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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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Chowdhury R, Khoury S, Leroux J, Alsayegh R, Lawlor CM, Graham ME. Alternative Therapies for Ankyloglossia-Associated Breastfeeding Challenges: A Systematic Review. Breastfeed Med 2024; 19:497-504. [PMID: 38592282 DOI: 10.1089/bfm.2024.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Background: Ankyloglossia (AG) diagnoses are increasingly common, and management is not standardized. Nonsurgical alternative therapies are frequently recommended in conjunction with or instead of frenotomy, with uncertain evidence. Objective: To evaluate the efficacy of nonsurgical alternative therapies (chiropractic care, myofunctional therapy, and osteopathy) in improving breastfeeding for infants diagnosed with AG. Methods: PubMed, Embase, CINAHL, Scopus, Web of Science, Clinicaltrials.gov, and Google Scholar were searched (September-October 2023). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A librarian-designed search included the terms "Ankyloglossia," "Non-surgical," "myofunctional therapy," "chiropractic," "osteopathy," and related therapies, with no date restrictions. English language studies of infants <24 months with AG and alternative therapy were included. Risk-of-bias evaluation used Newcastle-Ottawa Scale (NOS). Results: Of 1,304 identified articles, four studies (2016-2022) met inclusion criteria (two cross-sectional, one case report, and one case series). All studies reported frenotomy in combination with alternative therapy yielded favorable outcomes for maternal pain, weight gain, feeding duration, and maintenance of latch. The risk of bias was moderate for two studies, low for the case series, and not calculated for the case report, which has an inherent high risk of bias. All studies lacked control or comparator groups preventing definitive conclusions about the role of alternative therapies in AG. Conclusion: Although some studies suggest the potential benefits of combining alternative therapies with surgery for AG-related breastfeeding issues, the lack of control groups renders the evidence inconclusive. Nonsurgical approaches alone currently lack sufficient evidence. As these alternative therapies gain popularity, rigorous research is crucial to determine their cost-effectiveness and role in managing AG.
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Affiliation(s)
- Raisa Chowdhury
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Sami Khoury
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Canada
| | - Julie Leroux
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Raihanah Alsayegh
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - Claire M Lawlor
- Department of Otolaryngology, Children's National Medical Center, Washington, District of Columbia, USA
| | - M Elise Graham
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Canada
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3
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González Garrido MDP, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of Myofunctional Therapy in Ankyloglossia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12347. [PMID: 36231647 PMCID: PMC9566693 DOI: 10.3390/ijerph191912347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Ankyloglossia is a pathology of the tongue in which the frenulum appears anchored to the floor of the mouth. The treatment of choice for this pathology is frenectomy, but myofunctional therapy is emerging in recent years as a complement to surgical intervention. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of myofunctional therapy in ankyloglossia. The Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Pubmed, Web of Science and Scopus were searched. Study quality was determined using the PEDro scale, STROBE statement and single-case experimental design scale. Eleven studies were selected. Based on the studies included in this review, surgery is more effective than myofunctional therapy, although better results are achieved if both are combined. Improvements have been found in maternal pain, weight gain of babies, duration of breastfeeding, tongue mobility, strength and endurance, sleep apnea, mouth breathing and snoring, quality of life, clenching teeth, myofascial tension, pain after surgery and speech sound production. These findings must be taken with caution because of the small number of articles and their quality. Future clinical trials using larger sample sizes and with higher methodological quality are needed.
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Affiliation(s)
| | | | - Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, University of Cadiz, 11003 Cadiz, Spain
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006 Cadiz, Spain
| | | | - Gloria Gonzalez-Medina
- Department of Nursing and Physiotherapy, University of Cadiz, 11003 Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, 11003 Cadiz, Spain
- CTS-986 Physical Therapy and Health (FISA), University Institute of Research in Social Sustainable Development (INDESS), 11003 Cadiz, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, 11003 Cadiz, Spain
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006 Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, 11003 Cadiz, Spain
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Wen Z, Walner DL, Popova Y, Walner EG. Tongue-tie and breastfeeding. Int J Pediatr Otorhinolaryngol 2022; 160:111242. [PMID: 35930834 DOI: 10.1016/j.ijporl.2022.111242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficiency of maternal breastfeeding and maternal pain pre- and post-lingual frenulum release procedures in infants with ankyloglossia. METHODS Infants under 4 months of age with tongue-tie who were actively breastfeeding, and their mothers (mother-infant dyads) were recruited. Infants' ankyloglossia severity was evaluated using the Coryllos® ankyloglossia tongue-tie grading scale. Each mother completed a pre-procedure questionnaire where breastfeeding efficiency was evaluated using the LATCH® criteria. Each mother also reported a numeric score of pain with feeding, breastfeeding time, and a perceived feeding efficiency score. After the tongue-tie release procedure, each mother completed a post-procedure questionnaire within a 1-week to 1-month window to assess the change in breastfeeding efficiency using the LATCH® criteria, breastfeeding pain, breastfeeding time, and perceived breastfeeding efficiency. RESULTS 41 mother-infant dyads participated in the study. No surgical complications occurred during or post-procedure. All dyads reported improved (40) or equal (1) LATCH® scores: with a mean improved LATCH® score of 3.2 points (p < 4^10-15, 95% CI 2.6, 3.7.). The mean improved maternal perception of feeding was 3.3 points (p < 6^10-10,95% CI 2.6, 4.0.), the mean decreased maternal pain was 4.0 points (p < 1^10-14, 95% CI 3.3, 4.8), and the mean decreased maternal feeding time was 0.80 points (p = 0.002, 95% CI 0.5, 1.1.). CONCLUSION Lingual frenulum release procedures appear to consistently improve breastfeeding efficiency and decrease maternal pain.
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Affiliation(s)
- Zhaoyang Wen
- Chicago Medical School at Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA
| | - David L Walner
- Chicago Medical School at Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA; Advocate Children's Hospital, Department of Pediatric Otolaryngology, Park Ridge, IL, USA.
| | - Yulia Popova
- Advocate Children's Hospital, Department of Pediatric Otolaryngology, Park Ridge, IL, USA
| | - Emily G Walner
- Advocate Children's Hospital, Department of Pediatric Otolaryngology, Park Ridge, IL, USA
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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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Santos HKMPDS, Cunha DAD, Andrade RAD, Santos GDS, Silva HJD. The effects of lingual frenotomy on breastfeeding: an integrative review. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224110021] [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
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Shortland HAL, Hewat S, Vertigan A, Webb G. Orofacial Myofunctional Therapy and Myofunctional Devices Used in Speech Pathology Treatment: A Systematic Quantitative Review of the Literature. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:301-317. [PMID: 33472011 DOI: 10.1044/2020_ajslp-20-00245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose A growing number of speech-language pathologists (SLPs) are using orofacial myofunctional therapy (OMT) and/or myofunctional devices (MDs) in the treatment of their clients. However, governing bodies suggest SLPs carefully consider the availability and quality of evidence in the utilization of these therapies in speech-language pathology treatment. The purpose of this study was to review the existing evidence for OMT and MDs used by SLPs. Method A systematic quantitative review was conducted using key search terms in three electronic platforms housing multiple databases, along with a hand search, to identify additional literature. All studies published in English in full text were included if they reported pre- and posttreatment data of OMT and/or MDs provided by an SLP. Data were extracted and analyzed by the first author and confirmed by the co-authors. Results Twenty-eight studies met the criteria for inclusion in the review. Two thirds were published in the last decade and involved the use of OMT/MDs targeting multiple areas of speech pathology intervention within the same study, that is, swallowing, breathing, oral hygiene, and speech production. Majority of studies were rated as low level of evidence. All studies used OMT, with very few using MDs. While the assessment, treatment protocols, and outcome measures were highly variable, all of the studies reported an improvement in the function of the orofacial systems posttreatment. Few studies reported long-term follow-up data. Almost half of the studies recommended the use of OMT/MDs in a multidisciplinary/interdisciplinary team or in conjunction with other therapy. Conclusions There has been an increase in literature over the last decade in SLPs' use of OMT; however, there are only a small number of studies to date that explore the use of MDs. There is a growing body of evidence to support the use of OMT and MDs within a multidisciplinary team for people with communication and swallow difficulties. However, development of future research should consider investigating assessment and outcome measures, optimal dosage, and service delivery.
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Affiliation(s)
| | - Sally Hewat
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Anne Vertigan
- The University of Newcastle, Callaghan, New South Wales, Australia
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Gwendalyn Webb
- The University of Newcastle, Callaghan, New South Wales, Australia
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Sweat YY, Sweat M, Yu W, Sanz-Navarro M, Zhang L, Sun Z, Eliason S, Klein OD, Michon F, Chen Z, Amendt BA. Sox2 Controls Periderm and Rugae Development to Inhibit Oral Adhesions. J Dent Res 2020; 99:1397-1405. [PMID: 32674684 DOI: 10.1177/0022034520939013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In humans, ankyloglossia and cleft palate are common congenital craniofacial anomalies, and these are regulated by a complex gene regulatory network. Understanding the genetic underpinnings of ankyloglossia and cleft palate will be an important step toward rational treatment of these complex anomalies. We inactivated the Sry (sex-determining region Y)-box 2 (Sox2) gene in the developing oral epithelium, including the periderm, a transient structure that prevents abnormal oral adhesions during development. This resulted in ankyloglossia and cleft palate with 100% penetrance in embryos examined after embryonic day 14.5. In Sox2 conditional knockout embryos, the oral epithelium failed to differentiate, as demonstrated by the lack of keratin 6, a marker of the periderm. Further examination revealed that the adhesion of the tongue and mandible expressed the epithelial markers E-Cad and P63. The expanded epithelia are Sox9-, Pitx2-, and Tbx1-positive cells, which are markers of the dental epithelium; thus, the dental epithelium contributes to the development of oral adhesions. Furthermore, we found that Sox2 is required for palatal shelf extension, as well as for the formation of palatal rugae, which are signaling centers that regulate palatogenesis. In conclusion, the deletion of Sox2 in oral epithelium disrupts palatal shelf extension, palatal rugae formation, tooth development, and periderm formation. The periderm is required to inhibit oral adhesions and ankyloglossia, which is regulated by Sox2. In addition, oral adhesions occur through an expanded dental epithelial layer that inhibits epithelial invagination and incisor development. This process may contribute to dental anomalies due to ankyloglossia.
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Affiliation(s)
- Y Y Sweat
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA.,Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA, USA
| | - M Sweat
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA.,Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA, USA
| | - W Yu
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA.,Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA, USA
| | - M Sanz-Navarro
- Developmental Biology Program, Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - L Zhang
- Binzhou Medical University, Yantai, China
| | - Z Sun
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA
| | - S Eliason
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA.,Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA, USA
| | - O D Klein
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California-San Francisco, San Francisco, CA, USA
| | - F Michon
- Developmental Biology Program, Institute of Biotechnology, University of Helsinki, Helsinki, Finland.,Institute for Neurosciences of Montpellier, INSERM UMR1051, University of Montpellier, Montpellier, France
| | - Z Chen
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - B A Amendt
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA.,Craniofacial Anomalies Research Center, The University of Iowa, Iowa City, IA, USA.,College of Dentistry, The University of Iowa, Iowa City, IA, USA
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