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Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, Gilliland A. Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics 2024; 154:e2024067605. [PMID: 39069819 DOI: 10.1542/peds.2024-067605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024] Open
Abstract
Ankyloglossia refers to a congenitally tight lingual frenulum that limits the motion of the tongue. Whether the release of a tight lingual frenulum in neonates improves breastfeeding is not clear. Because many of the symptoms of ankyloglossia overlap those of other breastfeeding difficulties, a team partnership is necessary.
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Affiliation(s)
- Jennifer Thomas
- Department of Pediatrics, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Maya Bunik
- Department of Pediatrics, University of Colorado, School of Medicine, and Children's Hospital Colorado, Aurora, Colorado
| | - Alison Holmes
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Dartmouth Health Children's/Geisel School of Medicine, Lebanon, New Hampshire
| | - Martha Ann Keels
- Department of Pediatrics, Duke University, and Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Brenda Poindexter
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Anna Meyer
- Department of Pediatrics, University of California San Francisco School of Medicine, and University of California San Francisco Benioff Children's Hospital San Francisco, San Francisco, California
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Baxter R, Merkel-Walsh R, Lahey L, Knutsen C, Zaghi S. The buccal frenum: Trends in diagnosis and indications for treatment of buccal-ties among 466 healthcare professionals. J Oral Rehabil 2024; 51:369-379. [PMID: 37823364 DOI: 10.1111/joor.13609] [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] [Received: 08/30/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The buccal frenum is connective tissue that adheres the mucosa of the cheek to the alveolar process. When restricted, this condition is commonly known as a buccal- or cheek-tie. Restrictive buccal frena are often treated during tongue- and lip-tie procedures, yet widely accepted classification, diagnostic and treatment guidelines are lacking. OBJECTIVE Provide a scoping review on the evaluation and management of buccal-ties, including diagnosis, classification, symptoms and treatment, by surveying healthcare providers with experience evaluating and managing oral restrictions. METHODS Literature review and IRB-approved survey to assess practice patterns among healthcare providers identified from online directories of tongue-tie release providers and associated allied health professionals. RESULTS A multidisciplinary group of 466 providers responded. About 87% indicated that they assess buccal restrictions. Evaluation methods included finger sweep (89.1%), visual inspection (76.4%), tissue blanching (66.5%) and functional assessment (53.4%). Around 94% of providers reported that objective and subjective findings are both needed for diagnosis and that an estimated 5%-10% of infants may be affected. About 70% of providers release buccal-ties (if needed) simultaneously with tongue-ties, and 76.8% recommend post-operative stretches as necessary for optimal healing. Respondents indicated a need for further research, evidence-based assessments, a classification system and treatment protocols. CONCLUSION Evaluating a buccal frenum to diagnose a symptomatic buccal-tie relies upon visual inspection, palpation and assessment of oral function. Survey data and clinical experience are summarized to review classification systems, diagnostic/evaluation criteria and treatment recommendations as a foundational cornerstone for future works to build upon.
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Affiliation(s)
| | | | - Lisa Lahey
- Advanced Breastfeeding Care and Indy Myofunctional Therapy, Indianapolis, Indiana, USA
| | - Chad Knutsen
- The Breathe Institute, Los Angeles, California, USA
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Zhu Y, Zhang Y, Dong J, Ruan W, Yang S, Huang P, Duan X. MSX1 involved selective tooth agenesis and abnormal labial frenum, pedigree, and retrospective study. Oral Dis 2023; 29:3168-3172. [PMID: 36478500 DOI: 10.1111/odi.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Muscle segment homeobox gene 1 (MSX1) is widely expressed in craniofacial development and tooth formation. The aim of this study was to report a novel MSX1 mutation in a Chinese family with selective tooth agenesis and abnormal median maxillary labial frenum (MMLF). MATERIALS AND METHODS Mutation analysis was carried out by whole exome sequencing. The pMD18-T vector was used to verify the mutations. PubMed and Human Gene Mutation Database were searched to analyze the relationship between the mutations in MSX1 and related phenotypes. RESULTS A novel heterozygous mutation (c.75delG) in MSX1 was detected in the proband and her mother. They presented as oligodontia and lower attached hypertrophy median maxillary labial frenum. 60 MSX1 mutations from 39 reports did not declare malformed MMLF except our cases. Meanwhile, we found that the types and sites of MSX1 mutations may affect the selectivity of tooth agenesis and orofacial cleft. CONCLUSION This study suggests malformed MMLF as a new phenotype of MSX1 mutation and a specific relationship between MSX1 genotype and phenotype.
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Affiliation(s)
- Yulong Zhu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Disease; Shaanxi Key Laboratory of Stomatology; Department of Oral Biology, Clinic of Oral Rare Diseases and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Yanli Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Disease; Shaanxi Key Laboratory of Stomatology; Department of Oral Biology, Clinic of Oral Rare Diseases and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Jing Dong
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Disease; Shaanxi Key Laboratory of Stomatology; Department of Oral Biology, Clinic of Oral Rare Diseases and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Wenyan Ruan
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Disease; Shaanxi Key Laboratory of Stomatology; Department of Oral Biology, Clinic of Oral Rare Diseases and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Shaoqing Yang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Disease; Shaanxi Key Laboratory of Stomatology; Department of Oral Biology, Clinic of Oral Rare Diseases and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Ping Huang
- Department of Clinical Laboratory, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xiaohong Duan
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Disease; Shaanxi Key Laboratory of Stomatology; Department of Oral Biology, Clinic of Oral Rare Diseases and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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Carnino JM, Walia AS, Lara FR, Mwaura AM, Levi JR. The effect of frenectomy for tongue-tie, lip-tie, or cheek-tie on breastfeeding outcomes: A systematic review of articles over time and suggestions for management. Int J Pediatr Otorhinolaryngol 2023; 171:111638. [PMID: 37352592 DOI: 10.1016/j.ijporl.2023.111638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Tongue-tie, or ankyloglossia, is a common condition characterized by an abnormally short or tight lingual frenulum and is known to cause breastfeeding difficulties, leading to damage to the nipple, early discontinuation of breastfeeding, and delayed infant growth. In addition to tongue-tie, abnormal frenulums such as the labial frenulum and buccal frenulum can cause lip-tie and cheek-tie, respectively. While both of these conditions have been reported to potentially cause similar issues related to breastfeeding as tongue-tie, limited research has been conducted to understand their effects and how we should treat these conditions. METHODS In this systematic review, we conducted a comprehensive search of MEDLINE to analyze the trend in publications of all three of these conditions and their impact on breastfeeding for the past 36 years. Keywords included, "tongue-tie", "lip-tie", "cheek-tie", and "breastfeeding outcomes". RESULTS We found that publications describing the effect of only tongue-ties on breastfeeding have increased exponentially over time while less focus has been on other oral ties. It was also discovered that the majority of studies describing only lip-tie or tongue-tie were editorials, commentary, perspectives, or consensus statements. Finally, we found that articles describing more than one abnormal frenulum were more likely to be cited and articles describing tongue-tie only were published in the highest impact factor journals. CONCLUSION This study revealed a significant increase in publications discussing tongue-tie and a lack of research on lip-tie and cheek-tie in relation to breastfeeding. The findings highlight the need for more comprehensive research and attention to lip-tie and cheek-tie, as well as standardized diagnostic criteria. Ongoing debate surrounding management of these conditions stem from the lack of investigations on the impact of these abnormal frenulums and outcomes post-frenectomy. Future high-quality studies, specifically prospective cohort studies and randomized controlled trials, are necessary to provide more robust evidence and guide clinical practice.
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Affiliation(s)
- Jonathan M Carnino
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
| | - Anika S Walia
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - Amos M Mwaura
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; 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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Muacevic A, Adler JR. Labial Frenotomy for Symptomatic Isolated Upper Lip Tie. Cureus 2022; 14:e32755. [PMID: 36686132 PMCID: PMC9851728 DOI: 10.7759/cureus.32755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The benefits and challenges of successful breastfeeding for both mother and child have been well-established in the literature. While ankyloglossia, or tongue tie, alone or in combination with upper lip tie has been the focus of several previous studies, very few have directly addressed isolated symptomatic upper lip tie and the role of surgical correction for breastfeeding difficulties. MATERIALS AND METHODS Seven infants with isolated upper lip tie and breastfeeding difficulty were taken to the operating room for labial frenotomy. These infants were assessed at their follow-up visits for their degree of weight gain since their procedure. Their mothers were surveyed regarding their experiences with breastfeeding since the frenotomy was performed. RESULTS In this article, we present seven infants with isolated upper lip tie and breastfeeding difficulty who were treated with labial frenotomy. Subsequently, these infants demonstrated improved weight gain, and all mothers reported increased ease of breastfeeding. CONCLUSION These findings implicate lip tie as an underrecognized cause of breastfeeding difficulty and suggest that labial frenotomy is an effective treatment in these patients. Larger-scale randomized controlled studies are necessary to further evaluate this topic.
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Haischer-Rollo GD, Lu K, Drumm C, Fagiana A, Bowe SN, Aden J, Demarcantonio M. Superior Labial Frenulum Attachment Site and Correlation with Breastfeeding Outcomes. Laryngoscope 2022; 132:2498-2504. [PMID: 35234285 DOI: 10.1002/lary.30059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Current literature suggests that infant oral anatomy may impact breastfeeding outcomes. Our research seeks to evaluate superior labial frenulum (SLF) attachment site grade utilizing a modified existing system and investigate the correlation with breastfeeding outcomes. METHODS Two hundred and eight dyads were recruited from the nursery at Brooke Army Medical Center. The neonate's SLF and lingual frenulum were evaluated and photo-documented. Photos were assessed by blinded reviewers utilizing a modified Stanford SLF grade. Breastfeeding mothers completed surveys on attitudes and associated pain with feedings 24 h postdelivery, at 2 weeks and at 2 months. Categorical data were analyzed using chi-squared tests or Fisher's exact tests. Means and standard deviations were analyzed using analysis of variance or Wilcoxon's test. RESULTS At 2 weeks and 2 months, 86.8% and 72.8% were breastfeeding, respectively. At 2 months, SLF grade 1 newborn dyads had a significantly lower breastfeeding rate (50.0%) compared to SLF grade 2 (75.3%) and SLF grade 3 (85.7%) subjects (p = 0.0384). At 2 weeks and 2 months, there was no difference between SLF groups with regard to maternal breastfeeding attitudes or pain scores. There was no significant difference in terms of weight, referrals, or lingual-labial frenulectomy between SLF groups. CONCLUSIONS Our study shows no correlation between SLF attachment grade and breastfeeding outcomes to include length of breastfeeding, maternally reported confidence, maternal pain, or infant weight. Our findings do not support labial frenulectomy based on SLF grade alone and highlight the need for a more robust functional grading system. LEVEL OF EVIDENCE 2 Oxford Center for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653 Laryngoscope, 132:2498-2504, 2022.
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Affiliation(s)
- Gayle D Haischer-Rollo
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Khang Lu
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A.,Otolaryngology Department, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Caitlin Drumm
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Angela Fagiana
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Sarah N Bowe
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - James Aden
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A.,Graduate Medical Education Department, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Micheal Demarcantonio
- Otolaryngology Department, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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So RJ, Jenks C, Ryan MA, Tunkel DE, McKenna Benoit MK, Walsh JM. Upper lip tie: A novel classification scale with improved inter-rater reliability. Laryngoscope Investig Otolaryngol 2022; 7:1611-1617. [PMID: 36258882 PMCID: PMC9575066 DOI: 10.1002/lio2.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Upper lip tie (ULT) is a clinical condition with restrictive attachment of the superior labial frenulum (SLF), which may inhibit flanging of the lips. Objective outcome studies are lacking in part due to unreliable classification systems that rely solely upon a single attachment parameter of the SLF. This study's objectives are to describe a novel 3-point classification system for ULT and compare its inter-rater reliability to the Kotlow and Stanford systems. Methods Five raters used the Kotlow and Stanford systems, as well as our novel 3-point scale to score images of the SLF from 20 newborns seen at our institution between September 1, 2017 and April 1, 2018. Newborn birth weight, gestational age, and demographic data were collected from the infant's medical record. Fleiss's kappa was used to calculate inter-rater reliability for all classification systems. Results The parameters for our novel 3-point classification system for ULT were as follows: length from alveolar edge to frenulum gingival attachment, length of frenulum on stretch, and free-lip to total-lip length ratio. Our novel scale yielded the highest inter-rater reliability of 0.41, compared to 0.24 and 0.25 under the Kotlow and Stanford systems. Conclusion While the Kotlow and Stanford systems are based upon a single anatomical parameter, our novel 3-point classification scale uses three oral parameters that encompass anatomical points of attachment as well as the maximal length of the ULT on stretch. Our classification scheme is the first to incorporate a functional parameter of the SLF, and thereby more fully characterizes ULT.Level of Evidence: Level 4.
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Affiliation(s)
- Raymond J. So
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Carolyn Jenks
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Marisa A. Ryan
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - David E. Tunkel
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Margo K. McKenna Benoit
- Department of OtolaryngologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Jonathan M. Walsh
- Department of OtolaryngologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Hatami A, Dreyer CW, Meade MJ, Kaur S. Effectiveness of tongue-tie assessment tools in diagnosing and fulfilling lingual frenectomy criteria: a systematic review. Aust Dent J 2022; 67:212-219. [PMID: 35689515 PMCID: PMC9796854 DOI: 10.1111/adj.12921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 01/07/2023]
Abstract
It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose of this systematic review is to determine and evaluate any association between tongue-tie severity, as measured by pre-treatment assessment tools, and post-operative outcome following tongue-tie division. PubMed, EMBASE, and the Cochrane search engines were used to retrieve articles published between 1947 and 2021. Included studies consisted of patients with symptomatic tongue-tie, assessment by either the Coryllos, Kotlow, or Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) classification tool, and tongue-tie division. A total of 205 abstracts were identified; 31 studies met the criteria for a full-text review, of which, only 14 studies met the criteria for data extraction and analysis. Six studies used the HATLFF, 2 studies used the Kotlow, 5 studies used the Coryllos, and 1 study used a combination of both Kotlow and Coryllos methods. Significant heterogeneity was evident across all studies. No statistical correlation between the two variables could be determined. Although tongue-tie division procedures appear to provide benefits in breastfeeding and speech, there are no data to suggest a statistically significant association between the severity of tongue-tie, and the correct identification of patients who would benefit from tongue-tie division. © 2022 Australian Dental Association.
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Affiliation(s)
- A Hatami
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - CW Dreyer
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - MJ Meade
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - S Kaur
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
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Towfighi P, Johng SY, Lally MM, Harley EH. A Retrospective Cohort Study of the Impact of Upper Lip Tie Release on Breastfeeding in Infants. Breastfeed Med 2022; 17:446-452. [PMID: 35235369 DOI: 10.1089/bfm.2021.0140] [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] [Indexed: 11/12/2022]
Abstract
Objectives: Lingual frenotomies for the purpose of improving infant breastfeeding remain controversial, whereas maxillary frenotomies are even more so given the scant data and differing opinions on the matter. This study aimed at further elucidating the effect that maxillary frenula have on breastfeeding difficulties in infants. Methods: A retrospective chart review was performed on infants approximately aged 0-3 months who presented to a tongue tie/breastfeeding clinic from January to December of 2019. All analyzed infants had both lip and tongue ties classified by a clinician. Data on pre-frenotomy pain scores, lingual Coryllos classification, maxillary Kotlow classification, post-frenotomy complications, and breastfeeding success were captured. Results: Of the 316 infants, 224 underwent their first procedure at the tongue tie/breastfeeding clinic. Two hundred eleven out of 224 infants received a lingual frenotomy only, whereas the remaining 13 (5.8%) underwent both lingual and maxillary frenotomy procedures. Of the group of 211, 207 (98.1%) had successful feeding after 1 procedure; the remaining 4 underwent revision procedures to achieve successful feeding. All maxillary frenulum releases (n = 13) led to successful feeding without the need for revision procedures. Coryllos and Kotlow classification scores were significantly higher in the infants receiving both a maxillary and lingual frenulum release as compared with those receiving solely a lingual frenulum release. Conclusions: The majority (98.1%) of infants receiving a lingual frenulum release alone had successful feeding after only one procedure, and only 5.8% of all infants receiving any intervention required a maxillary frenulum release for successful feeding, calling into question the relative necessity of performing maxillary frenulum releases for breastfeeding difficulties.
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Affiliation(s)
- Parhom Towfighi
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Stephanie Y Johng
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Michelle M Lally
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Earl H Harley
- Georgetown University School of Medicine, Washington, District of Columbia, USA.,Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Murias I, Grzech-Leśniak K, Murias A, Walicka-Cupryś K, Dominiak M, Golob Deeb J, Matys J. Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review. Life (Basel) 2022; 12:life12040558. [PMID: 35455049 PMCID: PMC9031639 DOI: 10.3390/life12040558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.
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Affiliation(s)
- Iwona Murias
- EMDOLA, Wroclaw Medical University, 50-425 Wroclaw, Poland;
| | - Kinga Grzech-Leśniak
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Correspondence:
| | - Anna Murias
- Faculty of Medicine, Pavel Jozef Šafárik University, Trieda SNP 1, 040 11 Košice, Slovakia;
| | - Katarzyna Walicka-Cupryś
- Institute of Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland;
| | - Marzena Dominiak
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
| | - Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Jacek Matys
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland; (M.D.); (J.M.)
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Abstract
Tethered oral tissue may represent anatomic variation or true pathology with functional limitations. The most prevalent functional limitation is impaired feeding due to ankyloglossia. Treatment options include conservative management with feeding support versus intervention such as frenotomy or frenuloplasty. The benefits of intervention have yet to be fully elucidated. Many can agree that intervention may improve maternal pain during breastfeeding, but the impact of these procedures on feeding efficiency and intake is debated. Alternate ties such as posterior ankyloglossia and lip tie have been proposed as pathologic oral ties, but their true impact on feeding and speech articulation remains unclear.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
| | - Christen L Caloway
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Surgery, St. Joseph's University Medical Center, 11 Getty Avenue, Paterson, NJ 07503, USA.
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12
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Baxter RT, Zaghi S, Lashley AP. Safety and efficacy of maxillary labial frenectomy in children: A retrospective comparative cohort study. Int Orthod 2022; 20:100630. [PMID: 35283058 DOI: 10.1016/j.ortho.2022.100630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Maxillary frenectomy in children is a common procedure, but concerns about scar tissue affecting diastema closure prevent many clinicians from treating prior to orthodontics. OBJECTIVES To determine if maxillary frenectomy is safe and if diastema size is affected by early treatment. MATERIALS AND METHODS Paediatric patients with hypertrophic maxillary frena were treated under local anaesthesia with diode laser and CO2 laser. Diastema width was compared by calibrating and digitally measuring initial and postoperative intraoral photographs. RESULTS In total, 109 patients were included: 95 patients with primary dentition (39% male; mean age 1.9 years±1.5 years) and 14 with mixed dentition (43% male; mean age 8.1±1.3 years) with a mean follow-up of 18.0±13.2 months. No adverse outcomes were noted other than minor pain and swelling. In the primary dentition, a decrease in diastema width was observed in 94.7% with a mean closure of -1.4±1.0mm (range +0.7 to -5.1mm). In the mixed dentition, a decrease in diastema width was observed in 92.9% with a mean closure of -1.8±0.8mm (range 0 to -3.5mm). 74.5% of patients in the primary dentition and 75% of patients in the mixed dentition with preoperative diastema>2mm improved to<2mm width postoperatively. CONCLUSIONS Frenectomy is associated with cosmetic and oral hygiene benefits and when performed properly, does not impede diastema closure and may aid closure. Technique and case selection are critical to successful outcomes. IRB ethics approval was obtained from Solutions IRB protocol #2018/12/8, and this investigation was self-funded.
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Sugawara C, Yamana H, Sasagawa E, Yonezawa K, Hikita N, Morita K, Matsui H, Yasunaga H, Haruna M. Factors Associated with Surgical Treatment in Postpartum Women with Mastitis or Breast Abscess: A Retrospective Cohort Study. Breastfeed Med 2022; 17:233-238. [PMID: 34936486 DOI: 10.1089/bfm.2021.0244] [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] [Indexed: 11/13/2022]
Abstract
Objective: The aim of this study was to identify factors associated with requiring surgical treatment for mastitis or breast abscess in postpartum mothers. Materials and Methods: This was a retrospective cohort study using the Japan Medical Data Center Claims Database. Information on pairs of infants born between April 2012 and December 2016 and their mothers were extracted. Data regarding the baseline characteristics, medical history, medical practice, and prescription drugs of mothers and their infants were collected. Multivariable logistic regression analysis was used to examine factors associated with undergoing surgical treatment. Results: The data of 69,363 eligible mothers were analyzed. The proportion of mothers who were diagnosed with mastitis or breast abscess within 1 year after childbirth was 10.8% (7,516/69,363). There were 114 mothers who underwent surgical treatment within 1 year after childbirth. This was 0.2% of all mothers and 1.5% of those diagnosed with mastitis or breast abscess. Surgical treatment was significantly associated with mothers having their first child (adjusted odds ratio [AOR], 2.58; 95% confidence interval [CI], 1.63-4.07) compared to those with a second or later child; it was also significantly associated with the diagnosis of breast abscess (AOR, 10.38; 95% CI, 5.28-20.40). Conclusions: This was the first report of the prevalence of mastitis or breast abscess and the requirement for surgical treatment among postpartum mothers in Japan. A first diagnosis of breast abscess and having a first child were associated with requiring surgical treatment. Health care professionals providing postpartum care should be aware of these factors.
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Affiliation(s)
- Chihiro Sugawara
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emi Sasagawa
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Yonezawa
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Hikita
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Megumi Haruna
- Division of Health Sciences and Nursing, Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Naimer SA, Israel A, Gabbay A. Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study. Clin Exp Pediatr 2021; 64:130-135. [PMID: 32898944 PMCID: PMC7940086 DOI: 10.3345/cep.2020.00486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/19/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severe maxillary frenulum are needed. PURPOSE No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended followup of these newborn infants. METHODS This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likelihood of eventual feeding or oral disorders. RESULTS The convenience sample comprised of 61 consecutively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (P<0.01). There were no intergroup differences in other types of feeding difficulty, dental hygiene, pronunciation, or speech development. CONCLUSION Our findings suggest that a tethered labial frenulum is not associated with an increase in breastfeeding disturbances or oral disorders. These data encourage clinicians to question the need to intervene in cases of tethered maxillary frenula.
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Affiliation(s)
- Sody A Naimer
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, BeerSheva, Israel.,Elon Moreh Clinic, Clalit Health Services - Shomron district, Lev Shomron, Israel.,Community Pediatric Service, Kedumim Family Health Center, Clalit Health Services -Shomron district, Lev Shomron, Israel
| | - Ariel Israel
- Division of Planning and Strategy, Department of Research of Data, Clalit Health Services, Tel Aviv, Israel
| | - Aviezer Gabbay
- Department of Family Medicine, Faculty of Health Sciences, Hebrew University of Jerusalem, Jerusalem, Israel.,Family Health Center, Clalit Health Services, Jerusalem district, Jerusalem, Israel
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15
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Mills N, Lydon A, Davies‐Payne D, Keesing M, Geddes DT, Mirjalili SA. Imaging the breastfeeding swallow: Pilot study utilizing real-time MRI. Laryngoscope Investig Otolaryngol 2020; 5:572-579. [PMID: 32596502 PMCID: PMC7314469 DOI: 10.1002/lio2.397] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/20/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Knowledge of the breastfeeding swallow is limited by practical challenges. Radiation exposure to both mother and infant and the radiolucent properties of breastmilk make videofluoroscopy an unsuitable imaging modality. Furthermore, ultrasound is not ideal for capturing the complex 3-dimensional functional anatomy of swallowing. In this study we explore the feasibility of using real-time MRI to capture the breastfeeding swallow. METHODS Prospective observational study: Review of imaging from 12 normal infants (<5 months of age) and their mothers while breastfeeding using real-time MRI. RESULTS Static images were successfully captured in 11 infants and dynamic images in nine infants. This imaging modality confirms the dorsal surface of the infant's tongue elevates the maternal nipple to the hard palate, closing the space around the nipple with no air visible in the oral cavity during sucking and swallowing. We obtained dynamic imaging of mandibular movement with sucking, palatal elevation and pharyngeal constriction with swallowing, diaphragm movement with breathing and milk entering the stomach. Breastmilk was easily visualized, being high intensity on T2 sequences. Technical challenges were encountered secondary to infant movement and difficulties acquiring and maintaining midsagittal orientation. The similarity in tissue densities of the lips, tongue, nipple and hard palate limited definition between these structures. CONCLUSION Real-time MRI imaging was successful in capturing dynamic images of the breastfeeding swallow. However, technical and practical challenges make real-time MRI unlikely at present to be suitable for swallow assessment in clinical practice. Advances in technology and expertise in dynamic image capture may improve the feasibility of using MRI to understand and assess the breastfeeding swallow in the near future. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Nikki Mills
- Paediatric Otolaryngology DepartmentStarship Children's HospitalAucklandNew Zealand
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Anna‐Maria Lydon
- Centre for Advanced MRI, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - David Davies‐Payne
- Paediatric Radiology DepartmentStarship Children's HospitalAucklandNew Zealand
| | - Melissa Keesing
- Paediatric Speech‐language Therapy DepartmentStarship Children's HospitalAucklandNew Zealand
| | - Donna T Geddes
- School of Molecular Sciences, Faculty of ScienceUniversity of Western AustraliaCrawleyWAAustralia
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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16
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Razdan R, Callaham S, Saggio R, Chafin M, Carr MM. Maxillary Frenulum in Newborns: Association with Breastfeeding. Otolaryngol Head Neck Surg 2020; 162:954-958. [PMID: 32204658 DOI: 10.1177/0194599820913605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To relate maxillary and lingual frenulum configuration to breastfeeding success. Study Design Cross-sectional study. Setting Newborn nursery in tertiary care academic hospital. Subjects and Methods Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded. Results A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores ( P > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85). Conclusion We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.
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Affiliation(s)
- Reena Razdan
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Sarah Callaham
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Renee Saggio
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Mary Chafin
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Michele M. Carr
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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17
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Identification of oral cavity abnormalities in pre-term and full-term newborns: a cross-sectional and comparative study. Eur Arch Paediatr Dent 2019; 21:581-586. [PMID: 31811584 DOI: 10.1007/s40368-019-00499-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Compare maxillary labial frenum and lingual frenum topography, the ridges relationship and oral inclusion cysts occurrence between pre-term (PT) and full-term newborns (FT). METHODS This cross-sectional and comparative study was conducted through the evaluation of 74 PT and 100 FT. Data were collected from medical records: mother age, gestational age, gender, height, weight, and delivery type. The variables were verified by Chi-square test and Mann-Whitney U test, at 5% significance level. RESULTS Bohn's nodules and dental lamina cysts were more frequent in FT (P = 0.000). Epstein pearls occurrence was similar between FT and PT (P = 0.243). The lower alveolar ridge in distal position to the upper one was more prevalent in both groups. Abnormal upper labial frenum anatomy had been observed in 10.0% of FT. Upper labial frenum was attached in piriform papilla in 90.5% of PTG, whereas in FT, 61.0% were attached from crest of alveolar ridge to mucogingival line. CONCLUSIONS PT oral cavity presented some peculiarities when compared with FT: maxillary labial frenum insertion in the Piriform papilla and palatal cysts more prevalent than alveolar cysts.
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18
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Abstract
This narrative review surveys current research demonstrating how oral dysfunction can escalate into malocclusion, acquired craniofacial disorder and contribute to generational dysfunction, disorder and disease. INTRODUCTION Baseline orthodontic consultations are generally recommended beginning age seven. However, the dysmorphic changes that result in malocclusion are often evident years earlier. Similarly, following orthodontic treatment, patients require permanent retention when the bite is not stable, and without such retention, the malocclusion can return. SETTING AND POPULATION Narrative review article including research on infants, children and adults. MATERIALS AND METHODS This review is a brief survey of the symptomology of orofacial myofunctional disorder and outlines 10 areas of oral function that impact occlusal and facial development: breastfeeding, airway obstruction, soft tissue restriction, mouth breathing, oral resting posture, oral habits, swallowing, chewing, the impact of orofacial myofunctional disorder (OMD) over time and maternal oral dysfunction on the developing foetus. CONCLUSION Malocclusions and their acquired craniofacial dysmorphology are the result of chronic oral dysfunction and OMD. In order to achieve long-term stability of the face, it is critical to understand the underlying pathologies contributing to malocclusion, open bite and hard palate collapse.
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Affiliation(s)
- Linda D'Onofrio
- Oregon Health and Sciences University School of Dentistry, Portland, Oregon
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19
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20
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Ray S, Golden WC, Walsh J. Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns. JAMA Otolaryngol Head Neck Surg 2019; 145:931-938. [PMID: 31436823 DOI: 10.1001/jamaoto.2019.2302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The maxillary labial frenulum and its potential contribution to breastfeeding difficulty may substantially affect public health. However, objective studies of the frenulum are limited. Objective To measure the variations in length, thickness, and attachments of the maxillary labial frenulum in healthy newborns and to identify which anatomic measurements could be used in further research investigating the maxillary labial frenulum. Design, Setting, and Participants This prospective cross-sectional study conducted measurements on images of maxillary labial frenula captured by digital photography from 150 healthy newborns admitted to the newborn nursery at a tertiary care children's hospital in Maryland between September 1, 2017, and April 1, 2018. Main Outcomes and Measures The primary outcome was the measurement of numerous frenulum morphologic components. Results Of 150 newborns enrolled, 77 were female, the mean (SD) gestational age was 38.60 (1.72) weeks, and the mean (SD) birth weight was 3180 (570) g. The means and SDs of the morphologic components of the frenulum with the broadest distributions, which were most helpful in differentiating degrees of lip tethering, included the following: alveolar edge to frenulum gingival attachment, 1.53 (0.85) mm; frenulum length on stretch, 5.19 (1.68) mm; frenulum gingival attachment thickness, 0.84 (0.36) mm; frenulum labial attachment thickness, 2.83 (1.33) mm; and the percentage of free lip to total lip length, 87.38% (7.67%). Gingival attachment mean (SD) thickness differed between late-preterm (0.69 [0.24] mm) and term (0.88 [0.37] mm) infants (Cohen d, -0.52; 95% CI, -0.94 to -0.10). Conclusions and Relevance To our knowledge, this cross-sectional study was the first to objectively measure the numerous morphologic components of the upper lip anatomy in healthy newborns. Variations in maxillary labial frenulum morphology were identified, and some combination of the stated measurements may be used to create a more robust classification system to advance quality research in the association of lip-tie with breastfeeding difficulty.
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Affiliation(s)
- Shagnik Ray
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William Christopher Golden
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Caloway C, Hersh CJ, Baars R, Sally S, Diercks G, Hartnick CJ. Association of Feeding Evaluation With Frenotomy Rates in Infants With Breastfeeding Difficulties. JAMA Otolaryngol Head Neck Surg 2019; 145:817-822. [PMID: 31294774 DOI: 10.1001/jamaoto.2019.1696] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Inpatient surgical release of lingual frenulums rose 10-fold between 1997 and 2012 despite insufficient evidence that frenotomy for ankyloglossia is associated with improvements in breastfeeding. Clear indications for surgical release remain murky, and best practice guidelines have yet to be developed. Objective To determine whether infants referred for frenotomy to treat breastfeeding difficulties should undergo procedures after comprehensive feeding examination, during which the primary cause of feeding issues was identified, and targeted intervention was provided. Design, Setting, and Participants This observational quality improvement study followed mother-infant dyads between March and December of 2018 who were referred to our tertiary care center for difficulty with breastfeeding. All infants underwent a comprehensive feeding evaluation by speech and language pathologists who examined the infants' ability to breastfeed prior to a surgical consultation for initial frenotomy. Data analysis was performed between January 2019 and May 2019. Interventions A multidisciplinary feeding evaluation that examined infants' oral structure and function and their ability to breastfeed and that offered techniques for mothers to address any feeding difficulties prior to surgical intervention was developed. Infants either found success in feeding and weight gain through this program or underwent procedures. Main Outcomes and Measures The primary outcome was the percentage of frenotomy procedures following implementation of a multidisciplinary feeding team evaluation. The secondary outcome was the percentage of infants referred for lingual frenotomy who later had either combined lingual and labial frenotomy or labial frenotomy alone. Results Included in the study were 115 patients (median age, 34 days [interquartile range, 19-56 days], 68 (59%) were male) referred for surgical division of the lingual frenum. Following the development of a program with feeding examination with a pediatric speech and language pathologist, 72 (62.6%) patients subsequently did not undergo surgical procedures. Although all of the referrals were for lingual frenotomy, 10 (8.7%) underwent labial frenotomy alone and 32 (27.8%) underwent both labial and lingual frenotomy. Conclusions and Relevance The majority of patients referred for ankyloglossia may benefit from alternative intervention strategies following comprehensive feeding evaluation. Close collaboration and formation of multidisciplinary teams are imperative for treating these children.
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Affiliation(s)
| | | | - Rebecca Baars
- Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Sally
- Massachusetts General Hospital, Boston, Massachusetts
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22
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Patel PS, Wu DB, Schwartz Z, Rosenfeld RM. Upper lip frenotomy for neonatal breastfeeding problems. Int J Pediatr Otorhinolaryngol 2019; 124:190-192. [PMID: 31202037 DOI: 10.1016/j.ijporl.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Upper lip tie, without concomitant tongue tie, can prevent proper flanging of the upper lip during breastfeeding, resulting in a poor seal and suck for the infant with nipple pain and maternal dissatisfaction. Due to the lack of published studies on this subject, we report our technique and outcomes for in-office release of isolated upper lip tie. METHODS Using CPT Code 40,806 for 'incision of labial frenulum', 22 mother-infant dyads with infant age under 60 days with breastfeeding problems and a restrictive upper lip frenum were identified. These infants underwent in-office release of upper lip tie as detailed below. Outcomes of the procedure were assessed by a telephone survey to mothers within the 4-week period post-procedure. RESULTS 82% of mothers reported an improved latch and 73% noted increased satisfaction with breastfeeding. Lip pain, if present, resolved within 24 h for most children. Recurrence was reported by 9% of mothers; no infection or other complications occurred. CONCLUSION Upper lip frenotomy, in properly selected infants, has favorable short-term outcomes with mild transient discomfort and a low rate of recurrence. Since our study was short-term and did not include a control group, we are unable to comment on procedure efficacy or long-term impact.
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Affiliation(s)
- Prayag S Patel
- Department of Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 126, Brooklyn, NY, 11203, USA
| | - Derek B Wu
- Department of Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 126, Brooklyn, NY, 11203, USA
| | - Ziv Schwartz
- Department of Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 126, Brooklyn, NY, 11203, USA
| | - Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 126, Brooklyn, NY, 11203, USA.
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24
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Powers DC. IBCLC Role Differences. CLINICAL LACTATION 2019. [DOI: 10.1891/2158-0782.10.2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lactation consultants working with mothers and babies in different settings — whether hospital, clinic, home or support group — may find themselves not understanding the challenges and dissimilarities that are part of a distinctive lactation setting. In an effort to even the playing field, allowing for a bird's-eye view of inpatient and outpatient work life issues, this is an article designed to hone in on the variances that confront LC's depending upon where they interface with the breastfeeding dyad.
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25
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Nakhash R, Wasserteil N, Mimouni FB, Kasirer YM, Hammerman C, Bin-Nun A. Upper Lip Tie and Breastfeeding: A Systematic Review. Breastfeed Med 2019; 14:83-87. [PMID: 30681376 DOI: 10.1089/bfm.2018.0174] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Upper lip tie (ULT) articles have been recorded in Medline since 1998, while "labial frenum" articles have been recorded since 1946. OBJECTIVE to study the existing medical literature on ULT (or labial frenum or fraenum) as they relate to breastfeeding. MATERIALS AND METHODS Medline search engine was used to determine and subsequently retrieve all articles published on ULT from 1946 to 2018. Key-words of upper lip tie OR labial frenum were used for the search. We also used Google Scholar and Embase to widen our search, and used the PRISMA criteria for systematic reviews (SRs). Articles were classified as case reports (or series), reviews, editorials (or opinions), cohort studies, clinical trials (nonrandomized), randomized controlled trials (RCT), and SRs according to Medline's own classification. We systematically summarized all articles published to date. RESULTS AND CONCLUSION No RCT were found, and the evidence for routine ULT release in infants with breastfeeding difficulties is poor. The classification system proposed by Kotlow has not been found reliable both in terms of inter and intraobserver agreement and in terms of predicting the severity of the breastfeeding difficulties.
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Affiliation(s)
- Rizeq Nakhash
- 1 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Natanel Wasserteil
- 1 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Francis B Mimouni
- 1 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,2 Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair M Kasirer
- 1 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Cathy Hammerman
- 1 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,3 Department of Pediatrics, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Alona Bin-Nun
- 1 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,3 Department of Pediatrics, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
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26
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Stenberg WV. Periodontal Problems in Children and Adolescents. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00025-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Heo W, Ahn HC. Upper lip tie wrapping into the hard palate and anterior premaxilla causing alveolar hypoplasia. Arch Craniofac Surg 2018; 19:48-50. [PMID: 29609432 PMCID: PMC5894555 DOI: 10.7181/acfs.2018.19.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/22/2022] Open
Abstract
Bony anomaly caused by lip tie is not many reported yet. There was a case of upper lip tie wrapping into the anterior premaxilla. We represent a case of severe upper lip tie of limited lip motion, upper lips curling inside, and alveolar hypoplasia. Male patient was born on June 3, 2016. He had a deep philtral sulcus, low vermilion border and deep cupid’s bow of upper lip due to tension of short, stout and very tight frenulum. His upper lip motion was severely restricted in particular lip eversion. There was anterior alveolar hypoplasia with deep sulcus in anterior maxilla. Resection of frenulum cord with Z-plasty was performed at anterior premaxilla and upper lip sulcus. Frenulum was tightly attached to gingiva through gum and into hard palate. Width of frenulum cord was about 1 cm, and length was about 3 cm. He gained upper lip contour including cupid’s bow and normal vermilion border after the surgery. This case is severe upper lip tie showing the premaxillary hypoplasia, abnormal lip motion and contour for child. Although there is mild limitation of feeding with upper lip tie child, early detection and treatment are needed to correct bony growth.
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Affiliation(s)
- Woong Heo
- Department of Plastic and Reconstructive Surgery, Hanyang University Hospital, Seoul, Korea
| | - Hee Chang Ahn
- Department of Plastic and Reconstructive Surgery, Hanyang University Hospital, Seoul, Korea
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29
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Santa Maria C, Aby J, Truong MT, Thakur Y, Rea S, Messner A. The Superior Labial Frenulum in Newborns: What Is Normal? Glob Pediatr Health 2017; 4:2333794X17718896. [PMID: 28812052 PMCID: PMC5528911 DOI: 10.1177/2333794x17718896] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/14/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction and Objectives: There has been an emergence of procedures to release the superior labial frenula in infants, yet little is known about the normal appearance or incidence of severe attachment, or “lip-tie.” The objective of this article was to develop a classification system for superior labial frenula and to estimate the incidence of different degrees of attachment. Methods: A prospective cross-sectional study. Newborns were examined and had photographs taken of their upper frenula. Relevant medical professionals rated the appearance of the labial frenula using a previously described Kotlow classification system. The raters assessed each photograph twice and were blinded to their previous rating and to other raters’ scores. Results: All newborns have a labial frenula, with most attached at the gingival margins (83%). Raters had poor intra- and interrater reliability (64% to 74% and 8%, respectively), using the Kotlow classification system, which improved when the classification system was simplified. Conclusions: The Kotlow classification of lip-tie fails to be reproducible by relevant experts. The majority of infants had a significant level of attachment of the labial frenulum. As more procedures are done to release the upper lip frenulum, it is important to understand what degree of attachment is normal, or more common.
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Affiliation(s)
- Chloe Santa Maria
- Stanford University, Stanford, CA, USA.,Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Janelle Aby
- Stanford University, Stanford, CA, USA.,Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | | | - Sharon Rea
- Lucile Packard Children's Hospital, Stanford, CA, USA
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Baeza C, Genna CW, Murphy J, Hazelbaker AK, Kaplan M, Martinelli R, Marchesan I, Douglas P, Smillie C. Assessment and Classification of Tongue-Tie. CLINICAL LACTATION 2017. [DOI: 10.1891/2158-0782.8.3.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tongue-tie can cause many serious breastfeeding problems and even lead to breastfeeding cessation. As the mothers’ stories listed in “When Tongue-Ties Were Missed: Mothers’ Stories” attest, healthcare providers often do not correctly identify when a baby has a tongue-tie. Assessing tongue-tie is essential. What should clinicians look for? Which professionals should be the ones identifying and identifying tongue-tie? Assessing tongue-tie is the focus of this article.
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Benoiton L, Morgan M, Baguley K. Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic. Int J Pediatr Otorhinolaryngol 2016; 88:13-6. [PMID: 27497378 DOI: 10.1016/j.ijporl.2016.06.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Recent studies have shown an association between ankyloglossia (tongue tie) and upper-lip ties to breastfeeding difficulties. Treatment is commonly multidisciplinary involving lactation consultants and surgical management with tongue tie and upper lip tie release. There is currently limited data looking at posterior ankyloglossia and upper lip ties. METHODS Consecutive patients seen at an ENT outpatient clinic for ankyloglossia and upper-lip ties from May 2014-August 2015 were assessed for an outpatient frenotomy. Breastfeeding outcomes were assessed following the procedure. RESULTS 43 babies were seen and 34 patients had a procedure carried out. Babies ranged from 2 to 20 weeks old with the median age being 6.6 weeks. The most common presenting complaint was latching issues (85%) with mothers' painful nipples being the second (65%). 21 patients (62%) had a tongue tie release, 10 (29%) had both a tongue tie and upper lip tie divided, whereas 3 (9%) had an upper-lip tie alone divided. 29 (85%) of the patients who had a procedure carried out had an immediate improvement in breastfeeding, while 28 (82%) had a continued improvement at 2 weeks follow up. CONCLUSIONS Frenotomy for posterior ankyloglossia and upper lip ties is a simple procedure that can be carried out in an outpatient setting with apparent immediate benefit. Otolaryngologists are likely to have an increasing role to play in the evaluation and management of ankyloglossia and upper lip ties in babies with breastfeeding difficulties.
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Affiliation(s)
- Lara Benoiton
- Department of Otoarlyngology, Wellington Public Hospital, 56 Riddiford Street, Newtown, Wellington 6021, New Zealand.
| | - Maggie Morgan
- Neonatal Intensive Care Unit, Wellington Public Hospital, 56 Riddiford Street, Newtown, Wellington 6021, New Zealand
| | - Katherine Baguley
- Department of Otoarlyngology, Wellington Public Hospital, 56 Riddiford Street, Newtown, Wellington 6021, New Zealand
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Pransky SM, Lago D, Hong P. Breastfeeding difficulties and oral cavity anomalies: The influence of posterior ankyloglossia and upper-lip ties. Int J Pediatr Otorhinolaryngol 2015; 79:1714-7. [PMID: 26255605 DOI: 10.1016/j.ijporl.2015.07.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Oral cavity anomalies may contribute to breastfeeding problems. The objective of this study was to describe our experience in a high-volume breastfeeding difficulty clinic with a focus on posterior ankyloglossia and upper-lip ties. METHODS A retrospective review of patients from a dedicated breastfeeding difficulty clinic from January 2014 to December 2014 was performed. Those identified to have ankyloglossia and/or upper-lip ties underwent release procedures. Subjective breastfeeding changes were documented afterwards. RESULTS Of the 618 total patients, 290 (47%) had anterior ankyloglossia, 120 (19%) had posterior ankyloglossia, and 14 (2%) had upper-lip tie. Some patients had both anterior ankyloglossia and upper lip-tie (6%), or posterior ankyloglossia and upper-lip tie (5%). For those with anterior ankyloglossia, 78% reported some degree of improvement in breastfeeding after frenotomy. For those with posterior ankyloglossia, 91% reported some degree of improvement in breastfeeding after frenotomy. Upper lip-tie release also led to improved breastfeeding (100%). CONCLUSIONS Anterior and posterior ankyloglossia and upper-lip tie, or combinations thereof, were commonly recognized in our study population. Many newborns, however, also had no oral cavity anomalies. Although causation cannot be implied, these oral cavity anomalies may contribute to breastfeeding difficulties in some cases.
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Affiliation(s)
- Seth M Pransky
- Rady Children's Hospital, San Diego, CA, United States; Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, CA, United States.
| | - Denise Lago
- Rady Children's Hospital, San Diego, CA, United States
| | - Paul Hong
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada.
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