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Tongue tie or ankyloglossia has been the subject of much controversy. As defined in this review, tongue tie occurs when a common minor embryologic tissue remnant—persistence of midline sublingual tissue that usually undergoes apoptosis during embryonic development—causes restriction of normal tongue movement. Effective breastfeeding requires newborns to fine-tune their tongue movements to adapt to their mothers' particular nipple and breast anatomy and physiology. In the presence of tongue tie, two categories of signs/symptoms arise: those related to nipple trauma and those related to ineffective breast emptying and low infant intake. Untreated tongue tie can lead to untimely weaning and its attendant health risks. Frenotomy is a safe and effective procedure to release tongue tie and improve tongue function and breastfeeding outcomes.

Ankyloglossia, commonknown as tongue-tie, is a rare congenital oral anomaly in dogs. A complete attachment of the lingual frenulum to the floor of the oral cavity leads to limited mobility of the tongue including problems during eating and swallowing. In humans ankyloglossia is a common anomaly in newborn infants. In our report a 5-month old Anatolian Shepherd dog was surgically treated and full function of the tongue could be achieved with a horizontal-to-vertical frenuloplasty.

The purpose of this study was to establish a quantitative method to classify lingual frenulum as normal and altered. Methods: 98 people were included in this study. All measurements were made with maxium opening of the mouth. A digital caliper was used to measure the length of the frenulum under three conditions: a) with the tongue tip on the incisal papilla; b) with the tongue sucked up and maintained against the hard palate; and c) with tongue stretching over a spatula. Results: observations indicated that the most useful and statistically significant way of measuring frenulum length was achieved with maximum mouth opening and the tongue tip on the incisal papilla. Conclusion: this quantitative method was demonstrated to be effective for identifying and distinguishing normal and altered frenular length.

Ankyloglossia, or tongue-tie, is the result of a short, tight, lingual frenulum causing tethering of the tongue tip. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this study, we evaluated the treatment of patients greater than 3 years of age with persistent articulation problems related to ankyloglossia (n = 16). All patients underwent surgical correction either via a novel application of the 4-flap Z-frenuloplasty (n = 11) or via the more traditional horizontal-to-vertical frenuloplasty (n = 5). Frenulum length, tongue protrusion length, and speech evaluations (4-grade scaling) were documented preoperatively and at follow-up. For the 4-flap Z-frenuloplasty, 91% of patients showed at least 2 orders of improvement in speech, 64% showed complete resolution of articulation errors, and 9% demonstrated no improvement in speech. Frenulum length and tongue protrusion gained 37.5 +/- 13.5 mm (P < 0.001) (315% increase) and 36.2 +/- 7.6 mm (P < 0.001), respectively. In contrast, with the horizontal-to-vertical frenuloplasty, only 40% showed 1 order of improvement in speech, and 60% had no change in articulation. Frenulum length and tongue protrusion gained 11.2 +/- 4.15 mm (98% increase) and 13.2 +/- 2.6 mm (P = 0.0003), respectively. Our data indicated that the 4-flap Z-frenuloplasty was superior to the horizontal to vertical frenuloplasty with respect to tongue lengthening, protrusion, and articulation improvement for patients with symptomatic ankyloglossia.

Objectives: To provide diagnostic criteria for ankyloglossia in children by anatomical measurements; to investigate the correlation between severity of ankyloglossia and a series of morphofunctional findings; to evaluate the potential mismatch between a clinical suspect of ankyloglossia and the authentic anatomical diagnosis. Design: Two different techniques of anatomical measurements and a clinical evaluation of a series of morphofunctional findings were performed. Subjects and methods: In 200 children referred for evaluation and treatment of tongue-tie, the length of the frenulum and the interincisal distance were measured in maximum opening of the mouth and with the tip of the tongue touching the palatal papilla. Occlusion, type of bite, tongue resting position, swallowing mechanism, oral floor mobility, frenulum insertion modality and speech were investigated. Any correlation between these morphofunctional findings and anatomical measures was investigated. Results: Children with a frenulum length more than 2 cm and an interincisal distance of more than 2.3 cm were normal. In both measurements, significant correlations among mean values and other variables were observed. Moreover, three levels – mild, moderate and severe – of ankyloglossia were assessed. Conclusions: Length of frenulum and interincisal distance allow an assessment of severity of ankyloglossia in children. Ankyloglossia was not associated with infantile swallowing.

Ankyloglossia, or tongue-tie, is a congenital condition that results when the inferior lingual frenulum is too short and is attached to the tip of the tongue, limiting its normal movements. Ankyloglossia has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. Ankyloglossia occurs in 1.7% of all neonates. The pathogenesis of ankyloglossia is not known. This article reports the surgical management of a patient having ankyloglossia and abnormally thick frenum associated with restricted movement of tongue and midline diastema respectively. The treatment involved surgical removal of the lingual and labial frenum, which healed uneventfully.

Purpose: To propose a classification of the different lingual frenulum and to relate them to speech disorders. Methods: We evaluated 1402 patients’ frenulum with an age range of 5 years 8 months to 62 years 10 months between 1978 and 2002. Pictures were taken of the altered frenulum. Measures of maximal mouth opening, with and without tongue suction, were taken with a sliding caliper. Speech samples were also taken. Frenulum were then classified as normal; short; with anterior insertion, and short with anterior insertion. Results: From the 1402 patients evaluated, 127 (9%) presented with an altered frenulum insertion. For this study we considered only those with short or with anterior insertion. For those who had an altered frenulum, 62 (48.81%) presented with speech disorders. The more frequent speech disorders were: omission and substitution of /r/; {R}, and consonant clusters with /r/, and of /s/ and /z/. Frontal and lateral lisps also occurred. The frenulum of 21 patients was classified as short and of these, 12 patients (57%) presented with speech disorders. Of the 106 patients with anterior insertion, 50 (47.2%) presented with a speech disorder. After statistical analyses the relation between altered frenulum and speech disorders was considered significant with p

We sought to characterize examination findings and functional limitations due to ankyloglossia in adolescents and adults and to evaluate frenuloplasty in this group. Study design A prospective study was conducted of 15 individuals with ankyloglossia aged 14 to 68 years. Baseline symptoms were recorded by questionnaire, and tongue mobility measures were compared with that of 20 control subjects. Six subjects were reassessed postfrenuloplasty.Thirteen of 14 patients with uncorrected ankyloglossia (93%) noted symptoms including speech problems (50%) and mechanical limitations (57%), such as difficulty licking the lips. Mean tongue protrusion and elevation at baseline measured 15.5 +/- 6.0 mm and 13.6 +/- 8.0 mm, respectively, for patients and 32.0 +/- 3.9 mm and 30.3 +/- 4.9 mm for control subjects (P0.001). Postfrenuloplasty, tongue function improved both subjectively and objectively in 6 of 6 patients, with a mean gain of 9.2 mm for protrusion (P0.05) and 13.0 mm for elevation (P0.001).Symptoms related to ankyloglossia are prevalent in this age group and respond favorably to frenuloplasty.

We wanted to determine whether ankyloglossia is associated with articulation problems and the effect of frenuloplasty on speech and tongue mobility.We conducted a prospective study of 30 children aged 1 to 12 years with ankyloglossia undergoing frenuloplasty. Outcomes were assessed by measurements of tongue mobility, speech evaluation, and parent questionnaires.Mean tongue protrusion improved from 14.2 mm preoperatively to 25.8 mm postoperatively (P0.01). Similarly, mean tongue elevation improved from 5.2 to 22 mm (P0.01). Preoperative speech pathology evaluation documented articulation problems thought due to ankyloglossia in 15 of 21 children. Postoperative evaluation in 15 of these children showed improvement in articulation in 9, no change in 4 who had normal speech preoperatively, and an ongoing articulation disorder in 2. Parent perception of speech intelligibility on a scale of 1 to 5 improved from 3.4 to 4.2 (P0.01).Tongue mobility and speech improve significantly after frenuloplasty in children with ankyloglossia who have articulation problems.

Background: Ankyloglossia (tongue tie) is a congenital aberration characterized by a thick, toned, or short frenulum that causes limited tongue movement. Lingual frenectomy is performed for the treatment of patients with ankyloglossia. After surgery the patient can lift the tongue to the palate and can reach the labial portion of the maxillary left and right teeth. The purpose of this case report is to report frenectomy treatment in the lingual frenulum. Case Management: The 14-year-old female patient felt the tongue could not be lifted to the palate and it was difficult to clean the labial portion of the maxillary left and right teeth. On clinical examination the patient’s lingualis frenulum is short. The patient get prophylaxis treatment followed by a lingualis frenectomy surgery. Result: After 1 month control, the patient can lift the tongue to the palate and can clean the labial portion of the maxillary right and left teeth

Ankyloglossia or tongue-tie is the result of a short, tight, lingual frenulum causing difficulty in speech articulation due to limitation in tongue movement. In this article, we have reported a 24-year-old male with tongue-tie who complained of difficulty in speech following which he underwent frenectomy procedure under local anesthesia without any complications. Finally, he was given speech therapy sessions.

Background: The orofacial musculature plays a pivotal role in maintaining a balance in positioning of the teeth and any imbalance which occurs in this , results in malocclusion. Lingual frenum is a soft tissue structure which tethers the ventral surface of the tongue to the floor of the mouth. Objective: This study was performed to analyze the lingual frenal lengths in skeletal class I, class II and Class III malocclusion and to correlate relationship between both. Materials and Methods: This study comprised of 30 subjects, with 10 in each group and an impression was made with the maximum mouth opening position and the tip of tongue touching the incisive papilla. The length of the lingual frenum was then measured from the casts. The maximum mouth opening position was also determined by measuring the interincisal distance with the maximum mouth opening position. Statistical analysis was done to analyze the relationship between both. Results: The lingual frenum was found to be longest in class III malocclusion, with a statistical significant value of p

Objetivo avaliar características anatômicas do frênulo lingual de bebês no 1º, no 6º e no 12º mês de vida, comparando os achados com a literatura. Métodos foram realizados registros audiovisuais de frênulos linguais, normais ou alterados, de 71 bebês, de ambos os gêneros, no 1º, no 6º e no 12º mês de vida. Esses registros foram analisados por duas especialistas em motricidade orofacial considerando os seguintes aspectos anatômicos do frênulo lingual: espessura, fixação na língua e fixação no assoalho da boca, comparando esses dados com o que é citado na literatura. Resultados dos 71 bebês avaliados, 51 deles apresentaram frênulo com espessura delgada e 20 espessa. 40 bebês apresentaram fixação do frênulo no terço médio da língua; 27 entre o ápice e o terço médio da língua e 4 no ápice. Quanto à fixação no assoalho da boca, 42 bebês apresentaram a fixação do frênulo na crista alveolar inferior e 29 entre as carúnculas sublinguais. As características de todos os frênulos linguais observadas no 1º, no 6º e 12º mês de vida permaneceram as mesmas. Conclusão quanto à espessura, fixação na língua e fixação no assoalho da boca, o frênulo lingual dos 71 bebês examinados não se modificou durante o primeiro ano de vida, contrapondo-se à literatura. Purpose to assess the anatomical characteristics of lingual frenulum in infants at first, sixth and twelfth months of life and compare the findings to the statements found in the literature. Methods video recordings of the lingual frenulum – normal or altered – of 71 infants, from both genders at the first, sixth and twelfth months of life were taken. The recordings were analyzed by two specialists in orofacial motricity who observed the following anatomical aspects: thickness, attachment to the tongue and attachment to the floor of the mouth. The data collected were compared to the literature. Results of the 71infants, the lingual frenulum of 51 infants was thin and 20 had thick lingual frenulum. 40 infants had the lingual frenulum attached to the middle of the tongue, 27 had the attachment between the apex and the middle of the tongue, and 4 to the apex. Concerning attachment to the floor of the mouth, the lingual frenulum of 42 infants was attached to the alveolar crest and 29 had the attachment between the sublingual caruncles. The characteristics of the lingual frenulum observed at the first, sixth and twelfth months of life remained the same. Conclusion contrary to what has been stated in the literature changes concerning lingual frenulum thickness, attachment to the tongue and to the floor of the mouth were not observed in the 71 infants during the first year of life. KEYWORDS : Lingual Frenulum; Anatomy; Tongue

Objective: To review the first 12 months of assessment and release of lingual frenulum (frenotomy) at a breast-feeding clinic in a tertiary maternity hospital (August 2002 to end of July 2003) and to report on the breast-feeding outcomes and parental satisfaction. Methods: A structured telephone interview was conducted with the mother at least 3 months after the assessment. Data were collected about the presenting problem and the effect of release of the tongue-tie (if performed). Parents were also asked about their satisfaction with the procedure and of problems following the release. Results: Sixty-six babies were assessed in 12 months. If infants were assessed as: (i) having impaired lingual function (using the Hazelbaker assessment tool for lingual frenulum function); (ii) the frenulum visualized to be a thin membrane; and (iii) the parent(s) gave informed consent, the frenulum was released. Initial and follow-up data are available on 46 infants. Infants had a mean age of 18 days (range 3-98), 63% were male infants and most had difficulties with attachment to the breast. Frenotomy was performed on 35 infants and breast-feeding improved in 83%. Parents reported high levels of satisfaction with the frenotomy procedure and no complications were reported. Conclusion: Frenotomy is a safe and easy procedure. Infants with a significant tongue-tie that is interfering with breast-feeding have shown an improvement with breast-feeding following frenotomy.

An experimental protocol model for frenulum evaluation was first designed, and administered to ten infants in 2010. After obtaining the data and statistical analysis, the protocol was re-designed and administered to 100 infants. The aim of this study is to present an efficient and effective lingual frenulum protocol with scores for infants. From the experimental protocol model, a new protocol was designed. One speech-language pathologist, and specialist in orofacial myology, administered the new protocol to 100 full-term infants. All steps of the protocol were recorded and photographed. The data collected was sent to two specialists in the area, who evaluated the cases based on the recordings and photographs. The data from the three evaluations were compared. A two-part protocol was designed to evaluate the lingual frenulum in infants. The first part consists of clinical history with specific questions about family history and breastfeeding. The second part consists of clinical examination: anatomo-functional, non-nutritive and nutritive sucking evaluations. A new lingual frenulum protocol with scores for infants was designed, and has proved to be an effective tool for health professionals to assess and diagnose anatomical alterations of the lingual frenulum, and its possible interference with breastfeeding.

An efficient lingual frenulum protocol with scores is presented. From a specific lingual frenulum evaluation used until 2004, a new protocol was designed. Ten speech language pathologists experienced in orofacial myology used the new protocol with different groups of subjects. 1235 subjects were evaluated during 3 years. From the experience of these ten speech language pathologists, the protocol was re-structured, and a scoring system was added. Absence of alteration (normal tongue and frenulum) was scored zero. The alterations observed were scored in ascending order. Four additional speech language pathologists experienced in orofacial myology were trained by the researcher to administer the final version of the protocol. The protocol was administered in 2008 and 2009 to 239 subjects: 160 children between 7 years and 2 months old and 11 years and 7 months old; and to 79 adults from 16 years and 8 months or older. From the results of administration of the protocol, a new lingual frenulum protocol with scores was designed. According to the scores, the frenulum can be considered altered or normal. When the sum of general tests is equal or higher than 3, the frenulum may be altered. The interference of the lingual frenulum in the oral functions may be considered when the sum of the functional tests is equal or higher than 25. This new lingual frenulum protocol with scores was designed and has been an efficient tool to diagnose an altered lingual frenulum.

WOS: 000293661000001, A fold of tissue, the lingual frenulum, extends onto the inferior surface of the tongue from near the base of the tongue on midline. The shape, length and alignment of lingual frenulum vary between individuals. The aim of this study is to evaluate morphology of lingual frenulum with respect to gender. Ninety seven volunteers who were students and employees of Zonguldak Karaelmas University, School of Medicine participated in the study. Two individuals with a history of hepatitis and 20 individuals with inadequate photographs were excluded from the study. Morphometric analyses were performed on the photographs of 75 volunteers (36 men, 39 women). Lingual frenulum photograph of each individual was taken using standard photographic techniques. The individual opened his/her mouth as much as possible with the tongue in contact with the interior surface of the two middle incisors. The morphology of the lingual frenulum was evaluated with linear measurements and geometric morphometrics methods. The length of lingual frenulum between the attachments of it, to the floor of the mouth and the inferior surface of the tongue were measured using Digimizer software. Four reference points determined previously were marked by tpsDig2 software on photographs. This process was repeated for each sample to create a txt file containing reference points of 75 individuals. Statistical analysis of txt files were carried out using Morpheus software. There were no statistically significant differences between the linear measurements of lingual frenulum according to gender (p>0.05). Lingual frenulum had no gender differences according to geometric morphometrics analysis as well (p>0.05). It can be suggested that lingual frenulum had similar architecture in both sexes.

A fold of tissue, the lingual frenulum, extends onto the inferior surface of the tongue from near the base of the tongue on midline. The shape, length and alignment of lingual frenulum vary between individuals. The aim of this study is to evaluate morphology of lingual frenulum with respect to gender. Ninety seven volunteers who were students and employees of Zonguldak Karaelmas University, School of Medicine participated in the study. Two individuals with a history of hepatitis and 20 individuals with inadequate photographs were excluded from the study. Morphometric analyses were performed on the photographs of 75 volunteers (36 men, 39 women). Lingual frenulum photograph of each individual was taken using standard photographic techniques. The individual opened his/her mouth as much as possible with the tongue in contact with the interior surface of the two middle incisors. The morphology of the lingual frenulum was evaluated with linear measurements and geometric morphometrics methods. The length of lingual frenulum between the attachments of it, to the floor of the mouth and the inferior surface of the tongue were measured using Digimizer software. Four reference points determined previously were marked by tpsDig2 software on photographs. This process was repeated for each sample to create a txt file containing reference points of 75 individuals. Statistical analysis of txt files were carried out using Morpheus software. There were no statistically significant differences between the linear measurements of lingual frenulum according to gender (p>0.05). Lingual frenulum had no gender differences according to geometric morphometrics analysis as well (p>0.05). It can be suggested that lingual frenulum had similar architecture in both sexes.

Tongue-tie, or ankyloglossia, is poorly defined and involves a short, thick, fibrosed, or fixed lingual frenulum. Operative interventions were proposed already in Greek medicine. In the Middle Ages, competition arose between midwives, who used their nails to detach the frenulum, and surgeons, who were allowed to use instruments. During the last century, the justification for frenotomy shifted from improved language to enhanced feeding. Despite the high frequency of the intervention, little research has been performed on its benefit, which remains a controversial topic among different groups of health professionals.

The purpose of this study was to determine the relationship between the length of the lingual frenulum and craniofacial morphology and test the hypothesis that skeletal Class III malocclusion is related to tongue-tie, in which the lingual frenulum is short and restricts the mobility of the tongue.The sample consisted of 50 skeletal Class I patients (0°ANB angle4°), 50 skeletal Class II patients (ANB angle4°), and 50 skeletal Class III patients (ANB angle0°). Direct and indirect measuring methods were used to quantify the length of the lingual frenulum. The median lingual frenulum length was measured directly with a lingual frenulum ruler. It was evaluated indirectly by measuring the differences between the maximum mouth opening with and without the tip of the tongue touching the incisive papilla. A lateral cephalogram was taken for each subject and a computerized cephalometric analysis was used to assess the cranial morphology. Analysis of variance (ANOVA) was used to compare the differences among the 3 groups. The Pearson correlation analysis was used to detect any relationship between the lingual frenulum length and cephalometric variables.The median lingual frenulum length was significantly longer in the skeletal Class III subjects compared with the skeletal Class I and Class II subjects. The maximum opening of the mouth was significantly reduced in the skeletal Class III subjects compared with Class I and Class II subjects. Significant correlations were also found among the median lingual frenulum length, maximum mouth opening reduction, and the cephalometric variables such as the SNB and ANB angles, Wits appraisal, mandibular length, and the interincisal angle.The present study supports the hypothesis that skeletal Class III malocclusion is related to long median lingual frenulum or a tongue-tie tendency. Patients diagnosed with tongue-tie might have a tendency toward skeletal Class III malocclusion.

3歳から6歳の舌小帯正常児146名と小帯短縮児20名に対して小帯の付着位置ならびに形状を観察し,とくに小帯短縮児に対しては経年的な変化を調査した.1)小帯正常児に関して,小帯の形状は,膜状型74.7%,索状型11.6%,中間型13.7%であった.2)起始部形態は,0本型21.9%,1本型13.7%,2本型31.5%,3本型32.9%であり,扇状の起始形態が多かった.3)辺縁歯肉最頂部から舌小帯起始部までの距離は各年齢群とも,約5 mmであった.4)舌尖から舌小帯付着部位までの距離は各年代間に有意差は認められないものの,加齢に伴って大きくなる傾向が見られた.5)舌下小丘から小帯付着部までの距離は,3歳と6歳の間において,有意に増していた.6)舌下小丘から舌尖までの距離は,各年代間で加齢と共に増加する傾向が見られ,とくに3歳と4〜5歳ならびに6歳のそれぞれの間に有意差が認められた.7)小帯短縮群は,70%が初診時から何らかの変化を生じており,そのうち78.6%が,2年以上の経過観察を経ていた.舌小帯短縮であっても,小帯が正常へと変化することが期待できるため,とくに低年齢児においては外科的処置を行わず,十分な経過観察を行うことが重要である

OBJETIVO: comparar a classificação e a conduta dos profissionais das áreas de fonoaudiologia, odontologia e otorrinolaringologia quanto ao frênulo de língua. MÉTODOS: participaram dessa pesquisa 90 sujeitos, divididos em 3 grupos: 30 fonoaudiólogos, 30 odontólogos e 30 otorrinolaringologistas que responderam a dois protocolos, contendo quatro imagens de frênulos linguais. Os frênulos foram classificados como normal ou alterado. Quando a opção foi por alterado, foi indicada a conduta: cirúrgica, fonoterapia ou cirúrgica e fonoterapia. Os sujeitos também classificaram os frênulos de acordo com o tipo de inserção: normal, com inserção anteriorizada, curto ou curto com inserção anteriorizada. RESULTADOS: com relação à caracterização de frênulos linguais como normais ou alterados, verificou-se que a maioria dos profissionais teve opiniões semelhantes, caracterizando o frênulo normal como tal e o anteriorizado, o curto e o curto com inserção anteriorizada, como alterados. Com relação à conduta dos frênulos considerados alterados, a maioria dos odontólogos e otorrinolaringologistas, concordaram com a cirúrgica para todas as alterações dos frênulos. Para a maioria dos fonoaudiólogos, a conduta para o frênulo anteriorizado foi a fonoterapia e para os frênulos curto e curto com inserção anteriorizada, indicaram cirurgia seguida de fonoterapia. Quanto à classificação de acordo com o tipo de inserção, a opinião da maioria, foi coincidente nas três categorias profissionais. CONCLUSÃO: os achados mostraram coincidência na caracterização e na classificação dos frênulos linguais pelos profissionais das três áreas. Ocorreu divergência no que se referiu a conduta, cirúrgica com fonoterapia ou somente cirúrgica, para frênulo curto e frênulo curto com inserção anteriorizada. PURPOSE: to compare the classification and conduct of the professionals of speech language pathology, dentistry and otolaryngology fields regarding the lingual frenulum. METHODS: 90 participants took part in this research, divided into 3 groups: 30 speech language pathologists, 30 dentists and 30 otolaryngologists who answered two protocols, with 4 images of the lingual frenulum. The lingual frenulum was classified as normal or altered. When the option was "altered", the indicated conduct was: surgery, speech therapy or surgery and speech therapy. The participants also classified the frenulum according to the type of insertion: normal, with anterior insertion, short or short with anterior insertion. RESULTS: in relation to the characterization of the lingual frenulum as normal or altered, we found that most professionals had similar views, characterizing the normal frenulum as normal, and the anterior, the short one and short with anterior insertion as altered. In relation to the conduct of the altered lingual frenulum, the majority of dentists and otolaryngologists agreed about the surgical conduct for all altered frenulum. For the majority of speech language pathologists, the conduct for anterior lingual frenulum was speech therapy, and for the short lingual frenulum and short with anterior insertion, they indicated surgery followed by speech therapy. For the classification according to the type of insertion, the opinion of the majority of the three professional categories was the same. CONCLUSION: the findings showed agreement in characterization and classification of the lingual frenulum by professionals of the three areas. There was disagreement in relation to the conduct: surgery and speech therapy or only surgery for short frenulum and short with anterior insertion.

A review of cases of short frenulum (tongue-tie) seen in a recent year at the Lactation Institute and Breastfeeding Clinic provides data about its relationship to sucking and breastfeeding problems such as insufficient infant weight gain and reduced milk supply, sore nipples and repeat bouts of mastitis in the mother. Frenotomy was recommended for ten of 13 babies who appeared to have a short frenulum. Three mothers chose not to hae the frenulum clipped and either gave up breastfeeding or continued to experience problems. Breastfeeding was successfully established by the five healthy babies whose frenulum was clipped. The two babies for whom frenotomy did not completely correct breastfeeding problems had severe birth defects.

Amyloidosis is a lesion in which an amyloid substance deposits in various organs and tissues of the body.Recently, we experienced a case of primary amyloidosis forming multiple nodules in the tongue. The patient was a 74-year-old male.Multiple nodules, 5-10mm in diameter, were observed in the tongue and the lingual frenulum. Histopatliologically, the excised nodules were diagnosed as amyloidosis. The amyloid protein was identified as protein AL by potassium permanganate treatment.

Purpose: Ankyloglossia (btongue-tieQ) occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms. Methods: Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breastfeeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother. Results: There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06). Conclusion: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.

Background About 3% of infants are born with a tongue-tie which may lead to breastfeeding problems such as ineffective latch, painful attachment or poor weight gain. The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) has been developed to give a quantitative assessment of the tongue-tie and recommendation about frenotomy (release of the frenulum). The aim of this study was to assess the inter-rater reliability of the HATLFF. Methods Fifty-eight infants referred to the Breastfeeding Education and Support Services (BESS) at The Royal Women's Hospital for assessment of tongue-tie and 25 control infants were assessed by two clinicians independently. Results The Appearance items received kappas between about 0.4 to 0.6, which represents "moderate" reliability. The first three Function items (lateralization, lift and extension of tongue) had kappa values over 0.65 which indicates "substantial" agreement. The four Function items relating to infant sucking (spread, cupping, peristalsis and snapback) received low kappa values with insignificant p values. There was 96% agreement between the two assessors on the recommendation for frenotomy (kappa 0.92, excellent agreement). The study found that the Function Score can be more simply assessed using only the first three function items (ie not scoring the sucking items), with a cut-off of ≤4 for recommendation of frenotomy. Conclusion We found that the HATLFF has a high reliability in a study of infants with tongue-tie and control infants

Objective the Assessment Tool for Lingual Frenulum Function (ATLFF) is the only available tool designed to assess newborn babies for the severity of tongue-tie. The aim of this study was to describe the ATLFF scores obtained on a series of 148 tongue-tied newborn babies. Design prospective case series. Setting a 420-bed community hospital in St. Paul, Minnesota, USA. Participants newborn babies admitted to the normal newborn nursery from October 1, 2000 to May 1 2002. Measurements and findings all babies in the nursery were examined for tongue-tie. One-hundred and forty-eight tongue-tied babies were examined using the ATLFF by at least one of three examiners. The ATLFF could not be completed on five babies. Of the remaining babies, 40 (28%) received ‘perfect' scores, five (3.5%) received ‘acceptable' scores, and 19 (13.3%) received ‘function impaired' scores. The remaining 79 (55.2%) babies received scores that did not fall into any of the three categories of scores. The inter-rater agreement on whether or not the baby had a score of ‘function impaired' on the ATLFF was moderate (kappa=0.44). Key conclusions and implications for practice few tongue-tied babies had a score of ‘function impaired' on the ATLFF. It is a major limitation of the ATLFF that it does not classify most babies. The development and testing of a useful tool to determine which tongue-tied babies will have difficulty with breast feeding remains a research priority.

Objective: The purposes of this study were: (1) to determine whether breast-fed infants with tongue-tie have decreased rates of breast-feeding at 1 week and 1 month of age, (2) to determine the prevalence of tongue-tie, and (3) to test the usefulness of the Assessment Tool for Lingual Frenulum Function (ATLFF) in assessing the severity of tongue-tie in breast-feeding newborns. Methods: A case-control design was used. All infants in the Regions Hospital newborn nursery were examined for tongue-tie. Tongue-tied babies were examined using the ATLFF. Two breast-feeding babies with normal tongues were identified and matched for each case. Mothers were interviewed when the babies were 1 week and 1 month old. Results: The prevalence of tongue-tie was 4.2%. Forty-nine tongue-tied and 98 control infants were enrolled. Tongue-tied babies were 3 times as likely as control babies to be bottle fed only at 1 week [risk ratio (RR), 3.11; 95% confidence interval (CI), 1.21, 8.03) By 1 month, tongue-tied babies were as likely as controls to be bottle fed only. (RR, 1.00; 95% CI, 0.55, 1.82) Twelve of the tongue-tied infants had ATLFF scores of “Perfect,” none had scores of “Acceptable,” and 6 had scores of “Function Impaired.” The remaining 31 infants had scores that fell into none of these categories. Conclusions: Tongue-tie is a relatively common condition in newborns. Affected infants are significantly more likely to be exclusively bottle-fed by 1 week of age. The ATLFF was not a useful tool to identify which tongue-tied infants are at risk for breast-feeding problems.

Ankyloglossia is an uncommon oral anomaly that can cause difficulty with breast-feeding, speech articulation, and mechanical tasks such as licking the lips and kissing. For many years the subject of ankyloglossia has been controversial, with practitioners of many specialties having widely different views regarding its significance. In many children, ankyloglossia is asymptomatic; the condition may resolve spontaneously, or affected children may learn to compensate adequately for their decreased lingual mobility. Some children, however, benefit from surgical intervention (frenotomy or frenuloplasty) for their tongue-tie. Parents should be educated about the possible long-term effects of tongue-tie while their child is young (< 1 year of age), so that they may make an informed choice regarding possible therapy.

We prospectively studied 21 cases of attachment of the lingual frenulum treated with laser excision, and report the results of a questionnaire survey of patients in the immediate postoperative phase.

The short lingual frenulum can be a cause of breastfeeding problems, including sore and damaged nipples and inadequate feedings. This article describes two cases, discusses the difficulty in recognizing the condition, and describes the role of primary care providers in the recognition, diagnosis, and surgical treatment of the short lingual frenulum.

Background and Objectives : Ankyloglossia, manifested by the short and lingual frenulum, can affect tongue mobility and articulation. The purpose of this study is to evaluate the improvement of tongue mobility and articulation in patients with akyloglossia, which is treated by frenotomy. Subjects and Method : A prospective study was done for 81 patients with ankyloglossia undergoing frenotomy, and who were aged between 2 to 10 years old. Outcomes were assessed by measuring tongue mobility, analyzing the articulatory evaluation and reviewing patient questionnaires. Results : The mean length of tongue elevation improved from 7.4 mm preoperatively to 16.3 mm postoperatively (p

To the Editor: I read the article titled “Newborn Tongue-tie: Prevalence and Effect on Breast-Feeding” that appeared the January–February 2005 issue.[1][1] I am the author of the Assessment Tool for Lingual Frenulum Function (ATLFF) referred to in this article. There are several substantial

The LMA (laryngeal mask airway)-ProSeal introducer was developed for easy insertion and fewer PLMA related complications. We experienced tearing of the lingual frenulum incidentally caused by insertion of the PLMA with the introducer. We believe that the introducer may have some advantages concerning insertion PLMA but some disadvantages because it hinder patient tongue control.

Various causes for the periodontal complaint are generally classified as twofold; systemic and local ones. Of local causes, there are known the deposition of dental plaque, dental calculi, microbial colony and inadequate prosthetic materials. On the other hand, moreover, such congenital morphological anomalies as the shape of dental crowns, excessively shallow oral vestibule and abnormal development of the lingual frenulum can constitute local causes. All of these causes are recognized as being responsible for the incidence of some kind of periodontal disease or other.The enamel projection, which came to receive attention in recent years, has been studied so far concerning the length of enamel projection itself, size and classification of its incidence frequencies.In the belief that there must exist intimate relationships between the enamel projection seen on the molar and molar suffering from a periodontal disease, on the one hand, and the former and the resorption of alveolar rim of jaw bone, on the other, the author carried out the present study.For the study purpose, the author examined clinically the presence or absence of enamel projections directly in the mouth of patients diagnosed as suffering from some kind of periodontal disease and, where the direct observations of the periodontal teeth were not possible, the presenceof enamel projections was investigated on the teeth which were extracted from the periodontal patients. Additionally, a total sample of 552 upper and lower jaws was selected from the skull specimens and on the basis of these jaws, a fourfold classification was established concerning the presence or absence of enamel projections on the teeth planted in them and the degrees of resorption of alveolar rim, so that the incidence frequencies of each of 4 groups might be fully elucidated.As a result, the following conclusions were reached.1. In about 74% of 308 upper and lower molars which suffered from the periodontal disease, the incidence of enamel projections was confirmed.2. In nearly 90% of the upper and lower molars planted in jaw bones whose alveolar rims gave evidence of resorption, the incidence of enamel projections was established.3. The resorption of alveolar rims was observed in nearly 95% of the jaw alveolar specimens possessed of upper and lower molars, on which enamel projections were confirmed.On the strength of the above findings, it is to be concluded that there exists an intimate relationship between the presence of enamel projections and periodontal diseases, and the former may be regarded as constituting a noteworthy local cause of the latter.

Epidermoid cyst occurs throughout entrapped ectodermal tissue during embryonic development, or inflammatric and traumatic implantation of the epithelium. In the oral cavity, it occurs most commonly on the floor of the mouth, but may rarely occur on the lingual frenulum.The authors have experienced one case of epidermoid cyst on the lingual frenulum of a 47 years old woman. The lesion was surgically enucleated. This lesion was diagnosed by histopathological examination, the cyst cavity was filled with keratin, but contained no skin appendages.

RESUMO Objetivo: caracterizar e comparar as alterações de fala relacionadas às alterações do frênulo lingual em escolares, dos 8;6 anos aos 10;11 anos entre grupo controle e pesquisa. Métodos: avaliou-se 52 crianças em idade escolar (8;6 anos a 10;11 anos), de ambos os gêneros, regularmente matriculadas em Instituto privado, divididas em: grupo controle (sem alteração do frênulo lingual) e grupo pesquisa (com alteração do frênulo lingual). As crianças foram avaliadas por meio do Protocolo de Avaliação em Motricidade Orofacial utilizado em uma Clínica Escola e por meio das figuras utilizadas no Protocolo de Avaliação em Motricidade Orofacial, MBGR. Os testes utilizados para a análise estatística foram "Teste de Fisher", "Qui Quadrado" e "Anova", adotando-se como nível de significância 5% (p

Tongue-tie, or ankyloglossia, is poorly defined and involves a short, thick, fibrosed, or fixed lingual frenulum. Ankyloglossia has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. Ankyloglossia occurs in 1.7% of all neonates. As age advances, frenulum grows in length and normal function is established. Frenulectomy is recommended if it persists. We have also come across with the case of Tongue Tie in one of our patient. He is 19 years in age pursuing his graduation. He has got tongue tie which is persisting since birth. Keywords: Ankyloglossia; frenulum; frenulectomy. DOI: 10.3126/jcmsn.v6i3.4073Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.37-39