Evaluación del frenillo lingual en neonatos. Una revisión sistemática / Evaluation of the lingual frenulum in neonates. A Systematic Review

Introducción: el objetivo de esta revisión es responder al interrogante: ¿cuál es la metodología más eficaz de evaluación de frenillo lingual en neonatos? Bajo los pará-metros de objetividad, claridad y validación. Métodos: el estudio se realizó a través de una revisión sistemática, llevada a cabo con metodología Cochrane, en la que se utilizaron los descriptores de evaluación, frenillo lingual, anquiloglosia y recién nacido, y ejecutado en los bancos de datos Pubmed, Science Direct, Scielo. Para analizar el nivel de evidencia y grado de reco-mendación clínica, se tuvo en cuenta la clasificación GRADE y CEBM de Oxford. Resultados: por medio de la revisión se encontraron 2 evaluaciones y un tamizaje específicamente para recién nacidos, que evalúa de los 0 a los 30 días, los cuales se validan por medio de estudios de especificidad. Análisis y discusión: se identificó que los principales parámetros para diagnosti-car una alteración en el frenillo lingual son la anatomía y su funcionalidad. Conclusiones: según los estudios encontrados sí existe un método eficaz para el diagnóstico del frenillo lingual en neonatos.

Introduction: the objective of this review is to answer the question: What is the most effective methodology for assessing lingual frenulum in neonates? Under the parameters of objectivity, clarity and validation. Methods: the study was conducted through a systematic review carried out using the Cochrane methodology, in which the evaluation descriptors, lingual frenulum, ankyloglossia, and newborn were used, and developed in the Pubmed, Science Direct and Scielo data banks. To analyze the level of evidence and degree of clinical recom-mendation, the GRADE and CEBM classification of Oxford was taken into account. Results: through the review we found 2 evaluations and a screening specifically for new-borns that evaluates from 0 to 30 days, which are validated through specificity studies.Analysis and discussion: it was identified that the main parameters to diagnose an alteration in the lingual frenum are its anatomy and functionality. Conclusions: according to the studies found, there is an effective method for the diagnosis of the lingual frenulum in neonates.

Maxillary Frenulum in Newborns: Association with Breastfeeding.

OBJECTIVE: To relate maxillary and lingual frenulum configuration to breastfeeding success. STUDY DESIGN: Cross-sectional study. SETTING: Newborn nursery in tertiary care academic hospital. SUBJECTS AND METHODS: Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded. RESULTS: A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores (P > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85). CONCLUSION: We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.

Short lingual frenulum as a risk factor for sleep-disordered breathing in school-age children.

BACKGROUND: Recent evidence has emphasized the role of a short lingual frenulum in the pathogenesis of sleep-disordered breathing (SDB) in childhood. The oral dysfunction induced by a short frenulum may promote oral-facial dysmorphism, decreasing the size of upper airway lumen and increasing the risk of upper airway collapsibility during sleep. The aim of this study was to evaluate the presence of a short lingual frenulum as risk factor for SDB in children of school age, with and without snoring, who were recruited from the community. METHODS: Children aged 6-14 years were recruited from a school in Rome. For all participants, the previously described Sleep Clinical Record (SCR) was completed, and orthodontic evaluation and measurement of lingual frenulum were performed. Tongue strength and endurance were evaluated in all participants using the Iowa Oral Performance Instrument (IOPI). SDB was defined as positive SCR (≥6.5). RESULTS: We assessed 504 children with mean age of 9.6 ± 2.3 years, and in 114 of them (22.6%) a short frenulum was identified. Children with a short lingual frenulum were at significantly higher risk for a positive SCR compared to those with a frenulum of normal length (odds ratio = 2.980, 95% confidence interval = 1.260-6.997). Participants with positive or negative SCR did not differ in tongue strength or endurance. CONCLUSION: Short lingual frenulum is a risk factor for SDB. An early multidisciplinary approach and screening for SDB are indicated when this anatomical abnormality is recognized.

Revision Lingual Frenotomy Improves Patient-Reported Breastfeeding Outcomes: A Prospective Cohort Study.

BACKGROUND: Lingual frenotomy improves patient-reported outcome measures, including infant reflux and maternal nipple pain, and prolongs the nursing relationship; however, many mother-infant dyads continue to experience breastfeeding difficulty despite having had a frenotomy. Research aim: The aim of this study was to determine how incomplete release of the tethered lingual frenulum may result in persistent breastfeeding difficulties. METHODS: A one-group, observational, prospective cohort study was conducted. The sample consisted of breastfeeding mother-infant (0-9 months of age) dyads ( N = 54) after the mothers self-elected completion lingual frenotomy and/or maxillary labial frenectomy following prior lingual frenotomy performed elsewhere. Participants completed surveys preoperatively, 1-week postoperatively, and 1-month postoperatively consisting of the Breastfeeding Self-Efficacy Scale-Short-Form (BSES-SF), Visual Analog Scale (VAS) for nipple pain severity, and the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). RESULTS: Significant postoperative improvements were reported between mean preoperative scores compared with 1-week and 1-month scores of the BSES-SF, F(2) = 41.2, p < .001; the I-GERQ-R, F(2) = 22.7, p < .001; and VAS pain scale, F(2) = 46.1, p < .001. CONCLUSION: We demonstrated that besides nipple pain, measures of infant reflux symptoms and maternal breastfeeding self-confidence can improve following full release of the lingual frenulum. Additionally, a patient population was identified that could benefit from increased scrutiny of infant tongue function when initial frenotomy fails to improve breastfeeding symptoms.

The development of a tongue assessment tool to assist with tongue-tie identification.

AIM: To produce a simple tool with good transferability to provide a consistent assessment of tongue appearance and function in infants with tongue-tie. METHODS: The Bristol Tongue Assessment Tool (BTAT) was developed based on clinical practice and with reference to the Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF). This paper documents 224 tongue assessments using the BTAT. There were 126 tongue assessments recorded using the BTAT and ATLFF tools to facilitate comparisons between them. Paired BTAT assessments were obtained from eight midwives who were using the new assessment tool. RESULTS: There was acceptable internal reliability for the four-item BTAT (Cronbach's α=0.708) and the eight midwives who used it showed good correlation in the consistency of its use (ICC=0.760). The BTAT showed a strong and significant correlation (0.89) with the ATLFF, indicating that the simpler BTAT could be used in place of the more detailed assessment tool to score the extent of a tongue-tie. Midwives found it quick and easy to use and felt that it would be easy to teach to others. CONCLUSIONS: The BTAT provides an objective, clear and simple measure of the severity of a tongue-tie, to inform selection of infants for frenotomy and to monitor the effect of the procedure.

Prevalence of breastfeeding difficulties in newborns with a lingual frenulum: a prospective cohort series.

OBJECTIVE: The prevalence of a lingual frenulum in newborn infants is reportedly 0.3-12%. The purpose of this study was to describe the prevalence of a lingual frenulum based on the Coryllos classification in nonselected newborn infants after delivery, hypothesizing that it is higher than the values reported in the literature. STUDY DESIGN: The lingual frenula of 200 healthy infants were evaluated by visual examination and palpation within the first 3 days after delivery. The frenulum was categorized according to the four Coryllos classifications. Each infant's mother responded, immediately after the examination, to a structured questionnaire on the quality and type of feeding. An additional structured telephone interview with the 179 breastfeeding mothers was conducted 2 weeks later. RESULTS: All but one infant (n=199) had an observable or palpable lingual frenulum that was Coryllos type 1 (n=5), type 2 or 3 (n=147), or type 4 (n=47). Although our study was not powered enough to test for any correlation between the cessation of breastfeeding and the type of frenulum, we found no statistical correlation between the Coryllos type of lingual frenulum and the presence of breastfeeding difficulties. CONCLUSIONS: A lingual frenulum is a normal anatomical finding whose insertion point and Coryllos classification are not correlated with breastfeeding difficulties. We suggest that the term "lingual frenulum" should be used for anatomical description and that the term "tongue-tie" be reserved for a lingual frenulum associated with breastfeeding difficulties in newborns.

Ankyloglossia and tongue mobility.

AIM: Ankyloglossia or tongue-tie is a congenital condition of newborns when the inferior lingual fraenulum is too short and is attached to the tip of the tongue limiting its movement. The aim of this study was to evaluate the relationship between ankyloglossia classification and tongue mobility. In addition, the prevalence of ankyloglossia among males and females was assessed. METHODS: 300 subjects (150 boys and 150 girls) with an age range of 7-12 years were randomly selected from different schools. The distance between the uppermost point of lingual fraenulum and its insertion into the oral floor was measured in the subjects. The subjects were categorised from having no ankyloglossia to severe tongue-tie based on the measurements. RESULTS AND CONCLUSION: This study showed that ankyloglossia was more common in males. It also showed that only subjects with a lingual fraenulum of <1.5 cm suffered from inadequate tongue movement.

Lingual frenectomy and alveolar tap production: an acoustic and perceptual study.

In this phonetic study, productions of the consonant in the stressed syllable position of the word arara as produced by 13 subjects with short and/or anterior lingual frenulum were compared before and after lingual frenectomy. The results from the measurement of the stressed consonant duration and from the identification of the consonant manners of articulation based on the inspection of spectral characteristics are discussed and related to the answers to a perceptual identification test. After surgery, the number of tap productions did not increase, but alveolar productions did. These clinically relevant findings show frenectomy improved tongue mobility, but, as temporal controls were not totally re-established after surgery and 6-month speech therapy sessions, the production of the alveolar tap remained largely unchanged.

Lingual frenulum: changes after frenectomy.

PURPOSE: To describe the changes after frenectomy concerning mobility and functions of the tongue. METHODS: Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. RESULTS: Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. CONCLUSION: Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.

Lingual frenulum protocol with scores for infants.

An experimental protocol model for frenulum evaluation was first designed, and administered to ten infants in 2010. After obtaining the data and statistical analysis, the protocol was re-designed and administered to 100 infants. The aim of this study is to present an efficient and effective lingual frenulum protocol with scores for infants. From the experimental protocol model, a new protocol was designed. One speech-language pathologist, and specialist in orofacial myology, administered the new protocol to 100 full-term infants. All steps of the protocol were recorded and photographed. The data collected was sent to two specialists in the area, who evaluated the cases based on the recordings and photographs. The data from the three evaluations were compared. A two-part protocol was designed to evaluate the lingual frenulum in infants. The first part consists of clinical history with specific questions about family history and breastfeeding. The second part consists of clinical examination: anatomo-functional, non-nutritive and nutritive sucking evaluations. A new lingual frenulum protocol with scores for infants was designed, and has proved to be an effective tool for health professionals to assess and diagnose anatomical alterations of the lingual frenulum, and its possible interference with breastfeeding.

Lingual frenulum protocol.

An efficient lingual frenulum protocol with scores is presented. From a specific lingual frenulum evaluation used until 2004, a new protocol was designed. Ten speech language pathologists experienced in orofacial myology used the new protocol with different groups of subjects. 1235 subjects were evaluated during 3 years. From the experience of these ten speech language pathologists, the protocol was re-structured, and a scoring system was added. Absence of alteration (normal tongue and frenulum) was scored zero. The alterations observed were scored in ascending order. Four additional speech language pathologists experienced in orofacial myology were trained by the researcher to administer the final version of the protocol. The protocol was administered in 2008 and 2009 to 239 subjects: 160 children between 7 years and 2 months old and 11 years and 7 months old; and to 79 adults from 16 years and 8 months or older. From the results of administration of the protocol, a new lingual frenulum protocol with scores was designed. According to the scores, the frenulum can be considered altered or normal. When the sum of general tests is equal or higher than 3, the frenulum may be altered. The interference of the lingual frenulum in the oral functions may be considered when the sum of the functional tests is equal or higher than 25. This new lingual frenulum protocol with scores was designed and has been an efficient tool to diagnose an altered lingual frenulum.

Frênulo lingual: modificações após frenectomia / Lingual frenulum: changes after frenectomy

OBJETIVO: Descrever as mudanças ocorridas após a frenectomia com relação à mobilidade e funções da língua. MÉTODOS: Foram avaliados 53 sujeitos, os quais nunca haviam se submetido a fonoterapia ou a cirurgia do frênulo. Um protocolo com escores específicos para avaliação do frênulo lingual foi utilizado para avaliar os sujeitos com evidências de alteração neste aspecto. Foi encontrada alteração em dez sujeitos, que foram encaminhados a um otorrinolaringologista para frenectomia. Após a cirurgia, esses sujeitos foram reavaliados pelo fonoaudiólogo utilizando-se o mesmo protocolo. Fotos e vídeos foram usados para comparação. RESULTADOS: Trinta dias após a cirurgia, os sujeitos apresentaram a forma da ponta da língua modificada, assim como os movimentos melhorados. O fechamento labial e a fala também melhoraram. CONCLUSÃO: A frenectomia é eficiente para melhorar a mobilidade e a postura da língua, assim como suas funções, incluindo a produção da fala.

PURPOSE: To describe the changes after frenectomy concerning mobility and functions of the tongue. METHODS: Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. RESULTS: Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. CONCLUSION: Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.

Ankyloglossia: a morphofunctional investigation in children.

OBJECTIVES: To provide diagnostic criteria for ankyloglossia in children by anatomical measurements; to investigate the correlation between severity of ankyloglossia and a series of morphofunctional findings; to evaluate the potential mismatch between a clinical suspect of ankyloglossia and the authentic anatomical diagnosis. DESIGN: Two different techniques of anatomical measurements and a clinical evaluation of a series of morphofunctional findings were performed. SUBJECTS AND METHODS: In 200 children referred for evaluation and treatment of tongue-tie, the length of the frenulum and the interincisal distance were measured in maximum opening of the mouth and with the tip of the tongue touching the palatal papilla. Occlusion, type of bite, tongue resting position, swallowing mechanism, oral floor mobility, frenulum insertion modality and speech were investigated. Any correlation between these morphofunctional findings and anatomical measures was investigated. RESULTS: Children with a frenulum length more than 2 cm and an interincisal distance of more than 2.3 cm were normal. In both measurements, significant correlations among mean values and other variables were observed. Moreover, three levels -- mild, moderate and severe -- of ankyloglossia were assessed. CONCLUSIONS: Length of frenulum and interincisal distance allow an assessment of severity of ankyloglossia in children. Ankyloglossia was not associated with infantile swallowing.

Lingual frenulum: classification and speech interference.

PURPOSE: To propose a classification of the different lingual frenulum and to relate them to speech disorders. METHODS: We evaluated 1402 patients' frenulum with an age range of 5 years 8 months to 62 years 10 months between 1978 and 2002. Pictures were taken of the altered frenulum. Measures of maximal mouth opening, with and without tongue suction, were taken with a sliding caliper. Speech samples were also taken. Frenulum were then classified as normal; short; with anterior insertion, and short with anterior insertion. RESULTS: From the 1402 patients evaluated, 127 (9%) presented with an altered frenulum insertion. For this study we considered only those with short or with anterior insertion. For those who had an altered frenulum, 62 (48.81%) presented with speech disorders. The more frequent speech disorders were: omission and substitution of /r/; {R}, and consonant clusters with /r/, and of /s/ and /z/. Frontal and lateral lisps also occurred. The frenulum of 21 patients was classified as short and of these, 12 patients (57%) presented with speech disorders. Of the 106 patients with anterior insertion, 50 (47.2%) presented with a speech disorder. After statistical analyses the relation between altered frenulum and speech disorders was considered significant with p<0.001. CONCLUSION: The lingual frenulum was classified as normal, short and with anterior insertion. An altered frenulum may predispose the individual to exhibit an accompanying speech disorder.

Ankyloglossia: does it matter?

Ankyloglossia is an uncommon oral anomaly that can cause difficulty with breast-feeding, speech articulation, and mechanical tasks such as licking the lips and kissing. For many years the subject of ankyloglossia has been controversial, with practitioners of many specialties having widely different views regarding its significance. In many children, ankyloglossia is asymptomatic; the condition may resolve spontaneously, or affected children may learn to compensate adequately for their decreased lingual mobility. Some children, however, benefit from surgical intervention (frenotomy or frenuloplasty) for their tongue-tie. Parents should be educated about the possible long-term effects of tongue-tie while their child is young (< 1 year of age), so that they may make an informed choice regarding possible therapy.

Neutral zone approach for denture fabrication for a partial glossectomy patient: a clinical report.

According to the neutral zone concept, an appropriate denture form can be molded into a physiologic tooth arrangement by using a narrow rim bar occlusion, tissue conditioner, and a direct relining technique for both intaglio and cameo surfaces by using VLC reline resin. Denture stability can be obtained with this "border molding" technique, not only for edentulous patients but also for those with oral deformities.