Short Lingual Frenulum Research Articles

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

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

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.

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.

Short Lingual Frenulum as a Risk Factor for Cerebral Vasculopathies

Introduction: Tongue is the first functioning organ in the embryonic era. Its developmental alterations can result in malfunctions with damage in distant districts. Craniocervical anatomy suggests that tongue dysfunction may be involved in the damage to the arteriovenous encephalic flow. Objective: To evaluate the possible relationship between short frenulum and cerebral vasal problems. Method: We conducted an epidemiological research comparing the presence of vascular problems in families where the visited subject had short frenulum (which is a genetically transmitted pathology) and families where the visited subject did not have abnormality of the frenulum. Results: The presence of short tongue frenulum was correlated with the presence of episodes of vascular damage in about 80% of cases, while in families not affected by this tongue alteration the percentage of damage was between 10 and 13%. Conclusions: The enormous influence that the presence of an altered tongue frenulum seems to have on the future possibility of developing vascular problems should induce a more careful assessment of the presence of an incorrect-sized frenulum.

Atmospheric Plasma Lingual Frenectomy Followed by Post Operative Tongue Exercises: A Case Series.

The lingual frenulum is a submucosal component significantly involved in the mobility of the tongue. In the case of short lingual frenulum, different surgical approaches have been proposed. Atmospheric plasma is a thermal technique of vaporization or sublimation of the superficial tissues, without going deep, and the resulting fine carbonized layer avoids bleeding. The aim of the present investigation was to evaluate the effectiveness of atmospheric plasma (voltaic arc dermabrasion) for the frenectomy of a short lingual frenulum. A total of 30 patients with an age range between 6-11 years old and a class III/IV Kotlow's ankyloglossia classification were included in the study. The Kotlow's free-tongue, maximal interincisal mouth opening (MIO, mm) and interincisal mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP, mm) were calculated at the baseline, immediately postoperatively (T0), at one week (T1), one month (T2) and two months (T3). A significant increase of Kotlow's measurements, MOTTIP and MIO were detected when comparing the baseline and the T0 (p < 0.05). No significant difference was detected between the T0, T1 and T2 (p > 0.05). The atmospheric plasma demonstrated a very minimal invasive approach for frenectomy, without important or fibrotic complications and with very low recurrence rates.

Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? Case Report and Systematic Review.

Ankyloglossia (tongue-tie) is a condition of the oral cavity in which an abnormally short lingual frenulum affects the tongue's mobility. Literature on the correlation between ankyloglossia and obstructive sleep apnea (OSA) is scarce. The main objective of this study was to report our preliminary experience in adult OSA patients before and after ankyloglossia treatment, using drug-induced sleep endoscopy (DISE) to evaluate the upper airway modifications resulting after treatment, and to present a systematic review of the impact of ankyloglossia and its treatment on OSA adults. We found that, after frenotomy, regarding the DISE findings, and according to the VOTE classification, two of the three patients showed an improvement in tongue level, from 2A-P (complete anteroposterior collapse) to 1ap (partial anteroposterior collapse). The third patient showed no changes in his UA after frenotomy, neither worsening nor showing improvement. Thus, the results of this study suggest that frenotomy in OSA patients with ankyloglossia could reduce tongue collapse, probably by allowing the tongue to take into the physiological position in the oral cavity. These patients should undergo speech therapy and oropharyngeal exercises prior to any surgical procedure, in order to avoid glossoptosis and to improve the quality of life and sleep apnea results.

Grouping of Ankyloglossia According to Coryllos Anatomical Classification and Follow-Up Results for Breastfeeding: Single-Center, Cross-Sectional Study.

Ankyloglossia is a condition of limited tongue mobility caused by a short lingual frenulum. The diagnosis and treatment of ankyloglossia are still controversial. The main clinical problems encountered during breastfeeding are difficulty in sucking and its clinical reflections. This study aims to evaluate the infant population born with ankyloglossia and to determine the results of frenotomy. We conducted an observational, cross-sectional study among infants born in a tertiary hospital. We included all infants born between 1 January and 30 June 2022. The neonatal follow-up protocol for ankyloglossia was determined before the defined dates, and data were recorded during the screening period. The recorded data were retrospectively collected from the files. Within six months, 705 infants were born. Due to additional problems and other conditions that prevent breastfeeding, evaluable data of 207 (29.3%) infants could not be provided. Of the remaining 498 infants, 234 (33.2%) had ankyloglossia. While none of the infants without ankyloglossia had a breastfeeding problem after appropriate training, 28.6% of the ankyloglossia group had a breastfeeding problem (p < 0.001). The need for frenotomy differed significantly between Coryllos groups (p < 0.001). Breastfeeding was unsuccessful before frenotomy in 12 Coryllos type-1 patients, and all had difficulty in sucking. Frenotomy was performed within the three-month follow-up period in all patients with complaints of inability to firmly grasp the breast, nipple slipping from the mouth, and nipple biting during the first 24 h. In terms of breastfeeding problems, regardless of the anatomical typology, frenotomy can be performed safely in early life with successful results. If deficiencies or difficulties in breastfeeding are noticed in ankyloglossia patients even at the first control, frenotomy should be recommended in clinical conditions.

The current knowledge about ankyloglossia

Introduction: The topic of tongue tie causes a lot of discussion among specialists in areas of interest. The term ankyloglossia has been defined as a state of the lingual frenulum hindering its motor function. Aim: The aim of the study is to present the current views on the short lingual frenulum. Material and methods: The literature from 20192021 on this topic was searched for in PubMed and Google Scholar using keywords. Results: Ankyloglossia is a congenital abnormality that can cause difficulties in breastfeeding newborns and infants and that is the most important problem of this structure. Discussion: The affected sucking reflex generates further dysfunctions in the area of the oropharyngeal space, which may lead to malocclusion and speech impediments. The procedure of frenotomy is primarily aimed at achieving the correct tongue motility. High individual variability in the structure of the frenulum and the occurrence of compensation mechanisms among newborns who suck the breast incorrectly, make it difficult to develop a universal classification for assessing the indications for surgery. The current state of knowledge justifies the need for further, extensive interdisciplinary research and reaching a consensus regarding the procedure.

Evaluation of tongue mobility following release operation of ankyloglossia with genioglossus myotomy.

Ankyloglossia is a congenital anomaly characterized by a short lingual frenulum and severe form needs release surgery. Our goal in this study was to confirm the long-term safety and efficacy of Z-plasty with genioglossus myotomy compared with traditional Z-plasty alone and to develop a proper measurement tool to validate the postoperative results of release operations for ankyloglossia. Patients were divided in 2 groups, release with Z-plasty only group (group 1) and Z-plasty combined with genioglossus myotomy group (group 2) In group 2, the release of central longitudinal fiber of genioglossus muscle was added in the conventional Z-plasty operative procedure. To analyze the results of the surgery, we developed an objective assessment tool which is the direct length from the innermost point of the floor of mouth to the tip of the tongue, preoperatively and postoperatively, which is called “functional tongue length.” A total of 101 patients with ankyloglossia ranging in age from 36 months to 8 years underwent release operation. Although there was no significant difference in terms of postoperative measurements between groups in Kotlow class II, group 2 patients in Class III and IV showed greater postoperative functional tongue length. Also, there was no significant complication requiring secondary surgery. Our study demonstrated that adding genioglossus myotomy to a simple Z-plasty is a safe and effective method for improving the tongue mobility required to make lingual sounds, especially in moderate to severe form of ankyloglossia, along with suggestion of a new measurement tool, which can objectively assess tongue mobility with possibility for universal utilization in ankyloglossia release operation.

A minimally invasive surgical approach for treatment of ankyloglossia (Tounge Tie) with diode laser: A case report (A developmental anomaly)

Tongue tie otherwise called as Ankyloglossia is a developmental anomaly commonly characterized by a very short lingual frenulum that literally restricts the movements of tongue from the floor of mouth. An uncommon thick band extending beneath the ventral surface of tongue to floor of the mouth. This represents a uncommon length of the lingual frenulum. This causes problems in daily life of the person who was affected with the following difficulties of speech, deglutition, poor oral hygiene etc. This article reports a 19 year college going guy came to the department with the complaint of difficulty in speech and poor oral hygiene. The case was successfully treated with a soft tissue diode laser and followed up.

Relationship between short lingual frenulum and malocclusion. A multicentre study

ObjectiveAnkyloglossia is characterized by an abnormally short lingual frenulum, which impairs tongue movement. Ankyloglossia has been related to craniofacial growth disturbances and dental malocclusion. But even though there is a clear biological plausibility for this hypothesis, available evidence is scarce. MethodsA case–control design was followed. Patients between 4 and 14 years old were routinely screened for short lingual frenulum and recruited from the pediatric Otolaryngology consultation of 3 Spanish tertiary referral hospitals. Lingual frenulum was assessed with the Marchesan system. A cohort of cases with short lingual frenulum and a cohort of healthy controls matched for sex and age were included. Both cases and controls had pictures of occlusion. Occlusion was evaluated by an expert in orthodontics, blinded for the frenulum assessment. ResultsA total of 100 participants were included, 70 males and 30 females. The proportion of malocclusion in the short lingual frenulum group was 48%, while it was 24% in the normal frenulum group. The odds ratio of malocclusion for the short lingual frenulum patients was 2.92 (CI 95% 1.15–7.56). The difference was statistically significant (p=.012). This difference was significant for patients with class III occlusion (p=.029). There was no difference for patients with class II (p=.317). ConclusionsThis work supports the hypothesis that relates class III malocclusion with a short lingual frenulum.

Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review.

Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.

Oral cavity morphology among children at risk of sleep disordered breathing.

The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB). The study included children 3-17years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum. A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group. The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.

Reduced tongue mobility: an unrecognized risk factor of childhood obstructive sleep apnea.

Childhood obstructive sleep apnea (OSA) is an important and prevalent disease. A short lingual frenulum is a risk factor for OSA, but whether tongue mobility also plays a role in OSA etiology remains unknown. This study aimed to examine tongue mobility in children with and without OSA. We hypothesized that reduced tongue mobility was associated with OSA. We also evaluated the relationship between tongue mobility and craniofacial profile. This was a cross-sectional case-control study. Prepubertal Chinese children aged 5-12 years, suspected to have OSA were recruited from our sleep disorder clinic. All subjects underwent overnight polysomnography. The lingual frenulum was evaluated based on tongue mobility and free tongue length. Craniofacial measurements were assessed by lateral cephalometry. Eighty-two subjects (mean age: 8.32 ± 1.70 years, 57 males) were recruited. The mean tongue mobility was 58.2 (±19)% and 67.4 (±15)% (p = 0.019) in subjects with and without OSA, respectively. Tongue mobility was inversely correlated with OAHI (r = -0.218, p = 0.049). In multivariate logistic regression, low tongue mobility was independently associated with a higher risk of OSA after adjustment for age, sex, body mass index z-score, presence of large tonsils and turbinates, and nocturnal oral breathing (odds ratio = 3.65, 95% CI = 1.22 to 11.8). Tongue mobility was found to correlate with the cranial base angle (Ba-S-N) (r = 0.262, p = 0.018), which determines the relative position of the mandible. In prepubertal children, reduced tongue mobility is associated with the occurrence and severity of OSA. Assessing tongue mobility is recommended in childhood OSA management.

Relationship between short lingual frenulum and malocclusion. A multicentre study

ObjectiveAnkyloglossia is characterized by an abnormally short lingual frenulum, which impairs tongue movement. Ankyloglossia has been related to craniofacial growth disturbances and dental malocclusion. But even though there is a clear biological plausibility for this hypothesis, available evidence is scarce. MethodsA case–control design was followed. Patients between 4 and 14 years old were routinely screened for short lingual frenulum and recruited from the pediatric Otolaryngology consultation of 3 Spanish tertiary referral hospitals. Lingual frenulum was assessed with the Marchesan system. A cohort of cases with short lingual frenulum and a cohort of healthy controls matched for sex and age were included. Both cases and controls had pictures of occlusion. Occlusion was evaluated by an expert in orthodontics, blinded for the frenulum assessment. ResultsA total of 100 participants were included, 70 males and 30 females. The proportion of malocclusion in the short lingual frenulum group was 48%, while it was 24% in the normal frenulum group. The odds ratio of malocclusion for the short lingual frenulum patients was 2.92 (CI 95% 1.15–7.56). The difference was statistically significant (p=.012). This difference was significant for patients with class III occlusion (p=.029). There was no difference for patients with class II (p=.317). ConclusionsThis work supports the hypothesis that relates class III malocclusion with a short lingual frenulum.

The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study.

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.

Ankyloglossia treatment using Er;YSGG laser

Ankyloglossia or tongue tie is a congenital anomaly of the tongue characterized by a short lingual frenulum which may result in restriction of tongue movement or speech articulation problems. Ankyloglossia can lead tovarious problems, such as difficulties in breastfeeding in infants, maternal pain, and poor oral hygiene. Tonguetie can be treated with surgical modalities include frenotomy or frenectomy. In addition to surgical intervention,LASER therapy using a local anesthetic have been described. This case is about an ankyloglossia treatmentusing Er;YSGG laser.

Ankyloglossia and its surgical management

Ankyloglossia or tongue-tie is the result of a tight and short lingual frenulum which causes difficulty in breast feeding, eating and speech articulation due to limited tongue movement. In this condition, the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short lingual frenum. In this article, we have reported a 26 year old female patient with tongue-tie who complained of difficult in speech. She underwent frenectomy procedure under local anaesthesis without any complications. This was followed by speech therapy sessions.