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

Roberta Lopes De Castro Martinelli,Irene Queiroz Marchesan,Giédre Berretin-Felix

doi:10.1590/1982-0216201820410918

Roberta Lopes De Castro Martinelli, Irene Queiroz Marchesan + Show 1 more

Open Access

https://doi.org/10.1590/1982-0216201820410918

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Abstract

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.

Highlights

Lingual frenulum is a widely discussed subject[1,2,3,4,5,6,7], its anatomical characteristics have not been extensively studied
The posterior ankyloglossia or submucosal tonguetie, which consists of the presence of abnormal collagen fibers in a sub mucosal location surrounded by tight mucous membrane under the front of the tongue is a variation poorly described in the literature[8]
Visual inspection was conducted by performing a maneuver that consisted of rising the lateral margins of the tongue using the right and left gloved index fingers to visualize the anatomical characteristics of lingual frenulum

Summary

Introduction

Lingual frenulum is a widely discussed subject[1,2,3,4,5,6,7], its anatomical characteristics have not been extensively studied. Differentiating anatomical variations of lingual frenulum requires deep knowledge of the anatomy of both the tongue and the floor of the mouth. There are a few studies in the literature on posterior lingual frenulum and all of them classify it as posterior ankyloglossia[9,10,11,12,13]. Douglas[14] states that the published studies regarding posterior tongue-tie do not provide clear evidence that the diagnosis of posterior tongue-tie has validity, or that frenotomy is an effective treatment. Douglas claims that health professionals should be extremely cautious given the absence of reliable evidence or historical precedence to support the efficacy of frenotomy other than for anterior tongue-tie

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