Clinical guidelines and management of ankyloglossia with 1-year followup: report of 3 cases

Binder's phenotype with ankyloglossia: Report of a rare inherited association in an Indian female

Binder's syndrome, a rare congenital malformation of nasomaxillary complex, first described in 1962, has a hexad of characteristic clinical and radiographic features consisting of arhinoid face, intermaxillary hypoplasia with malocclusion, abnormal position of nasal bones, atrophy of nasal mucosa, reduced or absent anterior nasal spine and hypoplastic/absent frontal sinus. The typical facies due to mid-face hypoplasia may also be accompanied by other midline malformations such as cleft palate, spinal, skeletal and cardiac abnormalities. It is usually sporadic, of unknown etiology although various environmental and genetic mechanisms are implicated due to few familial cases predominantly in the Swedish population. A case of inherited Binder's syndrome is presented in an Indian female patient with an unusual finding of ankyloglossia (AG). The development of the anterior nasal spine and AG are chronologically related as they both occur during the 5^th–6^th weeks of gestation. The possible etiopathogenetic mechanisms for this rare association are reviewed.

Intervención logopédica posoperatoria del frenillo lingual en niños, adolescentes y adultos. Revisión integradora de literatura

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.

Sibilant production in Hebrew-speaking adults: Apical versus laminal

The Hebrew IPA charts describe the sibilants /s, z/ as 'alveolar fricatives', where the place of articulation on the palate is the alveolar ridge. The point of constriction on the tongue is not defined - apical (tip) or laminal (blade). Usually, speech and language pathologists (SLPs) use the apical placement in Hebrew articulation therapy. Some researchers and SLPs suggested that acceptable /s, z/ could be also produced with the laminal placement (i.e. the tip of the tongue approximating the lower incisors). The present study focused at the clinical level, attempting to determine the prevalence of these alternative points of constriction on the tongue for /s/ and /z/ in three different samples of Hebrew-speaking young adults (total n = 242), with typical articulation. Around 60% of the participants reported using the laminal position, regardless of several speaker-related variables (e.g. tongue-thrust swallowing, gender). Laminal production was more common in /s/ (than /z/), coda (than onset) position of the sibilant, mono- (than di-) syllabic words, and with non-alveolar (than alveolar) adjacent consonants. Experiment 3 revealed no acoustical differences between apical and laminal productions of /s/ and of /z/. From a clinical perspective, we wish to raise the awareness of SLPs to the prevalence of the two placements when treating Hebrew speakers, noting that tongue placements were highly correlated across sibilants. Finally, we recommend adopting a client-centred practice, where tongue placement is matched to the client. We further recommend selecting targets for intervention based on our findings, and separating between different prosodic positions in treatment.

Aetiology, diagnosis and treatment of Ankyloglossia

This review paper occupies with the frequency, etiology, diagnosis, treatment and the possible complications of Ankyloglossia (AG). AG is a congenital anomaly and its range varies from 0,1% to 4,8 %. There are several methods for the diagnosis of AG. The most popular method is the ‘’Hazelbaker’’, which assesses seven different tongue movements and five appearance characteristics. As far as the management of AG is concerned, there are two options, the ‘’wait-and-see’’ and the invasive procedure. The operator can choose between the frenotomy and the frenectomy. The difference is that in frenectomy the clinician removes the whole frenulum. Few complications have been mentioned, such as ulcers, pain, bleeding and noticeable scar, which were brought on to a second operation.

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol

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.