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Clinical Anatomy (New York, N.Y.) Sep 2019The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is...
The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered "normal" lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal "band" or "string" and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824-835, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
Topics: Ankyloglossia; Cadaver; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Lingual Frenum; Lingual Nerve; Male
PubMed: 31116462
DOI: 10.1002/ca.23410 -
Paediatrics & Child Health May 2015Ankyloglossia ('tongue-tie') is a relatively common congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict tongue tip mobility....
Ankyloglossia ('tongue-tie') is a relatively common congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict tongue tip mobility. There is considerable controversy regarding its diagnosis, clinical significance and management, and there is wide variation in practice in this regard. Most infants with ankyloglossia are asymptomatic and do not exhibit feeding problems. Based on available evidence, frenotomy cannot be recommended for all infants with ankyloglossia. There may be an association between ankyloglossia and significant breastfeeding difficulties in some infants. This subset of infants may benefit from frenotomy (the surgical division of the lingual frenulum). When an association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed to be necessary, frenotomy should be performed by a clinician experienced with the procedure and using appropriate analgesia. More definitive recommendations regarding the management of tongue-tie in infants await clear diagnostic criteria and appropriately designed trials.
PubMed: 26038641
DOI: 10.1093/pch/20.4.209 -
The Laryngoscope May 2017Numerous symptoms may arise that prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence...
OBJECTIVES/HYPOTHESIS
Numerous symptoms may arise that prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue-tie/lip-tie release on breastfeeding impairment.
STUDY DESIGN
Prospective, cohort study from June 2014 to April 2015 in a private practice setting.
METHODS
Study participants consisted of breastfeeding mother-infant (0-12 weeks of age) dyads with untreated ankyloglossia and/or tethered maxillary labial frenula who completed preoperative, 1 week, and 1 month postoperative surveys consisting of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), visual analog scale (VAS) for nipple pain severity, and the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). Breastmilk intake was measured preoperatively and 1 week postoperatively.
RESULTS
A total of 237 dyads were enrolled after self-electing laser lingual frenotomy and/or maxillary labial frenectomy. Isolated posterior tongue-tie was identified in 78% of infants. Significant postoperative improvements were reported between mean preoperative scores compared to 1 week and 1 month scores of the BSES-SF (F = 212.3; P < .001), the I-GERQ-R (F = 85.3; P < .001), and VAS pain scale (F = 259.8; P < .001). Average breastmilk intake improved 155% from 3.0 (2.9) to 4.9 (4.5) mL/min (P < .001).
CONCLUSIONS
Surgical release of tongue-tie/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.
LEVEL OF EVIDENCE
2c Laryngoscope, 127:1217-1223, 2017.
Topics: Ankyloglossia; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Lingual Frenum; Lip Diseases; Pain Measurement; Prospective Studies; Surveys and Questionnaires; Treatment Outcome
PubMed: 27641715
DOI: 10.1002/lary.26306 -
Ugeskrift For Laeger Apr 2024Ankyloglossia or tongue-tie is a condition where the anatomical variation of the sublingual frenulum can limit normal tongue function. In Denmark, as in other countries,... (Review)
Review
Ankyloglossia or tongue-tie is a condition where the anatomical variation of the sublingual frenulum can limit normal tongue function. In Denmark, as in other countries, an increase in the number of children treated for ankyloglossia has been described over the past years. Whether or not ankyloglossia and its release affect the speech has also been increasingly discussed on Danish television and social media. In this review, the possible connection between ankyloglossia, its surgical treatment, and speech development in children is discussed.
Topics: Humans; Ankyloglossia; Child; Language Development; Tongue; Lingual Frenum; Speech; Infant
PubMed: 38704717
DOI: 10.61409/V11230699 -
Laryngoscope Investigative... Oct 2019Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth....
BACKGROUND
Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility.
METHODS
Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient-reported outcome measures.
RESULTS
In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue-tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications.
CONCLUSION
Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited.
LEVEL OF EVIDENCE
3.
PubMed: 31637291
DOI: 10.1002/lio2.297 -
Children (Basel, Switzerland) Nov 2023The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in... (Review)
Review
AIM
The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy.
MATERIALS AND METHODS
A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: "lingual", "frenulectomy", "frenulotomy", "frenulum", "ankyloglossia", and "laser."
RESULTS
A total of 14 articles were included in this review, including four prospective observational studies, one case-control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table.
CONCLUSIONS
In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period.
PubMed: 38002899
DOI: 10.3390/children10111808 -
Paediatrics & Child Health Apr 2011Ankyloglossia (or tongue-tie) is a relatively uncommon congenital anomaly defined by an abnormally short lingual frenulum. Associations between tongue-tie and...
Ankyloglossia (or tongue-tie) is a relatively uncommon congenital anomaly defined by an abnormally short lingual frenulum. Associations between tongue-tie and breastfeeding problems in infants have been inconsistent, and are a longstanding source of controversy in the medical community. Definitions of ankyloglossia vary, and management suggestions are not based on randomized controlled trials. Surgical correction involves cutting the lingual frenulum (frenotomy). Based on current available evidence, frenotomy cannot be recommended. If, however, the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary, frenotomy should be performed by a clinician experienced with the procedure and with appropriate analgesia. More definitive recommendations regarding the management of tongue-tie in infants await appropriately designed trials.
PubMed: 22468126
DOI: 10.1093/pch/16.4.222a -
Revista Paulista de Pediatria : Orgao... 2017To critically examine the existing Brazilian and International scientific literature regarding the influence of short lingual frenulum over growth and development of the... (Review)
Review
OBJECTIVE
To critically examine the existing Brazilian and International scientific literature regarding the influence of short lingual frenulum over growth and development of the stomatognathic system, as well as how it impacts the achievement of the shape-function balance.
DATA SOURCES
An electronic literature search was conducted in databases, including MEDLINE/PubMed, Google Scholar, LILACS, SciELO, and ScienceDirect, using the key words "lingual frenum" and "development", as well as their equivalents in Brazilian Portuguese. The literature search yielded 51 papers published between January 1997 and the present date; 14 articles of clinical trials were selected for meeting the inclusion criteria and were read in full.
DATA SYNTHESIS
The integrated literature review supported the proposition that some malocclusions are closely related to the presence of ankyloglossia and, although very few clinical trials on this topic have been published so far, there is a consensus among authors concerning the negative effects of functional imbalances over the stomatognathic system's proper growth and development. Half of the studies found state that surgical interventions for releasing the lingual frenum are both safe and effective, concerning improvement in breastfeeding scores. Moreover, 4 out of the 14 studies included in this integrated review, report a negative influence of ankyloglossia over the orofacial muscular system.
CONCLUSIONS
There is a consensus among the authors concerning the negative effects of lingual frenulum's anatomic and functional alterations over craniofacial growth and development. The opinion about the early surgical intervention, however, is not unanimous.
Topics: Adolescent; Ankyloglossia; Child; Child, Preschool; Female; Humans; Infant; Male; Stomatognathic System
PubMed: 28977337
DOI: 10.1590/1984-0462/;2017;35;2;00016 -
International Journal of Environmental... Jun 2021This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients.
BACKGROUND
Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum.
METHODS
Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%).
RESULTS
In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe.
CONCLUSION
The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.
Topics: Child; Control Groups; Double-Blind Method; Humans; Lasers, Semiconductor; Lingual Frenum; Sleep Apnea, Obstructive
PubMed: 34204017
DOI: 10.3390/ijerph18116112