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An investigation of disparate gingival heights of the mandibular central incisor region in 93 children aged from 6 to 12 years was undertaken. Unaffected paired teeth demonstrated an age-associated increase in clinical crown length, similar to previous reports, suggesting a gradual remodelling of soft tissues. Affected teeth displayed a rapid increase in clinical crown length suggesting that by age 10 years true recession had occurred. Significant associations with gingival inflammation (at the 0.1% level), and with anterior crowding (at the 0.2% level), occurred. Frenal involvement did not influence the position of the gingival margin.

Previous studies have shown that implants of allogenic demineralized dentin in the abdominal muscle of rats and guinea-pigs, and possibly also in the gingival tissues of man, may induce heterotopic bone formation. A preliminary study of the bone-inducing effect of allogenic demineralized dentin in human gingival soft tissue is reported. A total of 15 dentin specimens were implanted in the gingiva of six patients (32–58 years of age) who required surgical periodontal treatment. In addition, one implant was placed in the frenulum labiale superior of each of eight patients. The implants remained in the tissues for 4–30 weeks and showed evidence of varying degrees of resorption, but they appeared to be well tolerated. The amount of resorption was not related to the observation time. Dentinal tubules were invaded by connective tissue cells. In a few instances remineralized of the demineralized dentin seemed to have occurred. In one case, an area resembling newly-formed hard tissue was observed. There was, however, no conclusive evidence of bone formation induced by the dentin implants.

A rostral mandibulectomy was performed on three dogs with mandibular neopiasia. The technique involves stabilization of the mandibular rami, excision of the mandible rostral to the frenulum of the tongue, and cosmetic closure of the wound. Two patients were living 11 months postoperatively. This technique is effective in treating some malignant neoplasms of the rostral mandible.

We are reporting the second lethal case of G syndrome occurring in a female. The developmental defects in this patient included posteriorly angulated auricles, bifid tip of tongue with a long frenulum, hypoplasia of the epiglottis and larynx, rocker bottom feet, and hypertrophied labia majora and clitoris. Additional anomalies not previously reported in the G syndrome were circumvallate placenta, and incompletely perforated hymen.

As the frenulum of the tongue extends to the alveolar mucous membrane, the shape of extension, the way it extends to or the positions of the mucous membrane to which it extends are different depending on the individuals. Since there has not been detailed report on this subject, the author made an investigation of 302 adults (146 males and 156 females) to find the following:1. Said extension was observed in about 70 per cent of the subject examined.2. Four different forms of extension were observed as (1) 1 strip, (2) 2 strips and (3) 3 strips frenula types and (4) in the form of a thin membrane. The 2 strips type leads in the frequency of occurrence with 20.86%, followed by the 1 strip type of 17.55%, 3 strips type of 17.22%, and the membrane type of 14.28%.3. The trend of increase was observed with the 1 strip type according to the aging process of the examined adults, while the 2 strips type was seen decreasing by aging.4. The lateral spread of the tips of frenula, in the case of more than 2 strips type or the thin membrane type, to reach either the left or right lateral incisors, or to reach both of the incisors, was observed with the highest frequency of 36.09%. With the single strip type the position of alveolar mucous membrane to which the frenulum extends was always the middle portion whose frequency was 17.55%, next to the above case. Further spread in the case of pluralstrips or mem-brane types to reach either or both of the left and right canines was 9.27%, and toeither or both of the left and right central incisors was the least with 6.95%. It was noted the extension to the canines tends to decrease by aging.

A rare case of midline cleft lip with the following deformities is presented: (a) Partial midline cleft of the upper lip. (b) Cleft alveolus. (c) A fibro-cystic swelling arising from the left side of the nasal septum and columella. (d) A frenulum and a cystic swelling attached to the frenulum and hanging into the mouth by a narrow pedicle.

I have discovered a physiological reflex mechanism which if properly stimulated (triggered), can elicit a totally reflexogenic orgasm and ejaculation in spinal cord injured males. I am hopeful and optimistic that the technique I have discovered and now delineate here will enable many, many cord injured individuals to experience ejaculation and/or orgasm for perhaps the first time since their injury. I am certain that there are limitations on the applicability and potential success of this technique, and I will discuss some of these in later sections of this paper.

Prolonged application of dilute hydrogen peroxide results in severe edema of the tongue and frenulum. The edema is probably a result of capillary leakage. This method of production is a very gentle one, and it may provide a model system for future evaluation of treatment techniques directed toward reducing or preventing edema.

The present study was undertaken with the idea that characters, so pre-eminently lepidopterous as the frenulum and its retinaculum, might throw some light on phylogenetic relationships in the Lepidoptera, if the progress of their development and specialization within the order were traced.

MULTIPLE primary carcinomas of the mouth are fairly common, whereas multiple primary carcinomas of the lung are decidedly uncommon. The following case is an example of five primary malignancies involving both the upper and lower airways. Report of a Case A 49-year-old white male truck driver was first admitted to the Minneapolis Veterans Administration Hospital on March 15, 1960 with the complaint of a sore in the mouth for the preceding six weeks. The patient had a history of smoking two packs of cigarettes per day for the past 30 years and consuming an average of one quart of whiskey per day. Examination of the mouth revealed an ulcerated 3-cm lesion with raised borders at the left anterior floor of the mouth with extension to the frenulum. A 1-cm superficial ulcer on the right lower lip was also noted. A chest film at this time was within normal limits. Biopsy

In an earlier paper (Braun, 1924) the writer described for the family Gelechiidae, a specialized type of retinaculum for the frenulum spines in the female, and pointed out that this specialized retinaculum, termed a subradial retinaculum, is apparently a recognition character for the family. The subradial retinaculum is present in its specialized form consisting of a row of strongly chitinized curved scales or spines, and as the only retinaculum for the frenulum spines of the female in the Gelechiidae alone. In the Blastobasidae, the transitional steps in the replacement of a subdorsal retinaculum by a subradial retinaculum have been preserved and here subdorsal and subradial retinacula function together in the female. Excepting only the isolated genus Idioglossa ,in which in the female, a specialized subradial retinaculum functions in conjunction with a comparatively specialized subcostal retinaculum of a character similar to that which appears to be developing, but is not functional in Gelechiidae, the subradial retinaculum has been found only in Gelechiidae and Blastobasidae.

The Nepticulidae possess some conspicuous characteristics not present in other Lepidoptera. The most noticeable of these are the crowding together and anastomosis of the main tracheal stems of the fore wings and the absence of true cross-veins (except the humeral cross-vein in rare instances). The nearest approach to this type of venation seems to be found among certain small Trichoptera; where however the base of media remains distinct and does not anastomose either with radius or cubitus. The presence of a true frenulum in the male in even the most primitive genera of Nepticulidae taken in conjunction with the fact that in the female we find both jugum on the fore wing and series of hooked spines on the costa of the hind wing also suggests their relationship to the Trichoptera. Other characteristics, such as the presence of the jugum in the female of the more primitive genera, the structure of the mouth parts, and the structure of the pupa ally them to the Eriocranid group of the Micropterygidae.

The rates of transfer of C14-labelled lidocaine and prilocaine through the frenulum of the tongue of the dog were studied in vitro and in situ. Tenfold increases of the local anaesthetic concentration on the outside of the frenulum increased the rate the radioactivity was transferred to the inside by tenfold in the in vitro preparation. In situ, a doubling of the local anaesthetic concentration resulted in a greater than twofold increase in transfer rate. The transfer of local anaesthetic both in vitro and in situ increased as the pH of the applied local anaesthetic solution increased. Incorporation of 1 per cent cetylpyridinium chloride into the local anaesthetic solution in vitro could either increase or decrease the transfer of local anaesthetic. When 0.1 or 0.01 per cent cetylpyridinium chloride was added to the local anaesthetic solution in situ, the rate of local anaesthetic transfer was increased. The similarity between transfer of local anaesthetics across the frenulum of the tongue and transfer across lipoid membrane is discussed.

Five possibly preventable deaths occurred in a series of 28 children with the Pierre Robin Syndrome. The primary goal in management is to move the base of the tongue from the pharynx. If this cannot be done easily, the reason, such as a tight lingular frenulum, should be found. A tongue traction stitch may be adequate to relieve the obstruction, but depending upon it for long periods of time is dangerous. The most adequate tongue-lip adhesion includes a mattress suture from the base of the tongue to beneath the chin. Patients with severe micrognathia who can be maintained in a prone position should have tongue-lip adhesion before discharge from the hospital to prevent acute airway obstruction subsequently. The Pierre Robin Syndrome is not incompatible with life, but does require good clinical judgement and careful attention to detail if treatment is to be successful.

A rare congenital amomaly, congenital fistulas of the lip, is discussed. A brief comment on general considerations and probable etiologic factors is offered, fered, and various surgical techniques for correction are mentioned. Six cases are presented and described, all involving members of the same family. The mother, who evidenced bilateral fistulas of the lower lip, had nine living off-spring—five girls and four boys. Of these, four daughters and one son exhibited the malformation in varying degrees of severity. A total of six out of eleven members of this family are afflicted. Two daughters also exhibited additional concurrent defects. The 3-year-old girl had a wide palatal cleft for which surgical correction had been advised, and her 4-year-old sister revealed an opaque scarified area in the soft palatal area which appered to be the result of an earlier surgical closure, although the mother professed no knowledge of such surgical correction. Also evident in this patient was a high frenulum attachment which severely limited the normal mobility of the tongue. In all cases the fistulas were bilateral on the lower lip, and in only one case was there an asymmctrical positioning of the defect. The depth of the sinuses, as measured by a calibrated probe, ranged from 3 to 7 mm.

An 18-year old Quarter Horse mare was presented in June 1980 with the primary complaint of needing her teeth floated. The owner believed the mare's tongue was cut and attributed this most probably to sharp points on her teeth. He had noted the mare's tongue bleeding approximately 16 months previously at which time he himself had floated her teeth with, in his opinion, favorable response. During the spring and summer of 1980, the mare had been on pasture and had suffered significant weight loss. Upon presentation, the mare stood and walked with her head and neck extended. (Figure 1) Ptyalism was evident, and a markedly fetid odor was noticed. There was marked bilateral firm enlargement of the parotid region which extended rostrally into the intermandibular space. Submandibular lymph nodes were bilaterally enlarged and painful. The mare objected to palpation of the neck which was tOO firm to allow delineation of anatomical structures. Upon excitation, inspiratory and expiratory stridor were audible, Speculum examination of the mouth revealed that the portion of the tongue rostral to the frenulum was completely absent. The rostral portion of the existing tongue was severely denuded and irregularly knobby and necrotic. The ulcerated porcion of the tongue was held to the remaining base of the tongue only by a thin ventral band of tissue. Endoscopic examination revealed marked reduction of the oropharynx. Both lateral walls billowed medially, and the roof of the pharynx appeared ventrally displaced. (Figure 2) The right dorsolateral aspect of the pharyngeal wall was displaced such that it partially obstructed the view of the right arytenoid cartilage. The integrity of the pharyngeal walls was not interrupted. No drainage was seen from either gutteral pouch opening. Upon entering the gutteral pouches, no exudate was seen; however, the

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

Nine midline sinuses of the upper lip in eight patients have been described previously. They have been located from the skin under the columella to the frenulum, and have always been directed towards the frenulum. Three new cases are presented: a sinus reaching from the skin of the philtrum to the frenulum in a child with Pierre Robin syndrome, another one in the frenulum of a patient with two separate midline sinuses of the nose, and a third in the frenulum of a child with a partial median cleft lip. The midline sinus is probably caused by disturbed development of the nasofrontal process. The combination of upper lip sinus and Pierre Robin's syndrome is hardly coincidental and supports the concept that the latter is not caused solely by a foetal malposition.

Almost one-half of the population of adolescent and adult Japanese males suffers from some degree of phimosis, i.e., the condition in which the prepuce is too long or too tightly covers the glans penis and causes complications. This condition makes local hygiene difficult, promotes secondary infection and purulence, retards maturation of the penis, and leads to sexual dysfunction that is psychologically and maritally distressing. Circumcision shortly after birth is not ordinarily practiced in Japan, and when relief of phimosis and its complications is attempted later in life by the conventional technique of circumcision or by limited operations like dorsal slit of the prepuce or incision of the frenulum of the prepuce, the condition and its related problems are not readily or always satisfactorily corrected. Consequently, new surgical techniques have been devised and are practiced at the Ohjimi Clinic for the relief of phimosis, especially for the sexual dysfunction that results from it.

Injury to the prepuce is uncommon. A total of 32 patients were treated within a 3-year period. A difference in the aetiology between boys and adults was noted. Accidental injury to the prepuce occurred in 6 boys, with zipper injuries being the commonest among children. Coital and self-inflicted injuries accounted for 85% of adult cases. In patients with coital injuries, predisposing phimosis or a short frenulum was common.

Eight patients, aged 9 months to 9 years, each with unusual complete cleft of the primary and secondary palate on one side and a complete cleft of the secondary palate on the opposite side, were evaluated. All showed varying deficiencies of median facial mesodermal dysgenesis characterized by absent frenulum, indefinite cupid's bow, deficient septal cartilage and nasal spine, and absent central and lateral incisor of the cleft side of the premaxilla. Computerized tomographic scan confirmed the absence of the central nervous system anomalies seen in midline clefts. Cephalometric studies revealed maxillary hypoplasia and no evident hypotelorism. These patients demonstrate a definable lack of median mesodermal penetration along with failure of lateral mesodermal penetration. It is to be noted that median facial dysgenesis can occur without recognizable central nervous system disorders. It is quite possible that microforms of median facial dysgenesis occur in unilateral and bilateral cleft lip and palate patients. This would help explain the wide variations of clefting seen clinically.

The external genitalia of four adult female pygmy chimpanzees (Pan paniscus) were examined during a 2-year period. It was found that the labia majora are retained in adults of this species and that, when tumescent, the labia minora effectively relocate the frenulum and clitoris so that they point anteriorly between the thighs. When detumescent, the configuration of the labia minora and clitoris resembles that of immature common chimpanzees (P. troglodytes). It is suggested that the simple, structural relocation of the clitoris from the normal condition noted in adult P. troglodytes makes possible the homosexual, intergenital rubbing observed in P. paniscus, when ventroventral juxtaposition of the individuals permits eye-to-eye contact. In addition, this change probably increases sexual stimulation of the female during heterosexual, ventroventral copulations. The possibility of intense, face-to-face sexual interactions has been achieved by P. paniscus without the evolution of bipedalism and the consequent reorientation of the genitalia seen in Homo sapiens.

SUMMARY As the result of the examination of thirty-eight human fœtuses it is concluded that the prepuce results from a combination of preputial fold formation and ingrowth of a cellular lamella. These processes are closely linked with the formation and fusion of the urethral folds on the glans. This fact accounts for the formation of the frenulum in normal males and the disposition of the prepuce in females and in cases of hypospadias.

A 6-year-old girl and her 9-year-old brother, born of nonconsanguineous parents, had hoarseness and multiple, asymptomatic, raised skin lesions present since childhood. On examination, both siblings had hoarseness and numerous skin-colored, waxy papules distributed over the forehead, face, neck, axilla, groin, and extremities. Acneiform (pocklike) scars were present on the face, trunk, and extremities. Eyelid beading (moniliform blepharosis) was present over bilateral upper and lower eyelids. The tongue, lips, and frenulum were thickened and infiltrated, and the patients were unable to protrude the tongue out of the mouth. The scalp had patchy alopecia. Histological examination of representative skin specimens (from both siblings) showed deposition of pink, amorphous material in the papillary dermis, around blood vessels, and around appendages. These deposits stained positive with Periodic Acid-Schiff stain, were diastase resistant, and were negative for Congo red, confirming our clinical diagnosis of lipoid proteinosis. Over 250 cases of this rare disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is rare.

Background. In order to evaluate the prevalence rates of Raynaud's phenomenon (RP) and specific clinical signs related to progressive systemic sclerosis (PSS) in the general population of Japan, inquiries were made concerning RP in the hands and dermatologic examinations were also conducted. Methods. One thousand and sixty-three subjects (332 men and 731 women) over 30 years of age who underwent inhabitants' health examinations in 1990 were considered for this study. Results. The prevalence of RP was 3.0% in men and 3.4% in women. In 8 men and 17 women with RP who received the blood tests, the positive rates of antinuclear antibody (ANA) were 12.5% and 35.3% in men and women, respectively. The prevalence rates of all five specific clinical signs related to PSS, sclerodactyly, pitting scars of the fingers, brown pigmentation of the body, shortened frenulum of the tongue, and flexion contracture of fingers, were under 2% in men and 3% in women. In women with RP the prevalence rates of sclerodactyly, pitting scars of the fingertips, brown pigmentation of the body, and shortened frenulum of the tongue were 16.0, 4.0, 4.0, and 16.0%, respectively. These values were significantly higher than those of persons without RP. Conclusions. Because some persons with primary RP may become typical cases of PSS within several years, a follow-up study, particulary for women who have positive titers of ANA with RP, should be carried out to find out whether the persons suffer from PSS or not.

This paper, treating the tortricid subfamily Olethreutinae, represents the second in a proposed three-part series examining variation in the number of bristles in the frenulum of female tortricid moths. Based on an examination of 6,333 individuals of 1,464 species representing 188 genera of Olethreutinae, the number of bristles in the female frenulum varies from one to six, and it is sometimes asymmetrical on the same specimen (7.5% of individuals examined). A three-bristled frenulum is the most common condition in Microcorsini, Endotheniini, Bactrini, Gatesclarkeanini, Olethreutini, Enarmoniini, and Eucosmini, with varying degrees of intraspecific variation in number within each tribe. However, in both Eucosmini and Enarmoniini several genera have a predominantly or exclusively two-bristled frenulum (e.g., Gypsonoma Meyrick, Herpystis Meyrick, and Rhopalovalva Kuznetsov in Eucosmini; Hystrichophora Walsingham, Neoanathamna Kawabe, and Pseudacroclita Oku in Enarmoniini). In Grapholitini, two- and three-bristled frenula occur in nearly equal frequency, suggesting that this character may be of some phylogenetic significance, but an overall pattern is not immediately obvious. In contrast to the situation in Chlidanotinae, where the distribution of the two- and three-bristled frenulum corroborates previously proposed phylogenetic hypotheses, we conclude that variation in the number of bristles in the frenulum in Olethreutinae is not phylogenetically informative at higher levels (e.g., tribes, subtribes) owing to the high degree of intrageneric and intraspecific variation. However, the number of bristles may be of phylogenetic significance at the generic level, particularly in Eucosmini and Grapholitini.

Among 25 patients with hypertrophic pyloric stenosis, a hypoplastic or absent mandibular frenulum was noted in 92%, compared with 1.6% of 319 control infants (P

ResumenLos frenillos aberrantes están incluidos dentro de las deformidades mucogingivales, y estas pueden alterar la función y la estética del periodonto de protección. Este estudio tuvo como objetivo evaluar la inserción de los frenillos labiales y establecer una relación con la pérdida papilar y recesión gingival a nivel de los dientes anterosuperiores y anteroinferiores.Materiales y métodosEstudio transversal que evaluó a 97 pacientes sistémicamente sanos en los cuales se evaluó el tipo de frenillo (TF), la altura del frenillo (AF), el tipo de recesión gingival y la pérdida papilar al nivel de los sectores anteriores maxilar y mandibular.ResultadosEl TF más prevalente fue el mucoso, con un 54,6% y 93,8% de prevalencia a nivel maxilar y de la mandíbula respectivamente; la AF promedio fue de 8,37mm±2,671mm para el frenillo labial maxilar y 8,33mm±1,657mm para el frenillo labial mandibular. No se encontraron relaciones entre el TF, la AF con la presencia y severidad de pérdida papilar y recesión gingival al nivel de los incisivos centrales (p>0,05).ConclusiónEl frenillo más común de la población estudiada fue el frenillo mucoso, no existiendo una relación directa entre su clasificación e inserción con la presencia de una recesión gingival o pérdida papilar.AbstractAberrant frenums are included within the mucogingival deformities, which can alter the function and aesthetic periodontal protection. This study aimed to evaluate the adherence of labial frenulum and establish a relationship with papillary loss and gingival recession of the anterior teeth in maxilla and in the jaw.Materials and methodsA cross-sectional study was conducted on 97 systemically healthy patients in whom the type of frenulum (TF), the height of the frenulum (AF), the type of gingival recession, and papillary loss was evaluated in the upper maxillary and mandibular sectors.ResultsThe most prevalent frenum was the mucosal. The prevalence of TF was 54.6% and 93.8% of maxilla and mandible, respectively. The mean AF was 8.37mm±2.671mm for the labial frenulum in maxillary, and 8.33mm±1.657mm for frenulum. No relationship was found between the TF, AF with the presence and severity of papillary loss and gingival recession (P>.05).ConclusionThe most common frenulum of the study population was the mucosal frenulum. There was no direct relationship between the classification and adherence of the frenulum with the presence of gingival recession or papillary loss.

Two cases are described in which enuresis developed secondary to vaginal filling during micturation. In these girls the frenulum between the labia minora was very close to the urethral orifice and this appeared to force urine into the vagina. It is likely that this disturbance will cease as the labia become more fully developed.

My kind correspondent, Mr. O. Meske, of Albany, sends me a male specimen presumbly belonging to this species, which we referred originally to the Cuban genus EuscirrhopterusGrote, and (from a female) considered congeneric with E. Poeyi Grote. THe specimen now sent has an undivided frenulum and is unquestionably a male. It does not show, however, the aberrant wing structure of Euscirrhopterus.

An easily assembled pressure device for control of frenular bleeding is described and illustrated. A technic for treatment of persistent frenular bleeding in hemophiliac patients is described. This method has been used successfully in two children with this injury who had not responded to the usual methods of treatment.

We have used ten tubes of sodium diarsenol furnished by the Diarsenol Company of Buffalo and thought that this preliminary note might be of service to others who wish to use this product. The drug was used in four cases. REPORT OF CASES Case 1 (No. 261).— A man, aged 36, single, presented himself on June 8, 1920, with four small indurated papules on the corona and an ulceration at the frenulum. Spirochetae pallidae were easily demonstrated. The Wassermann reaction was negative. On June 8 he was given 0.45 gm. of sodium diarsenol; on the 9th he received 0.6 gm. and on the 10th he again received 0.6 gm., that is, he received three doses on each of three successive days. He had no reaction and the therapeutic effect was equal to that of any preparation we have used. On June 14 he reported for mercury treatments and the papules

Lipoid Proteinosis. Presented by Dr. Harold Plotnick, Detroit. A white girl, age 5, has had a raspy, hoarse voice, thinning scalp hair, and recurrent scattered crusted lesions followed by "pocking" since infancy. Whitish growths on the inner surface of the lower lip have been noted by the mother in the past year. The patient has 4 siblings, including her fraternal twin (female). No other members of the family are affected. No history of consanguinity or diabetes was given. Physical Examination.— The patient had difficulty in protruding her tongue because of a short thickened frenulum. There was sparse hair growth over the frontoparietal scalp. Pock-like atrophic macular areas were scattered over the forehead, cheeks, bridge of nose, chin, upper natal cleft, midchest, ulnar surfaces, and posterior axillary folds. An occasional crust was noted over the face, chest, and shoulders. Keratotic-like yellowish papules were seen on the flexural fingers. Fine papules with