Frenotomia lingual em bebês diagnosticados com anquiloglossia pelo Teste da Linguinha: série de casos clínicos / Lingual frenectomy in babies diagnosed with ankyloglossia through the Tongue Test: a series of case reports

Objetivo: relatar uma série de casos clínicos de frenotomia lingual em bebês diagnosticados com anquilo-glossia pelo Teste da Linguinha. Relato de casos: cinco bebês, de 0 a 2 anos de idade, foram diagnosticados nas Unidade Básicas de Saúde e na Santa Casa de Misericórdia de Sobral, Ceará, com anquiloglossia mode-rada a severa. As mães relataram dificuldades de amamentação e engasgos das crianças. Os pacientes foram submetidos a procedimentos cirúrgicos de frenotomia lingual, que foram realizados na Universidade Federal do Ceará (UFC), Campus Sobral, no Grupo de Estudos em Odontopediatria (GEOP) do curso de graduação em Odontologia. As cirurgias foram realizadas com os pacientes conscientes e sob estabilização protetora. Foi administrada apenas anestesia tópica nos pacientes menores de 1 ano e anestesia infiltrativa naqueles com faixa etária maior que 1 ano. Em seguida, foi executado um pequeno corte na porção mediana do freio lingual e, quando necessário, realizada divulsão dos tecidos adjacentes. Ao final, foi feita a limpeza do local da cirurgia com a confirmação visual da efetiva liberação da língua. Por fim, as crianças receberam atestado e as mães, recomendações pós-cirúrgicas. Além disso, as crianças foram encaminhadas para consulta com o fonoaudiólogo e foram marcadas três consultas de retorno para o acompanhamento dos casos. Considera-ções finais: a frenotomia lingual mostrou-se uma técnica cirúrgica conservadora, eficaz e segura. Os bebês apresentaram excelentes resultados pós-operatórios e encontram-se em acompanhamento multiprofissional. (AU)

Objective: to report a series of clinical cases of lin-gual frenectomy in babies diagnosed with ankylo-glossia through the tongue test. Case Reports: five babies aged 0 to 2 years were diagnosed with moderate to severe ankyloglossia in Basic Health Units and in Santa Casa de Misericórdia do So-bral, Ceará, Brazil. The mothers of the children reported difficulties in breastfeeding and gagging. The patients were submitted to surgical procedu-res of lingual frenectomy, which were performed at the Federal University of Ceará (UFC), Cam-pus Sobral, in the Group of Studies in Pediatric Dentistry of the undergraduate dental course. The surgeries were performed with conscious patients under protective stabilization. Only topical anesthesia was administered in patients younger than 1 year and infiltrative anesthesia was used for those older than 1 year. Thereafter, a small cut was per-formed on the median portion of the lingual fre-nulum and, if necessary, divulsion of the adjacent tissues was performed. At the end, the surgical site was cleaned and the effective release of the tongue was confirmed visually. Finally, the chil-dren received medical certification and the mo-thers received postoperative recommendations. In addition, the children were referred to visits with a speech therapist and three follow-up ap-pointments were scheduled. Final considerations: lingual frenectomy proved to be a conservative, effective, and safe surgical technique. The babies presented excellent postoperative results and they are under multi-professional follow-up. (AU)

Lingual Chondrolipoma in a Dog.

A 13-year-old female Yorkshire terrier was presented with difficulty swallowing because of a lingual mass, which had grown to a size of 0.8 × 0.8 × 0.8 cm in 1 month. Grossly, the mass was located in the lingual frenulum and the cut surface was grey-white in colour. Microscopically, the mass was unencapsulated and composed of lobules of mature adipose tissue and cartilaginous tissue with abundant basophilic myxoid matrix separated by fibrous connective tissue. Immunohistochemically, almost all of these cells were positive for vimentin and S100. Chondroid cells and their adjacent spindle cells were also positive for SOX9. Based on these findings, a diagnosis of chondrolipoma was made. To the best of our knowledge, this is the first report of a chondrolipoma originating as a primary tumour in the lingual frenulum of a dog.

Rigid swelling of sublingual caruncle area due to the salivary gland duct obstruction by a sialolith

Sialolithiasis is the presence of calculus within the ductal system of a salivary gland. Among the diagnostic methods are inspection, palpation, checking the amount of saliva secreted and the identification of a sialolith. The authors present the case of a 37-year-old female patient with edema of the submandibular area and a bulging sublingual caruncle due to a calculus that obstructed the salivary gland ostium.

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.

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

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

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

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.

Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings.

INTRODUCTION: The aim of this study was to assess unilateral posterior crossbite, sucking habits, orofacial functions, and otolaryngological findings in the deciduous dentition. These findings would allow us to establish a preventive program for posterior crossbite, based on interceptive treatment at an early stage of dental development. We would determine the predictive value for posterior crossbite development in correlation with the duration of sucking habits. METHODS: Data were collected on 30 children (13 boys, 17 girls) with unilateral posterior crossbite (mean age, 5.5 years; range, 3.6-7.2 years) and 30 children (17 boys, 13 girls) without crossbite (mean age, 5.9 years; range, 5.4-6.7 years), randomly selected from a local kindergarten. Information about each subject's nutritive and nonnutritive sucking behaviors was collected through parent interviews and questionnaires. An orthodontist and an otolaryngologist clinically examined all the children. Study models were obtained from all children, and dental arch parameters including arch widths in the canine and second deciduous molar regions were measured directly from the models. The data were then compared between the posterior crossbite and the noncrossbite groups. RESULTS: The results indicated correlations between prolonged pacifier sucking habit (P = 0.001), short frenulum linguae (P <0.001), smaller maxillary arch width (P <0.001), greater mandibular arch width (P <0.002), and unilateral posterior crossbite. A receiver operating characteristic curve was plotted for the pacifier sucking time. The borderline for the development of posterior crossbite suggested by the receiver operating characteristic curve was 18 months of pacifier sucking duration. The odds ratios between the crossbite and noncrossbite groups were 3.6 (CI = 0.97-13.4) for pacifier habit duration of 18 to 35 months and 21.9 (CI = 3.7-129.4) for pacifier suckers of more than 36 months. No significant correlation between enlarged adenoids and tonsils or impaired nasal breathing and the crossbite was found. CONCLUSIONS: These results suggest that the duration of a pacifier habit and a short frenulum linguae are associated with posterior crossbite at the age of 4 or 5 years because of the low tongue posture in the mouth. Pediatricians and pedodontists should give precise recommendations for enhancing breast feeding and discontinuing pacifier habits at least until the child is 18 months of age. Further studies are also needed to determine more objectively the etiology of tongue posture, swallowing pattern, and the length of the frenulum linguae in children with posterior crossbite.

Prevalence of malocclusion in 13-15 year-old North Jordanian school children.

OBJECTIVES: This study was carried out to determine the prevalence of malocclusion in 13-15-year-old North Jordanian schoolchildren. METHODS: One thousand and three children aged 13-15 years (619 females, 384 males) were examined using Björk et al. (1964) registration method. A full clinical examination was carried out in the school premises using a mouth mirror under natural lighting. Alginate impressions were then taken for each student together with a wax bite. The impressions were poured the same day by an orthodontic technician. Peri-apical radiographs were taken for the students when hypodontia was suspected. RESULTS: Overall, the prevalence of malocclusion was 92%. Class II and III molars were found in 18.8% and 1.4% of the sample respectively. The malocclusion traits detected were crowding (50.4%), midline shift (31.7%), spaced dentition (26.7%), increased overjet (24.7%), deepbite (16.9%), crossbite (6.8), abnormal tooth form (7.7%), median diastema (6.9%), missing teeth (6%), ectopic canines (5.9%), inverted incisors (5.2%), high frenal attachment (3.9%), openbite (2.9%), tooth impaction (1.8%), reversed overjet (1.9%), scissorbite 0.3%. There was no statistically significant difference between males and females in the overall prevalence of malocclusion and the occlusal traits investigated. However, some dental anomalies showed significant differences. CONCLUSIONS: Prevalence of malocclusion among north Jordanians is comparable with other populations.

An epithelial target site in experimental graft-versus-host disease and cytokine-mediated cytotoxicity is defined by cytokeratin 15 expression.

The identity of cells within squamous epithelia that represent primary targets in acute graft-versus-host disease (GVHD) has been an enigma. Murine effector T cells implicated in the alloresponse by Vbeta complementarity-determining region-3 spectratype analysis were detected with a Vbeta-specific monoclonal antibody within discrete microdomains of tongue (lingual) squamous epithelium. These microdomains, termed rete-like prominences (RLPs), are similar to the rete ridges of human skin. Cells forming the basal layer of RLPs and of human skin rete ridges were shown to express a distinctive pattern of keratin expression defined by antibodies to cytokeratin 15 (K15). In experimental murine GVHD elicited across minor histocompatibility antigen barriers (miHA), early lesions involved selective apoptosis and loss of K15(+) staining within lingual RLPs. An in vitro organ culture model designed to investigate target cell injury by short-term exposure to tumor necrosis factor-alpha and interleukin-1beta, mediators relevant to GVHD, showed a similar pattern of apoptosis and loss of K15(+) reactivity within RLPs. In aggregate, these findings establish a novel cytoskeletal marker for target epithelial subpopulations that should facilitate evaluation of mechanisms of host cell injury in GVHD. These data may also enable the development of therapeutic approaches to abrogate disease at the level of target cell blockade.

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.

An oral 'follicular' choristoma presenting in the anterior floor of the mouth.

A 46-year-old Asian man presented with hair growing from the anterior floor of his mouth. The diagnosis of this lesion was an oral choristoma of a 'follicular' variety. A choristoma is defined as an overgrowth of normal tissue at an abnormal site. Only one other case of this particular lesion has been reported to date. This article proposes mechanisms as to the aetiology of this lesion, and its inclusion in the classification of oral choristomas.

Sublingual foregut cyst.

Foregut cysts are usually found in the mediastinum, the lung, or the wall of the upper gastrointestinal tract, but only rarely at the base of tongue. We report a sublingual foregut cyst in a 27-year-old man.

Traumatic ulcerative granuloma with stromal eosinophilia (Riga-Fede's disease and traumatic eosinophilic granuloma).

A review of the English literature revealed ten lesions classified as Riga-Fede's disease and nineteen lesions classified as traumatic eosinophilic granuloma. These two entities have the same histologic features and are often associated with a history of trauma. These are benign, reactive, nonosseous lesions that occur either in infancy or later in life. It is suggested that they be considered as one entity. To delineate them from more aggressive lesions, such as the eosinophilic granuloma of histiocytosis X, the author suggests the term traumatic ulcerative granuloma with stromal eosinophilia. Forty-one previously unreported cases are described. Histologic examination revealed the presence of mast cells in addition to eosinophils. A pathogenesis for traumatic ulcerative granuloma with stromal eosinophilia, based on the hypothesis that mast cells release an eosinophilic chemotactic factor and that eosinophils may act as cytotoxic agents, is suggested.