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Datusanantyo RA, Anggrahini SM, Prasetyo AT. Stunted girl: A heartbreaking case report of underdiagnosed and untreated posterior ankyloglossia. Int J Surg Case Rep 2024; 118:109648. [PMID: 38653172 PMCID: PMC11053302 DOI: 10.1016/j.ijscr.2024.109648] [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: 03/11/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Plastic surgeons can help to eliminate stunting by surgically treating children born with congenital craniofacial anomalies such as tongue-tie, or ankyloglossia. Releasing ankyloglossia can help to support breastfeeding and the later development of orofacial anatomy and physiology. Failure to do so can lead to growth and development difficulties in children. We report a heartbreaking case of a stunted 8 year-old female with underdiagnosed and untreated ankyloglossia. PRESENTATION OF CASE The patient was consulted with a short stature, speech disorder, and swallowing disorder. History taking and physical examination led to a diagnosis of type 4 (posterior) ankyloglossia. The Hazelbaker Assessment Tool for Lingual Frenulum Function mandated a frenotomy. Under general anesthesia, frenotomy was performed surgically, and significant tongue mobility was gained. DISCUSSION This case alerted both surgeon and pediatrician that collaboration is a must to intervene in such a specific congenital anomalies. Posterior (type 4) ankyloglossia may cause difficulties in tongue mobility which can lead to difficulties in breastfeeding and swallowing, speech disorders, and malocclusion. Posterior ankyloglossia is not only the most severe form of ankyloglossia, but also the most difficult to diagnose. CONCLUSION In the absence of social and environmental factors, posterior (type 4) ankyloglossia was the single most responsible factor in this growth and development delay in the girl. Timely diagnosis and treatment could have prevented such a stunted condition.
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Affiliation(s)
- Robertus Arian Datusanantyo
- Department of Surgery, Prof. Dr. W. Z. Johannes General Hospital/Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Simplicia Maria Anggrahini
- Department of Pediatrics, Prof. Dr. W. Z. Johannes General Hospital/Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
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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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Jaikaria A, Pahuja SK, Thakur S, Negi P. Treatment of partial ankyloglossia using Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF): A case report with 6-month follow-up. Natl J Maxillofac Surg 2021; 12:280-283. [PMID: 34483591 PMCID: PMC8386261 DOI: 10.4103/njms.njms_69_19] [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: 10/28/2019] [Revised: 06/25/2020] [Accepted: 02/11/2021] [Indexed: 12/14/2022] Open
Abstract
Ankyloglossia or "tongue-tie," observed in neonates, children, or adults, is characterized by an abnormally short, thick, fibrosed lingual frenulum which may cause restriction in function of tongue including limitation in tongue movement. The use of Hazelbaker Assessment Tool for Lingual Frenulum Function allows elaborate and extensive scoring of the anomaly. This article reports the surgical management of an 11-year-old patient having ankyloglossia associated with restricted movement of tongue and difficulty in speech. Six months postoperatively, the patient showed uneventful healing and was satisfied with the procedure.
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Affiliation(s)
- Astha Jaikaria
- Private Practitioner, MDS Pedodontics, HP Govt Dental College, Shimla, Himachal Pradesh, India
| | | | - Seema Thakur
- Department of Pedodontics, HPGDC, Shimla, Himachal Pradesh, India
| | - Pooja Negi
- Department of Prosthodontics, HPGDC, Shimla, Himachal Pradesh, India,Address for correspondence: Dr. Pooja Negi, Room No. 408, 4th Floor, HPGDC, Shimla, Himachal Pradesh, India. E-mail:
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Ramoser G, Guóth‐Gumberger M, Baumgartner‐Sigl S, Zoeggeler T, Scholl‐Bürgi S, Karall D. Frenotomy for tongue-tie (frenulum linguae breve) showed improved symptoms in the short- and long-term follow-up. Acta Paediatr 2019; 108:1861-1866. [PMID: 30968969 DOI: 10.1111/apa.14811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate clinical manifestations of tongue-tie as well as short-term and long-term outcomes following frenotomy. METHODS In this retrospective study, for 329 patients (295 infants and 34 children) who underwent frenotomy between 2011 and 2017, symptoms, short-term and long-term outcomes were evaluated. RESULTS Of the 295 infants (median age six weeks), 199 (=60%) showed inadequate breastfeeding. Symptoms were painful or sore maternal nipples, poor weight gain, dribbling milk from the corner of the mouth, reduced milk supply, inadequate latch during bottle-feeding and maternal mastitis. In the 34 children, predominant symptoms were articulation disorders, misaligned teeth and problems with swallowing solid food. Of the 141 patients with short-term feedback, 86% reported improvement, 13% an unchanged situation. In a former premature, the reported worsening of symptoms ('breath spells') are likely related to prematurity. Of the 164 patients where the questionnaire for long-term outcome was provided, 82% reported improvement, 16% an unchanged situation. For two infants worsening was reported, referring to refusal to drink from breast or bottle for two hours after the procedure and fever for one day, respectively. CONCLUSION Frenulum breve is a potential cause of breastfeeding difficulties and can be treated safely and efficiently by frenotomy.
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Affiliation(s)
- Gabriele Ramoser
- Clinic for Pediatrics I Medical University of Innsbruck Innsbruck Austria
| | | | | | - Thomas Zoeggeler
- Clinic for Pediatrics I Medical University of Innsbruck Innsbruck Austria
| | | | - Daniela Karall
- Clinic for Pediatrics I Medical University of Innsbruck Innsbruck Austria
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Mills N, Pransky SM, Geddes DT, Mirjalili SA. What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clin Anat 2019; 32:749-761. [PMID: 30701608 PMCID: PMC6850428 DOI: 10.1002/ca.23343] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 01/28/2023]
Abstract
Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in‐situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a “cord” or “submucosal band” of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in‐situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo‐documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm‐like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749–761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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Affiliation(s)
- Nikki Mills
- Department of Paediatric OtolaryngologyStarship Children's HospitalAucklandNew Zealand
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Seth M. Pransky
- Pediatric OtolaryngologistPediatric Specialty PartnersSan DiegoCalifornia
| | - Donna T. Geddes
- School of Medicine and PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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Martinelli RLDC, Marchesan IQ, Berretin-Felix G. Posterior lingual frenulum in infants: occurrence and maneuver for visual inspection. REVISTA CEFAC 2018. [DOI: 10.1590/1982-0216201820410918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to verify the occurrence of posterior or submucosal lingual frenulum and evaluate the efficiency of a special maneuver for its visual inspection. Methods: an experimental study including 1,715 healthy infants, in which prematurity, perinatal complications, craniofacial anomalies neurological disorders, and visible genetic syndromes were the exclusion criteria. A clinical examination was performed by means of a maneuver that consisted in rising the lateral margins of the tongue to visualize the anatomical characteristics of the lingual frenulum. In some of the infants, a special maneuver was performed to assist visualization of posterior lingual frenulum, since its visualization was not possible. The maneuver consisted in two simultaneous actions: elevating and pushing the tongue back. Results: 558 infants (32.54%), out of the 1,715 had posterior frenulum, which required the special maneuver that consisted in both elevating and pushing the tongue back, simultaneously. Conclusion: the occurrence of posterior lingual frenulum was high and the special maneuver consisted in elevating and pushing the tongue back proved to be efficient to visualize the posterior lingual frenulum.
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Fonteles CSR, Marques Ribeiro E, Sales Aragão Santos M, Ferreira Pequeno Leite R, Sales Assunção G, Monteiro AJ, Santos Pessoa AL, Giacheti CM, Cavalcante Kerbage S, Ribeiro TR, Pamplona de Góes Cavalcanti L. Lingual Frenulum Phenotypes in Brazilian Infants With Congenital Zika Syndrome. Cleft Palate Craniofac J 2018; 55:1391-1398. [DOI: 10.1177/1055665618766999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: The present study aimed to evaluate lingual frenulum in children affected by congenital Zika syndrome (CZS) and to analyze the association of lingual frenulum phenotypes with other variables. Design: This present work had a cross-sectional, descriptive study design. Setting: This study was carried out in Fortaleza (Brazil). The health professionals provided tertiary level of care. Data collection occurred during a multidisciplinary task force for evaluating infants affected by CZS in December 2 to 3, 2016. Patients: Fifty-four patients with CZS (1-12 months old; 32 girls and 22 boys) were recruited from a population of 70 infants. Interventions: A multidisciplinary group comprised of speech-language pathologist/audiologists and pediatric dentists evaluated all patients through an intraoral examination and a specific tongue maneuver protocol for infants. Main Outcome Measures: Lingual frenulum visibility was the primary outcome measure. Before initiating the study, we hypothesized that children with CZS had an absent lingual frenulum. Results: Lingual frenula were visible in 34 (63%) infants, whereas in 20 (37%) infants lingual frenula visibility required a specific maneuver to retract the tongue. Six of 20 infants presented posteriorly positioned lingual frenula that were visible after maneuver. Lingual frenula were covered by mucous tissue in 14 infants. Presence of posterior frenulum was associated with dysphagia ( P = 0.038). However, the presence of dysphagia in a multivariate model did not associate with the presence of a posterior lingual frenulum ( P = .069) or neurologic symptoms ( P = .056). Conclusion: Children with CZS showed predominance of a posterior lingual frenula covered by an overlapping curtain-like mucous membrane.
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Affiliation(s)
| | - Erlane Marques Ribeiro
- Albert Sabin Children’s Hospital (HIAS), Fortaleza, Ceará, Brazil
- Faculty of Medicine, Christus University Center (UNICHRISTUS), Fortaleza, Ceará, Brazil
| | | | | | | | - André Jalles Monteiro
- Department of Clinical Dentistry, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | | | - Célia Maria Giacheti
- Department of Speech-Language Pathology and Audiology, São Paulo State University Júlio de Mesquita Filho (UNESP), Marília, São Paulo, Brazil
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Walker RD, Messing S, Rosen-Carole C, McKenna Benoit M. Defining Tip-Frenulum Length for Ankyloglossia and Its Impact on Breastfeeding: A Prospective Cohort Study. Breastfeed Med 2018; 13:204-210. [PMID: 29620937 DOI: 10.1089/bfm.2017.0116] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the normal lingual frenulum anatomy in newborns and to evaluate tip-frenulum distance as an objective diagnostic tool for identifying newborns at risk for anterior and posterior tongue tie and breastfeeding difficulty. MATERIALS AND METHODS The distance from the tongue tip to the insertion of the lingual frenulum was measured in a group of 100 healthy newborns to establish normative data. The presence of a visible or palpable cord was noted. Inter-rater reliability was assessed. Breastfeeding surveys including a maternal pain scale and Infant Breastfeeding Assessment Tool (IBFAT) were administered on days of life 2 and 14 to determine whether these findings predict breastfeeding difficulty. RESULTS Mean tip-frenulum length was 9.07 mm. Intraclass correlation coefficient between observers for tip-frenulum length was 0.82. A visible cord was identified in 21 subjects (21%). A palpable cord was identified in 59 subjects (59%). Unweighted κ coefficients for inter-rater reliability of visible and palpable cords were 0.91 and 0.47, respectively. Visible cord and shorter tip-frenulum distance were independently predictive of higher maternal pain scores. A positive correlation was identified between tip-frenulum length and IBFAT scores for mothers with two or more previous breastfed children. CONCLUSIONS Tongue tip-frenulum length correlated with maternal nipple pain, and was useful as an objective tool for identifying newborns at risk for ankyloglossia. Maternal breastfeeding experience appears to be an important factor in the link between tongue anatomy and breastfeeding difficulty. The presence of a palpable cord was variable across examiners, and should be interpreted with caution when evaluating newborns for posterior tongue tie.
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Affiliation(s)
- Ryan D Walker
- 1 Department of Otolaryngology, University of Rochester , Rochester, New York
| | - Susan Messing
- 2 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York
| | - Casey Rosen-Carole
- 3 Department of Pediatrics and Obstetrics and Gynecology, University of Rochester , Rochester, New York
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Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics 2015; 135:e1458-66. [PMID: 25941303 PMCID: PMC9923619 DOI: 10.1542/peds.2015-0658] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this study was to systematically review literature on surgical and nonsurgical treatments for infants with ankyloglossia. METHODS Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched up to August 2014. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics and outcomes and assigned quality and strength-of-evidence ratings. RESULTS Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. We included comparative studies published in English. The evidence base is limited, consisting of small studies, short-term outcomes, and little information to characterize participants adequately. No studies addressed nonsurgical interventions, longer-term breastfeeding or growth outcomes, or surgical intervention compared with other approaches to improve breastfeeding, such as lactation consultation. CONCLUSIONS A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient.
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Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | | | - Melissa McPheeters
- Institute for Medicine and Public Health, Evidence-based Practice Center, and Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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Junqueira MA, Cunha NNO, Costa e Silva LL, Araújo LB, Moretti ABS, Couto Filho CEG, Sakai VT. Surgical techniques for the treatment of ankyloglossia in children: a case series. J Appl Oral Sci 2014; 22:241-8. [PMID: 25025566 PMCID: PMC4072276 DOI: 10.1590/1678-775720130629] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
This paper reports a series of clinical cases of ankyloglossia in children, which
were approached by different techniques: frenotomy and frenectomy with the use of one
hemostat, two hemostats, a groove director or laser. Information on the indications,
contraindications, advantages and disadvantages of the techniques was also presented.
Children diagnosed with ankyloglossia were subjected to different surgical
procedures. The choice of the techniques was based on the age of the patient, length
of the frenulum and availability of the instruments and equipment. All the techniques
presented are successful for the treatment of ankyloglossia and require a skilled
professional. Laser may be considered a simple and safe alternative for children
while reducing the amount of local anesthetics needed, the bleeding and the chances
of infection, swelling and discomfort.
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Deshmukh PK, Deshmukh K, Mangalgi A, Patil S, Hugar D, Kodangal SF. Van der woude syndrome with short review of the literature. Case Rep Dent 2014; 2014:871460. [PMID: 25050184 PMCID: PMC4090536 DOI: 10.1155/2014/871460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/29/2014] [Accepted: 05/26/2014] [Indexed: 11/25/2022] Open
Abstract
Van der Woude syndrome (VWS) is a rare autosomal dominant condition with high penetrance and variable expression. Clinical manifestation of this autosomal dominant clefting syndrome includes bilateral midline lower lip pits, cleft lip, and cleft palate along with hypodontia. These congenital lip pits appear as a malformation in the vermilion border of the lip, with or without excretion. Discomfort caused by spontaneous or induced drainage of saliva/mucus when pressure is applied or during a meal as well as poor aesthetic match is one of the main complaints of patients with congenital lip fistula. The pits are treated by surgical resection. Dentists should be aware of the congenital lip pits as in Van der Woude syndrome because they have been reported to be associated with a variety of malformations or other congenital disorders. Here, the authors report a rare case of Van der Woude syndrome with short review of the literature.
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Affiliation(s)
- Pallavi K. Deshmukh
- Department of Oral Medicine and Radiology, H.K.E.S.'s S. N. Institute of Dental Sciences and Research, Gulbarga, Karnataka 585103, India
| | - Kiran Deshmukh
- Department of Otorhinolaryngology, M. R. Medical College, Gulbarga, Karnataka 585103, India
| | - Anand Mangalgi
- Department of Oral and Maxillofacial Surgery, H.K.E.S.'s S. N. Institute of Dental Sciences and Research, Gulbarga, Karnataka 585103, India
| | - Subhash Patil
- Department of Community and Preventive Dentistry, H.K.E.S.'s S. N. Institute of Dental Sciences and Research, Gulbarga, Karnataka 585103, India
| | - Deepa Hugar
- Department of Oral Pathology and Microbiology, H.K.E.S.'s S. N. Institute of Dental Sciences and Research, Gulbarga, Karnataka 585103, India
| | - Saraswathi Fakirappa Kodangal
- Department of Oral Medicine and Radiology, H.K.E.S.'s S. N. Institute of Dental Sciences and Research, Gulbarga, Karnataka 585103, India
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O'Callahan C. Response to the letter to the editor regarding 'benefits of frenulotomy in infants with ankyloglossia' by Sethi et al. [Int. J. Pediatr. Otorhinolaryngol. 77 (2013) 762-765]. Int J Pediatr Otorhinolaryngol 2014; 78:572-3. [PMID: 24411815 DOI: 10.1016/j.ijporl.2013.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Cliff O'Callahan
- Pediatric Faculty and Director of Nurseries, Middlesex Hospital and Family Medicine Residency, Middletown, CT 06457, United States.
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Camargo ZA, Marchesan IQ, Oliveira LR, Svicero MAF, Pereira LCK, Madureira S. Lingual frenectomy and alveolar tap production: An acoustic and perceptual study. LOGOP PHONIATR VOCO 2013; 38:157-66. [DOI: 10.3109/14015439.2012.671357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Martinelli RLDC, Marchesan IQ, Berretin-Felix G. Protocolo de avaliação do frênulo lingual para bebês: relação entre aspectos anatômicos e funcionais. REVISTA CEFAC 2013. [DOI: 10.1590/s1516-18462013005000032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: verificar quais características do frênulo da língua influenciam nas funções de sucção e deglutição em bebês nascidos a termo, com a finalidade de propor adequações no protocolo proposto por Martinelli et al (2012). MÉTODO: foi aplicado o protocolo de avaliação do frênulo da língua em 100 bebês saudáveis nascidos a termo. Os filmes obtidos na avaliação foram analisados por duas fonoaudiólogas especialistas em MO, com experiência em avaliação de frênulo lingual. Foram aplicados os testes Qui-quadrado seguido do teste exato de Fisher, além da análise de variância, considerando os dados qualitativos e quantitativos, respectivamente. RESULTADOS: nos 16 bebês que apresentaram alteração do frênulo lingual, verificou-se a relação entre: a tendência do posicionamento da língua durante o choro e o tempo entre as mamadas; a forma da língua quando elevada e o cansaço para mamar; bem como a fixação do frênulo na língua e o movimento da língua na sucção não nutritiva. Pela análise dos dados dos bebês com alteração de frênulo lingual, foi possível definir as características indicativas de alteração, que possibilitaram a adequação do protocolo inicial, e a atribuição de escores. CONCLUSÃO: a forma da língua, quando elevada durante o choro, influencia o movimento da língua durante a sucção não nutritiva, e o ponto de fixação do frênulo na língua influencia o ritmo da sucção durante a amamentação. O novo protocolo com escores é uma ferramenta efetiva para avaliar e diagnosticar alterações anatômicas do frênulo da língua e suas possíveis interferências na amamentação.
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Steehler MW, Steehler MK, Harley EH. A retrospective review of frenotomy in neonates and infants with feeding difficulties. Int J Pediatr Otorhinolaryngol 2012; 76:1236-40. [PMID: 22704670 DOI: 10.1016/j.ijporl.2012.05.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To measure maternal breast feeding benefit after infant frenotomy. To investigate if timing of neonatal/infant frenotomy affects outcome. STUDY DESIGN Cohort survey and retrospective review. METHODS Medical records of neonates and infants suspected to have ankyloglossia between April 2006 and February 2011 were reviewed. Patient demographic data was compiled. A telephone survey was conducted to gather data on this cohort of patients. RESULTS Neonatal and infant consultations (N=367) were performed for feeding difficulties due to suspected ankyloglossia, 302 of these infants underwent frenotomy for ankyloglossia. A total of 91 mothers agreed to participate in a follow-up telephone survey regarding the intervention. Results showed that 80.4% of mothers strongly believed the procedure benefited their child's ability to breastfeed, and 82.9% of mothers were able to initiate/resume breastfeeding after the procedure was performed. The belief that frenotomy significantly benefitted an infant's ability to feed significantly differed in patients that had the procedure performed in the first week of life (86%) as compared to infants that had the procedure performed after the first week of life (74%) (p<0.003). CONCLUSIONS Based on maternal observations, when frenotomy is performed on neonates with ankyloglossia and feeding difficulties in the first week of life, there is more benefit than when it is performed after the first week of life. The population of patients with ankyloglossia is predominantly male with a high familial/genetic correlation associated with the phenotypic trait. Frenotomy for ankyloglossia demonstrates a high degree of maternal satisfaction, is well tolerated and has been shown to improve breastfeeding and decrease pain and difficulty associated with breastfeeding.
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Affiliation(s)
- Mark W Steehler
- Lake Erie Consortium for Osteopathic Medical Training, Erie, PA, United States; Millcreek Community Hospital, Erie, PA, United States
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Defining ankyloglossia: a case series of anterior and posterior tongue ties. Int J Pediatr Otorhinolaryngol 2010; 74:1003-6. [PMID: 20557951 DOI: 10.1016/j.ijporl.2010.05.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/18/2010] [Accepted: 05/23/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Ankyloglossia is a congenital condition in which tongue mobility is limited due to an abnormality of the lingual frenulum. The impact of ankyloglossia on breastfeeding is poorly understood but there is a recent trend toward more recognition of this condition and early intervention when needed. Currently, there lacks clear definition of ankyloglossia and different subtypes have been proposed with no clinical correlation. OBJECTIVE To determine the prevalence of anterior versus posterior ankyloglossia in a large series of consecutive patients and to assess clinical outcomes after frenotomy. METHODS Retrospective chart review of patients from July 2007 to July 2009 who were diagnosed with ankyloglossia and underwent office frenotomy. Baseline characteristics, specific feeding issues, type of ankyloglossia, and clinical outcomes after frenotomy were reviewed. RESULTS Of the 341 total patients, 322 (94%) had anterior ankyloglossia and 19 (6%) had posterior ankyloglossia. Median age at presentation was 2.7 weeks (range 1 day of life to 24 weeks); 227 were males and 114 were females. Revision frenotomy rates were significantly higher for the posterior ankyloglossia group (3.7% anterior and 21.1% posterior, p=0.008). CONCLUSION Anterior ankyloglossia is much more common and readily managed when compared to posterior ankyloglossia. Posterior ankyloglossia is a poorly recognized condition that may contribute to breastfeeding difficulties. The diagnosis is difficult due to the subtle clinical findings but relevant health care providers should be aware of this condition. Frenotomy is a simple, safe, and effective intervention for ankyloglossia which improves breastfeeding.
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