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International Journal of Pediatric... Aug 2023To investigate the opinions and practices of health professionals involved in ankyloglossia diagnosis and management in Australia.
OBJECTIVES
To investigate the opinions and practices of health professionals involved in ankyloglossia diagnosis and management in Australia.
METHOD
Two hundred and thirty-seven health professionals across Australia responded to an online survey including their diagnostic and management practice of ankyloglossia. Descriptive statistics, content analysis and thematic analysis were used to analyse quantitative data and open-ended responses, respectively.
RESULTS
Most (91.6%) respondents reported they are responsible for the assessment and diagnosis of ankyloglossia in their clinical practice. A majority (56.7%) reported using more than one assessment tool in clinical practice. Less than half (46.4%) reported providing treatment to manage ankyloglossia. Surgical management was used by 44.5%, and 56.4% used non-surgical management as their primary treatment of ankyloglossia. Of the total sample, 26.6% had completed no further training or professional development in the field. 46% of respondents stated they always educate parents about ankyloglossia diagnoses, whereas 29.5% reported they always educate parents about management of ankyloglossia. Of respondents, a high level of confidence was reported by 62.6% of health professionals in the assessment of infants with ankyloglossia. Of those who perform surgical management, 53.7% reported feeling extremely confident in their skills. Fifty-two percent of respondents reported they were dissatisfied with the current service delivery for infants with ankyloglossia.
CONCLUSIONS
The diagnosis, management and education practices varied greatly amongst health professionals in Australia. Clinical guidelines for all relevant health professionals are needed to ensure standardised diagnosis and management processes. In future, this will help guide evidence-based diagnosis and intervention for infants with ankyloglossia.
Topics: Infant; Humans; Ankyloglossia; Surveys and Questionnaires; Australia; Parents; Health Personnel; Lingual Frenum
PubMed: 37453216
DOI: 10.1016/j.ijporl.2023.111649 -
The Journal of Craniofacial Surgery Sep 2023Interdisciplinary evaluation is essential to diagnose and define clinical conduct for children and adults presenting with an altered lingual frenulum; however, there are... (Review)
Review
Interdisciplinary evaluation is essential to diagnose and define clinical conduct for children and adults presenting with an altered lingual frenulum; however, there are few reports on the subject in the literature. In this context, the following study exemplifies a proposed protocol for the surgical and SLT treatment of a lingual frenulum based on a review of the literature and the experience of speech and language therapists and maxillofacial surgeons from hospitals in Santiago de Chile. After its application, a history of breastfeeding with difficulties and a maintained preference for soft foods was reported. Upon anatomic examination, the lingual apex was heart-shaped, and the lingual frenulum was fixed in the upper third of the ventral side of the tongue, with a pointed shape, submerged up to the apex, and of adequate thickness. Meanwhile, upon functional examination, the tongue was descended at rest, performed tongue protrusion with restrictions (raising and clicking), did not achieve attachment or vibration, and presented distortion of the sounds / r/ and /rr/. With this information, an altered lingual frenulum was diagnosed, with the indication for surgery and postoperative speech and language therapy. The constructed instrument allowed for the standardization of the evaluation in different teams but should be validated in future research.
Topics: Child; Female; Adult; Humans; Lingual Frenum; Speech Therapy; Tongue; Breast Feeding; Tongue Diseases; Ankyloglossia
PubMed: 37427922
DOI: 10.1097/SCS.0000000000009523 -
International Journal of Pediatric... Aug 2023Tongue-tie, or ankyloglossia, is a common condition characterized by an abnormally short or tight lingual frenulum and is known to cause breastfeeding difficulties,...
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.
Topics: Infant; Female; Humans; Ankyloglossia; Breast Feeding; Lingual Frenum; Prospective Studies; Cheek; Lip
PubMed: 37352592
DOI: 10.1016/j.ijporl.2023.111638 -
American Journal of Speech-language... Jul 2023To deepen our understanding of the effects of ankyloglossia on articulation, the purpose of this study is to examine consonant production and the perceived accuracy of...
PURPOSE
To deepen our understanding of the effects of ankyloglossia on articulation, the purpose of this study is to examine consonant production and the perceived accuracy of Mandarin-speaking children with ankyloglossia.
METHOD
Ten tongue-tie (TT) and 10 typically developing (TD) children produced nine Mandarin sibilants that contrast in three places of articulation. Their speech productions were analyzed from six acoustic measurements. To further examine the perceptual consequences, an auditory transcription task ( = 21) was conducted.
RESULTS
The acoustic analyses discovered that the TT children failed to distinguish the three-way place contrast and produced significant acoustic deviations compared with the TD peers. The perceptual transcription results found that TT children's production was significantly misidentified, suggesting severely affected intelligibility.
CONCLUSIONS
The preliminary findings provide strong support for a correlation between ankyloglossia and distorted speech signals and suggest important interactions between sound errors and linguistic experience. We also propose that ankyloglossia should not be a purely appearance-based diagnosis and that speech production is a crucial index of tongue function in clinical decision making and monitoring.
Topics: Humans; Child; Ankyloglossia; Speech; Acoustics; Linguistics; Clinical Decision-Making; Phonetics
PubMed: 37195693
DOI: 10.1044/2023_AJSLP-22-00231 -
Otolaryngology--head and Neck Surgery :... Oct 2023The past 2 decades have seen a rapid increase in the diagnosis of ankyloglossia. Patients are often managed by lingual frenotomy. The objective is to define the clinical...
OBJECTIVE
The past 2 decades have seen a rapid increase in the diagnosis of ankyloglossia. Patients are often managed by lingual frenotomy. The objective is to define the clinical and socioeconomic factors that determine which patients receive frenotomy.
STUDY DESIGN
A retrospective analysis of commercially insured children.
SETTING
Optum Data Mart database.
METHODS
Trends in frenotomy including provider and setting were described. Multiple logistic regression was used to determine predictors of frenotomy.
RESULTS
Diagnosis of ankyloglossia increased from 2004 to 2019 (from 3377 in 2004 to 13,200 in 2019), while lingual frenotomy similarly increased from 1483 in 2004 to 6213 in 2019. The proportion of inpatient frenotomy procedures increased from 6.2% to 16.6% from 2004 to 2019, with pediatricians having the highest odds of performing inpatient frenotomies (odds ratio: 4.32, 95% confidence interval: 4.08, 4.57). Additionally, during the study period, the proportion of frenotomies performed by pediatricians increased from 13.01% in 2004 to 28.38% in 2019. In multivariate regression analyses, frenotomy was significantly associated with the male sex, white non-Hispanic ethnicity, higher parental income and education, and a greater number of siblings.
CONCLUSION
Ankyloglossia has been increasingly diagnosed in the past 2 decades, and among patients with ankyloglossia, frenotomy is increasingly performed. This trend was driven at least in part due to increasing rates of pediatricians as proceduralists. After accounting for maternal and patient-level clinical factors, socioeconomic differences in the management of ankyloglossia were observed.
Topics: Child; Humans; Male; United States; Infant; Ankyloglossia; Retrospective Studies; Lingual Frenum; Inpatients; Parents
PubMed: 36994937
DOI: 10.1002/ohn.332 -
Tethered Oral Tissue Release Among Breastfed Infants: Maternal Sources of Information and Treatment.Journal of Human Lactation : Official... Aug 2023Despite limited clinical consensus regarding surgery for tethered oral tissues ("tongue-tie") for resolving breastfeeding-related issues, the procedure has been... (Observational Study)
Observational Study
BACKGROUND
Despite limited clinical consensus regarding surgery for tethered oral tissues ("tongue-tie") for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes.
RESEARCH AIM
To explore experiences of breastfeeding mothers with infants having undergone "tongue-tie" surgery.
METHOD
This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being 18 years of age and previously or currently breastfeeding an infant with 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90.
RESULTS
The sample was predominantly white ( = 86; 95%), non-Hispanic ( = 84; 93%), married/cohabitating ( = 85; 94%), and currently providing their own milk ( = 81; 89%).Difficult latch was the primary reason for seeking help. Participants reported lingual ( = 84; 93%), labial ( = 79; 88%), and buccal ( = 16; 17%) tissue-release, with 80% ( = 73) reporting > 1 released. For each tissue released, > 80% ( = 72) of participants felt "very confident" in their ability to correctly identify it and 97% ( = 87) felt "very involved" and "strongly agreed" with surgical release. International Board Certified Lactation Consultants were the most frequently identified source of information ( = 45; 50%) and referrals ( = 38; 42%), while pediatric dentists most frequently performed interventions ( = 60; 67%).
CONCLUSIONS
Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.
Topics: Female; Humans; Infant; Ankyloglossia; Breast Feeding; Cross-Sectional Studies; Information Sources; Lingual Frenum
PubMed: 36945736
DOI: 10.1177/08903344231159378 -
Special Care in Dentistry : Official... 2023Epidermolysis bullosa (EB) is a group of genetic disorders characterized by fragility of the skin and mucosal membranes. Dystrophic EB (DEB) is caused by mutations in...
Impression technique modification and oral contracture release surgery for orthodontic treatment in a patient with severe microstomia due to recessive dystrophic epidermolysis bullosa.
INTRODUCTION
Epidermolysis bullosa (EB) is a group of genetic disorders characterized by fragility of the skin and mucosal membranes. Dystrophic EB (DEB) is caused by mutations in the gene coding for type VII collagen. Among the most frequent oral manifestations in Recessive DEB (RDEB) are oral ulcers and blisters, absence of tongue papillae and palatal rugae, ankyloglossia, oral vestibule obliteration, and microstomia. The following report describes a modified impression technique used in a patient with severe RDEB and severe microstomia to obtain models for orthodontic treatment with aligners.
CASE REPORT
A 25-year-old female patient with severe RDEB was referred for orthodontic treatment. Severe microstomia (8 mm), hindered the use of conventional trays or intraoral scanners to design the aligners. Therefore, a contracture release surgery in combination with a modified impression technique was performed to obtain an optimal impression and subsequent aligners for orthodontic treatment.
DISCUSSION
This case presents an alternative strategy to provide orthodontic treatment with aligners in patients with severe microstomia due to severe RDEB. Reports of orthodontic treatment in people living with EB, especially in RDEB, are still rare, with few publications about fixed braces, early teeth extraction and removable devices, and none using aligners. Most of the impression techniques reported are aimed at oral rehabilitation. The multidisciplinary approach and impression technique reported should broaden the alternatives of orthodontic techniques provided to patients with EB and severe microstomia.
CONCLUSIONS
This article describes an oral contracture release surgery and modified impression technique for obtaining good quality impression for the design of orthodontic aligners in patients with severe microstomia due to severe RDEB.
PubMed: 36504454
DOI: 10.1111/scd.12808 -
Ear, Nose, & Throat Journal Jul 2024The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation...
OBJECTIVE
The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation and intelligibility.
METHODS
A prospective cohort study was conducted. Pediatric patients (>2 years of age) being referred for speech concerns due to ankyloglossia were assessed by a pediatric otolaryngologist, and speech articulation was formally assessed by a speech language pathologist using the Goldman-Fristoe Test of Articulation 2 (GFTA-2). Patients then underwent a tongue-tie release procedure in clinic. After 1 month, speech articulation was reassessed with GFTA-2. Audio-recordings of sessions were evaluated by independent reviewers to assess speech intelligibility before and after tongue-tie release.
RESULTS
Twenty-five participants were included (mean age 3.7 years; 20 boys). The most common speech errors identified were phonological substitutions (80%) and gliding errors (56%). Seven children (28%) had abnormal lingual-alveolar and interdental sounds. Most speech sound errors (87.9%) were age/developmentally appropriate. GFTA-2 standard scores before and after tongue-tie release were 85.61 (SD 9.75) and 87.54 (SD 10.21), respectively, (P=.5). Mean intelligibility scores before and after tongue-tie release were 3.15 (SD .22) and 3.21 (SD .31), respectively, (P=.43).
CONCLUSION
The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility.
Topics: Humans; Speech Intelligibility; Prospective Studies; Male; Female; Child, Preschool; Ankyloglossia; Child; Articulation Disorders; Speech Articulation Tests; Tongue; Treatment Outcome; Speech Disorders
PubMed: 34911396
DOI: 10.1177/01455613211064045