Influence of Neonatal Ankyloglossia on exclusive breastfeeding in the six first months of life: a cohort study. / Influência da Anquiloglossia neonatal na amamentação exclusiva nos seis primeiros meses de vida: estudo de coorte.

PURPOSE: To analyze the influence of ankyloglossia on the prevalence and duration of exclusive breastfeeding of full-term infants up to the sixth month of life. METHODS: Prospective cohort study, carried out with 225 mother-infant dyads who were followed up in the first six months of life in a center specialized in breastfeeding in a tertiary hospital. Full-term infants with asymptomatic ankyloglossia (no need for surgery) were compared with infants without change at monthly follow-up. Ankyloglossia was diagnosed using the Bristol Tongue Assessment Tool, with a positive diagnosis being considered for those with a score less than or equal to 5 considering functional and anatomical aspects. Statistical analyzes were performed using descriptive statistics, logistic regression (weaning determinants), relative risk, and survival curves (to analyze breastfeeding duration between groups with and without ankyloglossia). RESULTS: Ankyloglossia was associated with weaning (considered even partial) before the sixth month of life. After adjusted analysis, a higher risk of weaning was detected in infants with this alteration, with a risk present from the second month of life. In the survival analysis, the duration of breastfeeding in infants with ankyloglossia was shorter when compared to children without alterations. CONCLUSION: Compared to infants with normal lingual frenulum, babies with ankyloglossia had shorter exclusive breastfeeding time, but well above the average observed in the general population. The risk of weaning for this group was also higher.

OBJETIVO: Analisar a influência da anquiloglossia na prevalência e no tempo de exclusividade do aleitamento materno de lactentes a termo até o sexto mês de vida. MÉTODOS: Estudo de coorte prospectivo, realizado com 225 díades mãe-bebê que foram acompanhadas nos seis primeiros meses de vida em centro especializado em amamentação em um hospital terciário. Lactentes a termo com anquiloglossia do tipo assintomática (sem necessidade de cirurgia) foram comparados com lactentes sem alteração em um acompanhamento mensal. O diagnóstico de anquiloglossia foi realizado através do Bristol Tongue Assessment Tool, sendo considerados com diagnóstico positivo aqueles com escore menores ou iguais a 5 considerando os aspectos funcionais e anatômicos. As análises estatísticas foram realizadas através de estatística descritiva, regressão logística (determinantes do desmame), risco relativo e curvas de sobrevivência (para analisar o tempo de aleitamento entre os grupos com e sem anquiloglossia). RESULTADOS: A anquiloglossia esteve associada com o desmame (considerado ainda que parcial) antes do sexto mês de vida. Após análise ajustada, foi detectado maior risco de desmame nos lactentes com a alteração presente, com risco presente a partir do segundo mês de vida. Na análise de sobrevida, o tempo de aleitamento nos lactentes com anquiloglossia foi menor quando comparadas às crianças sem alteração. CONCLUSÃO: Em comparação com lactentes com freio lingual normal, os bebês com anquiloglossia apresentaram tempo menor de aleitamento exclusivo, porém bem acima da média observada na população geral. O risco de desmame para este grupo também foi maior.

Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study.

Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

Relationship between Ankyloglossia and Breastfeeding: A Bibliometric Review

ABSTRACT Objective: To assess global trends in the publication of studies investigating the association between ankyloglossia and breastfeeding. Material and Methods: An electronic search was performed in the Scopus database without restrictions. Observational studies and clinical trials were included. Bibliometric indices such as publication year, authors, co-authors, journals, field of knowledge, countries, and the most cited keywords were analyzed using the VOSviewer program. Results: The search retrieved 350 studies, and 68 were selected. The first article was published in 2000 in the United States. The United States presented the highest number of publications (n=21), followed by Brazil (n=9) and the United Kingdom (n=9). An increase in publications on this theme was observed in 2013; 2021 was the year with the highest number of publications (n=14). The most common word was "frenulum". The authors with the highest number of publications were Botze and Dollbert from Israel (n=3), Ghaheri, and Mace from the United States (n=3). Among the journals, "Breastfeeding Medicine" presented the highest number of publications (n=7), followed by the "International Journal of Pediatric Otorhinolaryngology" (n=6), "CODAS" (n=5), "Journal of Human Lactation" (n=4) and "Pediatrics" (n=3); the latter published the top-cited studies, with 412 citations. Conclusion: There has been an increase in recent articles evaluating the correlation between ankyloglossia and breastfeeding, indicating the growing interest of researchers in this field.

Anquiloglossia sob a visão da odontologia: um panorama de evidências científicas / Anquiloglossia under the vision of dentistry: an overview of scientific evidence

Objetivos: Este trabalho teve como objetivo analisar o panorama geral de evidências científicas relevantes existentes sobre a anquiloglossia em âmbito odontológico. Métodos: Foram selecionados artigos científicos publicados em português e inglês, disponíveis no portal eletrônico PubMed e nos repositórios do SciELO e do Google Acadêmico, tendo sido incluídos artigos sem limite de data para publicação, utilizando os descritores: "Anquiloglossia", "Diagnóstico" e "Terapêutica". Resultados: A anquiloglossia é uma anomalia oral congênita caracterizada por freio lingual muito curto, que ocasiona graus variáveis de diminuição da mobilidade lingual, podendo ser parcial ou total. Sua etiologia é multifatorial, supondo-se um componente hereditário e/ou uma caracterização da permanência de tecido residual nessa região. O diagnóstico da anquiloglossia não é padronizado, mas, no Brasil é obrigatório a realização do Teste da Linguinha em todas as maternidades, visando o diagnóstico precoce dessa condição em recém-nascidos. A terapêutica, quando necessária, é através de intervenções cirúrgicas como: frenotomia, frenectomia e da técnica cirúrgica com laser diodo de alta potência. Conclusões: A anquiloglossia é caracterizada por freio lingual muito curto capaz de com diminuição da mobilidade lingual. Sua etiologia é multifatorial e ainda em partes desconhecida. O diagnóstico da anquiloglossia não é padronizado, mas se baseia em inspeções orais. A terapêutica dessa condição pode ser não-cirúrgica ou cirúrgica, dependendo de cada caso.

Objectives: This study aimed to analyze the general panorama of existing relevant scientific evidence on ankyloglossia in the dental field. Methods: Scientific articles published in Portuguese and English, available on the PubMed electronic portal and in the SciELO and Google Scholar repositories were selected, including articles with no date limit for publication, using the descriptors: "Anquiloglossia", "Diagnosis" and "Therapy". Results: Ankyloglossia is a congenital oral anomaly characterized by a very short lingual frenulum, which causes variable degrees of decrease in lingual mobility, which can be partial or total. Its etiology is multifactorial, assuming a hereditary component and/or a characterization of the permanence of residual tissue in this region. The diagnosis of ankyloglossia is not standardized, but in Brazil it is mandatory to perform the Linguinha Test in all maternity hospitals, aiming at the early diagnosis of this condition in newborns. Therapy, when necessary, is through surgical interventions such as: frenotomy, frenectomy and the surgical technique with high-power diode laser. Conclusions: Ankyloglossia is characterized by a very short lingual frenulum capable of reducing lingual mobility. Its etiology is multifactorial and still largely unknown. The diagnosis of ankyloglossia is not standardized, but is based on oral inspections. The treatment of this condition can be non-surgical or surgical, depending on each case.

Ankyloglossia in Monochorionic Diamniotic and Dichorionic Diamniotic Twins: A Cross-Sectional Study.

Objective: To determine the prevalence of ankyloglossia in diamniotic monochorionic and diamniotic dichorionic twins, as well as to verify the relationship between gender and type of pregnancy. Study Design: A cross-sectional observational study, carried out with 52 pairs of dichorionic/diamniotic twins and 49 monochorionic/diamniotic pairs. The data collection was carried out through the analysis of medical records and the results of the Neonatal Screening of the Tongue Frenulum Assessment Protocol in Babies, and corresponded to the period of 2 years (2020-2022). Statistical analysis of data was performed, considering the significance value of 5%. The study was approved by the Human Research Ethics Committee of the institution. Results: The statistical analysis of multiple logistic regression between the two groups of twins (Mono/Di and Di/Di) according to the socioeconomic, demographic, and clinical-epidemiological profile was statistically significant for some variables. The prevalence of ankyloglossia, according to the type of twin pregnancy, showed a statistically significant difference. There was no statistical difference in relation to sex and ankyloglossia, or between couples diagnosed with ankyloglossia according to the type of pregnancy. Conclusion: Monochorionic/diamniotic twins had a higher prevalence of ankyloglossia, regardless of gender.

Surgical and Speech Therapy Evaluation of Lingual Frenulum.

Interdisciplinary evaluation is essential to diagnose and define clinical conduct for children and adults presenting with an altered lingual frenulum; however, there are few reports on the subject in the literature. In this context, the following study exemplifies a proposed protocol for the surgical and SLT treatment of a lingual frenulum based on a review of the literature and the experience of speech and language therapists and maxillofacial surgeons from hospitals in Santiago de Chile. After its application, a history of breastfeeding with difficulties and a maintained preference for soft foods was reported. Upon anatomic examination, the lingual apex was heart-shaped, and the lingual frenulum was fixed in the upper third of the ventral side of the tongue, with a pointed shape, submerged up to the apex, and of adequate thickness. Meanwhile, upon functional examination, the tongue was descended at rest, performed tongue protrusion with restrictions (raising and clicking), did not achieve attachment or vibration, and presented distortion of the sounds / r/ and /rr/. With this information, an altered lingual frenulum was diagnosed, with the indication for surgery and postoperative speech and language therapy. The constructed instrument allowed for the standardization of the evaluation in different teams but should be validated in future research.

Perfil de serviços públicos que realizam avaliação do frênulo lingual em neonatos no Rio Grande do Norte / Profile of health services that assessthelingual frenulum of newborns in public and maternity hospitals of Rio Grande do Norte state / Perfil de servicios que realizanevaluación del frenillo lingual en neonatos en hospitales públicos y maternidades del estado de Rio Grande do Norte

Introdução:A anquiloglossia é caracterizada pela alteração do frênulo lingual resultando na restrição dos movimentos da língua. A avaliação do frênulo lingual em neonatos é importante para diagnosticar precocemente essa alteração. Objetivo:Traçar perfil de serviços que realizam avaliação do frênulo lingual em neonatos nos hospitais e maternidades públicas do estado do Rio Grande do Norte. Metodologia:Trata-se de um estudo observacional, descritivo e transversal, com abordagem quantitativa. Foram incluídos na pesquisa as maternidades públicas e filantrópicas do estadoque realizam procedimentos obstétricos e assistência materno-infantil. As informações acerca da avaliação do frênulo lingual em neonatos e caracterização desses serviços foram coletadas por meio de um questionário eletrônico. Os dados foram armazenados em planilhas no Excel e analisados através do programa estatístico SPSS versão 23.0, em queforam conduzidas análises das variáveis investigadas.Resultados:Participaram do estudo 23 hospitais e maternidades públicas do estado, econstatou-se que apenas 7 (30,44%) ofertam a avaliação do frênulo lingual em neonatos no próprio estabelecimento, enquantoas demais encaminham para outros serviços. O exame foi implantado nas maternidades entre os anos de 2014 e 2018. A quantidade de profissionais que realizam esta avaliação variou entre 1 e 9 por instituição, e os profissionais envolvidos foram os fonoaudiólogos e cirurgiões-dentistas. A prevalência da anquiloglossia variou de 3,7% a 14,5%. A maioria das maternidades realizam a frenotomia e o profissional que executa é o médico ou cirurgião-dentista.Conclusões:Constatou-se uma baixa oferta da avaliação do frênulo lingual em neonatos no próprio estabelecimento de nascimento. Além disso, essa oferta ainda não acontece de forma universal, principalmente no interior do estado (AU).

Introduction:Ankyloglossia is characterized by alterations in the lingual frenulum resulting in restricted tongue movements. Assessing the lingual frenulum in newborns is important for early diagnosis of this disorder. Objective:Describe the profile of health servicesthat assess the lingual frenulum of newborns in public and maternity hospitals of Rio Grande do Norte state. Methodology:This is a cross-sectional descriptive study using a quantitative approach. Included in the research were public and philanthropic maternity hospitals in statethat perform obstetric procedures and provide maternal and child care. The information about lingual frenulum assessment in newborns and characterization of these health services was collected via an electronic questionnaire. The data were stored in Excel spreadsheets and analyzed using the SPSS version 23.0 program, where analyses of the variables investigated were carried out. Results:A total of 23 public and maternity hospitalsparticipated, only 7 of which (30.44%) assessed the lingual frenulum of newborns on site, while the others referred them to other medical facilities. The examination was implemented in maternity hospitals between 2014 and 2018. The number of professionals who performed this assessment varied between 1 and 9 per institution, and included speech therapists, and dentists. The prevalence of ankyloglossia ranged from 3.7 to 14.5%. Most of the maternity hospitals performed frenotomy, where the procedure was conducted by a doctor or dentist. Conclusions:On-site lingual frenulum assessment of newborns was low in the institutions, and does not occur universally, mainly in the rural areas of the state (AU).

Introducción: La anquiloglosia se caracteriza por la alteración del frenillo lingual que resulta en la restricción de los movimientos de la lengua. La evaluación del frenillo lingual en neonatos es importante para un diagnóstico precoz de este trastorno.Objetivo: Delinear un perfil de servicios que realizanevaluación del frenillo lingual en neonatos en hospitales públicos y maternidades del estado de Rio Grande do Norte.Metodología: Se trata de un estudio observacional y transversal con enfoque cuantitativo. Se incluyeron en la investigación las maternidades públicas y filantrópicas del estadoque realizan procedimientos obstétricos y de atención materno-infantil. La información sobre la evaluación del frenillo lingual en neonatos y la caracterización de estos servicios fui recogido por medio de un cuestionario electrónico. Los datos fueron almacenados en hojas Excel y analizados utilizando el programa estadístico SPSSversión 23.0, donde se realizaron análisis de las variables investigadas. Resultados: Un total de 23 hospitales públicos y maternidades participaron del estudio, en el que se constató que solo 7 (30,44%) evalúan el frenillo lingual en neonatos en establecimiento propio, mientras los demás refieren a otros servicios. El examen se implementó en las maternidades entre 2014 y 2018. El número de profesionales que realizan esta evaluación varió entre 1 y 9 por institución, y los profesionales involucrados fueron terapeutas del habla y odontólogos. La prevalencia de anquiloglosia varió entre 3,7 y 14,5 %. La mayoría de las maternidades realizan la frenotomía y el profesional que la realiza es el médico u odontólogo. Conclusiones: Hubo una baja oferta de avaluación del frenillo lingual en neonatos en el propio establecimiento. Además, esta oferta aún no es universal, especialmente en el interior del estado (AU).

Effects of lingual frenotomy on breastfeeding and electrical activity of the masseter and suprahyoid muscles.

PURPOSE: To analyze the effects of lingual frenotomy on the breastfeeding of infants, based on the electrical activity of the masseter and suprahyoid muscles and assessment of the breastfeeding. METHODS: Observational study developed between October 2017 and June 2018 with a sample of 20 newborns and infants who attended a dental clinic and were diagnosed with ankyloglossia. Another 20 were excluded for meeting some of the following exclusion criteria: babies more than 6 months old, who were not on exclusive or mixed breastfeeding, who had other clinical impairments that interfered with breastfeeding, who had other foods introduced into their diet, who had neurological changes and/or craniofacial deformities, and/or who did not finish all the stages of the study. Breastfeeding was assessed with the UNICEF Breastfeeding Assessment and Observation Protocol, while the muscle electrical activity was assessed with the Electrical Activity Assessment Protocol for the Masseter and Suprahyoid Muscles in Newborns During Breastfeeding. The same speech-language-hearing therapist conducted the two assessments both before the conventional frenotomy and 7 days after it. RESULTS: The signs suggestive of breastfeeding difficulties changed 7 days after the surgery, with a p-value ≤ 0.002 for general observation of the mother, position of the infant, latch, and sucking. The maximum voluntary contraction of the masseter was the only integral parameter with a difference, as the electrical activity had decreased. CONCLUSION: Behaviors favorable to breastfeeding increased 7 days after the frenotomy in all the breastfeeding assessment categories, whereas the electrical activity of the masseter decreased.

Effect of lingual frenotomy on the breastfeeding improvement

To evaluate breastfeeding in babies up to six months of age before and after frenotomy surgery in a reference hospital in a city from Santa Catarina state. Methods: An observational quality improvement study, carried out with babies up to six months of age undergoing frenotomy and their mothers in a reference hospital in southern Santa Catarina state. A questionnaire was applied to the mothers in two moments (before and after the surgery), with information regarding breastfeeding, sociodemographic, anthropometric and behavioral characteristics of them and of the babies. Descriptive analyzes were performed and the association between breastfeeding and the independent variables was assessed through Pearson's chi-square and Fisher's exact tests, using a 5% significance level. Results: A total of 74 children were studied, with 48 of them returning after surgery. 83.8% were breastfed before surgery and 64.9% after surgery. Before surgery, 58.1% of children effectively took the breast at once. After surgery, this prevalence was 83.3% (p=0.015). Before surgery, 75.9% of the mothers reported not feeling pain, while, after surgery, almost all of them (95.8%) reported this (p=0.004). Most mothers reported improvement in grip (83.3%), increase in the duration of breastfeeding (69.0%), improvement of baby's breathing (75.0%), and an increase in the frequency of breastfeeding (51.7%). Conclusions: There was a decrease in the prevalence of breastfeeding after frenotomy. However, there was an improvement in the babies 'grip and breathing and a reduction in the mothers' pain when breastfeeding. It is emphasized the need to implement multidisciplinary actions in both primary and hospital care to assist mothers in order to prolong the duration of exclusive breastfeeding

Anquiloglossia em bebês: da embriologia ao tratamento - uma revisão de literatura / Ankyloglossia in babies: from embryology to treatment - a literature review

Objetivo: o objetivo do presente estudo foi realizar uma revisão narrativa de literatura sobre a anquiloglossia em bebês, apresentando os critérios para diagnóstico, implicações na amamentação e formas de tratamentos. Fontes dos dados: foram realizadas, em abril de 2022, buscas nas bases de dados PubMed e Scielo, considerando artigos publicados entre os anos 1990 e 2022. Foram utilizadas como palavras-chave: frenectomy; babies; ankyloglossia; breastfeeding. A seleção dos trabalhos foi realizada através da leitura dos títulos e dos resumos. Após a aplicação dos critérios de inclusão e exclusão, 27 artigos foram selecionados, sendo eles pesquisas originais, relatos de caso e revisões de literatura. Livros textos nacionais também foram utilizados. Síntese dos dados: apesar de não existir um teste para diagnóstico considerado padrão-ouro, a triagem neonatal para investigação de anquiloglossia é uma obrigatoriedade nas maternidades de todo o país. Os testes para diagnóstico mais utilizados no Brasil são "Teste da Linguinha" e de Bristol. Não foram encontradas evidências científicas que relacionem a frenotomia e/ou frenectomia à melhora da amamentação. A abordagem multidisciplinar abrangendo dentistas, fonoaudiólogos, pediatras, consultores de amamentação, otorrinolaringologistas, cirurgiões e outros profissionais capacitados, deve ser considerada para delinear a melhor conduta clínica. Dentre as técnicas cirúrgicas, a frenotomia em bebês mostra-se como sendo a mais segura por apresentar menos riscos de complicações transoperatórios e pós-cirúrgica. Conclusão: faz-se necessário a realização de estudos controlados e com baixo viés metodológico sobre diagnóstico, tratamento e impactos da anquiloglossia na amamentação para padronizar e nortear a conduta clínica da equipe multidisciplinar responsável pelo binômio mãe-bebê no período puerperal.

Objective: the aim was to conduct a narrative literature review on ankyloglossia in infants, presenting the criteria for diagnosis, implications on breastfeeding, and treatment options. Sources of data: a search was conducted in PubMed and Scielo databases, considering articles published between 1990 and 2022 in April 2022. The key words used were: frenectomy; babies; ankyloglossia; breastfeeding. The selection of the papers was made through the title and by reading the abstracts. After applying the inclusion and exclusion criteria, 27 articles were selected, which were original research, case reports and literature reviews. National textbooks were also used. Synthesis of data: there is no test for diagnosis considered gold standard, neonatal screening for ankyloglossia investigation is a mandatory in maternity hospitals all over the country. The most used diagnostic tests in Brazil are the "Martinelli Test" and the "Bristol test". No scientific evidence was found relating frenotomy and/or frenectomy to improve breastfeeding. A multidisciplinary approach including dentists, speech therapists, pediatricians, breastfeeding consultants, otorhinolaryngologists, surgeons, and other trained professionals must be considered to outline the best clinical management. Among the surgical techniques, frenotomy in infants is the safest because it presents fewer risks of transoperative and post-surgical complications. Conclusion: it is necessary to carry out controlled studies with low methodological bias on diagnosis, treatment, and the impact of ankyloglossia on breastfeeding, to standardize and guide the clinical management of the multidisciplinary team responsible for the mother-baby binomial during the puerperal period.

Anquiloglossia e alterações na fala: revisão integrativa da literatura / Ankyloglossia and speech disorders: integrative literature / Revieanquiloglosia y trastornos del habla: revisión integradora de la literatura

Objetivo: Caracterizar as alterações na fala decorrentes da anquiloglossia, por meio de revisão integrativa da literatura. Métodos e Procedimentos: Levantamento bibliográfico realizado em fevereiro de 2020, delimitado segundo os idiomas inglês, português, espanhol e idade a partir de 6 anos. Foram selecionados artigos disponíveis em quatro bases eletrônicas: PubMed, SciELO, Scopus, Web Of Science. Palavras-chave utilizadas: freio lingual; distúrbios na fala; anquiloglossia. Foram consideradas publicações de 2010 a 2020 mediante análise de metadados, a partir do título e resumo, para identificar pertinência à pesquisa. Foram excluídos estudos publicados há mais de dez anos, que não permitiram acesso ao texto integral, repetidos por sobreposição dos descritores, discrepantes do tema. Resultados e Discussão: Foram localizados 276 artigos, que após aplicados os critérios de inclusão e exclusão resultaram em 27. Os resultados encontrados indicam que sujeitos com alterações no frênulo lingual, principalmente na anquiloglossia, utilizam estratégias compensatórias variadas de lábios, língua e mandíbula para a produção dos fonemas 't', 'd', 'l', 'n', 's', 'z', 'r' e de grupos consonantais, que poderão apresentar distorção, substituição e/ou omissão, por serem de difícil produção com frênulo curto. Aos profissionais otorrinolaringologistas, ortodontistas e fonoaudiólogos é recomendada realização de exame clínico cuidadoso, que possibilite diagnóstico com objetivo de obter resultados satisfatórios em menor tempo e indicação de intervenções cirúrgicas, quando necessárias. Conclusão: A revisão integrativa da literatura aponta para a relação entre anquiloglossia e alterações na fala.

Objective: To characterize the speech disorders resulting from ankyloglossia, through an integrative literature review. Methods and Procedures: Bibliographic survey carried out in February 2020, delimited language (English, Portuguese, Spanish) and age (from 6 years old). Articles available in four electronic databases were selected: PubMed, SciELO, Scopus, Web of Science. Keywords used: lingual frenum; speech disorders; ankyloglossia. Manuscripts published from 2010 to 2020 were included based on metadata analysis that considered title and abstract to identify the relevance for this research. Studies published over ten years ago, those that did not allow access to the full text, manuscripts repeated due to overlapping of descriptors or diverging from the topic were excluded. Results and Discussion: 276 articles were initially identified; after the inclusion and exclusion criteria were applied, 27 studies were considered. The results showed that subjects with lingual frenulum alterations, mainly ankyloglossia, use varied compensatory strategies of lips, tongue and mandible for the production of the phonemes 't', 'd', 'l', 'n', 's', 'z', 'r' and consonant clusters, which may present distortion, substitution and/or omission, as their production is hindered by the short frenulum. Otorhinolaryngologists, orthodontists and speech therapists are recommended to conduct careful clinical examination, allowing for diagnosis, in order to obtain satisfactory results in less time and indication of surgical interventions, when necessary. Conclusion: The integrative literature review shows the relationship between ankyloglossia and speech disorders

Objetivo: Caracterizar las alteraciones del habla derivadas de la anquiloglosia, a través de una revisión integrativa de la literatura. Métodos y Procedimientos: Encuesta bibliográfica realizada en febrero de 2020, delimitada según inglés, portugués, español y edad a partir de 6 años. Bases de datos electrónicas seleccionadas: PubMed, SciELO, Scopus, Web Of Science. Palabras clave utilizadas: frenillo lingual; trastornos del habla; anquiloglosia. Las publicaciones de 2010 a 2020 se consideraron mediante análisis de metadatos, desde el título y el resumen. Se excluyeron los estudios publicados hace más de diez años, que no permitían el acceso al texto completo, repetidos por superposición de descriptores, discrepantes con el tema. Resultados y Discusión: Se localizaron 276 artículos, que luego de aplicar los criterios de inclusión y exclusión resultaron 27. Los resultados encontrados indican que los sujetos con alteraciones en el frenillo lingual, principalmente en anquiloglosia, utilizan variadas estrategias compensatorias de labios, lengua y mandíbula para la producción de los fonemas 't', 'd', 'l', 'n', 's', 'z', 'r' y grupos consonánticos, que pueden presentar distorsión, sustitución y/u omisión, porque son difíciles de producir con un frenillo corto. Se recomienda a los otorrinolaringólogos, ortodoncistas, logopedas profesionales que realicen examen clínico cuidadoso, que permita un diagnóstico con el objetivo de obtener resultados satisfactorios en menos tiempo e indicación de intervenciones quirúrgicas, cuando sea necesario. Conclusión: La revisión integrativa de la literatura apunta a la relación entre la anquiloglosia y los trastornos del habla.

Does neonatal ankyloglossia interfere in the growth of infants during the first 6 months of life? A case series nested in a cohort study.

BACKGROUND: Ankyloglossia is commonly reported as one of the major causes of breastfeeding difficulty. There is a lack of research on infant growth and latching performance with clinical measures. CASES PRESENTATION: We describe a series of eight clinical cases (three female and five male infants) in a specialized breastfeeding center in a tertiary hospital in Northeast Brazil. The mothers were of mixed race and ranged from 13 to 41 years of age. Ankyloglossia was diagnosed within the first 48 hours after delivery. We measured the standards of growth, the mothers' perception of breastfeeding, and a pain indicator, and performed an assessment of breastfeeding. The regularity of breastfeeding was maintained despite the early diagnosis of ankyloglossia. Growth indicators were not affected in the sixth month in any of the babies, with only one measuring below expectations in the third month, with no impact on general health. CONCLUSIONS: In the cases reported in this paper, the infants overcame the initial difficulties in breastfeeding and maintained their normal growth course in the first 6 months of life.

Tongue-tie in babies: diagnosis and laser frenectomy: case report / Anquiloglosia en bebés: diagnóstico y frenotomía con láser: informe de caso

Introduction: The World Health Organization (WHO) establishes that breast-feeding must be promoted, supported, and protected due to its benefits in maternal and child health and for the economic, environmental, family and community benefits it produces. Case Report: Ankyloglossia in the newborn can cause early cessation of breastfeeding. A clinical case of a 2-month-old baby, referred to the surgical team of the Dental Service of the Pereira Rossell Hospital Center, with difficulties in breastfeeding due to ankyloglossia is presented. Diagnosis and laser surgical treatment was performed. In the immediate postoperative period, there was an improvement, achieving breastfeeding without the aid of devices, and a progressive improvement during the month following the intervention occurred. Conclusion: Early diagnosis and timely intervention collaborate in the maintenance of lactation and in the progressive improvement of the process.

Introducción: La Organización Mundial de la Salud (OMS) establece que la lactancia materna debe ser promovida, apoyada y protegida por sus beneficios demostrados en la salud materno-infantil y por las ventajas económicas, ambientales, familiares y comunitarias que produce.Reporte de Caso: La anquiloglosia en el recién nacido puede provocar el abandono temprano de la lactancia. Se presenta un caso clínico de un bebe de 2 meses, derivado al equipo quirúrgico del Servicio Odontológico del Centro Hospitalario Pereira Rossell, por dificultades en el amamantamiento a causa de anquiloglosia. Se realizó el diagnóstico y tratamiento quirúrgico con láser. En el postoperatorio inmediato se registró una mejoría en el amamantamiento, logrando la lactancia sin intermediario y una mejoría progresiva en la praxis durante el mes siguiente a la intervención.Conclusión: El diagnóstico precoz y la intervención oportuna colaboran en el mantenimiento de la lactancia y en la mejora progresiva de la praxis.

Comparison Between Two Protocols for Ankyloglossia Diagnosis in Newborn Babies.

Purpose: Ankyloglossia is a congenital anomaly that restricts tongue movements and can interfere in breastfeeding. The purpose of this study was to compare two protocols for ankyloglossia diagnosis: (1) the Neonatal Tongue Screening Test (NTST); and (2) the Bristol Tongue Assessment Tool (BTAT). Methods: This was a cohort study involving live births at the University Hospital of Brasilia, Brasilia, Brazil, from August 2017 to July 2018. The gathered data were based on clinical examinations and interviews with mothers. The Stata software program was applied to conduct the analyses using the chi-square test, Spearman's correlation and the receiver operating characteristic (ROC) curve, and sensitivity, specificity, and positive and negative predictive values. Results: A total of 972 mother-baby dyads were evaluated. The protocols showed agreement (P ≤ 0.001) for an ankyloglossia diagnosis, according to Spearman's correlation. The prevalence of ankyloglossia was 5.5 percent (NTST) and 5.1 percent (BTAT) and was greater in the male gender in both protocols. According to the ROC curve, the four cutoff point showed better sensitivity and specificity (98.4 percent and 64.2 percent, respectively). The BTAT was highly accurate in comparison with the NTST. Conclusions: Both protocols showed similar low ankyloglossia prevalence. The Bristol Tongue Assessment Tool protocol is potentially more viable as a screening instrument than the Neonatal Tongue Screening Test protocol because it is simpler and more concise.

Adaptação Transcultural do Protocolo de Avaliação da Língua de Bristol (Brazilian Cross-Cultural Adaptation of the Bristol Tongue Assessment Tool - BTAT)) e do Protocolo de Avaliação de anquiloglossia em bebês amamentados (Tongue-tie and Breastfed Babies Assessment Tool - TABBY) / Adaptação Transcultural do Protocolo de Avaliação da Língua de Bristol (Brazilian Cross-Cultural Adaptation of the Bristol Tongue Assessment Tool - BTAT) e do Protocolo de Avaliação de anquiloglossia em bebês amamentados (Tongue-tie and Breastfed Babies Assessment Tool - TABBY)

Anquiloglossia: magnitude, diagnóstico e tratamento A anquiloglossia, comumente conhecida como "língua presa", é uma variação anatômica que limita a mobilidade da língua, causada por uma restrição do frênulo lingual. Uma revisão sistemática e meta-análise apontou que a prevalência de anquiloglossia (15 estudos; n = 24.536) foi de 8% (IC 95% 6-10%, p < 0,01), sendo de 7% no sexo masculino e 4% no sexo feminino. Observou-se ainda, uma prevalência de 10% ao usar um instrumento de avaliação padronizado em comparação com 7% ao usar o exame visual sozinho (p = 0,16), sem diferença estatisticamente significativa (HILL et al., 2021). Alguns estudos apontam que a presença de anquiloglossia pode levar a dificuldades de amamentação, incluindo incapacidade de o bebê se alimentar continuamente no peito, pega inadequada, baixo ganho de peso e trauma mamilar (INGRAM et al., 2015). Tendo em vista os inúmeros benefícios da amamentação, é crescente o interesse na identificação precoce da anquiloglossia e definição de seu tratamento (VICTORA et al., 2016). Alguns instrumentos para o diagnóstico de anquiloglossia foram propostos, como por exemplo a Ferramenta de Avaliação da Função do Frênulo Lingual (ATLFF) de Hazelbaker (AMIR et al. 2006); o sistema de classificação de Kotlow (KOTLOW L.A., 1999); a classificação da gravidade da anquiloglossia proposta por Coryllos (CORYLLOS et al., 2004): o Protocolo de Avaliação do Frênulo da Língua em Bebês de Martinelli (MARTINELLI et al., 2016) e o Protocolo de Avaliação da Língua de Bristol (Protocolo Bristol) (INGRAM et al., 2015), dentre outros. De forma geral, limitações são apontadas no tocante à avaliação das propriedades psicométricas de todos os instrumentos disponíveis (HILL et al., 2021). Em relação ao tratamento da anquiloglossia, uma revisão sistemática incluindo cinco ensaios clínicos randomizados (n= 302) mostrou que a frenotomia reduziu a dor nos mamilos das mães que amamentam no curto prazo, porém não foi identificado um efeito positivo consistente na amamentação. Os pesquisadores não relataram complicações graves, mas o número total de lactentes estudados foi pequeno. Assim, o pequeno número de estudos e deficiências metodológicas limitou a certeza dos achados, sendo necessário conduzir outros ensaios controlados randomizados com alta qualidade metodológica para determinar os efeitos da frenotomia (O'SHEA et al., 2017).

Applications of diode laser in periodontal therapy ­ clinical guidelines and tips / Aplicações do laser de diodo na terapia periodontal ­ Orientações e dicas clínicas

Os lasers de diodo tornaram-se ferramentas clínicas populares devido ao seu tamanho compacto, acessibilidade, facilidade de uso e versatilidade. O objetivo deste artigo é apresentar as diversas aplicações de um laser de diodo na prática diária e destacar os aspectos técnicos do uso do laser de diodo para o mesmo. Esta série de casos relata o manejo de seis diferentes situações clínicas com laser de diodo: anquiloglossia, bolsa periodontal, zênites gengivais desiguais, mucocele, hipersensibilidade dentinária e gengiva hiperpigmentada. Os pacientes foram tratados com laser de diodo de 940 nm com potência de 0,5 W a 2 W dependendo do caso. A cicatrização pós-operatória transcorreu sem intercorrências na maioria dos casos e foram observados resultados favoráveis. O laser de diodo ofereceu vantagens cirúrgicas como ­ campo seco, desinfecção do sítio cirúrgico e cirurgia sem sutura. Além disso, os autores observaram melhor satisfação do paciente devido à mínima dor ou edema pós-operatório e alívio imediato em caso de hipersensibilidade dentinária. Este artigo apresenta as aplicações cirúrgicas e não cirúrgicas do laser de diodo juntamente com os aspectos técnicos. Embora a literatura disponível não forneça evidências substanciais para comparação direta do laser de diodo com as técnicas convencionais, é seguro concluir que o laser de diodo é uma ferramenta eficiente para uso rotineiro em odontologia.(AU)

The diode lasers have become popular clinical tools because of their compact size, affordability, ease of use and versatility. The aim of this paper is to put forth the various applications of a diode laser in day to day practice and highlight the technical aspects of diode laser use for the same. This case series reports management of six different clinical situations with diode laser namely ­ ankyloglossia, periodontal pocket, unequal gingival zeniths, mucocele, dentinal hypersensitivity and hyper-pigmented gingiva. The patients were treated with 940 nm diode laser with power settings from 0.5 W to 2 W depending on the case. The post-operative healing was uneventful in most cases and favourable outcomes were observed. The diode laser offered surgical advantages like ­ dry field, disinfection of surgical site and suture-less surgery. In addition, the authors observed better patient satisfaction owing to minimal post-operative pain or swelling and immediate relief in case of dentinal hypersensitivity. This paper presents both surgical and non-surgical applications of diode laser along with the technical aspects. Even though the available literature does not lend substantial evidence for direct comparison of diode laser with conventional techniques, it is safe to conclude that diode laser is an efficient tool for routine use in dentistry.(AU)

Evaluation of the effects of high-level laser and electrocautery in lingual frenectomy surgeries in infants: protocol for a blinded randomised controlled clinical trial.

INTRODUCTION: Ankyloglossia (tongue-tie) is an anomaly characterised by an abnormally short, thick or small lingual frenulum that restricts tongue movements. This condition is considered one of the factors that can interfere with breast feeding by diminishing the ability of the newborn to latch adequately. According to the Brazilian Health Ministry, the prevalence of this anomaly among newborns is 3%-16%. Frenectomy is the most suitable surgical procedure for the treatment of ankyloglossia. The aim of this study is to compare the performance of electrocautery and high-power diode laser as forms of frenectomy. METHODS AND ANALYSIS: The proposed study will be a randomised, controlled, blind clinical trial involving the participation of healthy infants 0-3 months of age with breastfeeding difficulty and a diagnosis of tongue-tie with an indication for lingual frenectomy. The guardians will receive clarifications regarding the procedures and will authorise the participation of the infants by signing a statement of informed consent. A non-blinded researcher will perform the screening and procedures and a blinded researcher will perform the postoperative evaluations. Fifty-six infants will be randomly allocated into two groups (n=28): the electrocautery group or the high-power laser group. The preparation of the patients, asepsis and infection control procedures will rigorously follow biosafety norms. For both groups, patient histories will be taken, clinical evaluations will be performed and a standardised photograph of the lingual frenulum will be taken before surgery. The Bristol Tongue Assessment Tool will be used. We will evaluate pain in the mother during breast feeding before, immediately after, and 15 days after surgery. ETHICS AND DISSEMINATION: This protocol was submitted to the Research Ethics Committee of Nove de Julho University, having been given a favourable opinion (Number: 4387769). Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT04487418.

Anquiloglosia en el lactante amamantado. Puesta al día / Ankyloglossia in breastfeeding infants. An update

El frenillo lingual corto, o anquiloglosia, puede generar problemas durante la lactancia con repercusión en el desarrollo del lactante, daño en el pezón de la madre y abandono precoz de la lactancia. Actualmente no existe homogeneidad en los criterios diagnósticos, lo que ocasiona tanto sobrediagnóstico como infradiagnóstico de esta alteración, con las consecuencias clínicas que ello conlleva. La dificultad en el abordaje radica en saber cuándo se trata de variantes anatómicas normales o de un frenillo lingual sin repercusión funcional, y cuándo los problemas de lactancia, que clásicamente se le atribuyen se deben realmente al frenillo. Alrededor del 50 % de los niños con frenillo lingual corto no presenta problemas de lactancia o estos se resuelven con apoyo y asesoramiento. En el resto de casos se puede recurrir a tratamiento quirúrgico. En este artículo se ha realizado una actualización de la clasificación y tratamiento de la anquiloglosia que permitirá a los profesionales un manejo adecuado de estos pacientes

Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50 % of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients

Aspectos anatômicos e funcionais da língua após frenectomia em gemelares: relato de casos clínicos / Anatomic and functional aspects of the tongue after frenectomy in twin: clinical cases report

Objetivo: Relatar dois casos clínicos de alteração de frênulo lingual em gemelares, com 10 anos de idade, ambas do sexo feminino, avaliadas nos aspectos anatômicos e funcionais da língua antes e 15 dias após a frenectomia. Relato de casos: Inicialmente, o odontopediatra realizou a anamnese com a mãe. Em seguida, as participantes foram submetidas à avaliação clínica odontológica e, posteriormente, foi realizada a avaliação fonoaudiológica do frênulo lingual. A avaliação fonoaudiológica foi realizada por meio do Protocolo de Avaliação do Frênulo da Língua, que foi aplicado antes e 15 dias após a frenectomia. As duas participantes apresentaram melhor desempenho em provas anatômicas após o procedimento cirúrgico. Entretanto, algumas alterações, principalmente ao elevar a língua, continuaram sendo observadas em uma das pacientes 15 dias após a frenectomia. Ademais, as duas participantes passaram a executar a maioria dos movimentos de língua com maior precisão. No que se refere à fala, somente a participante que apresentava um maior número de alterações fonéticas anteriores, permaneceu com algumas alterações na fala decorridos 15 dias da cirurgia. Discussão: Algumas dificuldades envolvendo mobilidade da língua e alterações na fala podem persistir após a realização da cirurgia, indicando a necessidade de intervenção fonoaudiológica específica. Conclusão: Ambos os casos apresentaram melhora no desempenho tanto nas provas anatômicas quanto funcionais após a frenectomia.

Aim: to report two clinical cases of alteration of the lingual frenulum in twins, aged 10 years, both female, evaluated in the anatomical and functional aspects of the tongue before and 15 days after the frenectomy. Case reports: Initially, the paediatric dentistry performed the anamnesis with the mother. Then, the participants were submitted to a dental clinical evaluation and, sub-sequently, the speech language pathologist evaluation of the lingual frenulum was performed. The speech language pathologist assessment was performed using the Tongue Frenulum Evaluation Protocol, which was applied before and 15 days after the frenectomy. Both participants performed better in anatomical tests after the surgical procedure. However, some changes, especially when elevating the tongue, continued to be observed in one of the patients 15 days after the frenectomy. In addition, the two participants started to perform most of the tongue movements with greater precision. About speech, only the participant who had a greater number of previous phonetic changes, remained with some speech disorders after 15 days of surgery. Discussion: Some di-fficulties involving mobility of the tongue and changes in speech may persist after surgery, indicating the need for specific speech therapy intervention. Conclusion:Both cases showed improvement in performance both in anatomical and functional tests after frenectomy