Lingual Frenulum Research Articles

Lingual frenotomy for ankyloglossia in infants with breastfeeding difficulties: a longitudinal observational study.

Ankyloglossia, or tongue-tie, is a variation in the anatomy of the lingual frenulum that restricts tongue movement. It is recognised as a cause of breastfeeding difficulty. We prospectively collected data from a specialist tongue-tie assessment clinic and evaluated mothers' experience using a questionnaire. We prospectively collected data from the specialist tongue-tie assessment clinic from January 2023 to October 2023 to assess factors that may influence a lingual frenotomy in an infant. Mothers were invited to complete two questionnaires, one baseline in the clinic waiting room and one follow-up, 4weeks after their clinic visit. These self-reported questionnaires assessed breastfeeding challenges, the mother's motivation for seeking an opinion regarding ankyloglossia, and the continuity of breastfeeding 4weeks following the clinic visit. During these 10months, 157 infants attended the clinic, and 96 frenotomies were performed. One hundred one participants completed baseline questionnaires, and 34 participants completed follow-up questionnaires. When mothers were asked why they wanted their baby assessed for a tongue-tie, the most common answers were difficulty with latch and nipple pain, reported by 45% and 40%, respectively. The average reported pain while breastfeeding was scored at 2.53, graded from 0 to 5 in the baseline questionnaire. This improved to 1.47 amongst women whose infants had a frenotomy. Conclusion: Our study suggests that performing a frenotomy in infants diagnosed with ankyloglossia may positively impact breastfeeding.

Ankyloglossia: misinformation vs. evidence regarding its effects on feeding, speech, and other functions

Ankyloglossia, commonly, known as “tongue-tie,” is a congenital condition where a short, and often thickened lingual frenulum attaches the anterior tongue tip to the floor of the mouth. As a result of this “tie,” there is a restriction of tongue-tip movement. While ankyloglossia is sometimes associated with difficulties in breastfeeding newborns, the impact on speech production remains a topic of serious debate among professionals. The purpose of this article is to examine the current evidence regarding the effect of ankyloglossia on structure and function, particularly the effect on neonatal feeding and speech. Hopefully, this evidence will inform the practice of otolaryngologists, speech-language pathologists, and other relevant professionals for the benefit of affected children.

LASER ASSISTED TONGUE TIE RELEASE:A CASE REPORT

Tongue is an essential oral structure that is associated with several functions that directly or indirectly affect the speech, swallowing, nursing, position of teeth in the arch, periodontal structures, nutrition and certain social activities. Ankyloglossia or Tongue tie is a congenital anomaly characterised by short, thick lingual frenum which thereby restricts the movement of the tongue and is associated with infant feeding difficulties, speech disorders, and various mechanical and social issues related to the inability of the tongue to protrude. It is not a serious problem, but it effects the day-to-day activities. Detection of this anomaly in any stage of life and its management improves the quality of life. Considering the high vascularity and mobile structure of the tongue, management using laser is the simplest, safest and less traumatic of all the treatment modalities available with most promising results. This case report discusses management of ankyloglossia using Diode LASER.

The diagnosis of short lingual frenulum and how to promote breastfeeding.

The diagnosis of short lingual frenulum and how to promote breastfeeding.

Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report.

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.

Evaluation of lingual oscillometric blood pressure measurement in anaesthetized pigs

ObjectiveTo evaluate the agreement between measurements of invasive blood pressure (IBP) and oscillometric blood pressure from the tongue (OBPton) using a multiparameter monitor. Study designUnblinded, prospective, experimental study. AnimalsA total of 12 female Large White crossbreed pigs. MethodsPigs undergoing experimental procedures that required arterial cannula placement were recruited. A blood pressure cuff with the closest width to 40% of the circumference of the tongue was placed rostral to the lingual frenulum. Systolic, mean and diastolic IBP and OBPton were measured simultaneously at 5 minute intervals. Agreement between paired measurements was examined using Bland–Altman analysis. Mean bias, precision (standard deviation of mean bias), 95% limits of agreement, correlation coefficients and percentage of measurements within 10 and 20 mmHg of IBP were calculated. ResultsThe total numbers of paired measurements recorded were 124, 126 and 124 for systolic, mean and diastolic blood pressures, respectively. The mean bias, precision and 95% limits of agreement for systolic OBPton were 11.5, 11.5 (–11.1 to 34.2), for mean OBPton 5.6, 5.7 (–5.7 to 16.8) and for diastolic OBPton 7.6, 10.1 (–12.1 to 27.4) mmHg. Correlation coefficients were greater than 0.9 for mean OBPton only. More than 50% of measurements were within 10 mmHg of IBP and 80% of measurements were within 20 mmHg of IBP for mean and diastolic OBPton only. Conclusions and clinical relevanceThe tongue as a cuff site for oscillometric blood pressure measurement is a useful site for measuring mean arterial, but not systolic or diastolic blood pressure in anaesthetized Large White crossbreed pigs. This technique fulfils the American College of Veterinary Internal Medicine criteria for measuring mean arterial pressure but not systolic or diastolic arterial pressure.

Upper Jaw Development After Lingual Laser Frenectomy and Myofuntional Therapy.

Over the years, the role of the lingual frenulum in the development of skeletal structures has been evaluated. However, the effect of short lingual frenulum treatment on bone structures is unclear. We need to investigate the effect of surgery and myofunctional therapy on maxillary development. This could be the rationale to establish an orthodontic interception protocol. The case-control study was carried out in the Operative Unit of Pedodontics of the University Dental Clinic, at the Department of Medical, Oral and Biotechnological Sciences of the University of "G. D'Annunzio" Chieti-Pescara. The study population consisted in thirty children. The data were collected through anamnesis carried out by qualified health personnel before dental examination. Photos, frenulum length and cast measurements were taken. Student's t-test statistical analysis was used. Significance was ascertained based on the obtained P value of less than 0.01. The results confirmed the benefit of laser surgical treatment. The change in parameters related to the anterior palate region showed the power of frenectomy and myofunctional therapy in restoring the tongue's ability to stimulate bone development. The protocol adopted in the following study could be used in interceptive orthodontics. However, further studies are needed to evaluate the effects on the upper jaw over the long term that have higher sample numbers.

Frenotomy for Ankyloglossia: Conventional technique under general anesthesia in pediatric patients

Introduction: Ankyloglossia, commonly known as tongue-tie, is a prevalent birth defect characterized by a shortened and taut lingual frenulum, resulting in various complications. It occurs more frequently in males and can lead to breastfeeding difficulties, poor weight gain, and challenges in oral hygiene. The purpose of this article is to discuss frenotomy as a surgical intervention for ankyloglossia, involving the removal of the lingual frenulum under general anesthesia. Case History: a 9-year-old male patient with class III ankyloglossia, experiencing difficulty in pronouncing words and maintaining oral hygiene due to a short lingual frenulum. Despite initial behavioral challenges, comprehensive dental treatment, including frenectomy under general anesthesia, was successfully performed. Discussion: Ankyloglossia, or tongue-tie, results from cellular degeneration of the lingual frenulum, often associated with a genetic mutation in the MTHFR gene, affecting folate processing. Tongue development involves the migration of muscles from pharyngeal arches, leading to attachment issues at the lingual frenulum, causing ankyloglossia. Untreated consequences include feeding difficulties, dental decay, and speech articulation challenges. Conventional frenotomy, a simple and efficient technique, offers rapid, cost-effective symptom relief, promoting smooth recovery and improved outcomes compared to laser procedures. Conclusion: frenotomy for ankyloglossia under general anesthesia effectively improves tongue mobility and alleviates associated symptoms. General anesthesia ensures patient comfort and facilitates precise execution of the procedure. The conventional frenotomy technique enhances tongue movements, highlighting the efficacy of surgical intervention for this condition.

Frenectomy management for Ankyloglossia in a 1-Year-old patient under general anesthesia: A case report

Introduction: Ankyloglossia is defined as a congenital disorder that alters tongue mobility and function. It is listed as one of the possible reasons behind breastfeeding issues. The WHO currently recommends mothers to breastfeed exclusively up to 6 months of age, emphasizing the importance of promptly identifying any breastfeeding obstacles and determining the root cause of the problems as the primary focus. The purpose of writing this article is to describe a frenectomy as a surgical procedure that addresses ankyloglossia by excising the lingual frenulum with general anesthesia. Case History: A 1-year-old male patient presented at Dr. Saiful Anwar Regional General Hospital with complaints of difficulty in breastfeeding and consuming complementary foods, as well as prolonged pain experienced by the mother during breastfeeding. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. The patient was uncooperative (Frankl scale number 1). After analyzing the ankyloglossia, the choice of frenectomy with general anesthesia was chosen to treat this case. Discussion: Dental examinations and treatments for uncooperative 1-year-old children can be challenging in regular dental offices. Effective behavioral management, such as general anesthesia (GA), is required for safe and efficient treatment. GA involves a multidisciplinary team to oversee the procedure stages, allowing for one-visit treatment, reduced anxiety, and a safer, less painful dental experience. Conclusion: Frenectomy procedure under GA has been performed as an option to facilitate restorative therapy, improve nutritional intake, and quality of life.

Management of Ankyloglossia with different severity: a case series in dental surgery

Introduction: The lingual frenulum is an important oral structure that plays an important role in the act of suction, speech, and feeding. Ankyloglossia (tongue tie) is a congenital anomaly that results when lingual frenulum is too short and adhere to tip of tongue, limiting the tongue movement. This case report aimed to explain management of Ankyloglossia with different severity. Case Report: This case report reported three cases of ankyloglossia with different ages and complaints of difficulty in feeding and speech. The patients were treated for lingual frenectomy procedure under general anesthesia using one haemostats method. The haemostats were used to clamp the upper aspect of frenulum which might have been helpful to guide the incision close to ventral surface of tongue. Care had to be taken not to injure the submandibular ducts when making incision at lower part of tongue. The result after 1 week of surgery: the wound was completely healed. Conclusion: Ankyloglossia will impair the function of suction, speech and feeding that affecting a considerable number of infants and children. It is important that accurate information and guidance are given to parents with regard to the indications and potential benefit of tongue tie revision. These case series offer guidelines which can be used by general and pediatric dentist for examination, diagnosis and treatment of ankyloglossia in different severity.KeywordAnkyloglossia, congenital, lingual frenulum

Expanding the phenotype in Pitt-Hopkins syndrome; description of new oral finding and dental management considerations

BackgroundPitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder with physical, cognitive, and behavioral characteristics that is caused by heterozygous mutations in the TCF4 gene. Patients with PTHS might present a unique challenge for oral healthcare professionals because of the associated comorbidities.Case reportHere we describe a new case of PTHS in a 13-year-old girl with particular emphasis on oro-dental findings and oral healthcare management. Observed oro-dental findings in our case included shallow palate, absence of lingual frenum, gingival enlargement, thick lips and relative microdontia. The patient was unable to tolerate dental care under local anesthesia. Therefore, comprehensive dental treatment was performed under general anesthesia after a careful pre-anesthetic cardio-respiratory, neurological, and hematological evaluation. The patient was closely monitored intra-operatively for breathing rhythm, O2 saturation, and signs of respiratory distress. The patient was observed for 24 h post-op for respiratory distress and was discharged then uneventfully.ConclusionDental treatment under general anesthesia in these patients might be complicated by the abnormal breathing rhythm, and close monitoring and follow up for signs of respiratory distress after general anesthesia is necessary. Recognition of oral and dental findings might help to expand the phenotype and better characterize rare syndromes.

Labial ankyloglossia - a case report on fusion of frenums

Labial ankyloglossia is a rare condition where the lingual frenum is found to be continuous with the labial frenum. It is a rare condition that can have a significant impact on a patient’s quality of life. Early recognition and appropriate intervention can lead to substantial improvements in speech, oral hygiene, and overall well-being. This case report underscores the importance of considering labial ankyloglossia as a differential diagnosis in patients with lip-related issues and highlights the potential benefits of surgical correction in improving lip function and aesthetics.

Ankyloglossia-Related Speech Articulation Correction in Orthodontics: A Case Report

The ability of the tongue to protrude and elevate is the most crucial characteristic for activities like eating, speaking, nursing, and the development of dental arches. When the lingual frenum is short and tight, it can hinder the movement of the tongue, leading to malalignment of anterior teeth and Speech Articulation. This article discusses a case report of a 20-year-old male patient with a chief complaint of speech difficulty, maxillary anterior teeth spacing, and mandibular anterior teeth crowding. There was lingual frenum attachment suggestive of mild ankyloglossia. Patient underwent a lingual frenectomy pro- cedure under local anaesthesia which resulted in speech correction and relief of lower anterior crowding. Maxillary anterior spacing and midline diastema was corrected with orthodontic mechanotherapy and labial frenectomy, re- spectively. In cases where the frenulum anomaly is severe enough to result in both mechanical and functional limitations, surgery to reduce the frenulum (frenulectomy) is recommended. In consequence, it is fair to state that the chief complaint of inappropriate speech of the patient need to be resolved by an interdisciplinary approach.

Use of laser in Pediatric Dentistry frenectomy surgery: A scoping review

The frenulum is a fold of the buccal mucosa made up of fibrous or fibromuscular tissue covered by a mucous membrane and may present an anomaly and may limit movements of the tongue or lips. Ankyglossia is an anomaly in the lingual frenulum characterized by limited movement, altering speech and swallowing. The treatment of this anomaly is called frenectomy, which is a small surgery, where the frenulum is excised, so that that region can move without limitations. Since the use of laser in dentistry has been growing nowadays, it has been a great ally in frenectomy surgeries because it presents better trans and postoperative conditions. The objective of this study is to report, the current scenario of laser frenectomy in Pediatric Dentistry. Methodology: This study was carried out through a systematic scoping review, using the keywords Lip frenulum, Lingual frenum, Laser therapy and Pediatric dentistry, pointing out the applications of lasers in frenectomy surgery in pediatric patients. Results: The search found 18 studies and noting that laser frenectomy is a safe procedure to be used in Pediatric Dentistry. Conclusion: It is concluded that the use of laser in frenectomy in pediatric dentistry patients is very well accepted by patients and dentists in relation to conventional surgery because it is less invasive, without intercurrences and less bleeding, positively interfering with the patient’s quality of life.

A closer look at ankyloglossia in children—A case series

ABSTRACT Ankyloglossia, often known as tongue-tie, is characterized by a small lingual frenum that obstructs normal tongue movement. It is a rare congenital oral abnormality. The most significant clinical symptom of movement restriction is evaluated clinically by requesting the patient to protrude and elevate their tongues, where the “heart-shaped” tongue can be seen. In children, ankyloglossia can lead to breastfeeding difficulties, speech disorders, poor oral hygiene, and bullying during childhood and adolescence. Regarding the management of ankyloglossia and its clinical importance, there are always divergent views. For successful outcomes, postoperative tongue exercises and speech therapy are essential. These treatments can also measure tongue motions to examine the sounds of letters and words. Recently, the laser approach has been frequently used in dentistry to treat children with ankyloglossia. The present clinical case series of ankyloglossia in children describes a variety of treatments, including electrocautery, laser, and scalpel. Kotlow’s classification, the patient’s age, and patient cooperation played a role in the treatment decision. All of the surgical methods described are effective, but they all call for a trained expert. Both the laser and the electrocautery methods were regarded as suitable for children and safe processes. This case series highlights the significance of early tongue-tie diagnosis and treatment to avoid complications and facilitate improvement in eating and speaking issues. Considering children’s fear and anxiety, laser frenectomy provides a more efficient and comfortable treatment for both the child patient and the dentist when compared to the other two methods.

Management of Ankyloglossia Using Conventional Surgical Technique: A Case Series

Periodontal plastic surgery is a more conservative and precise technique practised to create more functional and aesthetic results for the treatment of mucogingival problems. The presence of an aberrant frenum is one of the aetiological factors associated with the persistence of a midline diastema. Inadequate dental plaque removal, poor oral hygiene, bifid tongue, impaired speech, and mucogingival problems like recession and black triangles need more attention. Ankyloglossia, or tongue-tie, is a congenital anomaly with an abnormally short lingual frenulum. The aberrant frenum can be treated with surgical removal of the frenum using either frenectomy or frenotomy procedures. In the present case series, frenectomy was performed using a conventional scalpel technique for the treatment of tongue tie.

Relationship of ankyloglossia and obstructive sleep apnea: systematic review and meta-analysis.

Recent studies have highlighted the potential role of a short lingual frenulum as a risk factor for pediatric obstructive sleep apnea syndrome. A shortened frenulum may contribute to abnormal orofacial development, leading to increased upper airway resistance and susceptibility to upper airway collapsibility during sleep. Recognizing early indicators, such as a short lingual frenulum, is crucial for prompt intervention. This systematic review aims to evaluate the association between a short lingual frenulum and the risk of obstructive sleep apnea syndrome in children. This systematic review adheres to PRISMA criteria for a quantitative analysis. A comprehensive search was conducted on five databases until January 2024 to identify relevant studies. The selected articles underwent rigorous analysis, considering study design, sample characteristics, lingual frenulum characterization, sleep assessment methods, and key findings. A total of 239 references were initially identified. Finally, six studies were included in the qualitative synthesis, with four studies eligible for the quantitative synthesis. The Newcastle-Ottawa scale was employed to assess study quality. Meta-analysis, supported by a moderate evidence profile according to the GRADE scale, revealed statistically significant differences, with odds ratios of 3.051 (confidence interval: 1.939 to 4.801) for a short frenulum and 12.304 (confidence interval: 6.141 to 24.653) for a high-arched palate. This systematic review and meta-analysis provide evidence supporting the association between ankyloglossia and obstructive sleep apnea in children. Nevertheless, it is crucial to consider additional factors such as tongue mobility and the presence of a high-arched palate in further evaluations.

Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis.

Tongue-tie, which is also known as ankyloglossia, is a common condition where the lingual frenulum is unusually tight or short. While most literature investigates the impact of tongue-tie on breastfeeding, recent articles have examined its role in speech production in children. However, these have not previously been reviewed systematically. This study aims to determine the impact of tongue-tie on speech outcomes and assess whether frenectomy can improve speech function. In this systematic review, we conducted a comprehensive search of PubMed/MEDLINE, Cochrane Library, Embase, and speechBITE to analyze primary studies investigating the impact of frenectomy for tongue-tie on speech outcomes. We extracted data regarding patient age, male to female ratio, procedure type, follow-up time, and speech outcomes and ran statistical analyses to determine if frenectomy for tongue-tie leads to improvement in speech issues in pediatric patients. Speech outcomes extracted were subjectively measured based on the interpretation of a speech and language pathologist or parent. Our analysis included 10 studies with an average patient age of 4.10 years, and average cohort size of 22.17 patients. Overall, frenectomy for tongue-tie was associated with an improvement in speech articulation (0.78; 95% CI: 0.64-0.87; P < .01). Increasing patient age was found to be negatively correlated with post-frenectomy speech outcomes (P = .01). However, this relationship disappeared in the adjusted model. Overall, we conclude that frenectomy is a suitable treatment to correct speech issues in select patients with tongue-tie if caught early in childhood. Despite the limited investigations around speech outcomes post-frenectomy, these results are informative to providers treating tongue-tie.

Ankyloglossia in newborns: incidence and breastfeeding follow-up at 1 and 6 months.

Ankyloglossia is an anatomical variation of the lingual frenulum that negatively interferes with the functionality of the tongue. This condition can affect breastfeeding negatively. The aim of this study is to assess the prevalence of ankyloglossia among healthy babies born in Siena Hospital and the correlation between ankyloglossia and breastfeeding difficulties. We performed an observational prospective study conducted on healthy and breastfed newborns born in Siena Hospital in the period between January and June 2022. The evaluation of lingual frenulum in the first few days of life was performed by Martinelli's Lingual Frenulum Protocol with scores for Infants (MLFPI), while the clinical assessment of breastfeeding initiation was performed by the Breastfeeding Observation and Evaluation Form according to WHO-UNICEF guidelines. We also compared the reliability in predicting breastfeeding of a tool that measured the features of the tongue frenulum: the Bristol Tongue Assessment Tool (BTT). Breastfeeding at one and six months of babies' age was assessed by telephone interview, and information among children's nutrition, weight growth and difficulties found in breastfeeding was also collected. This study was approved by the Pediatric Ethics Committee for Clinical Trials of the Tuscany Region. One hundred and ninety infants were included in the study; 21 (11.05%) had a MLFPI score ≥13. Data at one month of age showed a statistically higher MLFPI score (P value <0.001) in babies with breastfeeding difficulties (median score 13.0, IQR 5.5-14), than in those without (median score 5.0, IQR 2.0-7.5). Data at 6 months of age showed a similar difference in babies with and without breastfeeding difficulties (median 12.0, IQR 4.0-14.0 vs. 5.0, IQR 2.0-8.0 respectively). A MLFPI score ≥13 is positively associated with breastfeeding difficulties at 1 and 6 months. Also, the BTT was positively a risk factor for problems in breastfeeding at 1 and 6 months. A high MLFPI score is a risk factor of breastfeeding difficulties. In these cases, a referral to experienced personnel is advisable: they can provide the emotional and professional support to the mother-child dyad, and/or refer for surgical evaluation and frenotomy. In our cohort, the usefulness of either MLFPI score or BTT was evident in predicting breastfeeding difficulties; the rate of surgical removal of the frenulum was nonetheless low.

Connections beyond the tongue: A scoping review on ankyloglossia and its influence on breastfeeding

Breastfeeding is considered the best source of nutrition for babies. Ankyloglossia, or tongue tie, is an alteration in the lingual frenulum that can interfere with this process. AimTo explore the potential factors related to ankyloglossia that influence breastfeeding, for both infant and mother. MethodScoping review, following the JBI steps, in the Cochrane, CINAHL, Embase, LILACS, Pubmed and BDENF databases. A total of 1174 articles were found. Results46 articles made up the study sample, comprising four themes: (1) Maternal experience; (2) Epidemiology; (3) Infant difficulties; (4) Breastfeeding interventions and changes. ConclusionAnkyloglossia was associated with breastfeeding difficulties and its assessment was more effective when two or more instruments were used. Frenotomy was relatively effective for resuming breastfeeding. The production of knowledge about the relationship between ankyloglossia and breastfeeding helps nurses to update scientific evidence.