Prevalencia de anquiloglosia en neonatos y relación con datos auxológicos del recién nacido o con otras malformaciones o enfermedades asociadas / Prevalência de anquiloglossia em recém-nascidos e relação com dados auxológicos do recém-nascido ou com outras malformações ou doenças associadas / Prevalence of ankyloglossia in neonates and relationship with auxological data of the newborn or with other malformations or associated diseases

Objetivo: determinar la prevalencia de anquiloglosia en neonatos del Hospital Nostra Senyora de Meritxell del Principado de Andorra, Europa, así como la relación existente con datos auxológicos u otras malformaciones o enfermedades asociadas. Material y métodos: Se realizó un estudio descriptivo, transversal, retrospectivo poblacional de los recién nacidos durante un período de 8 meses. Se estudiaron once variables: presencia o no de anquiloglosia, tipo de frenillo corto, talla, peso, perímetro craneal, sexo, Rh y grupo sanguíneo, edad gestacional, malformaciones y patologías neonatales asociadas, de forma confidencial y anónima, correlacionándolas para ver si existía alguna asociación entre ellas. Resultados: Un total de 306 recién nacidos fueron incluidos en el estudio (52% varones y 48% mujeres). La prevalencia de anquiloglosia fue del 6,54% (n=20). Del total de varones (159/306), el 8,125% (n=13) presentaban anquiloglosia, mientras que en mujeres (147/306), la prevalencia fue del 4,79% (n=7), sin encontrar diferencias estadísticamente significativas respecto al sexo (p-valor=0,24). Según la clasificación de Coryllos, el tipo II fue el más frecuente (95% de los casos) y el 4,58% de los lactantes con anquiloglosia exhibieron patología/malformación. Conclusiones: La prevalencia de anquiloglosia en recién nacidos en Andorra, Europa, es similar a la observada por otros autores en investigaciones similares. No se observó asociación entre la presencia o no anquiloglosia y las variables estudiadas.

Objetivo: determinar a prevalência de anquiloglossia em recém-nascidos do Hospital Nostra Senyora de Meritxell do Principado de Andorra, Europa, bem como a relação existente com dados auxológicos ou outras malformações ou doenças associadas. Material e métodos: Foi realizado um estudo descritivo, transversal e retrospectivo da população de recém-nascidos durante um período de 8 meses. Onze variáveis foram estudadas: presença ou não de anquiloglossia, tipo de frênulo curto, altura, peso, perímetro craniano, sexo, Rh e grupo sanguíneo, idade gestacional, malformações e patologias neonatais associadas, de forma confidencial e anônima, correlacionando-as para ver se existia alguma associação entre eles. Resultados: Um total de 306 recém-nascidos foram incluídos no estudo (52% masculino e 48% feminino). A prevalência de anquiloglossia foi de 6,54% (n=20). Do total de homens (159/306), 8.125% (n=13) apresentavam anquiloglossia, enquanto nas mulheres (147/306) a prevalência foi de 4,79% (n=7), sem encontrar diferenças estatisticamente significantes em relação ao sexo (valor-p = 0,24). De acordo com a classificação de Coryllos, o tipo II foi o mais frequente (95% dos casos) e 4,58% dos lactente com anquiloglossia apresentaram patologia / malformação. Conclusões: A prevalência de anquiloglossia em recém-nascidos em Andorra, Europa, é semelhante à observada por outros autores em investigações semelhantes. Não foi observada associação entre a presença ou não anquiloglossia e as variáveis estudadas

Aim: to determine the prevalence of ankyloglossia in new-borns of the Nostra Senyora de Meritxell Hospital in the Principado de Andorra, Europe, as well as the existing relationship with auxological data or other malformations or associated diseases. Material and methods: A descriptive, cross-sectional, retrospective population study of 306 newborns was carried out over a period of 8 months. Eleven variables were studied: presence or no of ankyloglossia, type of short frenulum, height, weight, cranial perimeter, sex, Rh and blood group, gestational age, malformations and associated neonatal pathologies, confidentially and anonymously, correlating them to see if there was any association between them. Results: A total of 306 new-borns were included in the study (52% male and 48% female). The prevalence of ankyloglossia was 6,54% (n=20). Of the total of men (159/306), 8,125% (n=13) presented ankyloglossia, while woman (147/306), the prevalence was 4,79% (n=7), without finding statistically significant differences regarding sex (p-value=0,24). According to the Coryllos classification, type II was the most frequent (95% of cases) and 4,58% of infants with ankyloglossia exhibited pathology/malformation. Conclusions: The prevalence of ankyloglossia in new-borns in Andorra, Europe, is similar to that observed by other authors in similar research. No association was observed between the presence or not of ankyloglossia and the variables studied

Geometric model to predict improvement after lingual frenulectomy for ankyloglossia.

OBJECTIVES: Frenulectomy for ankyloglossia is an intervention that often improves breastfeeding quality for both the mother and infant. Current classification systems assess and identify patients with ankyloglossia, but they do not predict the degree of improvement after lingual frenulectomy. We propose an idealized geometric model to quantify the potential effect of frenulectomy for ankyloglossia. METHODS: Our geometric model depicts the intact lingual frenulum as a triangular pyramid of mucosa on the floor of mouth. After incising one edge of the pyramid, as is performed during a frenulectomy, the structure unfolds to a two-dimensional diamond whose dimensions can be calculated. Utilizing this calculation, we can predict percent improvement in tongue extension after frenulectomy based off the original dimensions of the pyramid. RESULTS: Our multivariable equation that allows for the calculation of the percent increase in tongue extension is based on the frenulum thickness, frenulum length, tongue length, and insertion point of the frenulum on the tongue. The initial height of the frenulum and the proximity of the frenulum insertion to the tip of the tongue had the largest impact on tongue extension, whereas frenulum width had the smallest impact. CONCLUSION: Lingual frenulectomy has subjectively been reported to improve lingual tongue movement. Our mathematical model identifies multiple anatomic variables that lead to an increase in tongue extension after frenulectomy. Our model is the first step in supporting this subjective improvement with quantifiable measurements, and can allow for future validation studies.

Defining the anatomy of the neonatal lingual frenulum.

The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered "normal" lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal "band" or "string" and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824-835, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum.

Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in-situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a "cord" or "submucosal band" of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in-situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo-documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm-like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749-761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Defining Tip-Frenulum Length for Ankyloglossia and Its Impact on Breastfeeding: A Prospective Cohort Study.

OBJECTIVE: The purpose of this study was to investigate the normal lingual frenulum anatomy in newborns and to evaluate tip-frenulum distance as an objective diagnostic tool for identifying newborns at risk for anterior and posterior tongue tie and breastfeeding difficulty. MATERIALS AND METHODS: The distance from the tongue tip to the insertion of the lingual frenulum was measured in a group of 100 healthy newborns to establish normative data. The presence of a visible or palpable cord was noted. Inter-rater reliability was assessed. Breastfeeding surveys including a maternal pain scale and Infant Breastfeeding Assessment Tool (IBFAT) were administered on days of life 2 and 14 to determine whether these findings predict breastfeeding difficulty. RESULTS: Mean tip-frenulum length was 9.07 mm. Intraclass correlation coefficient between observers for tip-frenulum length was 0.82. A visible cord was identified in 21 subjects (21%). A palpable cord was identified in 59 subjects (59%). Unweighted κ coefficients for inter-rater reliability of visible and palpable cords were 0.91 and 0.47, respectively. Visible cord and shorter tip-frenulum distance were independently predictive of higher maternal pain scores. A positive correlation was identified between tip-frenulum length and IBFAT scores for mothers with two or more previous breastfed children. CONCLUSIONS: Tongue tip-frenulum length correlated with maternal nipple pain, and was useful as an objective tool for identifying newborns at risk for ankyloglossia. Maternal breastfeeding experience appears to be an important factor in the link between tongue anatomy and breastfeeding difficulty. The presence of a palpable cord was variable across examiners, and should be interpreted with caution when evaluating newborns for posterior tongue tie.

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%...

The relationship between frenulum length and malocclusion.

This study sought to evaluate the relationship between the length of lingual frenula and various classes of malocclusion. One hundred-fifty patients who had been referred for orthodontic treatment were divided into 3 groups (n = 50) based on their lingual frenula ANB (Point A, nasion, point B) angle: Group 1 (ANB angle = 0-4 degrees), Group 2 (ANB angle >4 degrees), and Group 3 (ANB angle <0 degrees). The mean frenulum length for Group 1 subjects was 11.4 (±3.0) mm, compared to 9.5 (±3.5) mm for Group 2 subjects, and 14 (±3.0) for Group 3 subjects. According to 1-way ANOVA testing, these differences were statistically significant (P < 0.001). In addition, maximum mouth opening was also significantly greater for the Group 3 subjects (P < 0.001).

Lingual frenulum: changes after frenectomy.

PURPOSE: To describe the changes after frenectomy concerning mobility and functions of the tongue. METHODS: Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. RESULTS: Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. CONCLUSION: Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.

The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system.

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

Frênulo lingual: modificações após frenectomia / Lingual frenulum: changes after frenectomy

OBJETIVO: Descrever as mudanças ocorridas após a frenectomia com relação à mobilidade e funções da língua. MÉTODOS: Foram avaliados 53 sujeitos, os quais nunca haviam se submetido a fonoterapia ou a cirurgia do frênulo. Um protocolo com escores específicos para avaliação do frênulo lingual foi utilizado para avaliar os sujeitos com evidências de alteração neste aspecto. Foi encontrada alteração em dez sujeitos, que foram encaminhados a um otorrinolaringologista para frenectomia. Após a cirurgia, esses sujeitos foram reavaliados pelo fonoaudiólogo utilizando-se o mesmo protocolo. Fotos e vídeos foram usados para comparação. RESULTADOS: Trinta dias após a cirurgia, os sujeitos apresentaram a forma da ponta da língua modificada, assim como os movimentos melhorados. O fechamento labial e a fala também melhoraram. CONCLUSÃO: A frenectomia é eficiente para melhorar a mobilidade e a postura da língua, assim como suas funções, incluindo a produção da fala.

PURPOSE: To describe the changes after frenectomy concerning mobility and functions of the tongue. METHODS: Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. RESULTS: Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. CONCLUSION: Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.

Frenectomia lingual em bebê utilizando eletrocautério e tetracaína: relato de caso / Electrocautery and tetracaine in baby lingual frenectomy: case report

O artigo relata o caso clínico de frenectomia lingual em bebê, utilizando eletrocautério e anestesia tópica oftálmica (cloridrato de tetracaína). O uso de eletrocautério proporciona diminuição do tempo de trabalho, maior conforto e segurança do procedimento cirúrgico para o bebê e para o profissional. Já a utilização de anestesia tópica oftálmica, é recomendada para procedimentos de controle da dor, tendo melhor absorção em mucosa umedecida, maior profundidade e maior tempo de ação. Esta técnica segue os princípios da odontologia minimamente invasiva.

The article reports a case of lingual baby frenectomy, using electrocautery and topical ophthalmic anesthetic (tetracaine hydrochloride). The use of electrocautery provides reduction of working time, increased comfort and safety of surgery for the baby and the professional. And the use of topical ophthalmic anesthetic is recommended for pain control procedures, and better absorption in the mucosa, deeper and longe r action. This technique follows the principies of minimally invasive dentistry.

Evaluation of Lingual Frenulum Using Geometric Morphometrics / Evaluación del Frenillo Lingual Utilizando Morfometría Geométrica

A fold of tissue, the lingual frenulum, extends onto the inferior surface of the tongue from near the base of the tongue on midline. The shape, length and alignment of lingual frenulum vary between individuals. The aim of this study is to evaluate morphology of lingual frenulum with respect to gender. Ninety seven volunteers who were students and employees of Zonguldak Karaelmas University, School of Medicine participated in the study. Two individuals with a history of hepatitis and 20 individuals with inadequate photographs were excluded from the study. Morphometric analyses were performed on the photographs of 75 volunteers (36 men, 39 women). Lingual frenulum photograph of each individual was taken using standard photographic techniques. The individual opened his/her mouth as much as possible with the tongue in contact with the interior surface of the two middle incisors. The morphology of the lingual frenulum was evaluated with linear measurements and geometric morphometrics methods. The length of lingual frenulum between the attachments of it, to the floor of the mouth and the inferior surface of the tongue were measured using Digimizer software. Four reference points determined previously were marked by tpsDig2 software on photographs. This process was repeated for each sample to create a txt file containing reference points of 75 individuals. Statistical analysis of txt files were carried out using Morpheus software. There were no statistically significant differences between the linear measurements of lingual frenulum according to gender (p>0.05). Lingual frenulum had no gender differences according to geometric morphometrics analysis as well (p>0.05). It can be suggested that lingual frenulum had similar architecture in both sexes.

Un pliegue de tejido, el frenillo lingual, se extiende sobre la superficie inferior de la lengua cerca de su base en la línea mediana. La forma, la longitud y la alineación del frenillo lingual pueden variar entre los individuos. El objetivo de este estudio fue evaluar la morfología del frenillo lingual con respecto al sexo. Participaron en el estudio 97 voluntarios, estudiantes y empleados de la Facultad de Medicina de la Universidad Zonguldak Karaelmas. Dos individuos con antecedentes de hepatitis y 20 personas con fotografías inapropiadas fueron excluidas del estudio. El análisis morfométrico se llevó a cabo en las fotografías de 75 voluntarios (36 hombres y 39 mujeres). La fotografía del frenillo lingual de cada individuo fue tomada usando las técnicas fotográficas convencionales. Cada individuo abrió su boca tanto como fue posible con la lengua en contacto con la superficie interna de los dos incisivos centrales superiores. La morfología del frenillo lingual se evaluó con métodos de medidas lineales y morfometría geométrica. La longitud del frenillo lingual entre su origen e inserción del suelo de la boca a la superficie inferior de la lengua se midieron utilizando el software Digimizer. Cuatro puntos de referencia determinados previamente fueron marcados mediante el software tpsDig2 en cada fotografía. Este proceso se repitió en cada muestra para crear un archivo txt que contuviera los puntos de referencia de 75 personas. El análisis estadístico de los archivos txt se llevó a cabo utilizando el software Morpheus. No hubo diferencias estadísticamente significativas entre las mediciones lineales de frenillo lingual, en función del sexo (p>0,05). El frenillo lingual no tuvo diferencias de sexo según el análisis de morfometría geométrica (p>0,05). Se puede sugerir que el frenillo lingual tiene una arquitectura similar en ambos sexos.

Relationship between the lingual frenulum and craniofacial morphology in adults.

INTRODUCTION: The purpose of this study was to determine the relationship between the length of the lingual frenulum and craniofacial morphology and test the hypothesis that skeletal Class III malocclusion is related to tongue-tie, in which the lingual frenulum is short and restricts the mobility of the tongue. METHODS: The sample consisted of 50 skeletal Class I patients (0° < ANB angle < 4°), 50 skeletal Class II patients (ANB angle > 4°), and 50 skeletal Class III patients (ANB angle <0°). Direct and indirect measuring methods were used to quantify the length of the lingual frenulum. The median lingual frenulum length was measured directly with a lingual frenulum ruler. It was evaluated indirectly by measuring the differences between the maximum mouth opening with and without the tip of the tongue touching the incisive papilla. A lateral cephalogram was taken for each subject and a computerized cephalometric analysis was used to assess the cranial morphology. Analysis of variance (ANOVA) was used to compare the differences among the 3 groups. The Pearson correlation analysis was used to detect any relationship between the lingual frenulum length and cephalometric variables. RESULTS: The median lingual frenulum length was significantly longer in the skeletal Class III subjects compared with the skeletal Class I and Class II subjects. The maximum opening of the mouth was significantly reduced in the skeletal Class III subjects compared with Class I and Class II subjects. Significant correlations were also found among the median lingual frenulum length, maximum mouth opening reduction, and the cephalometric variables such as the SNB and ANB angles, Wits appraisal, mandibular length, and the interincisal angle. CONCLUSIONS: The present study supports the hypothesis that skeletal Class III malocclusion is related to long median lingual frenulum or a tongue-tie tendency. Patients diagnosed with tongue-tie might have a tendency toward skeletal Class III malocclusion.

Morphological adaptations of yak (Bos grunniens) tongue to the foraging environment of the Qinghai-Tibetan Plateau.

Using light and scanning electron microscopy, the morphological adaptations of the yak (Bos grunniens) tongue to its foraging environment in the Qinghai-Tibetan Plateau were studied. The tongue of the yak was compared with that of cattle (Bos taurus). Compared with cattle, yak tongues are on average 4 cm shorter (P < 0.001), and yak consume forages using the labia oris, rather than by extending the tongue into the harsh environment. The lingual prominence of yak is greater (P < 0.001) and more developed than in cattle. The conical papillae on the prominence surface of yak are slightly larger (diameter: P = 0.068 and height: P = 0.761) and more numerous (P < 0.001) than in cattle. The lenticular papillae on the prominence surface of yak are larger (diameter: P = 0.002 and height: P = 0.115) and more numerous (P = 0.007) than in cattle. Such characteristics may improve the digestibility of forage by the grinding of food between the tongue and the upper palate. Filiform, conical, lenticular, fungiform, and vallate papillae were observed on the dorsal surface of the tongues studied; no foliate papillae were observed. The papillae were covered by keratinized epithelium, which was thicker (P < 0.001) in the yak than in cattle. It is suggested that the development of characteristic filiform papillae, and more numerous lingual gland ducts and mucus-secreting pores in the lenticular, fungiform and vallate papillae, fungiform papillae, probably having mechanical functions, are all morphological adaptations by yak to diets with greater fiber and DM content as provided by the plants within the Qinghai-Tibetan Plateau environment. On average, yak has 26 vallate papillae and cattle have 28. In the vallate papillae of the yak, the taste buds are arranged in a monolayer within the epithelium, whereas they are multilayered (2 to 4) in those papillae in cattle. The number of taste buds in each vallate papillae was less (P < 0.001) in the yak than in cattle. Therefore, the gustatory function of the yak was weaker than in cattle. Yaks graze throughout the year on diverse natural grasslands and have evolved morphological characteristics enabling them to consume a wide variety of plant species, thereby better adapting them to the typically harsh characteristics of their pastures.

[Problematic breastfeeding due to a short frenulum]. / Problematische borstvoeding door een te korte tongriem.

Ankyloglossia (tongue tie) in the neonate can be a cause of breastfeeding problems. Frenotomy (cutting of the frenulum linguae) had fallen into disrepute, but has regained its place as a standard medical procedure in Anglo-Saxon countries, though not in the Netherlands. We present two neonates, both boys, presenting with breastfeeding problems caused by ankyloglossia. The first baby described did not drink enough and hence did not gain any weight. The mother of the second patient experienced a great deal of pain and had cracked nipples, caused by an abnormal suckling action. Both boys underwent frenotomy with good result. Recent ultrasound studies reveal that frenotomy immediately normalizes the suckling action in babies with ankyloglossia. Randomized controlled trials show that 95% of breastfeeding problems disappear. There is sufficient evidence to state that frenotomy is a very safe and useful procedure in neonates.

Ankyloglossia: a morphofunctional investigation in children.

OBJECTIVES: To provide diagnostic criteria for ankyloglossia in children by anatomical measurements; to investigate the correlation between severity of ankyloglossia and a series of morphofunctional findings; to evaluate the potential mismatch between a clinical suspect of ankyloglossia and the authentic anatomical diagnosis. DESIGN: Two different techniques of anatomical measurements and a clinical evaluation of a series of morphofunctional findings were performed. SUBJECTS AND METHODS: In 200 children referred for evaluation and treatment of tongue-tie, the length of the frenulum and the interincisal distance were measured in maximum opening of the mouth and with the tip of the tongue touching the palatal papilla. Occlusion, type of bite, tongue resting position, swallowing mechanism, oral floor mobility, frenulum insertion modality and speech were investigated. Any correlation between these morphofunctional findings and anatomical measures was investigated. RESULTS: Children with a frenulum length more than 2 cm and an interincisal distance of more than 2.3 cm were normal. In both measurements, significant correlations among mean values and other variables were observed. Moreover, three levels -- mild, moderate and severe -- of ankyloglossia were assessed. CONCLUSIONS: Length of frenulum and interincisal distance allow an assessment of severity of ankyloglossia in children. Ankyloglossia was not associated with infantile swallowing.

Lingual frenulum: quantitative evaluation proposal.

UNLABELLED: The purpose of this study was to establish a quantitative method to classify lingual frenulum as normal and altered. METHODS: 98 people were included in this study. All measurements were made with maxium opening of the mouth. A digital caliper was used to measure the length of the frenulum under three conditions: a) with the tongue tip on the incisal papilla; b) with the tongue sucked up and maintained against the hard palate; and c) with tongue stretching over a spatula. RESULTS: Observations indicated that the most useful and statistically significant way of measuring frenulum length was achieved with maximum mouth opening and the tongue tip on the incisal papilla. CONCLUSION: This quantitative method was demonstrated to be effective for identifying and distinguishing normal and altered frenular length.

Lingual frenulum: classification and speech interference.

PURPOSE: To propose a classification of the different lingual frenulum and to relate them to speech disorders. METHODS: We evaluated 1402 patients' frenulum with an age range of 5 years 8 months to 62 years 10 months between 1978 and 2002. Pictures were taken of the altered frenulum. Measures of maximal mouth opening, with and without tongue suction, were taken with a sliding caliper. Speech samples were also taken. Frenulum were then classified as normal; short; with anterior insertion, and short with anterior insertion. RESULTS: From the 1402 patients evaluated, 127 (9%) presented with an altered frenulum insertion. For this study we considered only those with short or with anterior insertion. For those who had an altered frenulum, 62 (48.81%) presented with speech disorders. The more frequent speech disorders were: omission and substitution of /r/; {R}, and consonant clusters with /r/, and of /s/ and /z/. Frontal and lateral lisps also occurred. The frenulum of 21 patients was classified as short and of these, 12 patients (57%) presented with speech disorders. Of the 106 patients with anterior insertion, 50 (47.2%) presented with a speech disorder. After statistical analyses the relation between altered frenulum and speech disorders was considered significant with p<0.001. CONCLUSION: The lingual frenulum was classified as normal, short and with anterior insertion. An altered frenulum may predispose the individual to exhibit an accompanying speech disorder.