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Tongue-tie (ankyloglossia) is a relatively common congenital anomaly characterised by an abnormally short lingual fraenulum, causing limitation of tongue mobility. There have been immense controversies regarding diagnosis, clinical significance and management of such condition hitherto. Although most tongue-tie babies are asymptomatic without feeding difficulties, operative corrections may be necessary in some cases to improve their breastfeeding. Using a meta-narrative reviewing study design, the aim of this concise review was to demonstrate the current evidences for surgical indications, optimal type and timing, and functional improvement from tongue-tie surgery. We reviewed and discussed the included evidences based on five topics: (1) basic sciences, (2) clinical equipoise, (3) anaesthesia during childhood, (4) evidence-based practice and surgical meta-analyses, and (5) appropriate patient assessment in routine paediatric practice.

Infants with posterior tongue-tie (PTT) can have substantial difficulty with breastfeeding and bottle-feeding. This study aimed to address the dearth in investigational objective data surrounding PTT release to better quantify the postoperative impacts of frenotomy for ankyloglossia.Prospective randomized, controlled trial.Private practice clinic.In a prospective, randomized controlled trial, infants 3 to 16 weeks of age with PTT undergoing frenotomy were examined using a bottle-feeding system capable of objectively measuring tongue function. Validated patient-reported outcome measures were also obtained simultaneously.Forty-seven infants with PTT were enrolled into an observational/control arm (n = 23) or interventional/surgical treatment arm (n = 24). The total cohort consisted of 29 (61.7%) male infants with a median age of 39 days. At the day 10 time point, the interventional arm demonstrated statistically significant improvement in 11 objectively obtained feeding metrics, indicating faster tongue speed, more rhythmic and coordinated sucking motions, and a tongue more capable of adapting to varying feeding demands. Significant improvement in breastfeeding self-efficacy was reported in the interventional group while poor self-confidence persisted in the observational group. Infant reflux symptoms improved in the interventional group while not in the control group. Nipple pain also persisted in the control group but improved in the surgical cohort.When measured 10 days after frenotomy for PTT, infants improve feeding parameters using an objective bottle-feeding system. Similar improvements are seen with patient-reported outcomes when PTT is released. Posterior tongue-tie is a valid clinical concern, and surgical release can improve infant and maternal symptoms.

The aim of this study was to compare, respectively, postoperative pain, wound healing, and patient satisfaction following lingual frenum extension treated with the Erbium Yttrium aluminum garnet. (Er:YAG) laser or the conventional scalpel. Twenty-eight patients receiving lingual frenectomy were randomly assigned to the Er:YAG laser group (n = 15) or the traditional scalpel group (n = 13). The surgical parameters were set to 3W or 4W basing on types of the lingual frenum when the Er:YAG laser was working. The same procedure was applied to the traditional scalpel group with transverse incision and longitudinal suture. The postoperative pain, wound healing and patient satisfaction were evaluated at 3 hours, 3, 7, and 30 days after operation. The visual analog scale score of postoperative pain in Er:YAG laser group was lower than that in traditional scalpel group at each time point. The wound healing score of the laser group were significantly lower than that of the traditional scalpel group at 3 and 7 days after surgery. There was no significant difference in mental, diet, and language satisfaction between the 2 groups at different time points after operation. In conclusion, Er:YAG laser was superior to the scalpel regarding minor soft-tissue surgery, and it could relieve the pain and discomfort of patients in the early stage of wound.

Purpose: The primary objective of this systematic review was to determine if frenotomy for ankyloglossia improves breastfeeding or speech outcomes in infants and children ages birth to 12.Method: L...

The aims of the study were to describe tongue function in infants experiencing breastfeeding difficulties and to examine changes in breastfeeding after frenotomy procedures. Mothers, and their infants, facing difficulties in breastfeeding were referred to the Vilnius University hospital Žalgirio clinic after assessment of breastfeeding quality by a lactation specialist. Anatomy evaluations included the type of ankyloglossia, tongue function, and the need for a frenotomy. All mothers completed the breastfeeding questionnaire twice, once during the referral consultation and 1 month later. The total breastfeeding hindrance score was calculated before and after the frenotomy. Fifty infants were included in the study and their mean age was 29.6 days (min age 1 day and max 78 days). The male to female ratio was 1.8:1.0. Of all infants, 70% had severe lingual function alterations and their mothers were facing issues in breastfeeding. After the frenotomy, there was a significant reduction in breastfeeding hindrance in infants who had disturbed function and aberrant anatomic characteristics. It was found that for type II ankyloglossia, the frenotomy procedure was significant more (p = 0.002) beneficial, than for type I ankyloglossia. After the frenotomy, there was a significant improvement in nine out of 14 criteria of breastfeeding (p = 0.001). Frenotomy procedures had a positive effect on improving breastfeeding. Current study analyses issues with breastfeeding. Dental practitioners and pediatricians should be familiar with this topic, as early and timely minimal invasive surgical intervention has a significant impact for better comfort of the mothers and continuation of breastfeeding.

Background A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one‐third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two‐thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual‐palatal suction (LPS). Objective This study aims to explore the utility and normative values of TRMR‐LPS as an adjunct to functional assessment of tongue mobility using TRMR‐TIP. Study Design Cross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population. Methods Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate. Results There was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R2 0.31 vs 0.05, P

The frenum is defined as a mucous membrane fold which attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frenum may hamper the gingival health if it is attached too closely to the gingival margin. The management of such an aberrant frenum is by performing a frenectomy/frenotomy. While performing frenectomy, conventional scalpel techniques have their own traditional drawbacks. To overcome them newer techniques like electrosurgery and lasers are increasingly used in routine periodontal practice. The present article is a report of two cases of frenectomy; first case is management of an aberrant maxillary labial frenum causing midline diastema and second case is management of an aberrant lingual frenum leading to complete ankyloglossia; both using electrosurgery. Electrosurgery has been defined as the intentional passage of high-frequency waveforms or currents through the tissues of the body to achieve a controllable surgical effect. Electrosurgery is a continuously evolving field with active research into various new applications.

Aim The aims of this systematic review were to first identify and summarise original research that compared symptoms of problematic feeding in infants with tongue tie before and after frenotomy and then evaluate the quality of measures used to assess problematic feeding. Methods CINAHL and PubMed were searched for ((tongue-tie) or (ankyloglossia)) and ((feeding) or (breastfeeding) or (bottle-feeding)) and ((frenotomy) or (frenectomy) or (frenulectomy) or (frenulotomy)). Original research reporting on feeding before and after frenotomy in infants under 1 year old was included. Results Maternal nipple pain, breastfeeding self-efficacy and LATCH scores improved after frenotomy. Few data are available on the effect of frenotomy on infant feeding. The measures used to assess infant feeding were not comprehensive and did not possess strong psychometric properties. Conclusion Literature suggests that maternal nipple pain, self-efficacy and LATCH scores improve in breastfeeding mother-infant dyads after frenotomy. However, current literature does not provide adequate data regarding the effect of frenotomy on the infant's ability to feed or which infants benefit from the procedure. Future research should utilise comprehensive, psychometrically sound measures to assess infants for tongue tie and to evaluate infant feeding to provide stronger evidence for the effect of frenotomy on feeding in infants with tongue tie.

To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population.A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed.Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques.Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.

The tongue is normally ankylosed to the floor of the mouth in utero. During fetal development, the ankylosed tongue is released from the floor of the mouth by apoptosis of the cells of the lingual frenum so that by the time of birth, the tongue is freely movable at one end. A critically important developmental anomaly - failed or incomplete apoptosis of the ankylosed tongue adversely affects growth of the face and jaws. This can have a significant impact on the growth and positioning of the infant's oral structures, leading to less than ideal maxillomandibular growth. Laser ankyloglossia release, performed as early as the second day of life, has the potential to prevent oral dysfunction and obviate the need for significant orthodontic therapy.

Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure ( P = .008), 76% (16/21) of slow eaters ate more rapidly ( P < .001), and 72% (23/32) of restless sleepers slept less restlessly ( P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.

Objective: To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding. Methods: This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test). Results: The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410 mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p = 0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p = 0.028). Conclusion: Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important. Resumo Objetivo: Caracterizar o frênulo lingual de recém-nascidos a termo, utilizando dois protocolos diferentes e verificar a relação do frênulo lingual com o aleitamento materno. Método: A amostra não probabilística foi constituída por 449 binômios mãe/bebê. Para a avaliação anatomofuncional do frênulo, utilizou-se o protocolo de avaliação do frênulo lingual para bebês “Teste da Linguinha” e o Bristol Tongue Assessment Tool. A mamada foi avaliada com o protocolo proposto pelo UNICEF. Foram criados escores (bom, regular, ruim) para avaliar cada aspecto da mamada a ser observada. Os resultados foram analisados através de estatísticas descritivas e inferenciais e testes de associação (Qui-quadrado de Pearson e Exato de Fisher). Resultados: O estudo mostrou que 14 bebês apresentaram alteração de frênulo lingual, nos quais três com dificuldade durante a sucção, necessitando de frenotomia na primeira semana de vida e 11 sem dificuldades durante a amamentação. Quanto à avaliação da mamada, 410 binômios mãe/bebê apresentaram o escore bom, 36 regular e 3 ruim. Houve associação estatisticamente significativa entre o protocolo “Teste da Linguinha” e amamentação (p = 0,028) e entre o protocolo Bristol Tongue Assessment Tool e amamentação (p = 0,028). Conclusão: Alterações no frênulo lingual estão associadas a interferências na qualidade da amamentação, sendo importante a avaliação do frênulo lingual em recém-nascidos.

To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements.An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery.After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum.This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.

To relate maxillary and lingual frenulum configuration to breastfeeding success.Cross-sectional study.Newborn nursery in tertiary care academic hospital.Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded.A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores (We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.

Ankyloglossia or tongue-tie is caused by an abnormally short, thick lingual frenum restricting the normal movements and functions of tongue. The lingual frenum may be fibrous or muscular and the tie may be complete or partial. This article describes the surgical management of an 18 year old female patient with ankyloglossia associated with reduced tongue mobility and speech difficulty. The treatment included frenectomy using a diode LASER accompanied by tongue training exercise and speech therapy. The patient showed increased tongue movements with uneventful healing after six months. Keywords: Ankyloglossia, Lingual frenectomy, Diode LASER.

Background Recent evidence has emphasized the role of a short lingual frenulum in the pathogenesis of sleep-disordered breathing (SDB) in childhood. The oral dysfunction induced by a short frenulum may promote oral−facial dysmorphism, decreasing the size of upper airway lumen and increasing the risk of upper airway collapsibility during sleep. The aim of this study was to evaluate the presence of a short lingual frenulum as risk factor for SDB in children of school age, with and without snoring, who were recruited from the community. Methods Children aged 6–14 years were recruited from a school in Rome. For all participants, the previously described Sleep Clinical Record (SCR) was completed, and orthodontic evaluation and measurement of lingual frenulum were performed. Tongue strength and endurance were evaluated in all participants using the Iowa Oral Performance Instrument (IOPI). SDB was defined as positive SCR (≥6.5). Results We assessed 504 children with mean age of 9.6 ± 2.3 years, and in 114 of them (22.6%) a short frenulum was identified. Children with a short lingual frenulum were at significantly higher risk for a positive SCR compared to those with a frenulum of normal length (odds ratio = 2.980, 95% confidence interval = 1.260–6.997). Participants with positive or negative SCR did not differ in tongue strength or endurance. Conclusion Short lingual frenulum is a risk factor for SDB. An early multidisciplinary approach and screening for SDB are indicated when this anatomical abnormality is recognized.

Objective The primary purpose of this study was to develop an operational definition of the oral condition of ankyloglossia (also called tongue-tie) that occurs in newborns (i.e., age birth–6 months) and that could consistently be used in research studies. Study Design This 4-round Delphi survey developed the consensus New York University–Tongue-Tie Case Definition (NYU-TTCD) by using a panel of ankyloglossia treatment experts. Results This tongue-tie case definition (TTCD) was carefully created in a step-wise manner from the bottom up by expert panelists over 4 rounds of inquiry. As a functioning case definition, it offers the diagnostician 2 separate pathways to identifying a newborn as being tongue tied. One pathway requires but a single pathognomonic anatomic feature, and the other pathway requires a single functional deficit accompanied by at least 2 of 12 other diagnostic items (functional, anatomic, or behavioral). Conclusions This Delphi survey, as administered to a panel of ankyloglossia treatment experts, produced the first consensus case definition of tongue-tie for newborns (i.e., age birth–6 months) for use in epidemiologic research studies ranging from descriptive prevalence studies to clinical trials. Next-step studies should establish the validity, reliability, and utility of this novel NYU-TTCD case definition for epidemiologic and clinical purposes.

GAPO syndrome is an entity with multiple congenital anomalies syndrome involving connective tissue characterized by growth retardation, alopecia, pseudoanodontia, and optic atrophy (GAPO) syndrome. To date, only approximately 45 cases of this extremely rare syndrome have been reported. We present thee case of a 9-year Indian male patient with GAPO syndrome in association with craniosynostosis along with degenerating optic nerve, short stature, partial anodontia, abnormally thick maxillary buccal and lingual frenum, born first to parents showing consanguineous marriage; however, the intelligence quotient of the child was good.

Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50% of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients.El frenillo lingual corto, o anquiloglosia, puede generar problemas durante la lactancia con repercusión en el desarrollo del lactante, daño en el pezón de la madre y abandono precoz de la lactancia. Actualmente no existe homogeneidad en los criterios diagnósticos, lo que ocasiona tanto sobrediagnóstico como infradiagnóstico de esta alteración, con las consecuencias clínicas que ello conlleva. La dificultad en el abordaje radica en saber cuándo se trata de variantes anatómicas normales o de un frenillo lingual sin repercusión funcional, y cuándo los problemas de lactancia, que clásicamente se le atribuyen, se deben realmente al frenillo. Alrededor del 50 % de los niños con frenillo lingual corto no presenta problemas de lactancia o estos se resuelven con apoyo y asesoramiento. En el resto de casos se puede recurrir a tratamiento quirúrgico. En este artículo se ha realizado una actualización de la clasificación y tratamiento de la anquiloglosia que permitirá a los profesionales un manejo adecuado de estos pacientes.

Ankyloglossia is a condition present in some newborns and can be associated with breastfeeding difficulties, leading to symptoms in the child and the mother. This study aimed to analyze the characteristics of newborns with tongue-tie and the symptoms reported by their mothers, and the short and long-term outcomes of frenotomy.We conducted a prospective and observational 7-month study in a Baby-Friendly Hospital (BFH). We included all the breastfed newborns without comorbidities that underwent a frenotomy.A total of 33 frenotomies were performed. The most common findings before the procedure were maternal breastfeeding pain (29/33), ineffective latch (18/33), and maternal nipple lesions (18/33). We observed that newborns surgically intervened later showed a high incidence of jaundice (p = 0.03), weight loss greater than 10% at hospital discharge (p = 0.004), and their mothers experienced pain more often (p = 0.004). At one month of age, there was an improvement in breastfeeding-related pain (p = 0.012) and its intensity (p = 0.016), the presence of maternal cracked nipples (p0.01), and latching on (p0.01).Ankyloglossia can prevent the correct establishment of breastfeeding. Frenotomy is associated with few complications, and when appropriately indicated, may have a positive impact on breastfeeding, reducing maternal pain, the presence of nipple lesions, and latching problems.La anquiloglosia está presente en algunos recién nacidos y puede interferir en el amamantamiento, produciendo sintomatología en el niño y en la madre. El objetivo de este estudio fue analizar las características de los recién nacidos con anquiloglosia, así como la sintomatología referida por sus madres, y la evolución tras la frenotomía.Estudio observacional analítico prospectivo de las frenotomías realizadas en la planta de maternidad de un hospital IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia) durante 7 meses. Se incluyeron todos los recién nacidos alimentados inicialmente con lactancia materna a quienes se realizó una frenotomía.Se realizaron 33 frenotomías. Los hallazgos más frecuentes previos a la frenotomía fueron dolor con las tomas (29/33), dificultad en el agarre (18/33) y presencia de grietas (18/33). Asimismo, se vio que los pacientes intervenidos más tarde presentaban con mayor frecuencia ictericia (p = 0.03) y pérdida de peso superior al 10% previa al alta (p = 0.004), y sus madres presentaron dolor con mayor frecuencia (p = 0.004). Al mes de vida se observó la mejoría del dolor con las tomas (p = 0.012) y su intensidad (p = 0.016), la presencia de grietas (p0.01) y el agarre al pecho (p0.01).La anquiloglosia puede impedir el correcto establecimiento de la lactancia materna. La frenotomía presenta escasas complicaciones y, cuando está bien indicada, puede mejorar el amamantamiento, reduciendo el dolor, la presencia de grietas y las dificultades en el agarre.

Ankyloglossia, commonly called “tongue-tie,” has been increasingly diagnosed in the breast-feeding infant, with growing numbers of surgical interventions in the last 2 decades. As more practitioners have become involved in the diagnosis and treatment, there has not been a consensus on terminology and indications for intervention. In 2020, the American Academy of Otolaryngology - Head and Neck Surgery Foundation reviewed the bodies of lactation, dental, pediatric, and otolaryngology literature to seek professional consensus and note areas requiring more definitive evidence. This article highlights the findings for the general pediatrician seeking to support breast-feeding dyads. [ Pediatr Ann . 2021;50(8):e310–e312.]

Resumen Introducción: El objetivo de esta revisión es responder al interrogante: ¿cuál es la metodología más eficaz de evaluación de frenillo lingual en neonatos? Bajo los parámetros de objetividad, claridad y validación. Métodos: El estudio se realizó a través de una revisión sistemática, llevada a cabo con metodología Cochrane, en la que se utilizaron los descriptores de evaluación, frenillo lingual, anquiloglosia y recién nacido, y ejecutado en los bancos de datos Pubmed, Science Direct, Scielo. Para analizar el nivel de evidencia y grado de recomendación clínica, se tuvo en cuenta la clasificación GRADE y CEBM de Oxford. Resultados: Por medio de la revisión se encontraron 2 evaluaciones y un tamizaje específicamente para recién nacidos, que evalúa de los 0 a los 30 días, los cuales se validan por medio de estudios de especificidad. Análisis y discusión: Se identificó que los principales parámetros para diagnosticar una alteración en el frenillo lingual son la anatomía y su funcionalidad. Conclusiones: Según los estudios encontrados sí existe un método eficaz para el diagnóstico del frenillo lingual en neonatos. Abstract Introduction: The objective of this review is to answer the question: What is the most effective methodology for assessing lingual frenulum in neonates? Under the parameters of objectivity, clarity and validation. Methods: The study was conducted through a systematic review carried out using the Cochrane methodology, in which the evaluation descriptors, lingual frenulum, ankyloglossia, and newborn were used, and developed in the Pubmed, Science Direct and Scielo data banks. To analyze the level of evidence and degree of clinical recommendation, the GRADE and CEBM classification of Oxford was taken into account. Results: Through the review we found 2 evaluations and a screening specifically for newborns that evaluates from 0 to 30 days, which are validated through specificity studies. Analysis and discussion: It was identified that the main parameters to diagnose an alteration in the lingual frenum are its anatomy and functionality. Conclusions: According to the studies found, there is an effective method for the diagnosis of the lingual frenulum in neonates.

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.

Introduction The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods The sample consisted of 334 infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. For mothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.

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.

AIM To investigate the incidence and characteristics of complications arising from frenotomy for ankyloglossia (tongue-tie) in New Zealand. METHODS Prospective surveillance among hospital-based paediatricians of complications arising from frenotomy for ankyloglossia to children

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.

During the last decade, increasing awareness of breastfeeding and its health benefits has not been reflected in the provision of lingual frenotomy in neonates with tongue-tie. This could be because of inconsistencies in our understanding of the importance and treatment of ankyloglossia. In this review, we discuss the current clinical guidance on diagnosis and management, and the future of such a service in the early postpartum period.

Our objective was to determine if there are differences in caregiver perception of speech for patients that undergo frenulectomy compared to patients that were not surgically treated.Ankyloglossia is a controversial topic without standardized treatment guidelines. Although there have been several studies suggesting that breastfeeding does improve after frenulectomy, there is a paucity of literature that investigates the relationship between ankyloglossia and speech.A retrospective chart review was conducted to identify patients with ankyloglossia. Patients were categorized into surgical treatment (frenulectomy) and non-treatment groups. Caregivers of both groups were contacted by phone and surveyed on speech quality and tongue mobility using Likert scores. Mann Whitney-U testing was used to determine if there were significant differences in perceived speech quality between the surgical and non-surgical groups.The caregivers of seventy-seven patients participated in the phone survey: 46 (60%) children in the surgical group and 31 (40%) children in the non-surgical group who participated in the phone survey. There were no differences in difficulty with speech (p = 0.484) and tongue mobility (p = 0.064) between the two groups. However, patients that underwent surgical intervention for ankyloglossia reported less difficulty with tongue tasks (p 0.001) compared to those who were not surgically treated. Additionally, 50% of patients that underwent surgery had a documented family history of ankyloglossia which was significantly higher than 16.1% in the non-surgical group (p = 0.002).It appears that children with ankyloglossia might have similar speech quality following frenulectomy in comparison to speech quality without treatment. Children who undergo frenulectomy may experience improvements in tongue tasks. This data should encourage further research on the management of speech concerns in children with ankyloglossia.

A Esclerose Sistêmica é uma doença autoimune sistêmica, progressiva, de etiologia desconhecida e relativamente rara. Caracteriza-se pela excessiva deposição de colágeno no tecido conjuntivo, pelo espessamento da pele, comprometimento de órgãos nobres internos e do sistema estomatognático. Objetivo: Caracterizar o frênulo e os aspectos da língua de indivíduos com esclerose sistêmica. Método: Trata-se de um estudo exploratório clínico, observacional, do tipo relato de casos. Foi realizada avaliação clínica do frênulo e dos aspectos da língua com um grupo de estudo composto por onze sujeitos, de ambos os sexos, oriundos do serviço de Reumatologia do Hospital Universitário em parceria com o grupo de estudo em motricidade orofacial, ambos da Universidade Federal de Sergipe, e de um grupo controle pareado em número, idade e sexo, sem doenças reumáticas, selecionados por conveniência. O período de coleta dos dados foi de três meses (de setembro a dezembro de 2017). Resultados: A amostra do grupo de estudo revelou alterações clínicas na espessura, no tamanho e na coloração do frênulo, como também nos aspectos da língua de indivíduos com esclerose sistêmica, tais como hipertonia, alteração do formato da ponta da língua quando em elevação, telangiectasia entre outros de menor ocorrência. Conclusão: As características alteradas do frênulo e da língua dos sujeitos com essa afecção evidenciam o comprometimento do sistema estomatognático e a importância da atuação fonoaudiológica na Reumatologia.

Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in-situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a "cord" or "submucosal band" of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in-situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo-documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm-like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749-761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Background Ehlers-Danlos syndrome (EDS) is part of connective tissue disorders and is characterized by skin hyperextensibility, joint hypermobility, easy bruising and other severe manifestations such as epilepsy, pneumothorax, arterial rupture and bowel perforation. In 2017 a new classification was published, indicating major and minor criteria for each form of EDS. Further reports in the past years tried to determine whether or not the absence of lingual frenulum should be included in minor criteria for the diagnosis of EDS, but a consensus has still not been reached. The aim of this study was to assess the clinical relevance of lingual frenulum absence, evaluating its prevalence in a cohort of EDS pediatric patients and comparing it to a group of controls. Methods Patients with Ehlers-Danlos syndrome were observed at our Department of Pediatrics of Policlinico S. Matteo in Pavia, Italy. Each patient underwent clinical examination of the oral cavity, and controls were chosen among patients referred to our Department. Results Thirty-three over 40 patients showed absence of lingual frenulum and 3 of them showed frenulum hypoplasia. Absence or hypoplasia of lingual frenulum showed a prevalence of 90% in our population, whereas only 3/170 controls (1.8%), had lingual frenulum absence. Overall, absence of the lingual frenulum showed a sensibility of 90% and a specificity of 98.2% in our population. Conclusions In agreement with other authors, we believe that the absence of lingual frenulum should be included in the minor diagnostic criteria for Ehlers-Danlos Syndrome.

Aim Ankyloglossia is a common congenital malformation characterized by a short, thick, or tight tongue frenulum, and its effect on speech articulation remains controversial. This study aimed to evaluate (a) the association between ankyloglossia and speech disorders, and (b) the effectiveness of surgical interventions on the articulation of patients with ankyloglossia. Material and methods A comprehensive search of PubMed was conducted. Randomized control trials (RCTs), cohort studies, case-control studies, and case series with over five cases were included. Result Of the 16 included studies, except for one cross-sectional study, all studies were small in sample size. The evidence quality was generally low, with an average of 3.88 in a 7-point system. Three studies investigated the occurrence of speech disorders in the ankyloglossia population and obtained different results. Fifteen studies assessed the effectiveness of surgery, among which eight self-control studies observed significant postoperative improvement, whereas three of four cohort studies with untreated controls reported no significant differences. Three RCTs compared surgical techniques and one pointed out the advantage of frenuloplasty over frenulotomy. Conclusion There was no clear connection between ankyloglossia and speech disorders. More widely accepted uniform grading systems and well-designed clinical studies are needed.

Tongue‐tie is characterized by an abnormally tight, short and thick lingual frenulum restricting the tongue's movement. This functional impairment can hinder a child's ability to maintain an effective latch and suckle and may lead to complex breastfeeding difficulties. The primary aim of this study was to explore the experiences of mothers who have breastfed a child with tongue‐tie, including their experiences with the health care system. A qualitative description study design was used. Two semistructured focus groups were conducted in February 2016 with a total of nine participants in the largest metropolitan area of Newfoundland and Labrador, Canada. Content analysis using constant comparison revealed a common incongruity between participants' breastfeeding expectations and their actual experiences of feeding a child with tongue‐tie. Three major themes are discussed: mothers' well‐being, strained interpersonal relationships and frustration with the health care system.

Purpose: The protocol for postoperative follow-up time after lingual frenotomy in breastfeeding infants with ankyloglossia was changed from 2 weeks to 1 week at our institution. This study examined...

Background Ehlers-Danlos syndrome (EDS) represents a group of connective tissue disorders characterized by the fragility of the soft connective tissues resulting in widespread skin, ligament, joint, blood vessel and internal organ involvement. The clinical spectrum is highly variable in terms of clinical features, complications, severity, biochemical characteristics and genes mutations. The kyphoscoliotic type EDS (EDS VIA) is a rare variant of the disease, with an incidence of 1:100.000 live births. EDS VIA presents at birth as severe muscular hypotonia, early onset of progressive kyphoscoliosis, marked hyperelasticity and fragility of the skin with abnormal scarring, severe joint hypermobility, luxations and osteopenia without a tendency to fractures. This condition is due to a mutation in the PLOD1 gene, and less commonly in FKBP14 gene, which results in the erroneous development of collagen molecules with consequent mechanical instability of the affected tissue. Case presentation A female newborn, found to be floppy at birth, presented a remarkable physical examination for joint hypermobility, muscle weakness, hyperelastic skin, a slight curve of the spine, the absence of the inferior labial and lingual frenulum. Due to severe hypotonia, neuromuscular disorders such as Spinal Muscular Atrophy (SMA), genetic diseases such as Prader Willi syndrome (PWS), myopathies and connective tissue disorders were considered in the differential diagnosis. Targeted gene sequencing were performed for SMN1, PLOD1, FKBP14, COL6A1, COL6A2, COL6A3. The urinary lysyl and hydroxy-lysyl pyridinoline ratio was diagnostic before discovering the homozygous duplication in the PLOD1 gene, which confirmed kyphoscoliotic EDS diagnosis. Conclusion In front of a floppy infant, a large variety of disorders should be considered, including some connective diseases. The presence at the birth of kyphoscoliosis, associated with joint hypermobility and the absence of the lingual and lower lip frenulum, should suggest an EDS.

Objectives To investigate and identify the concerns and opinions expressed in both parental and provider posts on social media about ankyloglossia. Methods In this study, posts on Twitter between 1/1/2008 and 12/31/2018 were collected using search terms and hashtags specific to pediatric ankyloglossia. The search terms included a primary phrase to indicate ankyloglossia along with a pediatric identifier. Tweets that met inclusion criteria were analyzed qualitatively via conventional content analysis. After all tweets were categorized, descriptive statistics were completed to determine frequency of each theme. Results In total, 5951 tweets were retrieved. Parents authored 982 (16.5%) of tweets, and 782 (13.1%) were by providers. The remaining 4187 tweets did not fit criteria for either the parent or provider groups. Amongst parents, the most common themes mentioned were feeding problems (309 tweets [32.4%]), followed by lip tie (215 [22.5%]), anxiety or emotion (207 [21.7%]), and maternal breastfeeding complications (127 [13.3%]). The number of tweets about ankyloglossia and frenotomy in 2018 had increased by 2395% since 2009. Amongst providers, 215 tweets were judged by the coders to provide an opinion on ankyloglossia, of which 94.4% had a pro-frenotomy sentiment. When a specialty was identified, tweets were most often by dentists (250 [31.9%]), followed by lactation consultants and International Board Certified Lactation Consultants (IBCLCs) (157 [29.7%]) and non-otolaryngologist physicians (79 [10.1%]). Otolaryngologists accounted for 8.7% (68 tweets) of posts about ankyloglossia. Conclusion Our findings demonstrate the spectrum of opinions that exist among both parents and providers about ankyloglossia. This can aid in shared-decision making by enabling the counseling provider to guide recommendations based on medical evidence with the understanding that there is a large amount of non-scientific information and opinions disseminated that may be shaping decisions.

RESUMO Objetivo Diagnosticar a anquiloglossia em recém-nascidos, comparando dois instrumentos de avaliação do frênulo lingual. Método Tratou-se de um estudo transversal, realizado em Recife, PE, Brasil no ano de 2018, com 147 mães/recém-nascidos com idade de até 30 dias de vida. Foram utilizados o Instrumento Bristol Tongue Assessment Tool (BTAT) e o Protocolo de Avaliação do Frênulo da Língua para Bebês (“Teste da Linguinha”). Dados sociodemográficos também foram anotados. Para a comparação entre os dois métodos de diagnóstico da anquiloglossia, foi utilizado o teste de McNemar e foram obtidos o valor da concordância de Kappa e o respectivo intervalo de confiança. Resultados A presença de anquiloglossia foi de 4,8%, quando diagnosticada por meio do BTAT, e de 17,0%, quando utilizado o “Teste da Linguinha”. Com relação ao sexo, 53,1% dos recém-nascidos eram do sexo masculino e 46,9% do sexo feminino; contudo, não houve associação entre a anquiloglossia e o sexo do recém-nascido nos dois métodos de avaliação. Conclusão O diagnóstico da anquiloglossia em recém-nascidos variou em função do instrumento de avaliação utilizado. ABSTRACT Purpose To diagnose ankyloglossia in newborns and compare two lingual frenulum assessment instruments. Methods This cross-sectional study was carried out in Recife, Pernambuco, Brazil, in 2018, with 147 mothers/newborns aged up to 30 days. The Bristol Tongue Assessment Tool and the Lingual Frenulum Evaluation Protocol for Infants were the instruments used. Sociodemographic data were also recorded. The two ankyloglossia diagnostic methods were compared using the McNemar test, obtaining the kappa agreement value and the confidence interval. Results Ankyloglossia was present in 4.8% when diagnosed with the Bristol Tongue Assessment Tool, and in 17.0% with the Tongue-Tie Test. Regarding sex, 53.1% of the newborns were males and 46.9% were females; however, there was no association between ankyloglossia and the newborn’s sex in either of the assessment methods. Conclusion The ankyloglossia diagnosis in newborns varied depending on the assessment instrument used.

Purpose Verify the position of lips and tongue at rest in newborns with and without ankyloglossia. Methods Cross-sectional study, carried out with 130 newborns in University Hospital. Data collection was performed by the researcher and speech-language pathologists from the Hospital. Information on gestational age, sex, weight, height and days of life was collected. The position of the lips and tongue at rest was evaluated through visual inspection with the newborns asleep. After the newborns were awakened, Neonatal Screening of the validated Protocol for the evaluation of the lingual frenulum for infants was performed to detect the alteration of the lingual frenulum. The data obtained were described and submitted to statistical analysis using the Chi-Square test to verify the association between the position of the lips with the tongue and to compare the position of the lips and tongue with and without ankyloglossia. The Mann-Whitney test was used to verify the behavior of the variables the differed between newborns with and without ankyloglossia. The significance level of 5% was adopted. Results When comparing the data, a significant difference was found between: weight and height with and without ankyloglossia; position of lips and tongue. An association between the position of the tongue and lips with and without ankyloglossia was also found. Conclusion Newborns without alteration of the lingual frenulum have a tendency to remain with their lips closed and their tongue elevated during rest and newborns with ankyloglossia have a tendency to keep their lips parted and their tongue low during rest.

The objective of this study was to demonstrate that frenotomy can help improve breastfeeding, tongue movement, and the mother’s comfort, if the assessment criteria are respected and the infant’s function and age are observed. Frenotomy was performed on two babies with breastfeeding difficulties who came to CEPAE - Center for Research and Dental Care, in 2018, as part of the course on Early Childhood Interdisciplinary Preventive Care at a Dental School. After anamnesis and clinical examination, the lingual frenulum assessment protocol for babies was applied. The necessary frenotomies were performed with topical anesthesia, scissors, and groove director. The babies were reassessed in follow-up visits 7 days after the procedure. The babies had gained weight and the mothers had found greater comfort and easiness when breastfeeding, after the procedure. It is concluded that the less time it takes from ankyloglossia diagnosis to intervention, the easier it is to resume breastfeeding. Also, the identification of ankyloglossia is more effective, and its intervention more efficient, through an interdisciplinary assessment.

Ankyloglossia is a failure of the tongue to release from the oral floor with reported consequences that include breastfeeding difficulties and speech impediments. Frenotomy is a commonly performed procedure for the treatment of ankyloglossia. Laser (light amplification by stimulated emission of radiation) is one of several mediums used to perform frenotomies. Although most frenotomies are uncomplicated, there remains a small possibility of complication, such as infection, pain, ductal injury, and hemorrhage, even in expert hands. Because frenotomies are most often performed in infants, postoperative hemorrhage is an important complication to look for as even small amount of bleed may prove fatal, due to low blood volume reserve. We report a case of delayed hemorrhage after laser frenotomy in a 6-week old infant displaying shock symptoms and required fluid resuscitation.

Background Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children. Methods Children from pre-, primary, secondary, and high school, aged 3–17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups. Results A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58–15.94]). Conclusions The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters.

To analyze the speed and amplitude of mandibular movements during speech before and after lingual frenectomy. Comparative, descriptive and cross-sectional study. Sample composed of 10 subjects with lingual frenulum alteration, between 15 and 21 years old. This study was started in October 2018 and ended in July 2019. Patients were taken to apply the Lingual Frenulum Evaluation Protocol, followed by measuring the maximum mouth opening with caliper; of mouth opening and closing speed and the range of mandibular movements during speech with a BioEGN electrognathograph. After 30 days, new records were obtained. Data were analyzed using the IMB SPSS version 23 statistical software. When comparing the subjects' mandibular movements before and after lingual frenectomy, the analysis of the variables showed that they presented statistically significant difference in the movements during the speech of Frontal Vertical Vertical Amplitude (AVPF). ) and Closing Speed ​​(FV), as well as the variables Maximum Mouth Opening (AMB) and Maximum Mouth Opening with tongue touching the incisive papilla (AMBpi), conferring ankyloglossia interference on the performance of mandibular movements. The present study shows that the speed and amplitude of mandibular movements during speech were improved after lingual frenectomy in patients with ankyloglossia.

Anecdotally, there has been an increase in ankyloglossia referrals and frenotomy procedures performed in recent years. Many studies have characterized frenotomy indications and outcomes, but none have quantified how the frequency of referrals and interventions have changed over time in the outpatient setting. This study analyzes temporal trends in the diagnosis and intervention of ankyloglossia in a pediatric otolaryngology practice to further clarify how patterns of management of this condition have changed over time.This study was a retrospective chart review of patients evaluated for ankyloglossia in an outpatient pediatric otolaryngology clinic between 2008 and 2018. The chi-square test for trend was used to assess yearly changes in the referral numbers, surgical interventions, and procedure indication prevalence proportions of interest.Referral numbers and frenotomy procedures increased as a percentage of total office visits from 2008 to 2018 (P = 0.0026, P 0.0001). The trend in frenotomies was especially pronounced in the 0 to 2-month age group (P 0.0001) but was not observed in the 2 months to 1-year (P = 0.30) or 1- to 4-year (P = 0.40) age groups. Frenotomy performed for concerns of feeding (P 0.0001) increased over the study period, but there was no significant increase in procedures performed for speech concerns (P = 0.13).Significant increases in referrals for frenotomy and number of frenotomy procedures performed are demonstrated, especially in young infants for feeding concerns. It is unlikely representative of a true increase in the incidence of ankyloglossia, but rather the result of cultural and clinical factors driving referrals and intervention.

Ankyloglossia, or "tongue-tie," refers to limited tongue mobility caused by a restrictive lingual frenulum. Previous studies have demonstrated rapid increases in diagnosis and treatment of ankyloglossia in the United States up to 2012. We performed an updated retrospective review of data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to evaluate trends in diagnosis of ankyloglossia and use of lingual frenotomy in the hospital setting. From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures. As seen previously, sex, type of insurance, median income ZIP code, and geographic region were associated with diagnosis of ankyloglossia. The observed trends from prior to 2012 have continued to increase, while unanswered questions about diagnostic criteria and about which infants should undergo frenotomy remain.

Objective: Comprehensive knowledge about the anatomy of the surgical site is an important prerequisite for any surgical procedure. This study aimed to assess the prevalence, position and anatomical characteristics of mandibular incisive canal (MIC), lingual foramen (LF) and anterior loop of the mandibular canal (ALMC) in an Iranian population using cone beam computed tomography (CBCT). Materials and Methods: This study was conducted on 103 patients who underwent CBCT prior to implant placement. The CBCT scans of patients were evaluated by two observers to determine the visibility and length of MIC, LF and ALMC. The buccolingual inclination of MIC at the initiation point of canal and canal path were also studied. Results: The prevalence of MIC, LF and ALMC was 90%, 76% and 84% on CBCT scans, respectively. The mean length of MIC and ALMC was 7.5mm and 1.2mm, respectively and the mean width of LF was 0.9mm. The MIC had a buccal inclination at the initiation point and approximated the lingual plate as extended towards the midline. Analytical statistics including independent samples t-test, paired samples t-test, ANOVA analyses were applied. Conclusion: Considering the high prevalence of MIC, ALMC and LF and wide range of MIC (1.2mm to 20mm) and ALMC (1mm to 9.9mm) length, CBCT is recommended for patients prior to surgical procedures in the anterior mandible to determine the exact location of these anatomical structures. Keywords: Mandible; Lingual frenum; Cone-beam computed tomography.

The frenotomy or surgical release of the lingual frenulum is performed with increasing frequency. Restricted tongue mobility, ankyloglossia, is the main indication for this procedure. This clinical diagnosis is often used as synonym for tongue-tie which is blamed for many feeding difficulties resulting in an increase in performed frenotomies. Until recently, little was known about the anatomical structure and normal variation of the tongue-tie. Different grading systems have been developed. Some are exclusively based on appearance of the tongue-tie; others also include functional elements. There is, however, no established relation between the tongue-tie score and the observed feeding problems or outcomes following frenotomy. Therefore, caution is warranted before submitting babies to this procedure.Conclusion: This narrative review aims to give an overview of current knowledge and concerns regarding the tongue-tie, which need to be considered before referral for a frenotomy. What is Known: • The presence of a tongue-tie is associated with a higher frequency of breastfeeding problems. • Hence, frenotomy is advocated and increasingly performed in infants with breastfeeding problems. Current tongue-tie classifications do not allow to predict breastfeeding problems. What is New: • New anatomy insights caution for possible complications resulting from this seemingly innocent practice of frenotomy. • Frenotomy should only be performed after multidisciplinary evaluation of feeding problems, following exclusion and remediation of other causative factors.

Objectives Frenulectomy for ankyloglossia is an intervention that often improves breastfeeding quality for both the mother and infant. Current classification systems assess and identify patients with ankyloglossia, but they do not predict the degree of improvement after lingual frenulectomy. We propose an idealized geometric model to quantify the potential effect of frenulectomy for ankyloglossia. Methods Our geometric model depicts the intact lingual frenulum as a triangular pyramid of mucosa on the floor of mouth. After incising one edge of the pyramid, as is performed during a frenulectomy, the structure unfolds to a two-dimensional diamond whose dimensions can be calculated. Utilizing this calculation, we can predict percent improvement in tongue extension after frenulectomy based off the original dimensions of the pyramid. Results Our multivariable equation that allows for the calculation of the percent increase in tongue extension is based on the frenulum thickness, frenulum length, tongue length, and insertion point of the frenulum on the tongue. The initial height of the frenulum and the proximity of the frenulum insertion to the tip of the tongue had the largest impact on tongue extension, whereas frenulum width had the smallest impact. Conclusion Lingual frenulectomy has subjectively been reported to improve lingual tongue movement. Our mathematical model identifies multiple anatomic variables that lead to an increase in tongue extension after frenulectomy. Our model is the first step in supporting this subjective improvement with quantifiable measurements, and can allow for future validation studies.

Objective To compare the surgical outcomes of simple frenotomy and the 4-flap Z-frenuloplasty according to the articulation test values and tongue-tie classification in patients with ankyloglossia with articulation difficulty. Study design prospective randomized study. Setting Tertiary academic center. Subjects and methods: Children with ankyloglossia with articulation difficulty were randomly divided into 2 groups for surgical treatment. Patients were evaluated for the tongue-tie classification and articulation test before surgery. Three months after the operation, the frenulum classification and articulation test were re-evaluated to compare the differences in surgical outcome between the two surgical methods. Results Out of 37 patients, 19 underwent the 4-flap Z-frenuloplasty and 18, the simple frenotomy. No differences were observed in the baseline characteristics of the patients assigned to both groups. Changes in the tongue-tie classification and improvement in the articulation test results were observed with both the surgical methods. Both surgical groups had significant improvement in the speech articulation test (consonants) but there was no difference in the speech outcomes between the surgical groups. Conclusion Although there was no significant difference in the surgical outcome between the two surgical methods, ankyloglossia patients showed improvement in a Korean speech articulation test 3 months after undergoing surgery to release the lingual frenulum.