Ankyloglossia and malocclusion: A systematic review and meta-analysis.

BACKGROUND: Ankyloglossia is a congenital alteration that affects the tongue's mobility, influencing craniofacial development; however, its association with malocclusion is still unclear. This systematic review and meta-analysis investigated the association between ankyloglossia and malocclusion in patients. TYPES OF STUDIES REVIEWED: The authors conducted a systematic review and meta-analysis of observational studies that investigated the association between malocclusion and the presence of ankyloglossia in any age group, used any assessment tool to diagnose ankyloglossia, and considered all types of malocclusion. The authors conducted searches in 8 electronic databases through July 1, 2022. They used Joanna Briggs Institute appraisal tools to assess the methodological quality and the Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS: Eleven studies (5 cross-sectional, 6 case-control) included 2,904 patients and over 13 occlusal alterations. The certainty of the evidence ranged from low through very low. Patients with Angle Class III malocclusion had similar or more inserted lingual frenula than patients with Class I malocclusion (standard mean difference, 0.37; 95% CI, -0.50 to 1.25) and Class II malocclusion (standard mean difference, 0.55; 95% CI, -0.52 to 1.63). Patients with Class III malocclusion had clinically significant increased mouth opening reduction compared with patients with Class I malocclusion (mean difference, 6.67; 95% CI, 4.01 to 9.33) and Class II malocclusion (mean difference, 5.04; 95% CI, 2.35 to 7.72) patients. PRACTICAL IMPLICATIONS: There is uncertain evidence that ankyloglossia may be associated with the development of occlusal alterations. Ankyloglossia did not influence the Angle classification. Clinicians should closely follow children with ankyloglossia to evaluate whether this condition interferes with the occlusion. Future research should prospectively follow up on the long-term association between ankyloglossia and malocclusion. The protocol was registered a priori in the PROSPERO database (CRD42021248034). No amendments were deemed necessary after the registration of the protocol. Some subgroup analyses planned a priori were not possible, such as the severity of ankyloglossia, sex, and age, due to the lack of studies reporting data for these subgroups.

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.

Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study.

BACKGROUND: The study aims to describe the lingual laser frenotomy perioperative protocol for newborns with ankyloglossia with or without breastfeeding difficulties developed by Odontostomatology and Neonatology and Neonatal Intensive Care Units of the Aldo Moro University of Bari. METHODS: Authors carried out a prospective observational cohort study. Newborns with ankyloglossia (classified by using both Coryllos' and Hazelbaker's criteria) with or without difficult breastfeeding (according to Infant Breastfeeding Assessment Tool) underwent diode laser frenotomy (800 ± 10 nm; 5 W; continuous wave mode; contact technique; under topical anesthesia) and follow-up visits after seven and thirty days postoperatively. The authors analyzed as main outcomes the perioperative pain intensity measured by the C.R.I.E.S. scale, the occurrence of complications and quality of healing, the quality of breastfeeding, newborn's postoperative weight gain, maternal nipple pain, and the presence of lesions as secondary outcomes. RESULTS: Fifty-six newborns were included in the current study. Intraoperative mean pain intensity was 5.7 ± 0.5 points, resolved within thirty postoperative minutes. Observed complications were mild punctuating bleeding, carbonization of the irradiated site, and transitory restlessness. All wounds were completely healed within the thirtieth postoperative day. During follow-up, a significant breastfeeding improvement was evident with satisfactory newborns' weight gain and a significant reduction of nipple pain and lesions (p < .05). CONCLUSION: Our lingual laser frenotomy protocol provided significant breastfeeding improvement in the mother-newborn dyads with low intraoperative pain and no significant complications.

Tongue-tie and breastfeeding.

OBJECTIVE: To evaluate the efficiency of maternal breastfeeding and maternal pain pre- and post-lingual frenulum release procedures in infants with ankyloglossia. METHODS: Infants under 4 months of age with tongue-tie who were actively breastfeeding, and their mothers (mother-infant dyads) were recruited. Infants' ankyloglossia severity was evaluated using the Coryllos® ankyloglossia tongue-tie grading scale. Each mother completed a pre-procedure questionnaire where breastfeeding efficiency was evaluated using the LATCH® criteria. Each mother also reported a numeric score of pain with feeding, breastfeeding time, and a perceived feeding efficiency score. After the tongue-tie release procedure, each mother completed a post-procedure questionnaire within a 1-week to 1-month window to assess the change in breastfeeding efficiency using the LATCH® criteria, breastfeeding pain, breastfeeding time, and perceived breastfeeding efficiency. RESULTS: 41 mother-infant dyads participated in the study. No surgical complications occurred during or post-procedure. All dyads reported improved (40) or equal (1) LATCH® scores: with a mean improved LATCH® score of 3.2 points (p < 4^10-15, 95% CI 2.6, 3.7.). The mean improved maternal perception of feeding was 3.3 points (p < 6^10-10,95% CI 2.6, 4.0.), the mean decreased maternal pain was 4.0 points (p < 1^10-14, 95% CI 3.3, 4.8), and the mean decreased maternal feeding time was 0.80 points (p = 0.002, 95% CI 0.5, 1.1.). CONCLUSION: Lingual frenulum release procedures appear to consistently improve breastfeeding efficiency and decrease maternal pain.

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey.

BACKGROUND: In the past 10-15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased performance of frenotomy. Physicians and other healthcare professionals with expertise in breastfeeding have voiced concerns about complications related to the performance of infant frenotomy. Reviews of this topic have reported no significant complications after frenotomy. Other data on complications consist of case reports. METHODS: An online survey was developed by physicians with expertise in breastfeeding and e-mailed to physician and dentist members of Academy of Breastfeeding Medicine (ABM) between 11 November and 31 December 2019. It requested information from the respondents who cared for the mother/infant breastfeeding couple about their experiences personally caring for infants with complications or misdiagnoses related to referral for frenotomy or the performance of a frenotomy. Data were analyzed using chi square, Cramer's V correlation, and binomial logistic regression. RESULTS: Of 211 eligible respondents, 129 (61%) had cared for an infant with a complication or misdiagnosis. Two hundred and nine (209) infants were reported to have a complication and 237 had a misdiagnosis. The most common misdiagnoses reported were 101 of 237 infants (43%) with neuromuscular dysfunction and 65 of 237 (27%) with inadequate breastfeeding support. The most common complications reported were a repeat procedure considered/requested/performed 65 of 203 (32%) and oral aversion 57 of 203 (28%). Parental report of infant pain was associated with performance of a posterior frenotomy (Chi Square p < .003). Bleeding was associated with using scissors/scalpel vs laser/bovie/electrosurgery (Chi Square p = .001). Oral aversion was associated with performance of frenotomy by laser/bovie/electrosurgery vs scissors/scalpel (adjusted Odds Ratio of 4.05; 95% CI 2.07, 7.93). CONCLUSIONS: Complications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to provide skilled breastfeeding support and to evaluate for other confounding problems that might impact infant breastfeeding before referral for frenotomy. Randomized controlled trials of optimized lactation support vs. frenotomy and of scissors vs laser in performance of frenotomy are needed.

Analgesic effect of inhaled lavender essential oil for frenotomy in healthy neonates: a randomized clinical trial.

BACKGROUND: Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates. METHODS: We conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the "experimental group" and "control group". In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate's nose for two minutes prior to and during the frenotomy. RESULTS: We enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups. CONCLUSIONS: We observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies.

The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia.

INTRODUCTION: Ankyloglossia is a congenital condition that restricts tongue mobility. The aim of this study is to evaluate the relationship between gender and pediatric ankyloglossia and evaluate the planning of ideal timing of surgery. METHODS: The files of pediatric patients in the Turkish population treated surgically for tongue-tie between June 2014 to June 2018 were scanned retrospectively. RESULTS: Three hundred and eighty-two pediatric patients were included in the study. Of these, 115 (30.1%) were female and 267 (69.9%) were male. The prevalence of ankyloglossia was significantly higher in males than in females (P < .001). The age of the patients at time of surgery ranged from 1 day to 114 months. The most common indication was sucking/feeding difficulties (82%) in patients younger than 2 years, and the most common symptom was speech problems (67%) in patients aged 2 years and older. CONCLUSION: In our study, the prevalence of ankyloglossia in Turkish society was significantly higher in males. Frenectomy surgery is a safe procedure that can be performed on the first day of life in newborns.

Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia.

OBJECTIVES: There is debate among otolaryngologists and other practitioners about whether upper lip tie contributes to difficulty with breastfeeding and whether upper lip tie and ankyloglossia are linked. Our objectives were to evaluate the anatomy of the upper lip (maxillary) frenulum, to determine if the visual anatomy of the upper lip has an effect on breastfeeding, and to determine whether the occurrence of lip tie and tongue tie are correlated. METHODS: A prospective cohort study of 100 healthy newborns was examined between day of life 3-7. Surveys were completed by the mother at the time of the initial exam and 2 weeks later. The maxillary frenulum was graded based on the Stanford and Kotlow classifications by two independent reviewers. Inter-rater reliability and relationships between tongue tie, lip tie, and the infant breastfeeding assessment tool (IBFAT) were calculated. RESULTS: Inter-rater reliability showed fair agreement (κ = 0.302) using the Kotlow scale and better agreement using the Stanford classification (κ = 0.458). There was no correlation between the upper lip tie classification and breastfeeding success score. Lastly, there was a modest inverse correlation in the degree of tethering for the tongue and lip. CONCLUSIONS: There was no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch. There was also no relationship between tip to frenulum length (tongue tie) and visualized lip anatomy, suggesting that tongue tie and lip tie may not cluster together in infants. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E1701-E1706, 2021.

Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: A prospective randomized study.

OBJECTIVE: To compare the surgical outcomes of simple frenotomy and the 4-flap Z-frenuloplasty according to the articulation test values and tongue-tie classification in patients with ankyloglossia with articulation difficulty. STUDY DESIGN: prospective randomized study. SETTING: Tertiary academic center. SUBJECTS: and methods: Children with ankyloglossia with articulation difficulty were randomly divided into 2 groups for surgical treatment. Patients were evaluated for the tongue-tie classification and articulation test before surgery. Three months after the operation, the frenulum classification and articulation test were re-evaluated to compare the differences in surgical outcome between the two surgical methods. RESULTS: Out of 37 patients, 19 underwent the 4-flap Z-frenuloplasty and 18, the simple frenotomy. No differences were observed in the baseline characteristics of the patients assigned to both groups. Changes in the tongue-tie classification and improvement in the articulation test results were observed with both the surgical methods. Both surgical groups had significant improvement in the speech articulation test (consonants) but there was no difference in the speech outcomes between the surgical groups. CONCLUSION: Although there was no significant difference in the surgical outcome between the two surgical methods, ankyloglossia patients showed improvement in a Korean speech articulation test 3 months after undergoing surgery to release the lingual frenulum.

Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study.

Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.

Speech production in young children with tongue-tie.

INTRODUCTION: Tongue-tie, or ankyloglossia, occurs in 4-10% of the population. Treatment of tongue-tie has increased by 420% in Australia between 2006 and 2016 and 866% in the United States between 1997 and 2012. Despite limited evidence, it has been suggested that tongue-tie can result in speech sound disorder (SSD). This study aimed to investigate tongue mobility and speech production outcomes in children with and without tongue-tie diagnoses. METHOD: Fifty-nine children aged 2; 1 to 4; 11 years were recruited and formed three groups: treated tongue-tie (TTT), untreated tongue-tie (UTT) and no tongue-tie (NTT). Measures of lingual frenulum structure and function, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected. RESULTS: No statistically significant differences were found between the TTT, UTT and NTT groups for tongue mobility, speech production or intelligibility. Significantly more UTT children had a history of speech pathology attendance than participants in the NTT group. CONCLUSION: This study provides preliminary evidence of no difference between tongue mobility and speech outcomes in young children with or without intervention for tongue-tie during infancy. This study assists with clinical decision making and makes recommendations for families not to proceed with surgical intervention for tongue-tie during infancy, for the sole outcome of improving speech production later in life.

Characteristics and considerations for children with ankyloglossia undergoing frenulectomy for dysphagia and aspiration.

OBJECTIVE: The purpose of this study is to analyze the basic demographics of patients who underwent frenulectomy at our institution as well as additional considerations regarding age, location of procedure, and possible effects on aspiration. METHODS: A retrospective chart review was performed based on CPT codes for frenulectomy and basic demographic data was collected. Other information such as presenting symptoms, type of ankyloglossia, location of the procedure, and modified barium swallow study (MBSS) information were also obtained. RESULTS: A total of 226 (66.4% male) patients underwent frenulectomy in the study time frame. Younger patients underwent frenulectomy for feeding symptoms (average age 6.5 months) and older children typically presented with speech related symptoms (average age 3.8 years). Of patients who had MBSS before and after the procedure, 5/11 (43%) had improvement of their aspiration after frenulectomy. CONCLUSIONS: Symptomatic ankyloglossia is more common in boys. Two age groups typically present for frenulectomy, infants for feeding difficulties and toddlers/preschoolers for speech related difficulties. Children with aspiration may benefit from frenulectomy, though aspiration is unlikely to resolve if other comorbidities are present. Proper evaluation and documentation of anatomy and functional tongue movement is important for future studies and decision-making regarding frenulectomy.

Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: What is the Connection?

Ankyloglossia, or tongue tie, and its impact on the oral phase of feeding has been studied and debated for decades. However, the impact of posterior tongue ties on the pharyngeal phase of swallowing is not well documented in the literature. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. However, in the setting of a normal MRI with normal motor development, other etiologies need to be explored. If it is not neurologic, could it be anatomic? We present a 21-month-old patient with significant pharyngeal phase dysphagia which was most saliently characterized by impaired base of tongue movement, poor pressure generation, and diffuse residue resulting in aspiration. He was eventually diagnosed with a posterior tongue tie and underwent a frenulectomy. Results via subsequent VFSS revealed significant improvement in base of tongue movement, pharyngeal pressure generation, and pharyngeal constriction, resulting in efficient movement of the bolus through the pharynx into the esophagus, no nasopharyngeal regurgitation, no aspiration, and near resolution of his pharyngeal dysphagia. Patients with impaired base of tongue movement and impaired pressure generation resulting in pharyngeal residue in the setting of a normal neurologic workup could possibly present with a posterior tongue tie which should be examined and included in the differential diagnosis.

The role of tongue-tie in breastfeeding problems-A prospective observational study.

AIM: We evaluated what determined breastfeeding problems in a non-selected mother-infant cohort, with special reference to tongue-tie and improvements in breastfeeding following frenulotomy. METHODS: This 2014-2015 prospective, observational study was carried out in a tertiary level maternity unit affiliated to the University of Freiburg, Germany, using a breastfeeding questionnaire, standardised breastfeeding scores and the Assessment Tool For Lingual Frenulum Function (ATLFF). The standard intervention was breastfeeding support, a frenulotomy for tongue-tie was performed if necessary. All cases of breastfeeding problems and, or tongue-tie, were followed up by telephone 2.5 weeks after birth. RESULTS: We enrolled 776 newborn-mother dyads: 345 had breastfeeding problems, 116 had a tongue-tie and 30 underwent a frenulotomy. In the multivariate analysis, severe breastfeeding problems were more frequent in newborn infants with tongue-tie, with an odds ratio (OR) of 2.6 (P= 0.014). Other risk factors were: no breastfeeding experience (OR 4.4, P = 0.001), low birth weight (OR 2.9, P = 0.001), prematurity (OR 3.6, P = 0.000) and Caesarean section (OR 1.6, P = 0.023). There was a significant reduction in breastfeeding problems after frenulotomy (P = 0.01). CONCLUSION: Tongue-tie had a significant impact on breastfeeding and so did low birth weights and prematurity. Frenulotomy proved helpful when breastfeeding problems were reported.

Acute presentation of an intraoral dermoid cyst causing airway compromise in a young child.

A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.

Versatilidad del colgajo famm para la cobertura de defectos intraorales / Versatility of the famm flap in intraoral reconstruction / Versatilidade do retalho FAMM na cobertura de defeitos intra-orais

Introducción y Objetivo: El colgajo FAMM (colgajo músculo-mucoso de arteria facial) descrito en 1992 por Pribaz y col, es un colgajo intraoral basado en la arteria facial, compuesto por mucosa oral, submucosa, músculo bucinador, arteria facial y por el plexo venoso correspondiente y puede ser de base inferior (flujo anterógrado) o superior (flujo retrógrado). Es un colgajo versátil que se puede usar en la reconstrucción de defectos de múltiples localizaciones (paladar, lengua o suelo de boca). Con este trabajo pretendemos demostrar su utilidad en la reconstrucción de diferentes defectos intraorales. Material y Método: Presentamos 3 casos en lo que empleamos el colgajo FAMM para reconstrucción intraoral: un paciente con anquiloglosia cicatricial secuela de carcinoma de suelo de boca, un paciente con fístula de paladar secuela de resección tumoral, y un paciente con exposición intraoral de arco mandibular por osteonecrosis secundaria a bifosfonatos. Resultados: Todos los colgajos sobrevivieron al 100% y permitieron una cobertura estable y duradera, con ausencia de complicaciones mayores. Conclusiones: El colgajo FAMM permite la reconstrucción de defectos intraorales y periorales con tejido bien vascularizado y de idénticas características a las de la zona a reconstruir, con baja morbilidad de la zona donante, lo que lo convierte en una excelente opción reconstructiva para defectos de esta región anatómica

Background and Objective: The facial artery musculo-mucosal (FAMM) flap, first described by Pribaz et al. in 1992, is an intraoral flap based on the facial artery. It is composed of mucosa, submucosa, buccinator muscle and the facial artery along with its venous plexus. The design of the flap can be inferiorly-based and rely on antegrade blood flow or superiorly-based with retrograde flow. The FAMM flap is a versatile flap that can be used for the reconstruction of defects of multiple locations (palate, lips, tongue, and floor of the mouth). The purpose of this study is to demonstrate the utility of the FAMM flap in the reconstruction of different intraoral defects. Methods: In this article the authors present 3 cases in which the FAMM flap was used for intraoral reconstruction: one patient with a history of ankyloglossia sequelae of a squamous cell carcinoma of the floor of the mouth; one patient with a palatal fistula sequelae of tumor excision; and one patient with a biphosphonate-related osteonecrosis of the mandible. Results: All flaps survived and provided a stable and reliable coverage of the defect. There were no major complications. Conclusions: The FAMM flap is a well vascularized flap that replaces like with like tissue. Because of its low morbidity, low rate of complications and reliable results, the FAMM flap is an excellent option for reconstruction of small to moderate intra-oral defects

Introdução e Objetivo: O retalho FAMM (facial artery musculo-mucosal flap), descrito em 1992 por Pribaz et al., é um retalho intra-oral baseado na artéria facial. É composto por mucosa oral, submucosa, músculo bucinador, artéria facial e pelo plexo venoso correspondente, podendo basear-se inferior (fluxo anterógrado) ou superiormente (fluxo retrógrado). É um retalho versátil que pode ser utilizado nareconstrução de defeitos em múltiplas localizações (palato, lábio, língua, pavimento da boca). Com este trabalho pretende-se demonstrar a utilidade do retalho FAMM na reconstrução de diferentes defeitos intra-orais. Material e Métodos: Os autores apresentam 3 casos em que se utilizou o retalho FAMM para reconstrução intra-oral: um doente com anquiloglossia cicatricial sequelar de carcinoma do pavimento da boca; uma doente com uma fístula do palato sequela de excisão tumoral; e um doente com exposição intra-oral do arco mandibular anterior por osteonecrose secundária a bifosfonatos. Resultados: Todos os retalhos sobreviveram a 100% e permitiram uma cobertura estável e duradoura, na ausência de complicações major. Conclusão: O retalho FAMM permite a reconstrução de defeitos intra e peri-orais com tecido bem vascularizado e de características idênticas à zona a reconstruir, com baixa morbilidade da zona dadora, o que o torna uma excelente opção reconstrutiva para defeitos desta região anatómica

Association between ankyloglossia and breastfeeding.

PURPOSE: To analyze the association between ankyloglossia and breastfeeding. METHODS: A cross-sectional study was undertaken on 130 newborn infants in exclusive breastfeeding with Apgar score ≥ 8 within the first five days of life. The research was approved by the Ethics Committee on Human Research. The data collection was performed by the researcher and by three trained speech therapists of the team. The protocols applied were the Neonatal Tongue Screening Test from the Lingual Frenulum Protocol for Infants, the UNICEF Breastfeeding Observation Aid, and the collection of maternal complaints related to the difficulty in breastfeeding was also considered. The data were submitted to statistical analysis - chi-square test and Fisher's exact test, with a significance level of 5%. RESULTS: When correlating the data, the statistical analysis revealed an association between ankyloglossia and the items of suckling category of the Breastfeeding Observation Aid. The association between complaint of difficulty in breastfeeding and ankyloglossia was also seen. CONCLUSION: On the first days of life, ankyloglossia is associated with the mother's breastfeeding complaint and with the newborn's sucking difficulty.

Home-Based Interventions in a Case of First Latch at 27 Days.

In this article, I describe the effects of home interventions on latching difficulty that persisted for 27 days for a mother-neonate dyad. The neonate manifested latching difficulty immediately after cesarean birth, and it became worse when nipple shields, bottles, and pacifiers were introduced. Manual expression and an electric pump were implemented when the neonate started losing weight, resulting in reduced frequency of breastfeeding directly at the breast. Additionally, the neonate continued to have latching difficulty after frenotomy. The use of home-based interventions supported ongoing educational opportunities for optimal latch, and I recommend that this type of health education be consistent among health professionals.

Congenital lateral cleft palate with unilateral craniofacial microsomia and lateral ankyloglossia.

Craniofacial microsomia is a group of anomalies that occur due to developmental defects in the first and second branchial arches during the embryological period. The disease has various craniofacial and extracraniofacial presentation patterns. Lateral cleft palate is distinct from the most common palate clefts because it is located lateral to the uvula. The presence of a lateral cleft palate has been very rarely reported in the literature, and the aetiopathogenesis of the disease is still not well understood. We aimed to report a case of the coexistence of lateral cleft palate and craniofacial microsomia and discuss the aetiopathogenesis of these diseases.