Frenectomia lingual com laser de diodo de alta potência: relato de caso / Lingual frenectomy with high-power diode laser: a case report / Frenectomía lingual con láser de diodo de alta potencia: informe de un caso

Introdução: A laserterapia de alta potência tem estabelecido proporções satisfatórias na odontologia e se tornando a primeira opção de conduta cirúrgica para procedimentos, trazendo qualidade de vida aos pacientes e praticidade aos Cirurgiões. Objetivo: Relatar caso clínico de frenectomia lingual com uso do laser de diodo de alta potência ressaltando os benefícios da conduta. Relato de caso: Paciente sexo feminino, leucoderma, sem alterações sistêmicas, chega à Clínica Escola de Odontologia da Universidade Federal de Campina Grande, com queixa principal de alterações na sua fonologia. No exame intraoral observou-se dificuldade de movimentação lingual e em formato de coração devido a inserção fibrosa do freio, sendo observado a Anquiloglossia. Após explicações da alteração, do tratamento, e assinatura do Termo de Consentimento, foi iniciado a cirurgia: antissepsia, anestesia com vasoconstrictor, e em modo contínuo utilizou-se o laser de diodo de alta potência (TW Surgical- MMO®) configurado em 2W de potência, fibra 600µm, no comprimento de onda infravermelho, de modo que as fibras fossem separadas uniformemente e promovesse mobilidade imediata da língua, por fim realizou-se uma sutura em ponto simples com fio reabsorvível. Para o pós-operatório foi prescrito Dipirona em caso de dor, e estabelecido o acompanhamento. No retorno de 7 dias observou-se cicatrização normal e não ingestão do medicamento, em 30 dias foi visto a completa cicatrização e mobilidade sem desconforto, além de relato da paciente de melhoria na condição de relacionamentos sociais, autoestima e deglutição. Conclusão: O resultado apresentado neste artigo ratifica a benefício da escolha do laser em comparação ao convencional, demonstrando que não há sangramento no trans e pós cirúrgico, além de favorecer o processo de reparação tecidual, da redução do tempo cirúrgico, aumento do conforto, e diminuição de uso de medicamento, desta forma associando o laser cirúrgico a melhoria da qualidade de vida.

Introduction: High-power laser therapy has established satisfactory proportions in dentistry and has become the first choice for surgical procedures, bringing quality of life to patients and convenience to surgeons. Objective: To report a clinical case of lingual frenectomy using high-power diode laser, highlighting the benefits of this approach. Case report: A female patient, leucoderma, without systemic alterations, arrived at the Dental School Clinic of the Federal University of Campina Grande with the main complaint of alterations in her phonology. In the intraoral examination, difficulty in lingual movement and a heart-shaped tongue due to fibrous insertion of the frenum were observed, indicating Ankyloglossia. After explanations of the condition, treatment, and signing of the Informed Consent Form, the surgery was initiated: antisepsis, anesthesia with vasoconstrictor, and continuous mode using a high-power diode laser configured at 2W of power, 600µm fiber, at an infrared wavelength, with the aim of uniformly separating the fibers and promoting immediate tongue mobility. Finally, a simple suture was performed using absorbable thread. For the postoperative period, Dipyrone was prescribed for pain relief, and follow-up was established. At the 7-day follow-up, normal healing was observed, and the patient did not require the medication. At 30 days, complete healing and discomfort-free mobility were observed, along with the patient's testimony of improvement in social relationships, self-esteem, and swallowing. Conclusion: The results presented in this article confirm the benefits of choosing laser therapy over conventional methods, demonstrating the absence of bleeding during and after surgery, promoting tissue repair, reducing surgical time, increasing comfort, and decreasing the use of medication. Therefore, the use of surgical laser is associated with an improvement in quality of life.

Introducción: La terapia láser de alta potencia se ha establecido en proporciones satisfactorias en odontología y se ha convertido en la primera elección para procedimientos quirúrgicos, aportando calidad de vida a los pacientes y practicidad a los cirujanos. Objetivo: Relatar un caso clínico de frenectomía lingual con láser de diodo de alta potencia, destacando los beneficios de este procedimiento. Relato del caso: Paciente del sexo femenino, leucoderma, sin alteraciones sistémicas, llegó a la Clínica de la Facultad de Odontología de la Universidad Federal de Campina Grande con la queja principal de alteraciones en su fonología. El examen intraoral reveló dificultad en el movimiento lingual y lengua en forma de corazón debido a la inserción fibrosa del freno, observándose anquiloglosia. Tras explicar la alteración, el tratamiento y firmar el consentimiento, se inició la cirugía: antisepsia, anestesia con vasoconstrictor y uso continuado de un láser de diodo de alta potencia (TW Surgical- MMO®) configurado a 2W de potencia, fibra de 600µm, a longitud de onda infrarroja, para que las fibras se separaran uniformemente y favorecieran la movilidad inmediata de la lengua, y finalmente una sutura de punto único con hilo reabsorbible. En el postoperatorio, se prescribió dipirona en caso de dolor y se estableció un seguimiento. En el seguimiento a los 7 días, se observó una cicatrización normal y no se tomó medicación. A los 30 días, se observó una cicatrización completa y movilidad sin molestias, así como el informe del paciente de una mejora de las relaciones sociales, la autoestima y la deglución. Conclusión: Los resultados presentados en este artículo confirman el beneficio de la elección del láser frente a la cirugía convencional, demostrando que no hay sangrado durante ni después de la cirugía, además de favorecer el proceso de reparación tisular, reducir el tiempo quirúrgico, aumentar el confort y reducir el uso de medicación, asociando así el láser quirúrgico a una mejor calidad de vida.

Tied to the Top: A Case Report on an Isolated Ankyloglossia Superior

@#<p><strong>Objective:</strong> To report a case of isolated ankyloglossia superior in a one-month-old boy.</p><p><strong>Methods:</strong></p><p style="text-align: left; padding-left: 30px;"><strong>Design:</strong> Case Report</p><p style="padding-left: 30px;"><strong>Setting:</strong> Tertiary Government Training Hospital </p><p style="padding-left: 30px;"><strong>Patient:</strong> One</p><p><strong>Results:</strong> A one-month-old boy with failure to thrive, feeding difficulties and a palatoglossal band that limited mouth opening and anterior posturing of the tongue was diagnosed to have non-syndromic ankyloglossia superior and underwent surgical transection of the fibrous ankylosis under intravenous sedation due to difficulty of insinuating an endotracheal tube orally. Direct latch breastfeeding was successfully adapted from the second to tenth postoperative day before they were lost to follow up.</p><p><strong>Conclusion:</strong> Despite a complicated pediatric airway, coordinated surgical and anesthesia management successfully restored tongue function and mouth opening to allow effective feeding.</p>

Mothers’ Perceptions and Experiences on Tongue-tie and Frenotomy: A Qualitative Study

@#Introduction: Tongue-tie is a congenital condition of a thickened, tightened or shortened frenulum. This condition may cause breastfeeding difficulties to both mother and infant, such as ineffective suckling and painful nipple. In older children, it can cause speech difficulties. Although many studies have investigated the problems associated with tongue-tie and its treatments, there are limited studies on the mother’s experiences of tongue-tie and post frenotomy. This study aimed to explore the mother’s experiences of tongue-tie associated problems, frenotomy and the outcome. Methods: In-depth interviews were conducted in a one-on-one setting with fifteen mothers whose infant and children underwent frenotomy. Data were collected, transcripted, translated and analysed according to themes. Results: The analysis revealed a common story of stressful challenges and difficulties of breastfeeding. The mothers described that tongue-tie caused poor latching, nipple pain and bleeding, prolong feeding and lack of sleep. Their infant had poor weight gain, sleeping problems, insufficient milk transfer, fatigue and constant crying. For the older children, mothers complained of restricted tongue movement, difficulty in licking ice cream and speech problems. All of them agreed that the frenotomy procedure was easy, simple and less invasive and the outcome was positive. Furthermore, mothers continued breastfeeding without any difficulties and complications. Conclusion: Mothers in this study had difficulties with breastfeeding. However, all of the reported symptoms improved after frenotomy. They considered frenotomy was a simple and safe procedure that was highly recommended for symptomatic tongue-tie.

Prevalence of ankyloglossia in newborns and impact of frenotomy in a Baby-Friendly Hospital / Prevalencia de la anquiloglosia en el recién nacido e impacto de la frenotomía en un hospital de la Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia

Abstract Background: Ankyloglossia is a condition present in some newborns and can be associated with breastfeeding difficulties, leading to symptoms in the child and the mother. This study aimed to analyze the characteristics of newborns with tongue-tie and the symptoms reported by their mothers, and the short and long-term outcomes of frenotomy. Methods: We conducted a prospective and observational 7-month study in a Baby-Friendly Hospital (BFH). We included all the breastfed newborns without comorbidities that underwent a frenotomy. Results: A total of 33 frenotomies were performed. The most common findings before the procedure were maternal breastfeeding pain (29/33), ineffective latch (18/33), and maternal nipple lesions (18/33). We observed that newborns surgically intervened later showed a high incidence of jaundice (p = 0.03), weight loss greater than 10% at hospital discharge (p = 0.004), and their mothers experienced pain more often (p = 0.004). At one month of age, there was an improvement in breastfeeding-related pain (p = 0.012) and its intensity (p = 0.016), the presence of maternal cracked nipples (p < 0.01), and latching on (p < 0.01). Conclusions: Ankyloglossia can prevent the correct establishment of breastfeeding. Frenotomy is associated with few complications, and when appropriately indicated, may have a positive impact on breastfeeding, reducing maternal pain, the presence of nipple lesions, and latching problems.

Resumen Introducción: La anquiloglosia está presente en algunos recién nacidos y puede interferir en el amamantamiento, produciendo sintomatología en el niño y en la madre. El objetivo de este estudio fue analizar las características de los recién nacidos con anquiloglosia, así como la sintomatología referida por sus madres, y la evolución tras la frenotomía. Métodos: Estudio observacional analítico prospectivo de las frenotomías realizadas en la planta de maternidad de un hospital IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia) durante 7 meses. Se incluyeron todos los recién nacidos alimentados inicialmente con lactancia materna a quienes se realizó una frenotomía. Resultados: Se realizaron 33 frenotomías. Los hallazgos más frecuentes previos a la frenotomía fueron dolor con las tomas (29/33), dificultad en el agarre (18/33) y presencia de grietas (18/33). Asimismo, se vio que los pacientes intervenidos más tarde presentaban con mayor frecuencia ictericia (p = 0.03) y pérdida de peso superior al 10% previa al alta (p = 0.004), y sus madres presentaron dolor con mayor frecuencia (p = 0.004). Al mes de vida se observó la mejoría del dolor con las tomas (p = 0.012) y su intensidad (p = 0.016), la presencia de grietas (p < 0.01) y el agarre al pecho (p < 0.01). Conclusiones: La anquiloglosia puede impedir el correcto establecimiento de la lactancia materna. La frenotomía presenta escasas complicaciones y, cuando está bien indicada, puede mejorar el amamantamiento, reduciendo el dolor, la presencia de grietas y las dificultades en el agarre.

La Anquiloglosia en los niños menores de tres meses / Ankyloglossia in children under three months old

Introducción: la lengua es un órgano muscular que interviene en importantes funciones dentro de la cavidad bucal, y la anquiloglosia es una alteración morfológica del frenillo que la une al suelo de la boca y limita sus movimientos a la vez que impide su óptimo desempeño. Objetivo: describir la presencia de anquiloglosia en un período de tres años. Método: se realizó un estudio transversal en los niños menores de tres meses de edad pertenecientes a la Clínica Estomatológica Manuel Angulo Farrán de Holguín, Cuba. La muestra estuvo constituida por 1 095 niños examinados en las consultas de genética de los policlínicos pertenecientes al área de la clínica en el período 2014-2016. Se distribuyeron los pacientes según sexo, áreas de salud, y años de estudio y se comparó la morbilidad por anquiloglosia con el resto de las patologías observadas en la población estudiada. Resultados: la morbilidad por anquiloglosia alcanzó el 4,20%, sin diferencias significativas entre ambos sexos (femenino 4,21% y masculino 4,19%) y entre las áreas de salud. La anquiloglosia representó el 77,97% de todas las afecciones detectadas, seguida por dientes neonatales (10,17%), fisuras palatinas (5,08%), manchas melánicas (3,39%), hemangiomas (1,69%) y fibromas (1,69%). Conclusiones: la anquiloglosia fue la afección más frecuente en niños menores de 3 meses de nacidos, de forma similar entre los sexos y las áreas de salud.

Introduction: the tongue is a muscular organ that takes part in important functions in oral cavity; its movements have been restricted by the abnormal short lingual frenulum observed in the condition called ankyloglossia. Objective: to describe the presence of ankyloglossia during a period of three years. Methods: a transversal descriptive research was made in less than 3 months old children belonging to the "Manuel Angulo Farrán" dental clinic from Holguín, Cuba. The sample was composed of 1095 patients who were examined into the Genetic consulting room of the health area belonging to the clinic since 2014 to 2016. Patients were identified by sex, health center areas and years of study. Finally, ankyloglossia morbidity was compared with the rest of the oral conditions observed by oral exam. Results: morbidity due to ankyloglossia reached 4.20%, without significant differences between both sexes (female 4.21% and male 4.19%) and between health areas. Ankyloglossia accounted for 77.97% of all conditions detected, followed by neonatal teeth (10.17%), palatal fissures (5.08%), melanic spots (3.39%), hemangiomas (1.69%) and fibroids (1.69%). Conclusions: ankyloglossia was the most frequent condition in children under 3 months of age, behaving similarly between the sexes and the health areas.

Tongue-tie division in neonates with breastfeeding difficulties: a systematic review / 中国实用护理杂志

Objective To systematically review the effect of Tongue-tie division on infants with breastfeeding difficulties. Methods The Cochrane Library, PubMed, CNKI and Wanfang data were searched for relevant articles. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria and extracted data regarding study design. RevMan 5.3 software was used to conduct Meta-analysis. Results A total of 151 articles were retrieved and finally 15 articles were included, which involved 1133 infants. Tongue-tie division provided objective improvements in poor latch, inefficient feeding, poor weight gain. Subjective improvements were also noted. But the results were inconsistent on pain improvement. Tongue-tie division increased breastfeeding rate. Conclusions Available evidence suggests that Tongue-tie division can improve breastfeeding, complications are rare, and it is acceptable by families.

Lingual frenulum and malocclusion: An overlooked tissue or a minor issue.

Context: Tongue-tie (more formally known as ankyloglossia) is a congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict mobility of the tongue tip impairing its ability to fulfill its functions. The clinical significance of ankyloglossia is varied; rarely symptomatic to a host of problems including infant feeding difficulties, speech disorders, malocclusions, and others. Aims: The need of this study was to evaluate the occurrence and severity of tongue-tie and its association with the type of malocclusions in two populations and also to correlate the various malocclusion traits with the grades of tongue-tie. Subjects and Methods: A total of 700 school children in the age group of 9–17 years were examined for the presence of tongue-tie, 350 from regular schools and 350 from special schools. The presence was evaluated, measured, and graded into Grades I–V according to Kotlow’s method. The malocclusion was assessed according to Angle’s classification. Severity of crowding was assessed by Little’s irregularity index in each case. Various other malocclusion traits were visually assessed, in relation to the positions of the teeth. Statistical Analysis Used: Spearman’s rank correlation method was used to test the relationship between type of malocclusions, grades of tongue-tie and severity of crowding. Significance was considered at the (P < 0.05) level. Results: Statistically significant differences were seen between grades of tongue-tie and Angle’s types of malocclusion and Spearman’s correlation between them showed negative correlation. The Spearman’s correlation showed a negative correlation between tongue-tie grades and severity of crowding. Conclusions: As the grade of tongue-tie increased, its association with Classes I and II malocclusion decreased. The lower grades of tongue-tie are associated with increased lower incisor crowding. Shorter, tight frenulums are more associated with maxillary constriction, anterior open bite, and spacing of the lower anteriors.

Surgical techniques for the treatment of ankyloglossia in children: a case series

This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

Prevalence of bifid tongue and Ankyloglossia in South Indian population with an emphasis on its embryogenesis / Prevalencia de lengua bífida y anquiloglosia en el Sur de la población India con énfasis en su embriogénesis

Disturbance in the organogenesis of tongue might lead to some malformations like tongue tie, bifid tongue and hairy tongue. Severe degrees of these anomalies may cause speech impairment or periodontal defects. The present study was done on patients of the southern coastal belt of India during the past two years, on gross tongue anomalies. The results of the present study reveal that occurrence of tongue tie is 0.2 percent and bifid tongue is 0.3 percent in the southern coastal population. Since great majority of these oral anomalies have genetic basis the purpose of the present report is to highlight that these anomalies can exist without any familial background and also to suggest that environmental factor may play a role in the etiogenesis of these anomalies.

La alteración en la organogénesis de la lengua puede dar lugar a algunas malformaciones como anquiloglosia, lengua bífida y lengua vellosa. Grados severos de estas anomalías puede provocar un trastorno del habla o defectos periodontales. El presente estudio se realizó, durante los últimos dos años, en pacientes de la franja costera del Sur de la India con anomalías graves en la lengua. Los resultados del estudio revelaron que, en la población costera del sur, la incidencia de anquiloglosia era de 0,2 porciento y de lengua bífida de 0,3 por ciento. Dado que la gran mayoría de estas anomalías orales tienen base genética, el propósito del presente informe fue poner de relieve que estas anomalías pueden existir sin ningún tipo de antecedentes familiares y también sugerir que los factores ambientales podrían jugar un papel en el etiogenesis de estas anomalías.

The Improvement of Tongue Mobility and Articulation after Frenotomy in Patient with Ankyloglossia / 대한이비인후과학회지

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<0.05). Similarly, the mean length of tongue protrusion improved from 15.0 mm to 26.0 mm (p<0.05). The mean articulation score improved from 8.5 to 9.9 (p<0.05). Parents' subjective satisfaction scores improved from 2.3 to 3.2 (p<0.05). CONCLUSION: Tongue mobility and articulation improved after frenotomy in patients with ankyloglossia.

Analysis of Speech Pathologic Evaluation for Children With Ankyloglossia

Ideal Surgical Period of Children with Tongue-tie: Analysis of 517 Cases / 中国康复理论与实践

@#ObjectiveTo investigate the ideal surgical period of children with tongue-tie.MethodsThe data of 517 children with tongue-tie treated by simply clipped surgery or horizontal-to-vertical plasty were analyzed retrospectively to evaluate the effect of operation and the level of phonologic prognosis.ResultsThe sex ratio was approximately 10∶4 (male∶female) in all groups. Two cases occurred postoperative hemorrhage. The follow-up compliance was better in children <1 year old, but higher levels of noncompliance occurred in children >1 years old. One year after surgical treatment, there were no phonologic disorders caused by tongue motion in children <1 year old, but the levels of phonologic prognosis in children >1 years old were better, moderate, and insignificant respectively.ConclusionThe ideal surgical period of children with tongue-tie is age of 6～12 months.

The Frenuloplasty and Speech Therapy Influenced on Phonemes in Tongue-tie

Tongue tie, often referred to as 'Ankyloglossia', is a congenital condition, recognized by an unusually thickened, tightened, or shortened lingual frenulum, which limits movement of the tongue in activities connected with feeding and which has an adverse impact on both dental health and speech. A common definition and objective measurements have been rare because the tongue is a complete soft tissue structure without non- mobile landmarks. From March of 1996 to November of 2001, preoperative and postoperative speech evaluation, post-speech therapy were performed in twelve patients. Each low picture consonants test was observed in tongue-tie patients. Overall picture consonants test was improved after frenuloplasty and postoperative speech therapy. Preoperative value of liquids and fricatives were lower than the other alveolar phonemes(p<0.05) and it was improved after frenuloplasty(p<0.05) and postoperative speech therapy(p<0.05). Frenuloplasty itself can improve the articulation of liquids and fricatives on short follow-up. But Frenuloplasty and postoperative speech therapy can be more improvement of the alveolar phonemes.

Effect of speech therapy on alveolar sound after lingual frenulotomy in tongue-tie patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many research papers showed that the most common articulation disorder in tongue-tie children was the error of alveolar sound. We performed speech therapy on alveolar sound after lingual frenulotomy to prove that the speech therapy after lingual frenulotomy improves the articulation of alveolar sound and that this effect is maintained. MATERIALS AND METHODS: We collected 28 children who never had speech therapy but could afford to have the speech therapy. The accuracy rate of consonant sound was calculated using a picture consonant test 2 weeks following the lingual frenulotomy. The speech therapy, called the phonetic placement and paired-stimulus technique, was performed 18 times for 3 months. This therapy decreased incidence rate of error. RESULTS: The incidence rate of alveolar sound error, which was calculated before speech therapy, was about 65%. And the incidence rate of alveolar sound error after speech therapy was 5-10%, which proved the effect of speech therapy. We divided alveolar sounds into target sounds and non-target sounds. And we performed speech therapy only on target sounds so the appearance rate of alveolar sound error decreased and the incidence rate of non-target sounds also decreased. We performed speech therapy after 2 weeks and the effect was maintained. CONCLUSION: The incidence rate of alveolar sound error decreased by using speech therapy and the effect was maintained. So the speech therapy must be performed after lingual frenulotomy.