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Smart S, Grant H, Tseng RJ. Beyond surgery: Pre- and post-operative care in children with ankyloglossia. Int J Paediatr Dent 2024. [PMID: 38982581 DOI: 10.1111/ipd.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/22/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Surgical intervention for tongue-tie, or ankyloglossia performed by paediatric dentists can alleviate symptoms and improve functional abilities in infants and children. Despite widespread practice, there are currently no established clinical guidelines or consistent approaches for pre- and post-operative care of children. AIM The aim of this study was to explore approaches to pre- and post-operative care for children with ankyloglossia having frenum surgery. DESIGN A scoping review of peer-reviewed articles in four electronic databases was conducted. Intervention studies that reported on pre- or post-operative regimens for infants, children and adolescents (0 to 18 years) with a diagnosis of tongue-tie or ankyloglossia, who had surgical intervention such as frenotomy or frenectomy, were included and quality assessments performed. RESULTS Twenty-three studies were identified, with seven studies incorporating both pre- and post-operative care, and 16 studies focussing solely on post-operative care. Tongue exercises were commonly prescribed, and only three studies examined the relationship between post-operative care and recovery outcomes. Considerable variability existed in study design, prescribed care and outcome measures. CONCLUSION There was substantial variability in pre- and post-operative care protocols, including dosage, frequency and duration of exercises and other care regimens for infants and children having frenum surgery. Further research is needed to determine the most effective course of pre- and post-operative care for children undergoing frenum surgery.
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Affiliation(s)
- Sharon Smart
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Hayley Grant
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Raymond J Tseng
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
- Division of Pediatric and Public Health, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
- North Carolina Tongue Tie Center, Cary, North Carolina, USA
- High House Pediatric Dentistry of Cary, Cary, North Carolina, USA
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Carnino JM, Rodriguez Lara F, Chan WP, Kennedy DG, Levi JR. Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2024; 133:566-574. [PMID: 38444142 DOI: 10.1177/00034894241236234] [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] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Tongue-tie, which is also known as ankyloglossia, is a common condition where the lingual frenulum is unusually tight or short. While most literature investigates the impact of tongue-tie on breastfeeding, recent articles have examined its role in speech production in children. However, these have not previously been reviewed systematically. This study aims to determine the impact of tongue-tie on speech outcomes and assess whether frenectomy can improve speech function. METHODS In this systematic review, we conducted a comprehensive search of PubMed/MEDLINE, Cochrane Library, Embase, and speechBITE to analyze primary studies investigating the impact of frenectomy for tongue-tie on speech outcomes. We extracted data regarding patient age, male to female ratio, procedure type, follow-up time, and speech outcomes and ran statistical analyses to determine if frenectomy for tongue-tie leads to improvement in speech issues in pediatric patients. Speech outcomes extracted were subjectively measured based on the interpretation of a speech and language pathologist or parent. RESULTS Our analysis included 10 studies with an average patient age of 4.10 years, and average cohort size of 22.17 patients. Overall, frenectomy for tongue-tie was associated with an improvement in speech articulation (0.78; 95% CI: 0.64-0.87; P < .01). Increasing patient age was found to be negatively correlated with post-frenectomy speech outcomes (P = .01). However, this relationship disappeared in the adjusted model. CONCLUSION Overall, we conclude that frenectomy is a suitable treatment to correct speech issues in select patients with tongue-tie if caught early in childhood. Despite the limited investigations around speech outcomes post-frenectomy, these results are informative to providers treating tongue-tie.
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Affiliation(s)
- Jonathan M Carnino
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - Wang Pong Chan
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Dean G Kennedy
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 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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Yu C, Li QQ, Zhang RZ, Chen SL, Xia FF, Zhou Z. Effects of different surgical treatments on children with ankyloglossia: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e065653. [PMID: 36600360 PMCID: PMC9730349 DOI: 10.1136/bmjopen-2022-065653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Ankyloglossia is a situation where the tongue tip cannot go beyond the mandibular incisor because the frenulum linguae is short. It could affect children's health by interfering with their ability to talk, breast feeding and dental development. The most effective measure to control ankyloglossia is the surgical method. However, which surgical procedure is the best one is still controversial. Thus, this protocol aims to assess the effectiveness of different surgical interventions in children with ankyloglossia. METHODS AND ANALYSIS PubMed, EMBASE, Cochrane Library, Web of Science and OVID will be searched for relevant information from inception to 31 May 2022. Observational studies in English that investigate the association between surgical methods and ankyloglossia will be included in this protocol. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle-Ottawa Quality Assessment Scale for longitudinal studies will be used to assess the included studies. The improvement of breast feeding and nipple pain will be the primary outcome. STATA V.15.1 will do the statistical analysis in the meta-analysis. Subgroup and meta-regression will be carried out based on the characteristics of included studies. ETHICS AND DISSEMINATION This systematic review and meta-analysis will summarise relevant information on the effects of different surgical treatments on patients with ankyloglossia. The results will be disseminated through peer-reviewed publications. The data included in this study will be extracted from the published original studies. Thus, ethical approval and informed consent will not be required. PROSPERO REGISTRATION NUMBER CRD42022323350.
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Affiliation(s)
- Chongqing Yu
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Qi-Qi Li
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Ruo-Zhen Zhang
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | | | - Fei-Fei Xia
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Zheng Zhou
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
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Choi JS, Park JH, Kim MC, Lim JS, Shim HS. Evaluation of tongue mobility following release operation of ankyloglossia with genioglossus myotomy. Medicine (Baltimore) 2022; 101:e29648. [PMID: 35960114 PMCID: PMC9371483 DOI: 10.1097/md.0000000000029648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Ankyloglossia is a congenital anomaly characterized by a short lingual frenulum and severe form needs release surgery. Our goal in this study was to confirm the long-term safety and efficacy of Z-plasty with genioglossus myotomy compared with traditional Z-plasty alone and to develop a proper measurement tool to validate the postoperative results of release operations for ankyloglossia. Patients were divided in 2 groups, release with Z-plasty only group (group 1) and Z-plasty combined with genioglossus myotomy group (group 2) In group 2, the release of central longitudinal fiber of genioglossus muscle was added in the conventional Z-plasty operative procedure. To analyze the results of the surgery, we developed an objective assessment tool which is the direct length from the innermost point of the floor of mouth to the tip of the tongue, preoperatively and postoperatively, which is called "functional tongue length." A total of 101 patients with ankyloglossia ranging in age from 36 months to 8 years underwent release operation. Although there was no significant difference in terms of postoperative measurements between groups in Kotlow class II, group 2 patients in Class III and IV showed greater postoperative functional tongue length. Also, there was no significant complication requiring secondary surgery. Our study demonstrated that adding genioglossus myotomy to a simple Z-plasty is a safe and effective method for improving the tongue mobility required to make lingual sounds, especially in moderate to severe form of ankyloglossia, along with suggestion of a new measurement tool, which can objectively assess tongue mobility with possibility for universal utilization in ankyloglossia release operation.
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Affiliation(s)
- Ji Seon Choi
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hwan Park
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Min Cheol Kim
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin Soo Lim
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- * Correspondence: Hyung-Sup Shim, MD, PhD, Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 joongbu-daero, Suwon, Korea (e-mail: )
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Wang J, Yang X, Hao S, Wang Y. The effect of ankyloglossia and tongue-tie division on speech articulation: A systematic review. Int J Paediatr Dent 2022; 32:144-156. [PMID: 33964037 DOI: 10.1111/ipd.12802] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
AIM Ankyloglossia is a common congenital malformation characterized by a short, thick, or tight tongue frenulum, and its effect on speech articulation remains controversial. This study aimed to evaluate (a) the association between ankyloglossia and speech disorders, and (b) the effectiveness of surgical interventions on the articulation of patients with ankyloglossia. MATERIAL AND METHODS A comprehensive search of PubMed was conducted. Randomized control trials (RCTs), cohort studies, case-control studies, and case series with more than five cases were included. RESULT Of the 16 included studies, except for one cross-sectional study, all studies were small in sample size. The evidence quality was generally low, with an average of 3.88 in a 7-point system. Three studies investigated the occurrence of speech disorders in the ankyloglossia population and obtained different results. Fifteen studies assessed the effectiveness of surgery, among which eight self-control studies observed significant postoperative improvement, whereas three of four cohort studies with untreated controls reported no significant differences. Three RCTs compared surgical techniques and one pointed out the advantage of frenuloplasty over frenulotomy. CONCLUSION There was no clear connection between ankyloglossia and speech disorders. More widely accepted uniform grading systems and well-designed clinical studies are needed.
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Affiliation(s)
- Jiahe Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyu Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Siyuan Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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7
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Inostroza-Allende F, Caviedes Ulloa C, González Jara M, Palomares-Aguilera M. Intervención logopédica posoperatoria del frenillo lingual en niños, adolescentes y adultos. Revisión integradora de literatura. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.74035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
En los últimos años ha existido un aumento significativo en el diagnóstico de la anquiloglosia, las cirugías del frenillo lingual y las publicaciones científicas. Al respecto, es necesario que los profesionales de la salud conozcan el tratamiento fonoaudiológico en estos casos. El objetivo del estudio fue describir la terapia fonoaudiológica implementada en niños, adolescentes y adultos luego de la frenotomía, frenectomía o frenuloplastia lingual, mediante una revisión integradora de literatura. Para esto, durante el segundo trimestre del 2020 las bases de datos electrónicas PUBMED, LILACS, SciELO y Cochrane, fueron consultadas utilizando las palabras claves en inglés: “Ankyloglossia”, “Tongue Tie”, “Lingual Frenulum”, “Lingual Frenum”, “Surgical Procedures”, “Frenuloplasty”, “Lingual Frenulectomy”, “Speech Therapy” y “Myofunctional Therapy”. Se seleccionaron artículos originales relacionados al tema, y fue creado un protocolo específico para la extracción de los datos. Fueron encontrados 798 artículos. 39 se incluyeron luego de la lectura de los títulos y la eliminación de duplicados, 13 luego de lectura de los resúmenes y 7 luego de la revisión de los textos completos. Finalmente, tras un análisis de referencias cruzadas 10 estudios fueron incluidos en esta revisión. Se concluye la importancia del tratamiento fonoaudiológico en el abordaje multidisciplinario del frenillo lingual, abordando aspectos de movilidad lingual, habla y otras funciones orofaciales alteradas luego del procedimiento quirúrgico.
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8
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Impact of ankyloglossia on the language development of children. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1006047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bargiel J, Gontarz M, Gąsiorowski K, Marecik T, Szczurowski P, Zapała J, Wyszyńska-Pawelec G. Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents-Preliminary Report and Step-by-Step Technique Showcase. MEDICINA-LITHUANIA 2021; 57:medicina57080848. [PMID: 34441053 PMCID: PMC8398067 DOI: 10.3390/medicina57080848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.
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10
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How to Treat a Tongue-tie: An Evidence-based Algorithm of Care. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3336. [PMID: 33564576 PMCID: PMC7859174 DOI: 10.1097/gox.0000000000003336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear.
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11
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Bawazir O, Bawazir A, Bawazir R, Bawazir F, Halabi N. Experiences and outcomes of frenotomy in children with ankyloglossia in multiple tertiary centers in Saudi Arabia. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Salt H, Claessen M, Johnston T, Smart S. Speech production in young children with tongue-tie. Int J Pediatr Otorhinolaryngol 2020; 134:110035. [PMID: 32298924 DOI: 10.1016/j.ijporl.2020.110035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Tongue-tie, or ankyloglossia, occurs in 4-10% of the population. Treatment of tongue-tie has increased by 420% in Australia between 2006 and 2016 and 866% in the United States between 1997 and 2012. Despite limited evidence, it has been suggested that tongue-tie can result in speech sound disorder (SSD). This study aimed to investigate tongue mobility and speech production outcomes in children with and without tongue-tie diagnoses. METHOD Fifty-nine children aged 2; 1 to 4; 11 years were recruited and formed three groups: treated tongue-tie (TTT), untreated tongue-tie (UTT) and no tongue-tie (NTT). Measures of lingual frenulum structure and function, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected. RESULTS No statistically significant differences were found between the TTT, UTT and NTT groups for tongue mobility, speech production or intelligibility. Significantly more UTT children had a history of speech pathology attendance than participants in the NTT group. CONCLUSION This study provides preliminary evidence of no difference between tongue mobility and speech outcomes in young children with or without intervention for tongue-tie during infancy. This study assists with clinical decision making and makes recommendations for families not to proceed with surgical intervention for tongue-tie during infancy, for the sole outcome of improving speech production later in life.
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Affiliation(s)
- Holly Salt
- Curtin University, Kent St, Bentley, WA, Australia, 6102.
| | - Mary Claessen
- Curtin University, Kent St, Bentley, WA, Australia, 6102.
| | - Timothy Johnston
- IKids Paediatric Dental Care, 94 Stirling Hwy, North Fremantle, WA, Australia, 6159.
| | - Sharon Smart
- Curtin University, Kent St, Bentley, WA, Australia, 6102.
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13
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Khan U, MacPherson J, Bezuhly M, Hong P. Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review. Otolaryngol Head Neck Surg 2020; 163:428-443. [DOI: 10.1177/0194599820917619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
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Affiliation(s)
- Usman Khan
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jake MacPherson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
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14
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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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Mezzapesa PP, Lepore G, Acella V, De Giglio N, Favia G. Clinical Outcomes of Diode Laser Treatment of Ankyloglossia in Children and Young Adults: A Report of Two Cases. Cureus 2020; 12:e7367. [PMID: 32328379 PMCID: PMC7174868 DOI: 10.7759/cureus.7367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lingual frenectomy/frenotomy is a relatively safe procedure for removing the lingual frenulum when it is thick, very tight, and/or restricting tongue movements, especially in children. Among all treatment options, diode laser surgery is the most effective. We present two cases wherein diode laser surgery was safe, with a near-total absence of intraoperative bleeding.
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Affiliation(s)
| | - Giulia Lepore
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Valerio Acella
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
| | - Nicola De Giglio
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA
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Marra PM, Itro A. Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.124] [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] Open
Affiliation(s)
| | - Angelo Itro
- University of Campania Luigi Vanvitelli, Italy
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Schlatter S, Schupp W, Otten J, Harnisch S, Kunze M, Stavropoulou D, Hentschel R. The role of tongue-tie in breastfeeding problems-A prospective observational study. Acta Paediatr 2019; 108:2214-2221. [PMID: 31265153 DOI: 10.1111/apa.14924] [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: 05/02/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
AIM We evaluated what determined breastfeeding problems in a non-selected mother-infant cohort, with special reference to tongue-tie and improvements in breastfeeding following frenulotomy. METHODS This 2014-2015 prospective, observational study was carried out in a tertiary level maternity unit affiliated to the University of Freiburg, Germany, using a breastfeeding questionnaire, standardised breastfeeding scores and the Assessment Tool For Lingual Frenulum Function (ATLFF). The standard intervention was breastfeeding support, a frenulotomy for tongue-tie was performed if necessary. All cases of breastfeeding problems and, or tongue-tie, were followed up by telephone 2.5 weeks after birth. RESULTS We enrolled 776 newborn-mother dyads: 345 had breastfeeding problems, 116 had a tongue-tie and 30 underwent a frenulotomy. In the multivariate analysis, severe breastfeeding problems were more frequent in newborn infants with tongue-tie, with an odds ratio (OR) of 2.6 (P= 0.014). Other risk factors were: no breastfeeding experience (OR 4.4, P = 0.001), low birth weight (OR 2.9, P = 0.001), prematurity (OR 3.6, P = 0.000) and Caesarean section (OR 1.6, P = 0.023). There was a significant reduction in breastfeeding problems after frenulotomy (P = 0.01). CONCLUSION Tongue-tie had a significant impact on breastfeeding and so did low birth weights and prematurity. Frenulotomy proved helpful when breastfeeding problems were reported.
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Affiliation(s)
- Sara‐Maria Schlatter
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
| | - Wiebke Schupp
- Center for Dental Medicine, Division of Oral and Maxillofacial Surgery, Medical Center University of Freiburg Freiburg Germany
| | - Jörg‐Elard Otten
- Center for Dental Medicine, Division of Oral and Maxillofacial Surgery, Medical Center University of Freiburg Freiburg Germany
| | - Sabine Harnisch
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center University of Freiburg Freiburg Germany
| | - Dimitra Stavropoulou
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
| | - Roland Hentschel
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
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Abstract
In the oropharyngeal region examinations, the abeslang (tongue depressor) used to create a wider field of vision and press down the tongue to make the pharynx easier. In order to look under the tongue, the depressor is redesigned so that it can be examined under the tongue and transformed into a retractor by creating an angle in the body of the present invention. This technique is intended to be used in conjunction with new technology surgical procedures. Our invention consists of the stem (1), the body (2), the end (3) and the notch (4), and the angle (5) in the angled model. This model, which is more effective than the routine tongue depressors at the same time it will not make any difference regarding cost. It will also allow the use of new surgical techniques while at the same time ensuring the exclusion of language in operations.
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Ata N, Alataş N, Yılmaz E, Adam AB, Gezgin B. The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia. EAR, NOSE & THROAT JOURNAL 2019; 100:NP158-NP160. [PMID: 31558060 DOI: 10.1177/0145561319867666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Ankyloglossia is a congenital condition that restricts tongue mobility. The aim of this study is to evaluate the relationship between gender and pediatric ankyloglossia and evaluate the planning of ideal timing of surgery. METHODS The files of pediatric patients in the Turkish population treated surgically for tongue-tie between June 2014 to June 2018 were scanned retrospectively. RESULTS Three hundred and eighty-two pediatric patients were included in the study. Of these, 115 (30.1%) were female and 267 (69.9%) were male. The prevalence of ankyloglossia was significantly higher in males than in females (P < .001). The age of the patients at time of surgery ranged from 1 day to 114 months. The most common indication was sucking/feeding difficulties (82%) in patients younger than 2 years, and the most common symptom was speech problems (67%) in patients aged 2 years and older. CONCLUSION In our study, the prevalence of ankyloglossia in Turkish society was significantly higher in males. Frenectomy surgery is a safe procedure that can be performed on the first day of life in newborns.
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Affiliation(s)
- Nurdoğan Ata
- Department of Otorhinolaryngology, 218507KTO Karatay University Medical Faculty, Medicana Hospital, Konya, Turkey
| | - Necat Alataş
- Department of Otolaryngology, Uşak University Medical Faculty, Uşak, Turkey
| | - Esra Yılmaz
- Department of Otolaryngology, Dr. Ali Kemal Belviranlı Maternity and Children's Hospital, Konya, Turkey
| | - Ayşe Bülbül Adam
- Department of Pediatric Surgery, Dr. Ali Kemal Belviranlı Maternity and Children's Hospital, Konya, Turkey
| | - Bahri Gezgin
- Department of Otorhinolaryngology, 218507KTO Karatay University Medical Faculty, Medicana Hospital, Konya, Turkey
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Hentschel R. Breastfeeding problems should be the only relevant criteria for deciding whether to carry out a frenotomy in infancy. Acta Paediatr 2018; 107:1697-1701. [PMID: 29873840 DOI: 10.1111/apa.14439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/05/2018] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
Abstract
Performing a frenotomy on tongue-tied infants is controversial, particularly with regard to breastfeeding issues. This paper reviews the literature to bring together clinical experiences and scientific evidence in this field. I found that some tongue-tied babies may exhibit breastfeeding problems, while others may feed perfectly. The literature suggests that medical breastfeeding-related problems should be the only relevant criteria to guide the decision-making for a frenotomy in infancy. The advantages and disadvantages of either a wait and see position or surgical approach are addressed. CONCLUSION The cornerstones for best practice are the meticulous examination, correct diagnosis and classification of tongue-tied infants.
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Affiliation(s)
- Roland Hentschel
- Department of General Pediatrics; Divsions of Neonatology/Intensive Care Medicine; Faculty of Medicine & Medical Center; University of Freiburg; Freiburg Germany
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Miranda PP, Cardoso CL, Gomes E. Interventions in the Alteration on Lingual Frenum: Systematic Review. Int Arch Otorhinolaryngol 2016; 20:275-80. [PMID: 27413412 PMCID: PMC4942291 DOI: 10.1055/s-0035-1568135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/20/2015] [Indexed: 11/06/2022] Open
Abstract
Introduction
Altered lingual frenum modifies the normal tongue mobility, which may influence the stomatognathic functions, resulting in anatomical, physiological and social damage to the subject. It is necessary that health professionals are aware of the process of evaluation, diagnostics and treatment used today, guiding their intervention. Objective
To perform a systematic review of what are the treatment methods used in cases of lingual frenum alteration. Data Synthesis
The literature searches were conducted in MEDLINE, LILACS, SciELO, Cochrane and IBECS, delimited by language (Portuguese, English, Spanish), date of publication (January 2000 to January 2014) and studies performed in humans. The selection order used to verify the eligibility of the studies were related to: full text availability; review the abstract; text analysis; final selection. Of the total 443 publications, 26 remained for analysis. The surgical approach was used in all studies, regardless of the study population (infants, children and adults), with a range of tools and techniques employed; speech therapy was recommended in the post surgical in 4 studies. Only 4 studies, all with infants, showed scientific evidence. Conclusion
Surgical intervention is effective for the remission of the limitations caused by the alteration on lingual frenum, but there is a deficit of studies with higher methodological quality. The benefits of speech therapy in the post surgical period are described from improvement in the language of mobility aspects and speech articulation.
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Affiliation(s)
| | | | - Erissandra Gomes
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Ferrés-Amat E, Pastor-Vera T, Ferrés-Amat E, Mareque-Bueno J, Prats-Armengol J, Ferrés-Padró E. Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Med Oral Patol Oral Cir Bucal 2016; 21:e39-47. [PMID: 26595832 PMCID: PMC4765751 DOI: 10.4317/medoral.20736] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/26/2015] [Indexed: 11/05/2022] Open
Abstract
Background Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients. Material and Methods This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years. Results 101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%). Conclusions The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain. Key words:Ankyloglossia, tongue-tie, lingual frenum.
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Affiliation(s)
- Elvira Ferrés-Amat
- Pediatric Dentistry Service, Oral and Maxillofacial Surgery Service, Hospital de Nens de Barcelona, Consell de Cent 437, 08009 Barcelona, Spain,
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Kim MJ, Kim SJ, Ha JW, Ha S. A Survey of Co-morbidity and Speech-Language Characteristics in Speech Sound Disorders. COMMUNICATION SCIENCES & DISORDERS 2015. [DOI: 10.12963/csd.15258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S, McPheeters M. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics 2015; 135:e1467-74. [PMID: 25941312 PMCID: PMC9923517 DOI: 10.1542/peds.2015-0660] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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
BACKGROUND AND OBJECTIVE Children with ankyloglossia, an abnormally short, thickened, or tight lingual frenulum, may have restricted tongue mobility and sequelae, such as speech and feeding difficulties and social concerns. We systematically reviewed literature on feeding, speech, and social outcomes of treatments for infants and children with ankyloglossia. METHODS Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two investigators independently extracted data on study populations, interventions, and outcomes and assessed study quality. RESULTS Two randomized controlled trials, 2 cohort studies, and 11 case series assessed the effects of frenotomy on feeding, speech, and social outcomes. Bottle feeding and social concerns, such as ability to use the tongue to eat ice cream and clean the mouth, improved more in treatment groups in comparative studies. Supplementary bottle feedings decreased over time in case series. Two cohort studies reported improvement in articulation and intelligibility with treatment. Other benefits were unclear. One randomized controlled trial reported improved articulation after Z-frenuloplasty compared with horizontal-to-vertical frenuloplasty. Numerous noncomparative studies reported speech benefits posttreatment; however, studies primarily discussed modalities, with outcomes including safety or feasibility, rather than speech. We included English-language studies, and few studies addressed longer-term speech, social, or feeding outcomes; nonsurgical approaches, such as complementary and alternative medicine; and outcomes beyond infancy, when speech or social concerns may arise. CONCLUSIONS Data are currently insufficient for assessing the effects of frenotomy on nonbreastfeeding outcomes that may be associated with ankyloglossia.
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Affiliation(s)
- Sivakumar Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee; and,Center for Surgical Quality and Outcomes Research
| | - Richard A. Epstein
- Institute for Medicine and Public Health, Evidence-based Practice Center,,Departments of Psychiatry
| | | | | | - Melissa McPheeters
- Institute for Medicine and Public Health, Evidence-based Practice Center, Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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Ito Y, Shimizu T, Nakamura T, Takatama C. Effectiveness of tongue-tie division for speech disorder in children. Pediatr Int 2015; 57:222-6. [PMID: 25142274 DOI: 10.1111/ped.12474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to determine the effectiveness of tongue-tie division (frenuloplasty/ frenulotomy) for speech articulation disorder in children with ankyloglossia (tongue-tie). METHODS Articulation test was done in five children (3-8 years old) with speech problems who underwent tongue-tie division. The test consisted of 50 pictures of common Japanese words with 2-3 syllables. The patients were interviewed by a speech therapist and asked to pronounce what the picture card showed. Misarticulations of substitution, omission, and distortion were assessed. The preoperative results were compared with postoperative examinations at 1 month, 3-4 months, and 1-2 years. RESULTS Nineteen substitutions that were observed in four patients preoperatively decreased to 10 in three patients at 1 month, 7 in three patients at 3-4 months, and 1 in one patient at 1-2 years postoperatively. Five omissions that were observed in four patients preoperatively decreased to 3 in three patients at 1 month, 2 in two patients at 3-4 months, and 1 in one patient at 1-2 years postoperatively. Thirteen distortions that were observed in five patients preoperatively decreased to 8 in four patients at 3-4 months but increased to 11 in three patients at 1-2 years postoperatively. CONCLUSIONS Substitution and omission improved relatively early after tongue-tie division and progressed to distortion, which is a less-impaired form of articulation disorder. Thus, distortion required more time for improvement and remained a defective speaking habit in some patients.
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Affiliation(s)
- Yasuo Ito
- Department of Pediatrics and Pediatric Surgery, International University of Health and Welfare Atami Hospital, Atami, Japan
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29
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Khairnar M, Pawar B, Khairnar D. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia. J Surg Tech Case Rep 2015; 6:49-54. [PMID: 25598942 PMCID: PMC4290039 DOI: 10.4103/2006-8808.147259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort.
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Affiliation(s)
- Mayur Khairnar
- Private Practice, Precision Dental Clinic, Mumbai, Maharashtra, India
| | - Babita Pawar
- Department Periodontology, Rural Dental College, Loni, Maharashtra, India
| | - Darshana Khairnar
- Private Practice, Precision Dental Clinic, Mumbai, Maharashtra, India
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30
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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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Abstract
Tongue tie or ankyloglossia is a congenital variation characterised by a short lingual frenulum which may result in restriction of tongue movement and thus impact on function. Tongue tie division (frenotomy) in affected infants with breastfeeding problems yields objective improvements in milk production and breastfeeding characteristics, including objective scoring measures, weight gain and reductions in maternal pain. For the majority of mothers, frenotomy appears to enhance maintenance of breastfeeding. Tongue tie division is a safe procedure with minimal complications. The commonest complication is minor bleeding. Recurrence leading to redivision occurs with rates of 0.003-13% reported; this appears to be more common with posterior than anterior ties. There are limited reports indicating that prophylactic frenotomy may promote subsequent speech development; however, evidence is currently insufficient to condone this practice and further good quality research into this area is warranted.
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Affiliation(s)
- Alastair Brookes
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, United Kingdom.
| | - Douglas M Bowley
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, United Kingdom.
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Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A. Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Arch Dis Child Fetal Neonatal Ed 2014; 99:F189-95. [PMID: 24249695 PMCID: PMC3995264 DOI: 10.1136/archdischild-2013-305031] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
TRIAL DESIGN A randomised, parallel group, pragmatic trial. SETTING A large UK maternity hospital. PARTICIPANTS Term infants <2 weeks old with a mild or moderate degree of tongue-tie, and their mothers who were having difficulties breastfeeding. OBJECTIVES To determine if immediate frenotomy was better than standard breastfeeding support. INTERVENTIONS Participants were randomised to an early frenotomy intervention group or a 'standard care' comparison group. OUTCOMES Primary outcome was breastfeeding at 5 days, with secondary outcomes of breastfeeding self-efficacy and pain on feeding. Final assessment was at 8 weeks; 20 also had qualitative interviews. Researchers assessing outcomes, but not participants, were blinded to group assignment. RESULTS 107 infants were randomised, 55 to the intervention group and 52 to the comparison group. Five-day outcome measures were available for 53 (96%) of the intervention group and 52 (100%) of the comparison group, and intention-to-treat analysis showed no difference in the primary outcome-Latch, Audible swallowing, nipple Type, Comfort, Hold score. Frenotomy did improve the tongue-tie and increased maternal breastfeeding self-efficacy. At 5 days, there was a 15.5% increase in bottle feeding in the comparison group compared with a 7.5% increase in the intervention group. After the 5-day clinic, 44 of the comparison group had requested a frenotomy; by 8 weeks only 6 (12%) were breastfeeding without a frenotomy. At 8 weeks, there were no differences between groups in the breastfeeding measures or in the infant weight. No adverse events were observed. CONCLUSIONS Early frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy. The majority in the comparison arm opted for the intervention after 5 days.
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Isaiah A, Pereira KD. Infected sublingual hematoma: a rare complication of frenulectomy. EAR, NOSE & THROAT JOURNAL 2014; 92:296-7. [PMID: 23904303 DOI: 10.1177/014556131309200706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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Walls A, Pierce M, Wang H, Steehler A, Steehler M, Harley EH. Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. Int J Pediatr Otorhinolaryngol 2014; 78:128-31. [PMID: 24315215 DOI: 10.1016/j.ijporl.2013.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 10/31/2013] [Accepted: 11/09/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate parental speech outcomes and tongue mobility in children with ankyloglossia who underwent frenotomy by an otolaryngologist during the neonatal period. STUDY DESIGN Cohort study and retrospective telephone survey. STUDY SETTING University Hospital. SUBJECTS AND METHODS Neonates previously diagnosed with congenital ankyloglossia were separated into Surgical Intervention (N=71) and No Surgical Intervention (N=15) Groups. A Control Group (N=18) of patients was identified from the hospital medical record database, which were not diagnosed with congenital ankyloglossia. A survey provided by a certified speech pathologist utilized a Likert scale to assess speech perception and tongue mobility by parental listeners. The questionnaire also analyzed oral motor activities and the medical professionals that identified the ankyloglossia shortly after birth. Statistical analyses were performed with the Wilcoxon Rank Sum Test and Fischer's Exact Test in order to determine an effect size=1. RESULTS There was significantly improved speech outcomes designated by parents in the Surgical Intervention Group when compared to the No Surgical Intervention Group [p<0.0001, p<0.0001], respectively. Furthermore, parents designated no difference in speech outcomes between the Surgical Intervention Group when analyzed against the Control Group [p=0.3781, p<0.2499], respectively. CONCLUSIONS There was a statistically significant improvement in speech outcomes and tongue mobility in children who underwent frenotomy compared to individuals who declined the operation. As a result of the data presented within this study, there appears to be a long-term benefit beyond feeding when frenotomy is performed in newborns with ankyloglossia.
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Affiliation(s)
- Andrew Walls
- Georgetown University School of Medicine, Washington, DC 20007, United States.
| | - Matthew Pierce
- Department of Otolaryngology - Head & Neck Surgery, Georgetown University Hospital, Washington, DC 20007, United States
| | - Hongkun Wang
- Department of Biostatistics - Georgetown University Medical Center, Georgetown University, Washington, DC 20007, United States
| | - Ashley Steehler
- The River School, Speech Pathology, Washington, DC 20007, United States
| | - Matthew Steehler
- Ear, Nose, & Throat Associates of Corpus Christi, Otolaryngology - Head and Neck Surgery, Corpus Christi, TX 78411, United States
| | - Earl H Harley
- Georgetown University School of Medicine, Washington, DC 20007, United States; Department of Otolaryngology - Head & Neck Surgery, Georgetown University Hospital, Washington, DC 20007, United States
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Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol 2013; 77:635-46. [PMID: 23537928 DOI: 10.1016/j.ijporl.2013.03.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/28/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically review the outcomes of tongue-tie division procedures in patients with ankyloglossia with the goal of (1) deriving clinically oriented insights into the effect of tongue-tie division procedures and (2) identifying needs in knowledge to stimulate further research. DATA SOURCES Medline, EMBASE, and Cochrane databases were searched without any limitations, for studies published between 1966 and June 2012. REVIEW METHODS Studies were included (level 4 evidence or above) if subjects of any age had ankyloglossia and underwent tongue-tie release. Outcome measures of interest were any subjective or objective measures of breastfeeding and speech outcomes, or reports of adverse events. RESULTS In all, 378 abstracts were generated from the literature searches; 20 studies met the criteria for data extraction and analysis. Of those, 15 studies were observational and 5 were randomized controlled trials. Tongue-tie division provided objective improvements in the following: LATCH scores (3 studies); SF-MPQ index (2 studies); IBFAT (1 study); milk production and feeding characteristics (3 studies); and infant weight gain (1 study). Subjective improvements were also noted in maternal perception of breastfeeding (14 studies) and maternal pain scores (4 studies). No definitive improvements in speech function were reported. The only significant adverse events were recurrent tongue-ties that required repeat procedures. CONCLUSION Ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breastfeeding; however, there was a limited number of studies available with quality evidence. There are no significant data to suggest a causative association between ankyloglossia and speech articulation problems. Aspects of ankyloglossia that would benefit from further research are described, and recommendations for tongue-tie release candidacy criteria are provided.
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Affiliation(s)
- Amanda N Webb
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Abstract
Ankyloglossia or tongue-tie is a disease in which the tongue has a mobility disorder because the lingual frenulum is short and tight, and as a result, the tongue tip is tied up. It may be asymptomatic or may cause various problems such as articulation disorder. Surgical treatment is required in many of the patients, and conventional methods release only the mucosal layer of the frenulum. However, conventional method alone is not as effective; therefore, the authors studied the addition of a partial myotomy of the genioglossus muscle along with mucosal layer release for treatment. The authors performed the surgery on 106 patients from 2005 to 2010, and during the surgery, the mucosal layer was released through Z-plasty after myotomy was performed on the contracted genioglossus muscle. During the follow-up, none of the patients showed signs and symptoms of tongue mobility impairment or articulation disorder caused by the partial myotomy of the genioglossus muscle, and a satisfactory outcome was obtained in achieving mobility of the tongue tip. Because tongue mobility disorder in ankyloglossia is accompanied by the contracture and shortening of the genioglossus muscle, an improved outcome is expected in the projection and mobility of the tongue tip from the combined application of conventional Z-plasty and genioglossus muscle release.
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Course and distribution of the lingual nerve in the ventral tongue region: anatomical considerations for frenectomy. J Craniofac Surg 2010; 20:1359-63. [PMID: 19816256 DOI: 10.1097/scs.0b013e3181ae42fa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to elucidate the sublingual and intralingual courses of the lingual nerve (LN) in the ventral tongue region, providing a clinical guide for safe surgical procedures such as frenectomy. We evaluated 16 specimens (32 sides) by gross observation after detailed dissections, and a further 6 specimens were examined after Sihler staining. All specimens were harvested from embalmed Korean cadavers. We classified the innervation patterns of the LN into 5 types and confirmed the distribution of the LN in the tip of the tongue. The classification of the LN was made with reference to a line formed by the interlacing of the styloglossus and genioglossus muscles. Based on the course of LN and the presence of a tiny twig (twigs directly innervating the ventral mucosa of the tongue, TM) directly innervating the sublingual mucosa, the course of the LN was classified as being straight, curved, or vertical and with or without the TM. Straight, curved, and vertical courses without the TM were seen in 9.4%, 46.9%, and 18.8% of the cases, respectively. Straight and curved courses with the TM were observed in 6.3% and 18.8% of the cases, respectively. Sihler staining revealed that the tongue tip is innervated by the LN. These findings indicate that surgical manipulations at the ventral tongue region might damage the LN and result in numbness of the tongue tip, and provide a useful anatomic reference for various surgical procedures involving the ventral tongue region.
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The Improvement of Tongue Mobility and Articulation after Frenotomy in Patient with Ankyloglossia. ACTA ACUST UNITED AC 2010. [DOI: 10.3342/kjorl-hns.2010.53.8.491] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Suter VG, Bornstein MM. Ankyloglossia: Facts and Myths in Diagnosis and Treatment. J Periodontol 2009; 80:1204-19. [DOI: 10.1902/jop.2009.090086] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Posterior ankyloglossia: a case report. Int J Pediatr Otorhinolaryngol 2009; 73:881-3. [PMID: 19303646 DOI: 10.1016/j.ijporl.2009.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 02/10/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022]
Abstract
Ankyloglossia, or tongue-tie, refers to an abnormally short lingual frenulum. Ankyloglossia is a recognized but poorly defined condition and has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. In infants, the most concerning symptoms are feeding difficulties and inability to breastfeed. While a recent trend toward breastfeeding has brought frenulectomy back into favor, the literature regarding treatment remains inconclusive. We report a case of posterior ankyloglossia with anterior mucosal hooding and a simple, safe, and effective way to treat it to improve breastfeeding.
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