Frenotomy for tongue-tie (frenulum linguae breve) showed improved symptoms in the short- and long-term follow-up

AIM

To evaluate clinical manifestations of tongue-tie as well as short-term and long-term outcomes following frenotomy.

METHODS

In this retrospective study, for 329 patients (295 infants and 34 children) who underwent frenotomy between 2011 and 2017, symptoms, short-term and long-term outcomes were evaluated.

RESULTS

Of the 295 infants (median age six weeks), 199 (=60%) showed inadequate breastfeeding. Symptoms were painful or sore maternal nipples, poor weight gain, dribbling milk from the corner of the mouth, reduced milk supply, inadequate latch during bottle-feeding and maternal mastitis. In the 34 children, predominant symptoms were articulation disorders, misaligned teeth and problems with swallowing solid food. Of the 141 patients with short-term feedback, 86% reported improvement, 13% an unchanged situation. In a former premature, the reported worsening of symptoms ('breath spells') are likely related to prematurity. Of the 164 patients where the questionnaire for long-term outcome was provided, 82% reported improvement, 16% an unchanged situation. For two infants worsening was reported, referring to refusal to drink from breast or bottle for two hours after the procedure and fever for one day, respectively.

CONCLUSION

Frenulum breve is a potential cause of breastfeeding difficulties and can be treated safely and efficiently by frenotomy.

Posterior lingual frenulum in infants: occurrence and maneuver for visual inspection

ABSTRACT Purpose: to verify the occurrence of posterior or submucosal lingual frenulum and evaluate the efficiency of a special maneuver for its visual inspection. Methods: an experimental study including 1,715 healthy infants, in which prematurity, perinatal complications, craniofacial anomalies neurological disorders, and visible genetic syndromes were the exclusion criteria. A clinical examination was performed by means of a maneuver that consisted in rising the lateral margins of the tongue to visualize the anatomical characteristics of the lingual frenulum. In some of the infants, a special maneuver was performed to assist visualization of posterior lingual frenulum, since its visualization was not possible. The maneuver consisted in two simultaneous actions: elevating and pushing the tongue back. Results: 558 infants (32.54%), out of the 1,715 had posterior frenulum, which required the special maneuver that consisted in both elevating and pushing the tongue back, simultaneously. Conclusion: the occurrence of posterior lingual frenulum was high and the special maneuver consisted in elevating and pushing the tongue back proved to be efficient to visualize the posterior lingual frenulum.

Lingual Frenulum Phenotypes in Brazilian Infants With Congenital Zika Syndrome

Objective:

The present study aimed to evaluate lingual frenulum in children affected by congenital Zika syndrome (CZS) and to analyze the association of lingual frenulum phenotypes with other variables.

Design:

This present work had a cross-sectional, descriptive study design.

Setting:

This study was carried out in Fortaleza (Brazil). The health professionals provided tertiary level of care. Data collection occurred during a multidisciplinary task force for evaluating infants affected by CZS in December 2 to 3, 2016.

Patients:

Fifty-four patients with CZS (1-12 months old; 32 girls and 22 boys) were recruited from a population of 70 infants.

Interventions:

A multidisciplinary group comprised of speech-language pathologist/audiologists and pediatric dentists evaluated all patients through an intraoral examination and a specific tongue maneuver protocol for infants.

Main Outcome Measures:

Lingual frenulum visibility was the primary outcome measure. Before initiating the study, we hypothesized that children with CZS had an absent lingual frenulum.

Results:

Lingual frenula were visible in 34 (63%) infants, whereas in 20 (37%) infants lingual frenula visibility required a specific maneuver to retract the tongue. Six of 20 infants presented posteriorly positioned lingual frenula that were visible after maneuver. Lingual frenula were covered by mucous tissue in 14 infants. Presence of posterior frenulum was associated with dysphagia ( P = 0.038). However, the presence of dysphagia in a multivariate model did not associate with the presence of a posterior lingual frenulum ( P = .069) or neurologic symptoms ( P = .056).

Conclusion:

Children with CZS showed predominance of a posterior lingual frenula covered by an overlapping curtain-like mucous membrane.

Diagnosing and understanding the maxillary lip-tie (superior labial, the maxillary labial frenum) as it relates to breastfeeding

Successful breastfeeding is dependent upon an infant's ability to correctly latch onto a mother's breast. If an infant is born with oral soft tissue abnormalities such as tongue-tie or lip-tie, breastfeeding may become challenging or impossible. During the oral evaluation of an infant presenting with breastfeeding problems, one area that is often overlooked and undiagnosed and, thus, untreated is the attachment of the upper lip to the maxillary gingival tissue. Historically, this tissue has been described as the superior labial frenum, median labial frenum, or maxillary labial frenum. These terms all refer to a segment of the mucous membrane in the midline of the upper lip containing loose connective tissue that inserts into the maxillary arch's loose, unattached gingival or tight, attached gingival tissue. There is no muscle contained within this tissue. In severe instances, this tissue may extend into the area behind the upper central incisors and incisive papilla. The author has defined and identified the restrictions of mobility of this tissue as a lip-tie, which reflects the clinical attachment of the upper lip to the maxillary arch. This article discusses the diagnosis and classifications of the lip-tie, as it affects an infant's latch onto the mother's breast. As more and more women choose to breastfeed, lip-ties must be considered as an impediment to breastfeeding, recognizing that they can affect a successful, painless latch and milk transfer.