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Tethered oral tissues can be considered as an issue that belongs under the scope of many specialists, such as paediatricians, lactation consultants, dentists, speech therapists, orthodontists, physiotherapists, ENT doctors and others. It is necessary to look at tethered oral tissues comprehensively in a broader timeframe. The article summarises the impact of tethered oral tissues on the patient throughout their development and highlights areas that could provide diagnostic clues to detect tethered oral tissues and their management from a multidisciplinary team perspective. The older the patient, the more specialists will be involved in their treatment. With this paper, we aim to arouse interest about the issue among different professionals and to prevent adverse effects on the health of the individual. Although tethered oral tissues are short stretches of tissue, they can have a very negative impact on the quality of life.

Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features that were associated with preputial development, namely the appearance of epidermal aggregates that appeared to be associated with formation of the preputial fold. Transverse and sagittal sections revealed that the epidermis of the glans is considerably thicker than that of the penile shaft. We described a novel morphogenetic mechanism of formation of the preputial lamina, namely the splitting of the thick epidermis of the glans into the preputial lamina and the epidermis via the intrusion of mesenchyme containing red blood cells and CD31-positive blood vessels. This process begins at 10-11 weeks of gestation in the proximal aspect of the glans and extends distally. The process is likely to be androgen-dependent and mediated via androgen receptors strategically localized to the morphogenetic process, but signaling through estrogen receptor may play a role. Estrogen receptor alpha (ESR1) has a very limited expression in the developing human glans and prepuce, while estrogen receptor beta (ESR2) is expressed more broadly in the developing preputial lamina, epidermis and urethra. Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally over several weeks to eventually reach the distal aspect of the glans and prepuce by 14-16 weeks of gestation.

Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features that were associated with preputial development, namely the appearance of epidermal aggregates that appeared to be associated with formation of the preputial fold. Transverse and sagittal sections revealed that the epidermis of the glans is considerably thicker than that of the penile shaft. We described a novel morphogenetic mechanism of formation of the preputial lamina, namely the splitting of the thick epidermis of the glans into the preputial lamina and the epidermis via the intrusion of mesenchyme containing red blood cells and CD31-positive blood vessels. This process begins at 10-11 weeks of gestation in the proximal aspect of the glans and extends distally. The process is likely to be androgen-dependent and mediated via androgen receptors strategically localized to the morphogenetic process, but signaling through estrogen receptor may play a role. Estrogen receptor alpha (ESR1) has a very limited expression in the developing human glans and prepuce, while estrogen receptor beta (ESR2) is expressed more broadly in the developing preputial lamina, epidermis and urethra. Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally over several weeks to eventually reach the distal aspect of the glans and prepuce by 14-16 weeks of gestation.

The Glanular-Frenular Collar (GFC) technique has evolved since it was first described in 2017. The technique involves reconstruction of the septum glandis , which has been overlooked in the history of hypospadias, and formation of the frenulum, creating the ventral wall of the glanular urethra without dissecting the glans, leaving room for the formation of the navicular fossa. We present a case of distal hypospadias corrected with the GFC technique and demonstrate the important steps of the surgical technique. The aesthetic result corresponded to the normal anatomy of the glans and frenular triangle, and the functional result showed a free and wavy shape of urine that resembled the normal flow from the urethra. In the normal anatomy of the penis, the wings of the glans are separated ventrally by the septum glandis and the frenulum. The navicular-shaped glanular urethra and its vertical, elliptical opening are covered by the fibroelastic septum glandis, unlike the penile urethra, which is surrounded by the corpus spongiosum. Reconstruction of hypospadias should include the formation of a septum glandis , frenulum, and navicular fossa. The GFC technique demonstrates the importance of a dual surgical approach for glanular and penile urethra reconstruction. [ABSTRACT FROM AUTHOR]

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

The frenum is a narrow mucosa fold surrounded by muscle fibers that connect the lips to the alveolar mucosa and the periosteum beneath. Midline spacing, commonly called as diastema, recession, interference with prosthodontic therapy, and difficulty speaking are all symptoms of a high frenal attachment. Frenectomy is a surgical treatment that involves removing the aberrant frenal connection. The frenum is a connective tissue membrane that connects one mouth surface to the next. The purpose of this study is to see how popular high frenal attachment is among children who visit a university dentistry hospital. This was a retrospective investigation evaluating the prevalence of high frenal attachment in patients visiting a Chennai dental institution. From June 2019 to March 2021, 11278 patients visited a dental clinic. [ABSTRACT FROM AUTHOR]

The frenum is a narrow mucosa fold surrounded by muscle fibers that connect the lips to the alveolar mucosa and the periosteum beneath. Midline spacing, commonly called as diastema, recession, interference with prosthodontic therapy, and difficulty speaking are all symptoms of a high frenal attachment. Frenectomy is a surgical treatment that involves removing the aberrant frenal connection. The frenum is a connective tissue membrane that connects one mouth surface to the next. The purpose of this study is to see how popular high frenal attachment is among children who visit a university dentistry hospital. This was a retrospective investigation evaluating the prevalence of high frenal attachment in patients visiting a Chennai dental institution. From June 2019 to March 2021, 11278 patients visited a dental clinic.

Background The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severe maxillary frenulum are needed. Purpose No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended followup of these newborn infants. Methods This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likelihood of eventual feeding or oral disorders. Results The convenience sample comprised of 61 consecutively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (P

Abstract 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.

The oriental armyworm, Mythimna separata (Lepidoptera: Noctuidae) is a harmful pest which causes heavy loss in agricultural crops. Sex identification of M. separata is very important for understanding the biology and management of this pest. Development of fast and convenient methods to identify M. separata female and male is the necessary prerequisite for conducting gender-related studies. In this study, new methods to differentiate sex of M. separata at pupal and adult stages were investigated. Our results showed that posterior abdominal segments containing genital organs which are morphological traits to differentiate female and male. Genital openings are important characters for the female and male pupae differentiation. For female pupa, it locates on the ventral side of eighth and ninth abdominal segments and appears as a visible longitudinal suture; for male pupa, it locates on the ventral side of the ninth abdominal segment and appears as a short slit surrounded by a pair of visible semicircular lumps. Bristle numbers are another indicator for sex differentiation of adults. Each female has three-bristled frenulum and each male has one bristled-frenulum near the base of hind wing of each side of moth body. We confirmed the two sex differentiation methods manually by dissecting genitalia of adults and found their genger was as same as what we examined the sex of pupae and adults using the morphological methods.

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 <.0001). Conclusions: This study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility. [ABSTRACT FROM AUTHOR]

Background: The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severe maxillary frenulum are needed. Purpose: No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended followup of these newborn infants. Methods: This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likelihood of eventual feeding or oral disorders. Results: The convenience sample comprised of 61 consecutively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (P<0.01). There were no intergroup differences in other types of feeding difficulty, dental hygiene, pronunciation, or speech development. Conclusion: Our findings suggest that a tethered labial frenulum is not associated with an increase in breastfeeding disturbances or oral disorders. These data encourage clinicians to question the need to intervene in cases of tethered maxillary frenula. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Almost all surgical repair techniques for hypospadias include dissection of the glans penis, and covering the neo‐urethra with the glans tissue circumferentially. Surprisingly, the presence of the "septum glandis" in the ventral midline has been overlooked for decades. A careful examination of six patients with iatrogenic hypospadias (IH) revealed direct indications of the septum glandis. All patients were treated with long‐term urethral catheterisation in the paediatric intensive care unit due to neurologic and/or metabolic diseases. The glans was disrupted in all patients due to ventral midline compression of the urethral catheter, which resulted in a tear in the septum glandis. A remnant of the septum glandis was clearly observed in patients with an incomplete tear. Further injuries caused tear in the frenulum and corpus spongiosum, exposed the glanular urethra and made its vertical elliptical shape, the "fossa navicularis", visible. Intact contours of the separated glans wings were observed in all patients. The glans wings merge ventrally in the midline, but are separated by a fine connective tissue (septum glandis) in conjunction with the frenulum, which is involved in the formation of the ventral wall of the glanular urethra. IH provides further insight into the structural anatomy of the normal human glans and glanular urethra. [ABSTRACT FROM AUTHOR]

The frenum has its origin from the remnant of central cells of vestibular lamina which predominantly has connective tissue and least amount of muscle fibers. Labial frenum is a vertical band of oral mucosa that attaches the cheeks and lips to the alveolar mucosa of the mandibular and maxillary arches, limiting the movement of the lips and cheeks. The aim of the study was to find out the prevalence of type of maxillary labial frenal attachment among 18-30 years. The present retrospective study was conducted among 100 outpatients who reported to a private institution in Chennai from June 2019 to March 2020. Data regarding the type of frenal attachment was collected and analysed. From our current study, it was found out that out of 100 patients, 41% had gingival type, 27% had mucosal and papillary type, 5% had papillary penetrating type of maxillary labial frenal attachment and there was no significant association between gender and type of frenal attachment (Pearson Chi-Square test - 1.105, df-3, p value - 0.776(>0.05); statistically not significant). Within the limitations of the present study, the most prevalent type of maxillary frenal attachment in the given population was gingival type. Least prevalent type was papillary penetrating and there was no significant association between gender and type of frenal attachment. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effects of lingual frenotomy on adults with restrictive ankyloglossia and difficult direct laryngoscopy exposure. Methods: A case series study was conducted. Restriction of tongue protrusion due to ankyloglossia was identified in 2 patients who had a history of suboptimal true vocal fold (TVF) exposure on direct laryngoscopy for phonomicrosurgery. Inadequate exposure of the vocal folds was achieved on direct laryngoscopy attempts with manual tongue protrusion. Mandibular tori were not present in these patients. An intraoperative lingual frenotomy was performed in both patients. Results: After frenotomy and with manual tongue protrusion, direct laryngoscopy exposure was substantially improved allowing for considerably more visualization of the anterior TVFs. Conclusion: Lingual frenulum procedures with manual tongue protrusion should be considered in select adult patients with restrictive ankyloglossia affecting optimal direct laryngoscopy exposure., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objectives: The surgical correction of a short frenulum includes several procedures that vary in complexity of the technique and the use of stitches, lasers, or skin grafts. However, little is known about the effect of these procedures on meatal stenosis. A possible association of frenular artery trauma during circumcision and subsequent meatal stenosis has raised concerns regarding the importance of frenulum preservation. We hereby report our experience over 15 years of applying the “pull-and-burn” method for short frenulum correction. Patients and Methods: A total of 236 patients underwent the “pull-and-burn” procedure for short frenulum under local anesthesia on an outpatient basis between November 2002 and November 2017. The method is suture free and involves tearing the frenulum superficially and vertically by the aid of a low-power, high-frequency hyfrecator, avoiding the underlying frenular vessels. Patients were advised for a regular follow-up visit at 2–3 months postoperatively and were reviewed for symptoms and signs suggestive of meatal stenosis. Results: Follow-up files were available for 228 patients (96.6%). No symptoms suggestive of meatal stenosis (dysuria and stream pattern abnormalities) were reported by any patient. Examination of the urethral meatus revealed normal appearance, with no signs of edema or scarring in all the 228 patients. Conclusions: The “pull-and-burn” method is a simple and safe procedure for the correction of short frenulum that respects anatomically the delicate vasculature of the frenular area, resulting in the preservation of the integrity of the urethral meatus.

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Brian J Morris,1,2 Stephen Moreton,3 John N Krieger4 1School of Medical Sciences, University of Sydney, Sydney, NSW, Australia; 2Bosch Institute, University of Sydney, Sydney, NSW, Australia; 3CircFacts.org, Warrington, UK; 4Department of Urology, University of Washington School of Medicine, Seattle, WA, USAMale circumcision is a very common procedure globally. Technical improvements that reduce adverse events are welcome. It has been suggested that meatal stenosis (MS) is a long-term complication of circumcision. Diagnosis of MS is usually based on a change in the elliptical shape of the meatal opening to a circular shape because of fibrosis or scarring, with visually apparent narrowing. There are, however, natural differences in meatal widths in different males, so a narrow meatus does not necessarily indicate functionally significant stenosis.View the original paper by Karami et al and colleagues.

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

The normal development of the glanular urethra is closely related to the normal development of the foreskin. A ventral deficit in the foreskin results with the failure to develop the septum glandis and frenulum, which also form the ventral wall of the glanular and subcoronal urethra. Here we present the anatomical modeling of the foreskin in order to obtain a mucosal collar for the reconstruction of the glanular hypospadias with the GFC technique (Glanular-Frenular-Collar), which can also be used for various purposes to reconstruct the urethra in hypospadias. [ABSTRACT FROM AUTHOR]

The upper lip frenulum with an overgrown structure or improper attachment is a common cause of hygienic, orthodontic, or prosthetic issues that prompt surgical intervention. The following article presents the surgical methods for the elimination of the overgrown frenulum, discussing and comparing them. Commonly used and described in the literature methods for surgical correction of the upper lip frenulum include frenulectomy, frenuloplasty, and laser excision of the frenulum. The article presents, discusses, and compares the methods of surgical correction of the upper lip frenulum, highlighting the advantages and disadvantages of each procedure. According to researchers, when comparing methods using a scalpel, Z-frenuloplasty is characterized by the lowest recurrence rate and consequently the highest effectiveness in eliminating the problem of an overgrown frenulum. The article also outlines several advantages of using laser methods (diode laser, CO2 laser), such as the elimination of bleeding, reduced postoperative pain reported by patients, and the lack of need for suturing the postoperative wound. Each case depends on a thorough clinical examination of the patient, identifying the specific problem, making an accurate diagnosis, and ultimately adjusting the choice of one of the methods to the individual conditions and medical issue of the patient.

Abstract Objectives 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. Introduction 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. Methods 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. Results 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). Conclusions 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. [ABSTRACT FROM AUTHOR]

Maxillary labial frenulum is a fold of mucous membrane that connects the upper lip and alveolar maxillary bone. The coronary placed frenulum requires surgical treatment. The measurement, classification and representation of the different levels of maxillary labial frenulum has not been studied a lot in literature. For this reason, the objective of this study was to show the classification and determine the presence of different levels of maxillary labial frenulum attachments in young adults. The study included 100 students. Clinical examination of the maxillary labial frenulum was done and the level of the attachment and morphological appearance determined. Statistical analysis was performed with the help of SPSS 11.5. The sample comprised 100 dental students, 75 (75%) of whom were female and 25 (25%) male, the average age was 23.23 ± 3.6. The most common was the gingival attachment of maxillary labial frenulum (76%), papillary (12%), mucous (8%) and the least common was papillary palatal attachment level (2%). According to the morphological manifestation the most common was the simple frenulum (78%).In young adults the most common level of the maxillary labial frenulum attachment was the gingival one and the most common morphological type was the simple one. The least common was the palatal papillary level of frenulum attachment. There was no difference in the prevalence of different levels of maxillary labial frenulum attachment or morphological types between the male and female sexes.

We assembled a complete mitochondrial genome of a unique Australian skipper butterfly Euschemon rafflesia (Hesperiidae) from next generation sequencing reads. The 15,447 bp mitogenome covers 13 protein-coding genes (PCGs), 22 transfer RNA genes (tRNAs), 2 ribosomal RNA genes (rRNAs), and an A + T-rich region. Its gene order is typical for mitogenomes of Lepidoptera. Phylogenetic analysis places Euschemon rafflesia as a sister to the rest of Hesperiidae except Coeliadinae.

Candida spp. are opportunistic unicellular fungi, known to cause oral, vaginal, lung and occasionally systemic infections. Characteristically, they colonize the oral cavity, the mucosal surfaces of the cheek, palate, and tongue. Usually harmless, oral Candidas may become pathogenic under immunosuppressive conditions, dentures presence, or salivary flow impairment. Accurate species identification is important because C. dubliniensis can rapidly develop fluconazole resistance. We report C. dubliniensis in an immunocompetent patient with a metal lingual frenulum piercing.

Background and Objectives: The surgical correction of a short frenulum includes several procedures that vary in complexity of the technique and the use of stitches, lasers, or skin grafts. However, little is known about the effect of these procedures on meatal stenosis. A possible association of frenular artery trauma during circumcision and subsequent meatal stenosis has raised concerns regarding the importance of frenulum preservation. We hereby report our experience over 15 years of applying the “pull-and-burn” method for short frenulum correction. Patients and Methods: A total of 236 patients underwent the “pull-and-burn” procedure for short frenulum under local anesthesia on an outpatient basis between November 2002 and November 2017. The method is suture free and involves tearing the frenulum superficially and vertically by the aid of a low-power, high-frequency hyfrecator, avoiding the underlying frenular vessels. Patients were advised for a regular follow-up visit at 2–3 months postoperatively and were reviewed for symptoms and signs suggestive of meatal stenosis. Results: Follow-up files were available for 228 patients (96.6%). No symptoms suggestive of meatal stenosis (dysuria and stream pattern abnormalities) were reported by any patient. Examination of the urethral meatus revealed normal appearance, with no signs of edema or scarring in all the 228 patients. Conclusions: The “pull-and-burn” method is a simple and safe procedure for the correction of short frenulum that respects anatomically the delicate vasculature of the frenular area, resulting in the preservation of the integrity of the urethral meatus. [ABSTRACT FROM AUTHOR]

Objective: In the normal human penis, the glans wings are in apposition in the midline ventrally, and are separated by the "septum glandis" and "frenulum" of the prepuce. However, most of the hypospadias repair techniques include dissection of the glans wings and their approximation enclosing the neourethra within the glans. Material and methods: In order to obtain detailed information about the normal anatomy of glans penis, magnetic resonance imaging (MRI) findings of the penis were studied in three adults. Transverse, and sagittal sections of the penis were performed with a 1.5-T MRI scanner. Results: The present MRI study has confirmed that the glans wings do not fuse at the ventral midline and they are seperated by a fibrous tissue (septum glandis). This fibrous tissue is connected to the frenulum, traversing the wings of the glans penis. The glanular urethra forming the fossa navicularis has a wider caliber than the proximal urethra, and its walls are radiologically seen as the extension of that fibrous tissue. Conclusion: The male urethra is not a uniform tubular structure and has distinct attachments in glans penis. The glans wings are separated ventrally by the septum glandis and frenulum. In hypospadias, the septum glandis and frenulum are entirely missing structures. Therefore, in hypospadias surgery, the anatomical features of the glanular urethra must be taken into consideration. [ABSTRACT FROM AUTHOR]

Objectives: To characterize associations between restricted tongue mobility and maxillofacial development.Setting and Sample Population: Cross-sectional cohort study of 302 consecutive subjects from an orthodontic practice.Material and Methods: Tongue mobility (measured with tongue range of motion ratio [TRMR] and Kotlow free tongue measurement) was correlated with measurements of the maxillofacial skeleton obtained from dental casts and cephalometric radiographs.Results: Tongue range of motion ratio and Kotlow measures of restricted tongue mobility were associated with (i) ratio of maxillary intercanine width to canine arch length, (ii) ratio of maxillary intermolar width to canine arch length and (iii) soft palate length. Restricted tongue mobility was not associated with hyoid bone position or Angle's skeletal classification.Conclusions: Restricted tongue mobility was associated with narrowing of the maxillary arch and elongation of the soft palate in this study. These findings suggest that variations in tongue mobility may affect maxillofacial development. [ABSTRACT FROM AUTHOR]

Purpose: Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility. Methods: A prospective cohort study of 1052 consecutive patients was evaluated during a 3-month period. Age, gender, ethnicity, height, weight, BMI, maximal interincisal mouth opening (MIO), mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP), Kotlow's free-tongue measurement, and presence of severe tongue-tie were recorded. Secondary outcome measures include tongue range of motion deficit (TRMD, difference between MIO and MOTTIP) and tongue range of motion ratio (TRMR, ratio of MOTTIP to MIO). Results: Results indicate that MIO is dependent on age and height; MOTTIP and TRMD are dependent on MIO; Kotlow's free-tongue measurement is an independent measure of free-tongue length and tongue mobility. TRMR is the only independent measurement of tongue mobility that is directly associated with restrictions in tongue function. Conclusions: We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. 'Functional' ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50-80%, grade 3 < 50%, grade 4 < 25%. [ABSTRACT FROM AUTHOR]

Frenal attachments are thin folds of mucous membrane with enclosed muscle fibers that attach the lips to the alveolar mucosa and underlying periosteum. Most often, during the oral examination of the patient the dentist gives very little importance to the frenum, for assessing its morpholology and attachment. However, it has been seen that an abnormal frenum can be an indicator of a syndrome. This paper highlights the different frenal attachments seen in association with various syndromic as well as non-syndromic conditions.