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.

Dysfunctional suction dynamics in newborns with ankyloglossia / Dinâmica de sucção disfuncional em recém-nascidos com anquiloglossia

ABSTRACT Purpose Compare infant suction in babies with and without ankyloglossia using a microprocessor-controlled pressure sensor coupled to a pacifier. Methods Fifty-five infants from 0 to 2 months of age underwent clinical examination for ankyloglossia, after which they were offered a silicone pacifier connected to the pressure acquisition device and suction activity was recorded. Thus, we extracted the frequency of sucks within a burst, the average suck duration, the burst duration, the number of sucks per burst, the maximum amplitude of sucks per burst and the inter-burst interval. Results The key difference in newborns with ankyloglossia in relation to control was that they perform longer bursts of suction activity. Conclusion The longer burst durations are likely a compensatory strategy and may underlie the pain reported by mothers during breastfeeding. We therefore propose a method for objectively quantifying some parameters of infant suction capacity and demonstrate its use in assisting the evaluation of ankyloglossia.

RESUMO Objetivo Comparar a sucção infantil em bebês com e sem anquiloglossia usando um sensor de pressão controlado por microprocessador acoplado a uma chupeta. Método Cinquenta e cinco lactentes de 0 a 2 meses de idade foram submetidos ao exame clínico de anquiloglossia, em seguida foi oferecido uma chupeta de silicone conectada ao dispositivo de aquisição de pressão e a atividade de sucção foi registrada. Assim, obtivemos dados sobre a frequência de sucções dentro de um período de sucções, a duração média da sucção, a duração da rajada, o número de sucções por rajada, a amplitude máxima das sucções por rajada e o intervalo entre rajadas. O teste t não pareado foi utilizado para comparações entre os grupos. Resultados A principal diferença dos recém-nascidos com anquiloglossia em relação aos do grupo controle é que eles realizam rajadas mais longas durante a atividade de sucção. Conclusão A duração mais longa das rajadas é provavelmente uma estratégia compensatória e pode estar por trás da dor relatada pelas mães durante a amamentação. Portanto, propomos um método para quantificar objetivamente alguns parâmetros da sucção infantil e demonstramos seu uso para auxiliar na avaliação da anquiloglossia.

Management of Tongue-Tie Using Diode Laser for Speech Clarity: A Case Report.

A congenital condition called ankyloglossia, or tongue tie, is characterized by an excessively short or tight lingual frenum that restricts the tongue's movement and flexibility. Although ankyloglossia, or tongue tie, is not a serious sign, it can cause a variety of challenges, such as difficulty with newborn feeding, speech problems, and many mechanical and social problems since there are restricted tongue movements, such as protrusion of the tongue. It is recommended to get a lingual frenectomy to treat ankyloglossia. A 24-year-old female patient reported to the Department of Periodontics with class II, moderate lingual tie, or ankyloglossia. Under local anesthesia, the lingual frenectomy is performed with a diode laser by placing a hemostat across the frenal attachment at the base of the tongue, and an incision is made. The laser surgery took less time and was more comfortable for the patient because there was less discomfort. There was no postoperative pain or hemorrhage. The above case report can appreciate the normal frenal attachment that is more than 16 mm, and the patient can hold the tip of the tongue and function comfortably. A follow-up visit after three months revealed normal frenal attachment and complete healing of the frenum. This case report demonstrates unequivocally that lingual frenectomy using a diode laser has advantages over traditional procedures in that it reduces or eliminates postoperative pain and minimizes hemorrhage and swelling.

Effect of lingual frenotomy on the breastfeeding improvement

To evaluate breastfeeding in babies up to six months of age before and after frenotomy surgery in a reference hospital in a city from Santa Catarina state. Methods: An observational quality improvement study, carried out with babies up to six months of age undergoing frenotomy and their mothers in a reference hospital in southern Santa Catarina state. A questionnaire was applied to the mothers in two moments (before and after the surgery), with information regarding breastfeeding, sociodemographic, anthropometric and behavioral characteristics of them and of the babies. Descriptive analyzes were performed and the association between breastfeeding and the independent variables was assessed through Pearson's chi-square and Fisher's exact tests, using a 5% significance level. Results: A total of 74 children were studied, with 48 of them returning after surgery. 83.8% were breastfed before surgery and 64.9% after surgery. Before surgery, 58.1% of children effectively took the breast at once. After surgery, this prevalence was 83.3% (p=0.015). Before surgery, 75.9% of the mothers reported not feeling pain, while, after surgery, almost all of them (95.8%) reported this (p=0.004). Most mothers reported improvement in grip (83.3%), increase in the duration of breastfeeding (69.0%), improvement of baby's breathing (75.0%), and an increase in the frequency of breastfeeding (51.7%). Conclusions: There was a decrease in the prevalence of breastfeeding after frenotomy. However, there was an improvement in the babies 'grip and breathing and a reduction in the mothers' pain when breastfeeding. It is emphasized the need to implement multidisciplinary actions in both primary and hospital care to assist mothers in order to prolong the duration of exclusive breastfeeding

Effects of lingual frenotomy on breastfeeding and electrical activity of the masseter and suprahyoid muscles / Efeito da frenotomia lingual na amamentação e na atividade elétrica dos músculos masseter e supra-hióideos

ABSTRACT 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.

RESUMO Objetivo Analisar os efeitos da frenotomia lingual na amamentação de recém-nascidos, com base na atividade elétrica dos músculos masseter e supra-hióideos e avaliação da mamada. Método Estudo observacional, desenvolvido entre outubro de 2017 e junho de 2018. Amostra de 20 recém-nascidos e lactentes de uma clínica odontológica, diagnosticados com anquiloglossia; 20 foram excluídos por se encaixarem em algum dos critérios de exclusão: ter mais de seis meses de vida, não fazer aleitamento materno exclusivo ou misto, apresentar outro comprometimento clínico que interfira na amamentação, ter iniciado a ingestão de outros alimentos, alterações neurológicas e/ou deformidades craniofaciais e não ter finalizado todas as etapas do estudo. A avaliação da amamentação seguiu o Protocolo de Observação e Avaliação da Mamada da UNICEF, e a avaliação da atividade elétrica muscular o Protocolo de Avaliação da Atividade Elétrica dos Músculos Masseter e Supra-hióideos em Recém-Nascidos Durante a Alimentação, ambas realizadas pela mesma fonoaudióloga antes da frenotomia convencional e sete dias após. Resultados Os sinais sugestivos de dificuldade na amamentação mudaram sete dias após a cirurgia, com valor de p≤0,002 para a observação geral da mãe, posição do bebê, pega e sucção. Houve diferença apenas no parâmetro integral da Contração Voluntária Máxima do masseter, com diminuição da atividade elétrica. Conclusão Sete dias após a frenotomia observou-se aumento de comportamentos favoráveis ​​à amamentação em todas as categorias de avaliação da mamada e diminuição da atividade elétrica do masseter.

Análise quantitativa de frenectomias realizadas no contexto do SUS após obrigatoriedade do teste da linguinha / Quantitative analysis of frenectomies performed in the context of the SUS after mandatory tongue test

RESUMO Buscou-se investigar e conhecer a frequência e a distribuição de frenotomias e fenectomias realizadas no Sistema Único de Saúde (SUS) após os dispositivos legais que instituíram o teste da linguinha, bem como entender quais profissionais estão realizando o procedimento cirúrgico. Estudo descritivo analítico, retrospectivo, com dados secundários, disponíveis no Sistema de Informações Ambulatoriais do DataSUS, extraídos por meio do TabWin. Observou-se um aumento considerável no número de procedimentos, porém, com flutuações nos anos seguintes. Das frenectomias registradas no SUS, no período, 33% foram realizadas por dentistas na atenção primária. Os resultados apontaram que houve um aumento substancial no número de procedimentos cirúrgicos em dois momentos, em 2014 e em 2017, possivelmente em decorrência da publicação da Lei nº 13.002/2014 e da Nota Técnica (NT) nº 09/2016. A NT nº 35/2018 deslocou o diagnóstico e o tratamento para a média complexidade, possivelmente resultando em filas, principalmente em se tratando de cirurgias que poderiam ser realizadas na atenção primária. Apesar de não haver unanimidade quanto à correlação anquiloglossia e desmame, não parece haver um monitoramento para evitar cirurgias desnecessárias, uma vez que a ordenha pode não ser afetada e o acompanhamento ser realizado para confirmar ou não essa necessidade.

ABSTRACT This study sought to investigate and to know the frequency and the distribution of frenotomies and frenectomies performed in the Unified Health System (SUS) after the legal provisions that instituted the tong test, and to understand which professionals are performing the surgical procedure. This is an analytical, descriptive, retrospective study, with secondary data, available in the DATASUS Information System. It was observed that a considerable increase in the number of procedures, but with fluctuations in the following years. Out of the frenectomies registered in the SUS in the period, 33% were performed by dentists in primary care. The results showed that there was a substantial increase in the number of surgical procedures in two moments, in 2014 and in 2017, possibly as a result of the publication of Ordinance nº 13.002/2014 and Technical Note (NT) No. 09/2016. NT No. 35/2018 shifted diagnosis and treatment to medium complexity, possibly resulting in queues, especially in the case of surgeries that could be performed in primary care. Although there is no unanimity regarding the correlation between ankyloglossia and weaning, there seems to be no monitoring to avoid unnecessary surgeries, since milking may not be affected and follow-up is carried out to confirm or not this need.

Anquiloglossia e alterações na fala: revisão integrativa da literatura / Ankyloglossia and speech disorders: integrative literature / Revieanquiloglosia y trastornos del habla: revisión integradora de la literatura

Objetivo: Caracterizar as alterações na fala decorrentes da anquiloglossia, por meio de revisão integrativa da literatura. Métodos e Procedimentos: Levantamento bibliográfico realizado em fevereiro de 2020, delimitado segundo os idiomas inglês, português, espanhol e idade a partir de 6 anos. Foram selecionados artigos disponíveis em quatro bases eletrônicas: PubMed, SciELO, Scopus, Web Of Science. Palavras-chave utilizadas: freio lingual; distúrbios na fala; anquiloglossia. Foram consideradas publicações de 2010 a 2020 mediante análise de metadados, a partir do título e resumo, para identificar pertinência à pesquisa. Foram excluídos estudos publicados há mais de dez anos, que não permitiram acesso ao texto integral, repetidos por sobreposição dos descritores, discrepantes do tema. Resultados e Discussão: Foram localizados 276 artigos, que após aplicados os critérios de inclusão e exclusão resultaram em 27. Os resultados encontrados indicam que sujeitos com alterações no frênulo lingual, principalmente na anquiloglossia, utilizam estratégias compensatórias variadas de lábios, língua e mandíbula para a produção dos fonemas 't', 'd', 'l', 'n', 's', 'z', 'r' e de grupos consonantais, que poderão apresentar distorção, substituição e/ou omissão, por serem de difícil produção com frênulo curto. Aos profissionais otorrinolaringologistas, ortodontistas e fonoaudiólogos é recomendada realização de exame clínico cuidadoso, que possibilite diagnóstico com objetivo de obter resultados satisfatórios em menor tempo e indicação de intervenções cirúrgicas, quando necessárias. Conclusão: A revisão integrativa da literatura aponta para a relação entre anquiloglossia e alterações na fala.

Objective: To characterize the speech disorders resulting from ankyloglossia, through an integrative literature review. Methods and Procedures: Bibliographic survey carried out in February 2020, delimited language (English, Portuguese, Spanish) and age (from 6 years old). Articles available in four electronic databases were selected: PubMed, SciELO, Scopus, Web of Science. Keywords used: lingual frenum; speech disorders; ankyloglossia. Manuscripts published from 2010 to 2020 were included based on metadata analysis that considered title and abstract to identify the relevance for this research. Studies published over ten years ago, those that did not allow access to the full text, manuscripts repeated due to overlapping of descriptors or diverging from the topic were excluded. Results and Discussion: 276 articles were initially identified; after the inclusion and exclusion criteria were applied, 27 studies were considered. The results showed that subjects with lingual frenulum alterations, mainly ankyloglossia, use varied compensatory strategies of lips, tongue and mandible for the production of the phonemes 't', 'd', 'l', 'n', 's', 'z', 'r' and consonant clusters, which may present distortion, substitution and/or omission, as their production is hindered by the short frenulum. Otorhinolaryngologists, orthodontists and speech therapists are recommended to conduct careful clinical examination, allowing for diagnosis, in order to obtain satisfactory results in less time and indication of surgical interventions, when necessary. Conclusion: The integrative literature review shows the relationship between ankyloglossia and speech disorders

Objetivo: Caracterizar las alteraciones del habla derivadas de la anquiloglosia, a través de una revisión integrativa de la literatura. Métodos y Procedimientos: Encuesta bibliográfica realizada en febrero de 2020, delimitada según inglés, portugués, español y edad a partir de 6 años. Bases de datos electrónicas seleccionadas: PubMed, SciELO, Scopus, Web Of Science. Palabras clave utilizadas: frenillo lingual; trastornos del habla; anquiloglosia. Las publicaciones de 2010 a 2020 se consideraron mediante análisis de metadatos, desde el título y el resumen. Se excluyeron los estudios publicados hace más de diez años, que no permitían el acceso al texto completo, repetidos por superposición de descriptores, discrepantes con el tema. Resultados y Discusión: Se localizaron 276 artículos, que luego de aplicar los criterios de inclusión y exclusión resultaron 27. Los resultados encontrados indican que los sujetos con alteraciones en el frenillo lingual, principalmente en anquiloglosia, utilizan variadas estrategias compensatorias de labios, lengua y mandíbula para la producción de los fonemas 't', 'd', 'l', 'n', 's', 'z', 'r' y grupos consonánticos, que pueden presentar distorsión, sustitución y/u omisión, porque son difíciles de producir con un frenillo corto. Se recomienda a los otorrinolaringólogos, ortodoncistas, logopedas profesionales que realicen examen clínico cuidadoso, que permita un diagnóstico con el objetivo de obtener resultados satisfactorios en menos tiempo e indicación de intervenciones quirúrgicas, cuando sea necesario. Conclusión: La revisión integrativa de la literatura apunta a la relación entre la anquiloglosia y los trastornos del habla.

Tongue-tie in babies: diagnosis and laser frenectomy: case report / Anquiloglosia en bebés: diagnóstico y frenotomía con láser: informe de caso

Introduction: The World Health Organization (WHO) establishes that breast-feeding must be promoted, supported, and protected due to its benefits in maternal and child health and for the economic, environmental, family and community benefits it produces. Case Report: Ankyloglossia in the newborn can cause early cessation of breastfeeding. A clinical case of a 2-month-old baby, referred to the surgical team of the Dental Service of the Pereira Rossell Hospital Center, with difficulties in breastfeeding due to ankyloglossia is presented. Diagnosis and laser surgical treatment was performed. In the immediate postoperative period, there was an improvement, achieving breastfeeding without the aid of devices, and a progressive improvement during the month following the intervention occurred. Conclusion: Early diagnosis and timely intervention collaborate in the maintenance of lactation and in the progressive improvement of the process.

Introducción: La Organización Mundial de la Salud (OMS) establece que la lactancia materna debe ser promovida, apoyada y protegida por sus beneficios demostrados en la salud materno-infantil y por las ventajas económicas, ambientales, familiares y comunitarias que produce.Reporte de Caso: La anquiloglosia en el recién nacido puede provocar el abandono temprano de la lactancia. Se presenta un caso clínico de un bebe de 2 meses, derivado al equipo quirúrgico del Servicio Odontológico del Centro Hospitalario Pereira Rossell, por dificultades en el amamantamiento a causa de anquiloglosia. Se realizó el diagnóstico y tratamiento quirúrgico con láser. En el postoperatorio inmediato se registró una mejoría en el amamantamiento, logrando la lactancia sin intermediario y una mejoría progresiva en la praxis durante el mes siguiente a la intervención.Conclusión: El diagnóstico precoz y la intervención oportuna colaboran en el mantenimiento de la lactancia y en la mejora progresiva de la praxis.

Effect of Lingual Frenotomy on Tongue and Lip Rest Position: A Nonrandomized Clinical Trial

Abstract Introduction The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods The sample consisted of 334 infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. For mothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.

Effect of Lingual Frenotomy on Tongue and Lip Rest Position: A Nonrandomized Clinical Trial.

Introduction The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods The sample consisted of 334 infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. For mothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.

The effects of lingual frenotomy on breastfeeding: an integrative review

ABSTRACT Purpose: to investigate what effects lingual frenotomy has on breastfeeding. Methods: based on the research question - "Is there a relationship between the improvement in breastfeeding and the lingual frenotomy?" -, a bibliographical survey was carried out in three databases, using the following descriptors: ankyloglossia, lingual frenum, breastfeeding and frenotomy. Frenotomy is a free term. Original articles with babies up to 6 months old who had difficulties breastfeeding due to ankyloglossia and who had been submitted to lingual frenotomy were chosen. An instrument was developed, containing the following information: name of the authors, year of publication, country of origin, the objective of the study, type of study, sample, main results, and conclusion. Literature Review: of the 243 articles screened, four met the inclusion criteria for this study. It was observed that, after lingual frenotomy, some changes may take place in breastfeeding patterns, such as an increase in the number of suctions and a decrease in the time of pause in between series of suctions. Conclusion: the lingual frenotomy can be an important procedure in the treatment of babies with ankyloglossia, possibly helping improve the latch and breastfeeding.

Perfil de la producción científica sobre anquiloglosia / Profile of scientific production on ankyloglossia

Este trabajo tiene como objetivodescribir el perfil de la producción científica referente a anquiloglosia. Para ello fuerealizada una investigación por medio de la búsqueda de artículos científicos indexados en las bases de datos electrónicas LILACS y PUBMED. Para la revisión bibliométrica fueron considerados y tabulados los datos referidos al año de publicación, tipo de estudio y nivel de evidencia. Los datos fueron discutidos sobre la óptica cuantitativa y de valores representativos. Los primeros resultados permitieron analizar 651 estudios publicados. La mayor parte de las investigaciones sobre anquiloglosia encontradas correspondieron a estudios de tipo descriptivo y serie de casos (49,31%) seguido de relato de caso, investigación in vitro, en animales y revisión de literatura (24,27%), cohorte y casos-controles (11,98%), opinión de experto (11,68%), ensayo clínico randomizado (1,54%) y revisión sistemática (1,22%). Pocos estudios abordaron complicaciones durante o después de la realización de la cirugía para liberación del frenillo lingual. En conclusión, la producción científica sobre anquiloglosia ha mostrado un creciente aumento en los últimos 28 años, siendo publicados estudios con nivel de evidencia 1, 2 y 3, cuyo mayor enfoque fue realizado en la cirugía para la liberación del frenillo lingual.

This work aims to describe the profileof scientific production referring to ankyloglossia. For this an investigation was carried out by searching for scientific articles indexed in the electronic databases LILACS and PUBMED. For the bibliometric review, the data referring to the year of publication, type of study and level of evidence were examined and tabulated. The data were discussed on the quantitative and representative values optics. The first results allowed to analyzic 651 published studies were analyzed. Most of the research on tongue tie found correspond to descriptive studies and case series (49.31%), followed by case reports, in vitro research, in animals and literature review (24.27%), cohort and cases and controls (11.98%), specialist opinion (11.68%), randomized clinical trials (1.54%) and systematic reviews (1.22%). Few studies addressed complications during or after lingual frenulum release surgery. In conclusion Scientific production on ankyloglossia has shown an increasing increase in the last 28 years, with studies with evidence levels 1, 2 and 3 being published, whose main focus was the performance of surgery to release the lingual frenulum.

Frenotomy: from assessment to surgical intervention / Frenotomia: da avaliação à intervenção cirúrgica

ABSTRACT The objective of this study was to demonstrate that frenotomy can help improve breastfeeding, tongue movement, and the mother's comfort, if the assessment criteria are respected and the infant's function and age are observed. Frenotomy was performed on two babies with breastfeeding difficulties who came to CEPAE - Center for Research and Dental Care, in 2018, as part of the course on Early Childhood Interdisciplinary Preventive Care at a Dental School. After anamnesis and clinical examination, the lingual frenulum assessment protocol for babies was applied. The necessary frenotomies were performed with topical anesthesia, scissors, and groove director. The babies were reassessed in follow-up visits 7 days after the procedure. The babies had gained weight and the mothers had found greater comfort and easiness when breastfeeding, after the procedure. It is concluded that the less time it takes from ankyloglossia diagnosis to intervention, the easier it is to resume breastfeeding. Also, the identification of ankyloglossia is more effective, and its intervention more efficient, through an interdisciplinary assessment.

RESUMO O objetivo do estudo foi mostrar que a frenotomia pode contribuir para a melhora da amamentação, movimentação lingual e desconforto materno se respeitados os critérios de avaliação, observando a função e idade do lactente. Foram realizadas frenotomias em dois bebês com dificuldade de amamentação que compareceram ao Cepae - Centro de Pesquisa e Atendimento Odontológico, no curso de Atendimento Interdisciplinar Preventivo na Primeira Infância de uma Faculdade de Odontologia, no ano de 2018. Após anamnese e exame clínico foi aplicado o protocolo de avaliação de frênulo lingual para bebês, sendo realizadas as frenotomias necessárias, com a utilização de anestésico tópico, tesoura e tentacânula. Os bebês retornaram para reavaliação após 7 dias do procedimento. Foram observados ganho de peso dos bebês e maior conforto e facilidade das mães durante a amamentação após os procedimentos. Conclui-se que quanto menor o tempo entre o diagnóstico e a intervenção na anquiloglossia, mais fácil se dá o retorno à amamentação, e que a avaliação interdisciplinar torna a identificação mais eficaz e a intervenção da anquiloglossia mais eficiente.

Diagnóstico de anquiloglossia em recém-nascidos: existe diferença em função do instrumento de avaliação? / Diagnosis of ankyloglossia in newborns: is there any difference related to the screening method?

RESUMO Objetivo Diagnosticar a anquiloglossia em recém-nascidos, comparando dois instrumentos de avaliação do frênulo lingual. Método Tratou-se de um estudo transversal, realizado em Recife, PE, Brasil no ano de 2018, com 147 mães/recém-nascidos com idade de até 30 dias de vida. Foram utilizados o Instrumento Bristol Tongue Assessment Tool (BTAT) e o Protocolo de Avaliação do Frênulo da Língua para Bebês ("Teste da Linguinha"). Dados sociodemográficos também foram anotados. Para a comparação entre os dois métodos de diagnóstico da anquiloglossia, foi utilizado o teste de McNemar e foram obtidos o valor da concordância de Kappa e o respectivo intervalo de confiança. Resultados A presença de anquiloglossia foi de 4,8%, quando diagnosticada por meio do BTAT, e de 17,0%, quando utilizado o "Teste da Linguinha". Com relação ao sexo, 53,1% dos recém-nascidos eram do sexo masculino e 46,9% do sexo feminino; contudo, não houve associação entre a anquiloglossia e o sexo do recém-nascido nos dois métodos de avaliação. Conclusão O diagnóstico da anquiloglossia em recém-nascidos variou em função do instrumento de avaliação utilizado.

ABSTRACT Purpose To diagnose ankyloglossia in newborns and compare two lingual frenulum assessment instruments. Methods This cross-sectional study was carried out in Recife, Pernambuco, Brazil, in 2018, with 147 mothers/newborns aged up to 30 days. The Bristol Tongue Assessment Tool and the Lingual Frenulum Evaluation Protocol for Infants were the instruments used. Sociodemographic data were also recorded. The two ankyloglossia diagnostic methods were compared using the McNemar test, obtaining the kappa agreement value and the confidence interval. Results Ankyloglossia was present in 4.8% when diagnosed with the Bristol Tongue Assessment Tool, and in 17.0% with the Tongue-Tie Test. Regarding sex, 53.1% of the newborns were males and 46.9% were females; however, there was no association between ankyloglossia and the newborn's sex in either of the assessment methods. Conclusion The ankyloglossia diagnosis in newborns varied depending on the assessment instrument used.

Patologías del área oral en los recién nacidos e infantes: frenillos y las aportaciones de los sistemas láser / Pathologies of the oral area in newborns and infants: frenula and contributions of laser systems

El propósito de este artículo es mejorar nuestro conocimiento sobre las estructuras y función de los diferentes elementos presentes en la boca del recién nacido, ya que en ocasiones los odontólogos no recuerdan la importancia de la boca en el desarrollo general del lactante y la necesidad de una intervención temprana con láseres para ayudarles a obtener un buen estado de su sistema oral. Realizamos una exploración clínica integral del paciente con el fin de realizar un diagnóstico más preciso. Cuando la cirugía sea necesaria, recomendamos utilizar láseres de Erbio siempre que sea posible (láser de 2780nm Er, Cr: YSGG o un Er: YAG de 2940nm), ya que es una opción rápida y eficaz para tratar estas lesiones orales, especialmente los frenillos labiales o linguales que pueden poner en riesgo el acto de amamantar; Asimismo podemos utilizar láseres de diodo (810nm, 940nm, 980 nm o un láser Nd: YAG de 1064nm o de CO2 10.600- 9600 nm) con sus gafas de seguridad específicas. Estos sistemas láser utilizados por un profesional certificado, en colaboración con un personal debidamente entrenado, son un factor muy importante durante la cirugía. Al tener un conocimiento adecuado de las estructuras orales y sus patologías, podemos diagnosticar si esos trastornos deben tratarse quirúrgicamente y, de ser así, cómo proceder con los sistemas láser, ya que son procedimientos mínimamente invasivos; o si debiésemos recomendar a los padres que visiten a un terapeuta miofuncional para ayudar a recuperar la función normal. La comprensión de las estructuras orales de los recién nacidos es muy importante para promover el desarrollo del crecimiento craneofacial y para brindar un servicio importante a las madres, dándoles a sus bebés un buen comienzo en la vida desde una etapa muy temprana. Necesitamos mejorar la colaboración entre profesionales de diferentes disciplinas con el fin de mejorar nuestro conocimiento.

The purpose of this article is to improve our knowledge about the structures and function of the different elements present in the mouth of newborns since dentists sometimes do not remember the importance of the mouth in the general development of infants and the need for an early intervention with lasers to help them obtain a good state of their Oral System. We performed a comprehensive clinical exploration of the patient in order to make a more accurate diagnosis. When surgery is necessary, we recommend to use erbium lasers when possible (2780nm Er, Cr: YSGG laser or a 2940nm Er: YAG), as they are a quick and effective option to treat these oral lesions, especially lip or tongue ties which can risk the act of breastfeeding; moreover, we can also use diode lasers (810nm, 940nm, 980nm or a 1064nm Nd:YAG laser or CO2 10.600-9600 nm.) al lof them with their specifical safety goggles. These laser systems used by a certified professional, in collaboration with a properly trained staff, are a very important factor during the surgery.By having proper knowledge of the oral structures and their pathologies, we are able to diagnose whether those disorders should be surgically treated and if so, how to proceed with laser systems as they are minimally invasive procedures; or if we should recommend parents to visit a myofunctional therapist in order to help recover the normal function.The understanding of oral structures of newborns is very important in order to improve the development of craniofacial growth and provide an important service to mothers by giving their babies a right start in life from a very early stage. We need to improve collaboration between professionals from different disciplines in order to enhance our knowledge.

Surgical treatment of ankyloglossia using an ophthalmic topical anesthetic and a tentacannula for tongue elevation: a case report

Ankyloglossia is characterized by the presence of a short lingual frenum that can be inserted from the alveolar ridge to the lingual apex and, until promoting a true fusion of the tongue to the floor. A short lingual frenum can generate several problems such as phonetic disorders. Objective: To describe a surgical technique for the treatment of ankyloglossia using a topical ophthalmic anesthetic and a tentacannula for tongue elevation. Case report: A 15-year-old female was referred for lingual frenulum surgery due to speech impairment. Clinical examination revealed the presence of ankyloglossia which was both hindering the pronunciation of T, D, L phonemes and reducing tongue mobility. The surgical technique chosen was a lingual frenectomy. An ophthalmic topical anesthetic was initially applied to the lateral borders of the frenum with the patient in an upright position and in the presence of adequate aspiration. With the aid of a tentacannula the tongue was raised and the frenulum gradually released with a Goldman-Fox serrated scissor. The topical anesthetic was continuously trickled onto the surgical site during surgery. Results: No postoperative pain was reported by the patient, healing occurred normally and there was no recurrence of abnormal frenulum insertion. Conclusion: The advantages of this technique in comparison to conventional methods which use infiltrative anesthesia include less trauma and a more precise evaluation of tongue movements during surgery, because there will be better control of mobility for the patient when compared to infiltrative techniques.

Introdução: A anquiloglossia caracteriza-se pela presença de um freio lingual curto que pode inserir-se desde o rebordo alveolar até o ápice lingual e, até promover uma verdadeira fusão da língua ao assoalho. Um freio lingual curto poderá gerar vários problemas como distúrbios fonéticos. Objetivo: descrever uma técnica cirúrgica para tratamento da anquiloglossia utilizando um anestésico tópico oftálmico e uma tentacânula para elevação da língua. Relato do caso: Uma paciente com 15 anos de idade foi encaminhada para cirurgia do frênulo lingual devido ao comprometimento da fala. O exame clínico revelou a presença de anquiloglossia, dificultando a pronúncia dos fonemas T, D, L e, reduzindo a mobilidade da língua. A técnica cirúrgica escolhida foi a frenectomia lingual. Um anestésico tópico oftálmico foi aplicado inicialmente nas bordas laterais do freio com o paciente na posição vertical e na presença de aspiração adequada. Com o auxílio de uma tentacânula, a língua foi elevada e o frênulo foi gradualmente liberado com uma tesoura serrilhada Goldman-Fox. O anestésico tópico foi continuamente gotejado para o local cirúrgico durante a cirurgia. Resultados: Nenhuma dor pós-operatória foi relatada pelo paciente, a cicatrização ocorreu normalmente e não houve recorrência da inserção anormal do frênulo. Conclusão: As vantagens dessa técnica em comparação aos métodos convencionais que utilizam anestesia infiltrativa, incluem menor trauma e uma avaliação mais precisa dos movimentos da língua durante a cirurgia, pois haverá um melhor controle da mobilidade do paciente quando comparado às técnicas infiltrativas.

Double lingual frenulum: a case report.

BACKGROUND: The lingual frenulum is a mucous membrane fold found underneath the tongue. It helps the tongue to perform its function. There are few anomalies that can affect the lingual frenulum, such as ankyloglossia and absence of the lingual frenulum. We report a case of two lingual frenula to educate practitioners about the presence of such an anomaly. CASE PRESENTATION: A 10-year-old healthy Saudi girl came to our dental clinic complaining of "malpositioned frontal teeth." Upon intraoral examination, two lingual frenula were found connecting the tongue with the floor of the mouth. Intraoral examination revealed no other abnormalities. CONCLUSION: Double lingual frenulum is an existing frenulum anomaly that did not affect normal function of our patient. A search of the literature revealed that this may well be the first reported case of such a condition.

Laser lingual frenectomy: basal eutonia achievement by natural homeostatis.

The aim of present study is a macro evaluation of adjustment to allow homeostasis before and after frenectomy. Macro analysis was done on 7 pediatric patients tested firstly simple surface elettromyography (EMG) to evaluate masticatory muscles, secondly the Romberg's test to assess the posture and thirdly cephalometric analysis according to Giannì and Rocabado to assess orthodontic variations. The frenectomy was performed with diode laser (wavelength 890 nm). Pre-frenectomy EMG outcomes indicate a clear masticatory muscular imbalance with a different electrical activity compared to physiological standard values and functional basal balance. Results after frenectomy EMG show a normalization of basal values with an improvement of mandibular posture. Depending on cephalometric analysis, outcomes reveal a tendency to normalize the cervical lordosis, previously altered. Ultimately, pre-frenectomy Romberg's test shows initial instability in the static posture, which decreases after frenectomy. In conclusion, the short lingual fraenum not only has static correlations with the oral cavity but also dynamic connections with the cervical posture and muscular basal organization. So, homeostasis includes macro alterations involving muscular tone and bone position. Frenectomy could favor the restoration of the basal eutonia achieved by a natural homeostasis.

Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique

Abstract Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.