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Melong J, Bezuhly M, Hong P. The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility. EAR, NOSE & THROAT JOURNAL 2024; 103:NP450-NP454. [PMID: 34911396 DOI: 10.1177/01455613211064045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation and intelligibility. METHODS A prospective cohort study was conducted. Pediatric patients (>2 years of age) being referred for speech concerns due to ankyloglossia were assessed by a pediatric otolaryngologist, and speech articulation was formally assessed by a speech language pathologist using the Goldman-Fristoe Test of Articulation 2 (GFTA-2). Patients then underwent a tongue-tie release procedure in clinic. After 1 month, speech articulation was reassessed with GFTA-2. Audio-recordings of sessions were evaluated by independent reviewers to assess speech intelligibility before and after tongue-tie release. RESULTS Twenty-five participants were included (mean age 3.7 years; 20 boys). The most common speech errors identified were phonological substitutions (80%) and gliding errors (56%). Seven children (28%) had abnormal lingual-alveolar and interdental sounds. Most speech sound errors (87.9%) were age/developmentally appropriate. GFTA-2 standard scores before and after tongue-tie release were 85.61 (SD 9.75) and 87.54 (SD 10.21), respectively, (P=.5). Mean intelligibility scores before and after tongue-tie release were 3.15 (SD .22) and 3.21 (SD .31), respectively, (P=.43). CONCLUSION The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility.
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Affiliation(s)
- Jonathan Melong
- Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - Michael Bezuhly
- Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - Paul Hong
- Dalhousie University Faculty of Medicine, Halifax, NS, Canada
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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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Usha GP, Alex JSR. Speech assessment tool methods for speech impaired children: a systematic literature review on the state-of-the-art in Speech impairment analysis. MULTIMEDIA TOOLS AND APPLICATIONS 2023; 82:1-38. [PMID: 37362682 PMCID: PMC9986674 DOI: 10.1007/s11042-023-14913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 12/23/2022] [Accepted: 02/12/2023] [Indexed: 06/28/2023]
Abstract
Speech is a powerful, natural mode of communication that facilitates effective interactions in human societies. However, when fluency or flow of speech is affected or interrupted, it leads to speech impairment. There are several types of speech impairment depending on the speech pattern and range from mild to severe. Childhood apraxia of speech (CAS) is the most common speech disorder in children, with 1 out of 12 children diagnosed globally. Significant advancements in speech assessment tools have been reported to assist speech-language pathologists diagnosis speech impairment. In recent years, speech assessment tools have also gained popularity among pediatricians and teachers who work with preschoolers. Automatic speech tools can be more accurate for detecting speech sound disorders (SSD) than human-based speech assessment methods. This systematic literature review covers 88 studies, including more than 500 children, infants, toddlers, and a few adolescents, (both male and female) (age = 0-17) representing speech impairment from more than 10 countries. It discusses the state-of-the-art speech assessment methods, including tools, techniques, and protocols for speech-impaired children. Additionally, this review summarizes notable outcomes in detecting speech impairments using said assessment methods and discusses various limitations such as universality, reliability, and validity. Finally, we consider the challenges and future directions for speech impairment assessment tool research.
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Affiliation(s)
- Gowri Prasood Usha
- School of Electronics Engineering, Vellore Institute of Technology, Chennai, 600127 India
| | - John Sahaya Rani Alex
- School of Electronics Engineering, Vellore Institute of Technology, Chennai, 600127 India
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Zhao H, He X, Wang J. Efficacy of Infants Release of Ankyloglossia on Speech Articulation: A Randomized Trial. EAR, NOSE & THROAT JOURNAL 2022:1455613221087946. [PMID: 35324342 DOI: 10.1177/01455613221087946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The relationship between ankyloglossia and speech is controversial. Our objective in the present study was to determine the most appropriate intervention and optimal timing for infants with speech articulation caused by ankyloglossia. PATIENTS AND METHODS A total of 341 pediatric patients (aged 2 to 5 years) being referred for speech concerns due to ankyloglossia were enrolled in a randomized trial and assigned to either a surgical intervention (N = 166) or a no surgical intervention (N = 175) group. Subsequently, patients were further categorized into 3 groups according to age: 2 to < 3 years, 3 to < 4 years, and 4 to < 5 years. Measures of tongue appearance, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected at preintervention (T0), 2-month postintervention (T1), 6-month postintervention (T2), and 12-month postintervention (T3). RESULTS No statistically significant difference was found between surgical intervention and no surgical intervention groups for tongue appearance, tongue mobility, speech production, and intelligibility in the 2 to < 3 years age. However, there was significantly improved speech production and intelligibility in the surgical intervention group when compared to the no surgical intervention group in the 3 to < 4 and 4 to < 5 years old age. CONCLUSION Surgical intervention should not be performed too early for infants aged 2 to < 3 years with speech articulation caused by ankyloglossia, but rather watch and wait for the physiological growth of the lingual frenulum. The optimal timing range for surgical intervention is 4 to 5 years. This should provide certain significant guidance for infants with speech articulation caused by ankyloglossia.
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Affiliation(s)
- Hongfang Zhao
- School of Stomatology, 12426Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xiaoli He
- School of Stomatology, 12426Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Jianrong Wang
- School of Petrochemical Engineering, 56677Lanzhou University of Technology, Lanzhou, Gansu, People's Republic of China
- Gansu Province Maternal and Child Health Hospital, Lanzhou, Gansu, People's Republic of China
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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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Prameswari N, Herniyati H, Sucahyo B, Brahmanta A, Syahdinda MR. Cephalometric Analysis, Severity Malocclusion, and Orthodontic Treatment Need Using IOTN in Deaf Children. Eur J Dent 2021; 16:599-605. [PMID: 34820826 PMCID: PMC9507555 DOI: 10.1055/s-0041-1735936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives
Studies associated with deaf children's malocclusion and their treatment need are still very rare. Therefore, cephalometric analysis with the ability to access the skeletal, dental, and soft tissues can be used to score the severity of malocclusion and index of orthodontic treatment need (IOTN) in deaf children. This study examined the use of cephalometric analysis, severity malocclusion, and orthodontic treatment need in deaf students at special need school type B (SLB-B)
Tunarungu Karya Mulia
in Surabaya using IOTN along with investigating IOTN correlation with the result of dental cephalometric analysis and dental health component (DHC) and aesthetic component (AC) in IOTN index.
Material and Methods
Sample data consisted of 33 students between the ages of 8 to 12 years old and never had any orthodontic treatment. This investigation applied the indices from IOTN, in which DHC had 10 malocclusions, and AC with the aesthetic anterior dentition comprising 10 color photographs and different dental attractiveness levels. In addition, scores were chosen from the worst feature, with the data analyzed at a significant correlation test of 0.05%.
Result
There was no skeletal abnormality in deaf children. It displayed the highest number of malocclusion severity scores, while the DHC assessment showed the moderate and severe categories. Based on AC evaluation, the highest numbers of malocclusion severity were found in good and moderate category in terms of teeth arrangement and aesthetic.
Conclusion
There was a correlation between the dental cephalometric analysis in deaf children and treatment need using IOTN with AC and DHC.
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Affiliation(s)
- Noengki Prameswari
- Department of Orthodontic, Faculty of Dental Medicine, Universitas Hang Tuah, Surabaya, Indonesia
| | - Herniyati Herniyati
- Department of Orthodontic, Faculty of Dental Medicine, Universitas Jember, Jember, Indonesia
| | - Bambang Sucahyo
- Department of Orthodontic, Faculty of Dental Medicine, Universitas Hang Tuah, Surabaya, Indonesia
| | - Arya Brahmanta
- Department of Orthodontic, Faculty of Dental Medicine, Universitas Hang Tuah, Surabaya, Indonesia
| | - Meralda Rossy Syahdinda
- Department of Orthodontic, Faculty of Dental Medicine, Universitas Hang Tuah, Surabaya, Indonesia
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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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Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: A prospective randomized study. Int J Pediatr Otorhinolaryngol 2020; 136:110146. [PMID: 32540779 DOI: 10.1016/j.ijporl.2020.110146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the surgical outcomes of simple frenotomy and the 4-flap Z-frenuloplasty according to the articulation test values and tongue-tie classification in patients with ankyloglossia with articulation difficulty. STUDY DESIGN prospective randomized study. SETTING Tertiary academic center. SUBJECTS and methods: Children with ankyloglossia with articulation difficulty were randomly divided into 2 groups for surgical treatment. Patients were evaluated for the tongue-tie classification and articulation test before surgery. Three months after the operation, the frenulum classification and articulation test were re-evaluated to compare the differences in surgical outcome between the two surgical methods. RESULTS Out of 37 patients, 19 underwent the 4-flap Z-frenuloplasty and 18, the simple frenotomy. No differences were observed in the baseline characteristics of the patients assigned to both groups. Changes in the tongue-tie classification and improvement in the articulation test results were observed with both the surgical methods. Both surgical groups had significant improvement in the speech articulation test (consonants) but there was no difference in the speech outcomes between the surgical groups. CONCLUSION Although there was no significant difference in the surgical outcome between the two surgical methods, ankyloglossia patients showed improvement in a Korean speech articulation test 3 months after undergoing surgery to release the lingual frenulum.
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Baxter R, Merkel-Walsh R, Baxter BS, Lashley A, Rendell NR. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study. Clin Pediatr (Phila) 2020; 59:885-892. [PMID: 32462918 DOI: 10.1177/0009922820928055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.
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Affiliation(s)
| | - Robyn Merkel-Walsh
- TalkTools, Charleston, SC, USA.,Ridgefield Board of Education, Ridgefield, NJ, USA
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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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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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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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