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.

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

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

Comparison Between Two Protocols for Ankyloglossia Diagnosis in Newborn Babies.

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

Clinical and x-ray oral evaluation in patients with congenital Zika Virus.

OBJECTIVE: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. METHODOLOGY: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student's t-test and nominal logistic regression were used (p<0.05). RESULTS: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). CONCLUSIONS: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

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.

Association between ankyloglossia and breastfeeding / Associação entre anquiloglossia e amamentação

ABSTRACT 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.

RESUMO Objetivo Verificar associação entre anquiloglossia e amamentação. Método Estudo transversal, realizado em 130 recém-nascidos, em um Hospital Universitário. Foram incluídos recém-nascidos entre um a cinco dias de vida, com Apgar score ≥ 8, em aleitamento materno exclusivo. Participaram da pesquisa apenas recém-nascidos de termo e saudáveis. Esta pesquisa foi aprovada pelo Comitê de Pesquisa com Seres Humanos. A coleta de dados foi realizada pela pesquisadora e por três fonoaudiólogas da equipe, devidamente treinadas e calibradas. Os protocolos aplicados foram: avaliação anatomofuncional do Protocolo de avaliação do frênulo da língua em bebês, o Protocolo de Observação da Mamada da UNICEF e coleta das queixas maternas referentes a dificuldade ou não para amamentar. Os dados obtidos foram submetidos à análise estatística, sendo aplicado o teste Qui-quadrado e teste exato de Fisher, adotando nível de significância de 5%. Resultados Quando correlacionados os dados, a análise estatística demonstrou associação entre anquiloglossia e os itens da categoria de sucção do Protocolo de Observação da Mamada. Encontrou-se também associação entre queixa de dificuldade para amamentar e anquiloglossia. Conclusão Nos primeiros dias de vida, a anquiloglossia está associada com queixa da mãe para amamentar e com a dificuldade de sucção do recém-nascido.

Clinical and x-ray oral evaluation in patients with congenital Zika Virus

Abstract Objective: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. Methodology: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student's t-test and nominal logistic regression were used (p<0.05). Results: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). Conclusions: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

Características morfológicas encontradas na cavidade oral de neonatos: revisão de literatura / Morphological characteristics found in the oral cavity of newborns: a literature review

Objetivo: revisar a literatura sobre as característicasmorfológicas da cavidade oral de recém-nascidos. Revisãode literatura: as profissões da área de saúde estãocada vez mais voltadas para um acompanhamentoprecoce do indivíduo, iniciando-se antes mesmo donascimento ou nos primeiros dias de vida da criança.Sendo assim, recém-nascidos apresentam na cavidadeoral características peculiares da sua fase de desenvolvimentoque podem trazer dúvidas para os pais e/ouresponsáveis. As principais variações da cavidade oralde recém-nascidos envolvem tecidos duros e tecidosmoles. Considerando o posicionamento dos maxilares,as alterações mais comuns são: mordida aberta anterior,sobremordida e mordida topo a topo. Em relação aos tecidosmoles, o contorno dos lábios dos recém-nascidosse apresenta triangular e, com a amamentação constante,forma-se um aumento de volume na linha média dolábio superior. Considerações finais: além de ser necessárioque os profissionais da área tenham conhecimentodas características morfológicas da cavidade oral dosrecém-nascidos, também é imprescindível que estessaibam diagnosticar possíveis anormalidades e, quandohouver necessidade, indicar tratamento adequado. (AU)

Objective: to review the literature on the morphological characteristics of the oral cavity of newborns. Literature review: health professions are increasingly focused on the early follow-up of individuals, starting even before birth or during the first days of life of the child. Therefore, the oral cavity of newborns presents characteristics particular to their development phase, which may cause doubts to parents and/or caregivers. The major variations of the oral cavity of newborns involve both hard and soft tissues. Considering the positioning of the jaws, the most common changes are anterior open bite, overbite, and edge-to-edge bite. Regarding the soft tissues, the contour of the lips of newborns is triangular and constant breastfeeding causes an increase of volume formed in the midline of the upper lip. Final considerations: therefore, health professionals are required not only to understand the morphological characteristics of the oral cavity of newborns, but it is also essential that they are able to diagnose potential abnormalities and to indicate appropriate treatment when necessary. (AU)

Is the Neonatal Tongue Screening Test a valid and reliable tool for detecting ankyloglossia in newborns?

BACKGROUND: Although there is a lack of strong evidence for the association between ankyloglossia in newborns and impaired breastfeeding, screening for ankyloglossia using the Neonatal Tongue Screening Test (NTST) is mandated by law in Brazilian maternities. AIM: To assess the reliability and validity of the NTST. DESIGN: cohort study; baseline sample comprised 268 mother-newborn dyads. At follow-up, 169 mothers were contacted by telephone. Interviews with the mothers for data collection were performed up to 48 h and at 1-3 months after childbirth. Trained and calibrated personnel performed the oral examinations of the newborns. Thirty newborns were examined for inter-reproducibility assessment. RESULTS: Of the 268 newborns included, 212 had a lingual frenulum that could be visually inspected and their NTST scores ranged from zero to nine (mean = 2.0, ±2.0). Interexaminer reproducibility was acceptable (Intraclass correlation coefficient = 0.77). Internal consistency of the NTST was poor (Cronbach's alpha = 0.28). Construct validity was investigated through the association between NTST scores and difficulties in breastfeeding at baseline and follow-up, and infants' weight gain at follow-up (mean age 32 ± 6.7 days). No statistically significant associations were found. CONCLUSION: NTST is neither reliable nor valid for detecting ankyloglossia that may interfere with breastfeeding in newborns.

Lingual Frenulum Phenotypes in Brazilian Infants With Congenital Zika Syndrome.

OBJECTIVE: The present study aimed to evaluate lingual frenulum in children affected by congenital Zika syndrome (CZS) and to analyze the association of lingual frenulum phenotypes with other variables. DESIGN: This present work had a cross-sectional, descriptive study design. SETTING: This study was carried out in Fortaleza (Brazil). The health professionals provided tertiary level of care. Data collection occurred during a multidisciplinary task force for evaluating infants affected by CZS in December 2 to 3, 2016. PATIENTS: Fifty-four patients with CZS (1-12 months old; 32 girls and 22 boys) were recruited from a population of 70 infants. INTERVENTIONS: A multidisciplinary group comprised of speech-language pathologist/audiologists and pediatric dentists evaluated all patients through an intraoral examination and a specific tongue maneuver protocol for infants. MAIN OUTCOME MEASURES: Lingual frenulum visibility was the primary outcome measure. Before initiating the study, we hypothesized that children with CZS had an absent lingual frenulum. RESULTS: Lingual frenula were visible in 34 (63%) infants, whereas in 20 (37%) infants lingual frenula visibility required a specific maneuver to retract the tongue. Six of 20 infants presented posteriorly positioned lingual frenula that were visible after maneuver. Lingual frenula were covered by mucous tissue in 14 infants. Presence of posterior frenulum was associated with dysphagia ( P = 0.038). However, the presence of dysphagia in a multivariate model did not associate with the presence of a posterior lingual frenulum ( P = .069) or neurologic symptoms ( P = .056). CONCLUSION: Children with CZS showed predominance of a posterior lingual frenula covered by an overlapping curtain-like mucous membrane.

Prevalência de anquiloglossia em recém-nascidos e avaliação da confiabilidade e validade do Teste da Linguinha na triagem neonatal / Prevalence of ankyloglossia in newborns and reliability and validity of the Lingual Frenulum Assessment Protocol in Babies (Teste da Linguinha) in neonatal screening

Introdução: O exame de triagem neonatal, conhecido como "Teste da Linguinha" (TL), é realizado através da aplicação do "Protocolo de Avaliação do Frênulo da Língua em Bebês". Este exame é obrigatório em todos os hospitais e maternidades do Brasil desde dezembro de 2014 e tem por objetivo diagnosticar a anquiloglossia que tenha potencial de interferir negativamente no aleitamento materno. Objetivos: 1. Estimar a prevalência de anquiloglossia em recém-nascidos saudáveis de uma maternidade da rede pública de saúde do Rio de Janeiro; 2. Avaliar a confiabilidade e a validade de construto do TL na triagem neonatal. Métodos: O estudo foi realizado em uma maternidade pública do Rio de Janeiro. A amostra de díades mãe/filho incluiu neonatos saudáveis, a termo, de até 48 horas de vida e peso maior ou igual a 2.500 g. Os dados foram coletados por três examinadoras treinadas (duas odontopediatras e uma fonoaudióloga), através de entrevistas com as puérperas, observação da mamada e aplicação do TL. As mães foram entrevistadas um mês após o nascimento da criança, por telefone, por estudantes de odontologia. A confiabilidade do protocolo foi medida através da sua consistência interna e estabilidade. A validade de construto foi analisada através da correlação entre: os escores produzidos com a aplicação do instrumento; indicadores autopercebidos de sucesso e insucesso da amamentação; e a dificuldade na amamentação, medida através do Protocolo de Observação da Mamada ­ UNICEF adaptado. A análise estatística foi feita com o programa Stata 14.0®. Resultados: Entre 25.08.2015 a 30.09.2015 foram examinadas 268 díades mãe/filho. A prevalência da anquiloglossia foi igual a 2,24% (IC 95% = 0,83%; 4,81%). O valor do coeficiente de correlação intraclasse para a confiabilidade entre as três examinadoras foi 0,77 (IC95%:0,64; 0,89) e o valor do coeficiente Alfa de Cronbach para a consistência interna foi 0,28 (limite inferior do IC 95%: 0,14). A correlação entre a pontuação total da escala e a autopercepção: da dificuldade para amamentar, da satisfação com a amamentação, e da dor ao amamentar foram 0,05 (p=0,42), 0,01 (p=0,87) e 0,007 (p=0,92), respectivamente. A correlação entre a pontuação do "TL" e o Protocolo de Observação da Mamada UNICEF- adaptado foi 0,27 (p<0,001). Conclusão: A prevalência da anquiloglossia foi muito baixa O "TL" utilizado na triagem neonatal apresentou estabilidade aceitável e baixa consistência interna. Não foi possível confirmar a sua validade. Esses achados sugerem que o seu uso na identificação de recém-nascidos com anquiloglossia capaz de interferir negativamente na amamentação não deve ser recomendado.

Introduction. The "Lingual Frenulum Assessment Protocol in Babies", popularly known as "Teste da Linguinha" (TL), is a neonatal screening test mandatory in all hospitals and maternity hospitals in Brazil since December 2014. The TL aims to diagnose ankyloglossia that may have a negative impact on breastfeeding. Objectives. 1. To estimate the prevalence of ankyloglossia in healthy newborns from a public maternity in Rio de Janeiro; 2. To evaluate the reliability and validity of the "Lingual Frenulum Assessment Protocol in Babies" when it is used as a screening test. Methods. This study was conducted at a public maternity in the city of Rio de Janeiro, Brazil. The TL was applied to a sample of healthy term newborns, weighing 2.500 g or more, within 48 hours of birth. Data were collected by three trained examiners (two pediatric dentists and one speech therapist), through interviews with the mothers, assessment of breastfeeding and the application of the TL to newborns. One month after the child´s birth, mothers were interviewed by phone by undergraduate dental students in order to collect information about their experiences with breastfeeding after hospital discharge. The assessment of the reliability of the TL included the measurement of its internal consistency and stability. The validity of the protocol was analyzed by the correlation between the scores of the instrument and those of self-perceived indicators of breastfeeding success and failure, and professionally determined breastfeeding difficulty as measured by the Adapted Breastfeeding Observation Aid UNICEF protocol. Statistical analysis was performed with Stata 14.0® software. Results. Total sample comprised 268 dyads mothers/child, recruited between August 25 and September 30, 2015. The prevalence of anklyloglossia was 2.24% (IC 95% = 0.83; 4.81%). The inter-rater reliability among the three examiners as measured by the intraclass correlation coefficient was 0.77 (95% CI: 0.64, 0.89) and the Cronbach's alpha coefficient for internal consistency was 0.28 (95% CI lower limit: 0.14). The correlations between the total TL score and self-perceived difficulty to breastfeed, satisfaction with breastfeeding, and pain while breastfeeding were respectively 0.05 (p = 0.42), 0.01 (p = 0.87) and 0.007 (p = 0.92). The correlation between the TL score and the adapted UNICEF protocol was 0.27 (p <0.001). Conclusion. The prevalence of anklyloglossia was very low. The "Lingual Frenulum Assessment Protocol for Babies" used as a screening test presented acceptable stability and low internal consistency. It was not possible to confirm its validity. These findings suggest that the use of the "Lingual Frenulum Assessment Protocol for Babies" for identifying newborns with ankyloglossia that may negatively interfere with breastfeeding should not be recommended.

The effects of frenotomy on breastfeeding.

UNLABELLED: Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals. OBJECTIVE: To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mother's complaints. MATERIAL AND METHODS: Oral yes/no questions about breastfeeding symptoms and sucking/swallowing/breathing coordination were answered by the mothers of 109, 30 day old infants. On the same day the infants had their lingual frenulum assessed by administering a lingual frenulum protocol. After the assessment, all tongue-tied infants were referred for frenotomy; nevertheless, only 14 underwent the surgery. Of the 109 infants, 14 infants who did not have frenulum alterations were included as controls. Birth order and gender were the criteria for recruiting the control group. The tongue-tied infants underwent lingual frenotomy at 45 days of age. At the conclusion of the frenotomy, the infants were breastfed. At 75 days old, both groups--control and post-frenotomy--were reassessed. Before the reassessment the same oral yes/no questions were answered by the mothers of the 14 infants who underwent frenotomy. The mothers of the control group answered the questionnaire only at the time of the first assessment. Data were subjected to statistical analysis. RESULTS: After frenotomy, the number of sucks increased and the pause length between sucking decreased during breastfeeding. The controls maintained the same patterns observed in the first assessment. From the questionnaire answered by the mothers of the 14 tongue-tied infants, at 30 days and 75 days, we observed that the symptoms concerning breastfeeding and sucking/swallowing/breathing coordination were improved after lingual frenotomy. CONCLUSIONS: After lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy.

Teste da linguinha e a anquiloglossia: as controvérsias do assunto / Litle tongue test and ankyloglossia: the controversies of the subject

Resumo / No Congresso Nacional tramita um projeto de lei que institui o “teste da linguinha” para tornar obrigatória a avaliação bucal criteriosa de recém-nascidos, especialmente quanto à mobilidade lingual, a partir da análise do frênulo lingual. Essa iniciativa da Sociedade Brasileira de Fonoaudiologia sofre restrição por parte da Sociedade Brasileira de Pediatria, que a considera desnecessária e onerosa. O objetivo é o diagnóstico e tratamento precoce da anquiloglossia resultante da inserção curta e/ou anteriorizada do frênulo lingual. A plena mobilidade da língua favorece o desempenho das suas várias funções desde quando bebê até a fase adulta da vida. A avaliação bucal em todos os recém-nascidos pode levar, ainda, a diagnósticos mais precoces de fissuras, dentes natais, cistos e tumores. Os vários aspectos da anquiloglossia são discutidos no presente trabalho.

Attention to rhotacism language problem by oral surgery and vibrostimulatory therapy: a case report / Tratamiento para el problema del lenguaje de rotacismo mediante cirugía oral y terapia vibroestimulatoria: reporte de un caso

Ankyloglossia may prevent the tongue from contacting the anterior palate, which promotes an infantile swallow and hamper the progression to an adult-like swallow. This can result in an open bite deformity and in some cases it can be associated to mandibular prognathism and language problems like rhotacism, described as the inability or difficulty in pronouncing the sound / r /. The surgical cut of the frenum tissue that connects the tongue to the jawbone (frenulectomy) and the language rehabilitation treatment with functional oral devices, represent an alternative treatment for this problem. An 11-year-old boy reported with language performance problems, dental malposition and diagnostic of ankyloglossia condition, received frenulectomy surgery and language rehabilitation treatment with functional oral devices during six months. Language diagnosis was carried out in three periods of time: prior to the surgery, four weeks after the surgery and six months later. Combined surgical and functional therapies proved to be a better alternative than only surgical therapy. Combined therapies increased the speech abilities as well as swallowing functions, therefore, the patient's self-esteem.

La anquiloglosia puede evitar que la lengua entre en contacto con la región anterior del paladar, lo que promueve una deglución infantil y dificultan la adecuada deglusión en el adulto. Esto también puede dar lugar a una mordida abierta y en algunos casos, estar asociada con prognatismo mandibular y problemas de lenguaje como el rotacismo, que se describen como la incapacidad o dificultad para pronunciar el sonido / r /. La exsición quirúrgica del tejido que conecta frenillo de la lengua a la mandíbula (frenectomía) y el tratamiento rehabilitador del lenguaje con dispositivos orales funcionales, representan una alternativa de tratamiento para este problema. Un niño de 11 años de edad, con problemas de lenguaje, malposición dental y diagnóstico de anquiloglosia, fue sometido a frenectomía y tratamiento de rehabilitación dellenguaje mediante dispositivos orales funcionales durante seis meses. El diagnóstico del lenguaje se llevó a cabo en tres periodos de tiempo: antes de la cirugía, cuatro semanas después de la cirugía y seis meses más tarde. La combinación de tratamiento quirúrgico y funcionales demostraron ser una alternativa mejor que la terapia quirúrgica por sí sola. Las terapias combinadas aumentaron la capacidad del habla, así como funciones de deglución, por lo tanto, la autoestima del paciente.

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.

Anquiloglossia: relato de caso / Ankyloglossia: case report

Introdução: O freio lingual é uma estrutura anatômica que tem importante participação no ato da sucção, fala e alimentação. Um freio lingual curto e aderido ao soalho bucal dificulta os movimentos da língua, o que pode prejudicar as diversas funções dessa estrutura. Tal alteração é denominada clinicamente pelo termo anquiloglossia. Objetivo e relato de caso: Descrever um caso de anquiloglossia numa criança do sexo feminino, com 2 anos de idade, atendida na clínica de Puericultura do Departamento de Pediatria da Universidade Federal do Paraná. A menina teve o diagnóstico de anquiloglossia do tipo II e foi tratada por frenectomia. Conclusão: O exame rotineiro do freio lingual permite a identificação de anormalidades de sua inserção e possibilita medidas preventivas para as intercorrências no período do aleitamento materno.

Introduction: The lingual frenulum is an anatomic structure that plays an important role in the act of suction, speech and feeding. A short and adhered lingual frenulum obstructs the tongue movement. This can impair the diverse functions of this structure. This alteration is called ankyloglossia. Objective and case report: The aim of this article is to relate a case of ankyloglossia in a female child of two-years old who was examined in the Clinic of Child Care of the Department of Pediatrics, Federal University of Paranß. The child was diagnosed with type II ankyloglossia and treated by frenectomy. Conclusion: The routine examination of the lingual frenulum permits the identification of insertion abnormalities and enables the establishment of preventive measures for complications during the period of breastfeeding.

Surgical treatment of ankyloglossia in babies--case report.

Ankyloglossia is an anomaly that is characterized by the abnormal insertion of the lingual frenulum that hinders protrusion and elevation of the tongue towards the palate, due to the short and thick composition of the frenulum. In babies it can cause inefficient nursing at the mother's breast, inadequate transfer of milk and pain in the mother's breast, resulting in early weaning and weight loss. An 8-month-old baby boy was brought to the clinic by his mother because he found it difficult to suck and consequently avoiding breast feeding, and was apparently losing weight. During the clinical exam it was observed that the patient presented little mobility of the tongue. Owing to the degree of ankyloglossia and the features of malnutrition present, it was decided to carry out complete removal of the frenulum under general anesthesia. Although this procedure might increase the risk of morbidity, the possibility of recurrence and the need to perform further procedures are avoided; the main advantage is reducing aggravation of the clinical problems.

Frequência de anquiloglossia em uma comunidade indígena brasileira / Frequency of ankyloglossia in a community of native Brazilians

Objetivo: Avaliar a prevalência de anquiloglossia na comunidade indígena Umutina, no município de Barra do Bugres (MT), em diversas faixas etárias. Métodos: A amostra foi constituída de 291 índios que se submeteram ao exame clínico. Resultados: A anquiloglossia foi observada em 108 (37,11%) índios. O sexo masculino apresentou maior prevalência, sendo 57 casos (43,8%), enquanto o sexo feminino apresentou 51(31,7%) dos casos. A distribuição da faixa etária foi feita após análise de agrupamento hierárquico, distribuídas em três grupos: 1-20 anos, 21-45 anos e 46-99 anos. Sendo que a anquiloglossia apresentou maior prevalência na faixa etária de 1- 20 anos, com 65 casos (40,6%). Conclusão: Verificou-se que, apesar da anquiloglossia se apresentar nas etnias da reserva indígena Umutina com frequência elevada, a mesma não parece ser responsável por alterações associadas à fonação, mastigação, presença de diastema e problemas periodontais, uma vez que essas alterações foram observadas em baixa frequência e não foram motivos de queixas da população.

Objective: This study aimed to assess the prevalence of ankyloglossia in people of different age groups living in the native Brazilian community of Umutina, in the municipality of Barra do Bugres/ Mato Grosso. Methods: The sample consisted of 291 native Brazilians who underwent clinical examination. Results: Ankyloglossia was observed in 108 (37.11%) individuals. There was a greater prevalence of ankyloglossia among males, with 57 cases (43.8%) against 51 cases (31.7%) in females. Age distribution was done after analyzing the hierarchical grouping, resulting in three age groups: 1- to 20-year-olds, 21- to 45-year-olds and 46- to 99-year-olds. Ankyloglossia was more prevalent in the youngest group, with 65 cases (40.6%). Conclusion: Although there is a high rate of ankyloglossia among the individuals who live in the Umutina Reservation, ankyloglossia does not seem responsible for the changes associated with phonation, mastication, presence of diastema and periodontal problems, since these changes were infrequent and generated no complaint.

Autosomal-dominant ankyloglossia and tooth number anomalies.

Ankyloglossia is a congenital oral anomaly characterized by the presence of a hypertrophic lingual frenulum. It frequently accompanies X-linked cleft palate and is sometimes seen alone due to mutations in the gene encoding the transcription factor TBX22, while knockout of Lgr5 in the mouse results in ankyloglossia. The aim of the present study was to characterize the phenotype and to verify sequence variations in the LGR5 gene in a Brazilian family with ankyloglossia associated with tooth number anomalies. Twelve individuals of three generations were submitted to physical, oral, and radiographic examinations and molecular analysis. Eight had ankyloglossia with various degrees of severity. Six also had hypodontia in the lower incisor region; one had a supernumerary tooth in this region, and another had a supernumerary tooth in the lower premolar region. The characterization of this family determined an autosomal-dominant inheritance and excluded the LGR5 gene mutations as being involved in the pathogenesis of this condition.

Moebius syndrome: clinical manifestations in a pediatric patient.

Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication improved.