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.

Surface Electromyographic Analysis of the Suprahyoid Muscles in Infants Based on Lingual Frenulum Attachment during Breastfeeding.

Muscle electrical activity analysis can aid in the identification of oral motor dysfunctions, such as those resulting from an altered lingual frenulum, which consequently impairs feeding. Here, we aim to analyze the suprahyoid muscle electrical activity of infants via surface electromyography, based on lingual frenulum attachment to the sublingual aspect of the tongue and floor of the mouth during breastfeeding. In the present study, we have studied full-term infants of both genders, aged between 1 and 4 months old. The mean muscle activities were recorded in microvolts and converted into percent values of the reference value. Associations between the root mean square and independent variables were tested by one-way analysis of variance and Student's t-test, with a significance level of 5% and test power of 95%, respectively. We evaluated 235 infants. Lower mean muscle electrical activity was observed with the lingual frenulum attached to apex/lower alveolar ridge, followed by attachment to the middle third/lower alveolar ridge, and between the middle third and apex/lower alveolar ridge. Greater suprahyoid muscle activity was observed with lingual frenulum attachment to the middle third of the tongue/sublingual caruncles, showing a coordination between swallowing, sucking, and breathing. Surface electromyography is effective in diagnosing lingual frenulum alterations, the attachment points of which raises doubt concerning the restriction of tongue mobility. Thus, it is possible to identify oral motor dysfunctions.

All Tied Up! Influences of Oral Frenulae on Breastfeeding and their Recommended Management Strategies.

BACKGROUND: Recently, there has been an increased awareness of the role of the labial and lingual frenulae on a neonate's ability to latch and breastfeed efficiently. This critical review explores the (i) oral physiology of a baby nursing (ii) factors that can decrease a baby's ability to nurse efficiently, the problems these cause and their management and the (iii) relation between poor nursing efficacy and the risk of early childhood caries (ECC) Study design: An expansive search of the literature was performed using four electronic databases. RESULTS AND CONCLUSIONS: Most studies assessing the role of labial and lingual frenulae on breastfeeding were of a low quality. The relation between ECC and poor nursing efficacy was found to be largely speculative. Hence, the results of these studies should be interpreted with caution. Despite the limited quality and external validity of the current evidence, in cases where breastfeeding difficulties are identified, surgical management of labial or lingual frenulae may provide some subjective improvements in breastfeeding outcome.

La anquiloglosia y las dificultades que presenta en el amamantamiento / Ankyloglossia and difficulties in breastfeeding

Objetivo: Conocer la evidencia científica disponible sobre las posibles alteraciones en la lactancia materna que pueden ser provocadas por la anquiloglosia, así como su diagnóstico y posible tratamiento. Metodología: Búsqueda en las bases de datos PubMed, Cochrane Library, LILACS, Dialnet, Cuiden, Enfispo, IME, Scielo y Joanna Briggs Institute de los estudios publicados en el periodo comprendido entre los años 2008 y 2017. Resultados: En los lactantes con anquiloglosia se observan tomas más largas al pecho, dolor en los pezones de la madre y una disminución de la producción de leche, entre otras situaciones. La herramienta de Hazelbaker es el criterio diagnóstico más utilizado. También se han considerado distintas formas de tratamiento, aunque parece que el más extendido y valorado es la frenotomía. Conclusiones: Existe una asociación entre la anquiloglosia y las posibles complicaciones con la lactancia materna, no así en lo referente al diagnóstico y al tratamiento, que es controvertido según los distintos estudios consultados (AU)

Objective: To know the available scientific evidence on whether the ankyloglossia may induce alterations in breastfeeding, as well as diagnosis and possible treatment. Methods: A literature review on the databases PubMed, Cochrane Library, LILACS, Dialnet, Cuiden, Enfispo, IME, Scielo and Joanna Briggs Institute from the studies published from 2008 to 2017 was conducted. Results: In infants with ankyloglossia longer shots, pain in the mother's nipples and a decrease in milk production among others are observed. Hazelbaker assessment tool is the most widely used diagnostic criteria. Different ways of treatment have also been seen, although it seems that the most extended and appreciated treatment is the frenotomy. Conclusions: There is an association between complications with breastfeeding and tongue tie, not so in relation to diagnosis and treatment, which is controversial according to the different consulted articles (AU)

Validação do protocolo de avaliação do frênulo da língua em bebês / Validation of the lingual frenulum Protocol for infants

Este estudo teve por objetivo validar o Protocolo de avaliação do frênulo da língua em bebês. Para isso, a partir do cálculo amostral, foi aplicado o protocolo em 100 bebês saudáveis, nascidos a termo, com 30 dias de vida, em amamentação exclusiva. O processo de validação consistiu da análise da validade de conteúdo, de critério e de construto, bem como da confiabilidade, sensibilidade, especificidade, valor preditivo positivo e negativo. A validade de conteúdo foi realizada por três examinadores, por meio da classificação de cada item quanto à clareza e posterior aplicação do Índice de Validação do Conteúdo. As avaliadoras sugeriram modificações no protocolo, por consenso, possibilitando obter a versão final. Para a validade de critério, comparou-se o Protocolo de avaliação do frênulo da língua em bebês com o instrumento Bristol Tongue Assessment Tool (BTAT). A validade de construto foi analisada a partir da comparação dos escores do protocolo aplicado nos bebês com 30 e 75 dias. As avaliações foram realizadas por duas fonoaudiólogas especialistas em Motricidade Orofacial (denominadas A1 e A2), devidamente treinadas e calibradas, por meio da análise das filmagens realizadas durante a aplicação do protocolo, para verificação da concordância entre examinadores, bem como definição dos valores de sensibilidade, especificidade e valores preditivos. Para a análise da concordância intra-avaliador foi realizado o teste/reteste de 20% da amostra pela A2. Quanto ao tratamento estatístico, para a análise de concordância intra e entre avaliadores, foram utilizados o Coeficiente de Correlação Intraclasse e o cálculo do erro do método. Para análise da validade de construto foram aplicados os testes de Wilcoxon e Mann-Whitney. O nível de significância adotado em todos os testes foi de 5%. Houve 100% de concordância na validação do conteúdo...

The aim of this study was to validate the “lingual frenulum Protocol for infants”. Based on the results from the sample size calculation, the protocol was administered to 100 healthy full-term infants, who were being exclusively breastfeed, at 30 days of life. The validation process included the analysis of content validity, criterion validity, construct validity, reliability, sensitivity, specificity, positive predictive value, negative predictive value. The content validity was determined by the judgment of three experts, who rated the clarity of each item, and by a Content Validity Index (CVI) determination. By consensus, the examiners suggested some modifications for the final version. The criterion validity was measured by comparing the Lingual Frenulum Protocol for Infants and the Bristol Tongue Assessment Tool (BTAT). The construct validity was performed by comparing the scores of the protocol of the control group and of the experimental group before and after surgery. The assessments were performed by two Speech Language Pathologists, experienced in Orofacial Motricity (A1 and A2), who were trained and calibrated. Analyses of the images collected during the administration of the protocol and the clinical history were performed in order to verify the agreement between the examiners as well as the definition of sensitivity, specificity, positive predictive value, and negative predictive value. Intra-rater agreement analysis was performed by comparing data from assessment and re-assessment of 20% sample conducted by A2. Regarding statistical treatment, the Intraclass Correlation Coefficient (ICC) and calculation of error of method were used. The Wilcoxon test and Mann-Whitney were used for the analysis of the construct validity. The significance level of 5% (p<0.05) was adopted in all analyses. The agreement percentage for content validation was 100%...

Validação do protocolo de avaliação do frênulo da língua em bebês / Validation of the lingual frenulum Protocol for infants

Este estudo teve por objetivo validar o Protocolo de avaliação do frênulo da língua em bebês. Para isso, a partir do cálculo amostral, foi aplicado o protocolo em 100 bebês saudáveis, nascidos a termo, com 30 dias de vida, em amamentação exclusiva. O processo de validação consistiu da análise da validade de conteúdo, de critério e de construto, bem como da confiabilidade, sensibilidade, especificidade, valor preditivo positivo e negativo. A validade de conteúdo foi realizada por três examinadores, por meio da classificação de cada item quanto à clareza e posterior aplicação do Índice de Validação do Conteúdo. As avaliadoras sugeriram modificações no protocolo, por consenso, possibilitando obter a versão final. Para a validade de critério, comparou-se o Protocolo de avaliação do frênulo da língua em bebês com o instrumento Bristol Tongue Assessment Tool (BTAT). A validade de construto foi analisada a partir da comparação dos escores do protocolo aplicado nos bebês com 30 e 75 dias. As avaliações foram realizadas por duas fonoaudiólogas especialistas em Motricidade Orofacial (denominadas A1 e A2), devidamente treinadas e calibradas, por meio da análise das filmagens realizadas durante a aplicação do protocolo, para verificação da concordância entre examinadores, bem como definição dos valores de sensibilidade, especificidade e valores preditivos. Para a análise da concordância intra-avaliador foi realizado o teste/reteste de 20% da amostra pela A2. Quanto ao tratamento estatístico, para a análise de concordância intra e entre avaliadores, foram utilizados o Coeficiente de Correlação Intraclasse e o cálculo do erro do método. Para análise da validade de construto foram aplicados os testes de Wilcoxon e Mann-Whitney. O nível de significância adotado em todos os testes foi de 5%. Houve 100% de concordância na validação do conteúdo...

The aim of this study was to validate the “lingual frenulum Protocol for infants”. Based on the results from the sample size calculation, the protocol was administered to 100 healthy full-term infants, who were being exclusively breastfeed, at 30 days of life. The validation process included the analysis of content validity, criterion validity, construct validity, reliability, sensitivity, specificity, positive predictive value, negative predictive value. The content validity was determined by the judgment of three experts, who rated the clarity of each item, and by a Content Validity Index (CVI) determination. By consensus, the examiners suggested some modifications for the final version. The criterion validity was measured by comparing the Lingual Frenulum Protocol for Infants and the Bristol Tongue Assessment Tool (BTAT). The construct validity was performed by comparing the scores of the protocol of the control group and of the experimental group before and after surgery. The assessments were performed by two Speech Language Pathologists, experienced in Orofacial Motricity (A1 and A2), who were trained and calibrated. Analyses of the images collected during the administration of the protocol and the clinical history were performed in order to verify the agreement between the examiners as well as the definition of sensitivity, specificity, positive predictive value, and negative predictive value. Intra-rater agreement analysis was performed by comparing data from assessment and re-assessment of 20% sample conducted by A2. Regarding statistical treatment, the Intraclass Correlation Coefficient (ICC) and calculation of error of method were used. The Wilcoxon test and Mann-Whitney were used for the analysis of the construct validity. The significance level of 5% (p<0.05) was adopted in all analyses. The agreement percentage for content validation was 100%...

Ultrastructural study of the relationship between the morphogenesis of filiform papillae and the keratinization of the lingual epithelium in the mouse.

Tongues were removed from fetuses of mice on the 15th day of gestation (E15), from newborns (P0), and from juveniles on the 7th day (p7) and on the 21st day (P21) after birth for examination by light microscopy and transmission electron microscopy. In the fetuses at E15, no rudiments of filiform papillae were visible on the dorsal surface of the tongue. No evidence of keratinization was recognized throughout the entire dorsal lingual epithelium. At P0, rudiments of filiform papillae were compactly distributed over the dorsal surface, as are the filiform papillae in the adult, but their tips were rounder than those of the filiform papillae in the adult. Cell columns in the epithelium, with different degrees of keratinization of the type observed in the matured adult were indistinct. However, a keratinized layer was clearly visible on the tip of each filiform papilla. In juveniles at P7, the filiform papillae on the anterior part of the tongue were long and slender, and the anterior and posterior cell columns of the filiform papillae were identical to those in the adult. These results indicate that, in mice, the morphogenesis of filiform papillae advances in parallel with keratinization of the lingual epithelium from the stage just before birth to a stage a few weeks after birth.

Morphology of the lingual apparatus of the domestic chicken, Gallus gallus, with special attention to the structure of the fasciae.

A detailed redescription of the mechanically interacting structural elements of the lingual apparatus of the domestic chicken, Gallus gallus, revealed the functional and constructional role of organized connective tissue (i.e., ligaments and fasciae) as structural elements that ensure the proper biomechanical interactions among the various structures within the lingual apparatus (e.g., cartilaginous and bony skeletal elements, muscles, salivary glands, epithelial structures). Fasciae, together with extrinsic muscles, also connect the lingual apparatus to the other components of the feeding apparatus, such as the skull, jaw apparatus, and larynx. For example, the hyoid apparatus is attached to the skull by a sheath-like fascia (F. vaginalis), the internal structure of which is described here for the first time. Thus, the hyoid suspension in birds differs fundamentally from that in mammals. This study is the first to examine all biomechanically functioning structural elements that are part of the galliform lingual apparatus in a systematic and comprehensive manner. It also provides a set of novel characters that may be useful for future comparative studies in evolutionary and functional morphology.

[Studies on the functional effect of the M. mylohyoideus on the base construction of total prostheses]. / Untersuchungen über den funktionellen Einflubeta des M. mylohyoideus auf die Basisgestaltung unterer Totalprothesen

By means of anatomical examinations as well as radiograms and jaw models of probands the inclination angles of the fibers of the oral diaphragm inserting in the hyoid bone are determined in order to obtain information for shaping the lingual margins of complete lower dentures. The transition from these fibers to the fibers inserting in the median raphe of the mylohyoid muscle is about 6 to 9 mm before the tip of the alveolar tubercle in edentulous mandibles, and in the area between the roots of the second molars in dentulous lower jaws with normal position of molars. In this area the muscle has, in most cases, an angle of inclination between 30 and 40 degrees to the perpendicular plane. The inclination of the posterior fibers of the mylohyoid muscle is most frequently between 10 and 25 degrees. The difference in inclination is mainly due to the varying width of the muscular insertion in the hyoid bone.