Effect of myofunctional exercise combined with laser-assisted frenectomy in the management of paediatric tongue tie.

We present three cases for the management of paediatric tongue tie (ankyloglossia) through laser-assisted frenectomy and postoperative oral myofunctional exercises. Ankyloglossia, characterised by a restricted lingual frenulum, poses challenges in tongue movement and is traditionally treated with surgical interventions. Laser technology, particularly diode lasers, has shown promise in paediatric cases due to reduced bleeding, minimal discomfort and faster recovery. The case series presents three instances where patients underwent laser-assisted frenectomy, demonstrating improved tongue function and speech outcomes. The comprehensive approach includes adherence to safety protocols, meticulous surgical techniques and the integration of postoperative exercises. Results indicate significant improvement in speech and tongue mobility, with no reported pain or complications. The study underscores the efficacy, safety and patient-centric nature of the combined laser and exercise strategy in addressing ankyloglossia in paediatric dentistry, emphasising the need for further research and long-term follow-up studies to validate its sustained effectiveness.

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.

Alternative Therapies for Ankyloglossia-Associated Breastfeeding Challenges: A Systematic Review.

Background: Ankyloglossia (AG) diagnoses are increasingly common, and management is not standardized. Nonsurgical alternative therapies are frequently recommended in conjunction with or instead of frenotomy, with uncertain evidence. Objective: To evaluate the efficacy of nonsurgical alternative therapies (chiropractic care, myofunctional therapy, and osteopathy) in improving breastfeeding for infants diagnosed with AG. Methods: PubMed, Embase, CINAHL, Scopus, Web of Science, Clinicaltrials.gov, and Google Scholar were searched (September-October 2023). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A librarian-designed search included the terms "Ankyloglossia," "Non-surgical," "myofunctional therapy," "chiropractic," "osteopathy," and related therapies, with no date restrictions. English language studies of infants <24 months with AG and alternative therapy were included. Risk-of-bias evaluation used Newcastle-Ottawa Scale (NOS). Results: Of 1,304 identified articles, four studies (2016-2022) met inclusion criteria (two cross-sectional, one case report, and one case series). All studies reported frenotomy in combination with alternative therapy yielded favorable outcomes for maternal pain, weight gain, feeding duration, and maintenance of latch. The risk of bias was moderate for two studies, low for the case series, and not calculated for the case report, which has an inherent high risk of bias. All studies lacked control or comparator groups preventing definitive conclusions about the role of alternative therapies in AG. Conclusion: Although some studies suggest the potential benefits of combining alternative therapies with surgery for AG-related breastfeeding issues, the lack of control groups renders the evidence inconclusive. Nonsurgical approaches alone currently lack sufficient evidence. As these alternative therapies gain popularity, rigorous research is crucial to determine their cost-effectiveness and role in managing AG.

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.

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

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

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

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

Ranula Formation After Lingual Frenectomy in a Newborn.

Ankyloglossia is a developmental anomaly characterized by a shortened lingual frenulum, which can range from cases with no clinical relevance to severe cases, where frenectomy may be indicated. In newborns, this indication has increased exponentially. The purpose of this report is to discuss obstruction of the sublingual caruncle, with a recurrent ranula, as a post-surgical complication of laser lingual frenectomy performed in a newborn. The treatment provided is also discussed (marsupialization and removal of the affected sublingual glands). Lingual frenectomy should be performed with great care, especially in newborns, because the sublingual caruncles can be affected and complications can occur.

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).