongue mobility (measured with tongue range of motion ratio [TRMR] and Kotlow free tongue measurement) was correlated with measurements of the maxillofacial skeleton obtained from dental casts and cephalometric radiographs. RESULTS Tongue range of motion ratio and Kotlow measures of restricted tongue mobility were associated with (i) ratio of maxillary intercanine width to canine arch length, (ii) ratio of maxillary intermolar width to canine arch length and (iii) soft palate length. Restricted tongue mobility was not associated with hyoid bone position or Angle's skeletal classification. CONCLUSIONS Restricted tongue mobility was associated with narrowing of the maxillary arch and elongation of the soft palate in this study. These findings suggest that variations in tongue mobility may affect maxillofacial development.
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Affiliation(s)
- A J Yoon
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, USA
| | - S Zaghi
- Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, CA, USA.,UCLA Health, Santa Monica, CA, USA
| | - S Ha
- UCLA School of Dentistry, Los Angeles, CA, USA
| | - C S Law
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, USA
| | - C Guilleminault
- Sleep Medicine Division, Stanford Outpatient Medical Center, Redwood City, CA, USA
| | - S Y Liu
- Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, CA, USA
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Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev 2017; 40:203-214. [PMID: 29103943 DOI: 10.1016/j.smrv.2017.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/21/2017] [Accepted: 06/26/2017] [Indexed: 01/01/2023]
Abstract
The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse. We review early development of oral-facial structures and the anatomical variants that may be present at birth and can impact nasal breathing. After birth, there is a continuous interaction between orofacial functions and growth of anatomic features. We review the dysfunctions identified to date that may impact orofacial development leading to sleep-disordered-breathing through changes in the orofacial growth. The identification of risk-factors, ultimately leading to full-blown obstructive sleep apnea, may allow early recognition of these factors and the development of treatments to eliminate early problems or at least decrease their impact.
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Affiliation(s)
- Christian Guilleminault
- Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan.
| | - Yu-Shu Huang
- Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan
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