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Valderrama-Penagos JX, Rodríguez Alcalá L, Plaza G, Baptista P, Garcia Iriarte MT, Correa EJ, O’Connor-Reina C. Ankyloglossia in Children, a Cause of Obstructive Sleep Apnoea: Case Report of Paediatric Ankyloglossia and Sleep Apnoea: DISE Resolves the Mystery. CHILDREN (BASEL, SWITZERLAND) 2024; 11:218. [PMID: 38397330 PMCID: PMC10887148 DOI: 10.3390/children11020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Tongue mobility is an obstructive sleep apnoea (OSA) marker and myofunctional therapy (MFT) target. For this reason, all paediatric patients with sleep-disordered breathing should require a combined functional assessment from an ear, nose, and throat (ENT) specialist and a phonoaudiologist to confirm or rule out the presence of ankyloglossia. To our knowledge, this is the first case of a 13-year-old girl diagnosed with severe OSA and a significant decrease of 94% in her apnoea index (AI), requiring frenotomy with an immediate postoperative change in the tongue position. A drug-induced sleep endoscopy (DISE) was performed before and immediately postfrenotomy, and the anatomical changes provoked by this surgery during sleep were confirmed for the first time.
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Affiliation(s)
| | - Laura Rodríguez Alcalá
- Department of Otorhinolaryngology, Hospital Quiron Salud Marbella, Av. Severo Ochoa 22, 29603 Marbella, Spain
| | - Guillermo Plaza
- Department of Otorhinolaryngology, Hospital Fuenlabrada, Universidad Rey Juan Carlos I, 28032 Madrid, Spain
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, 31008 Pamplona, Spain
| | | | - Eduardo J. Correa
- Department of Otorhinolaryngology, Hospital La Linea, 11300 La Linea de la Concepción, Spain
| | - Carlos O’Connor-Reina
- Department of Otorhinolaryngology, Hospital Quiron Salud Marbella, Av. Severo Ochoa 22, 29603 Marbella, Spain
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Cordray H, Mahendran GN, Tey CS, Nemeth J, Raol N. The Impact of Ankyloglossia Beyond Breastfeeding: A Scoping Review of Potential Symptoms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:3048-3063. [PMID: 37606583 DOI: 10.1044/2023_ajslp-23-00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo tongue-tie release (frenotomy) during infancy. DATA SOURCES This study contains data from PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar (1961-January 2023). REVIEW METHOD The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Experimental and observational studies were eligible if they reported baseline outcomes associated with ankyloglossia in children above a year of age. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded. CONCLUSIONS Twenty-six of 1,568 screened studies (> 1,228 patients) were included. Six studies were high quality and 20 were medium quality. Studies identified various symptoms that may be partially attributable to ankyloglossia after infancy, including speech/articulation difficulties, eating difficulties, dysphagia, sleep-disordered breathing symptoms, dental malocclusion, and social embarrassment such as oral hygiene issues. Multiple comparative studies found associations between ankyloglossia and risk factors for obstructive sleep apnea; a randomized controlled trial found that frenotomy may attenuate apnea severity. Ankyloglossia may also promote dental crowding. IMPLICATIONS FOR PRACTICE Ankyloglossia may be associated with myriad effects on children's quality of life that extend beyond breastfeeding, but current data regarding the impact are inconclusive. This review provides a map of symptoms that providers may want to evaluate as we continue to debate the decision to proceed with frenotomy or nonsurgical therapies in children with ankyloglossia. A continuing need exists for controlled efficacy research on frenotomy for symptoms in older children and on possible longitudinal benefits of early frenotomy for maxillofacial development. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23900199.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Ching Siong Tey
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Psychology, University of Georgia, Athens
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? Case Report and Systematic Review. J Clin Med 2022; 12:jcm12010201. [PMID: 36615001 PMCID: PMC9821269 DOI: 10.3390/jcm12010201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Ankyloglossia (tongue-tie) is a condition of the oral cavity in which an abnormally short lingual frenulum affects the tongue's mobility. Literature on the correlation between ankyloglossia and obstructive sleep apnea (OSA) is scarce. The main objective of this study was to report our preliminary experience in adult OSA patients before and after ankyloglossia treatment, using drug-induced sleep endoscopy (DISE) to evaluate the upper airway modifications resulting after treatment, and to present a systematic review of the impact of ankyloglossia and its treatment on OSA adults. We found that, after frenotomy, regarding the DISE findings, and according to the VOTE classification, two of the three patients showed an improvement in tongue level, from 2A-P (complete anteroposterior collapse) to 1ap (partial anteroposterior collapse). The third patient showed no changes in his UA after frenotomy, neither worsening nor showing improvement. Thus, the results of this study suggest that frenotomy in OSA patients with ankyloglossia could reduce tongue collapse, probably by allowing the tongue to take into the physiological position in the oral cavity. These patients should undergo speech therapy and oropharyngeal exercises prior to any surgical procedure, in order to avoid glossoptosis and to improve the quality of life and sleep apnea results.
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Burska Z, Burghard M, Brożek-Mądry E, Sierdziński J, Krzeski A. Oral cavity morphology among children at risk of sleep disordered breathing. Eur Arch Paediatr Dent 2022; 23:429-435. [PMID: 35366217 DOI: 10.1007/s40368-022-00701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB). METHODS The study included children 3-17 years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum. RESULTS A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1 years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group. CONCLUSION The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.
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Affiliation(s)
- Z Burska
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland
| | - M Burghard
- Medical Center in Ostrołęka, Ostroleka, Poland
| | - E Brożek-Mądry
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland.
| | - J Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - A Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland
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Yap YY. Evaluation and Management of Snoring. Sleep Med Clin 2022; 17:25-39. [PMID: 35216759 DOI: 10.1016/j.jsmc.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Snoring can be harmless (primary) or a symptom of sleep-disordered breathing (secondary) and should alert the physician to evaluate the patient for risks thereof. Phenotypes of snoring and sleep-disordered breathing (SDB) are anatomic and nonanatomic and identifying these phenotypes and their interrelationships are critical to effective therapy. Mouth breathing alerts the physician to nasal airway obstruction, signals orofacial growth changes in children, and heralds the progression of SDB. Systematic evaluation to establish phenotypes includes assessing sleep habits, comorbidities, upper airway examination, polysomnography, and drug-induced sleep endoscopy. Strategies for treatment should be personalized and precise to the phenotype(s) to achieve the most benefit.
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Affiliation(s)
- Yoke-Yeow Yap
- KPJ Johor Specialist Hospital, 39b Jalan Abdul Samad, Johor Bahru 80100, Malaysia.
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Ducloyer M, Wargny M, Medo C, Gourraud PA, Clement R, Levieux K, Gras-Le Guen C, Corre P, Rambaud C. The Ogival Palate: A New Risk Marker of Sudden Unexpected Death in Infancy? Front Pediatr 2022; 10:809725. [PMID: 35509830 PMCID: PMC9058094 DOI: 10.3389/fped.2022.809725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ogival palate (i.e., a narrow and high-arched palate) is usually described in obstructive breath disorder but has been found in infants unexpectedly deceased. We studied the association between ogival palate and sudden unexpected death in infancy (SUDI) on the basis of a computed tomography (CT) evaluation. METHODS We conducted a monocentric case-control study of children under 2 years of age who died of SUDI, for which a head CT scan and an autopsy were performed between 2011 and 2018. Each case was matched by sex and age (± 30 days) to two controls selected among living children in the same center who benefited from a cranio-encephalic CT scan. Four parameters of the hard palate were measured by CT: height, width, length, and sagittal angle; the height/width ratio was calculated. The presence of an ogival palate was also subjectively evaluated by the radiologists, independently from the measurements. Standardized odds ratios (OR) were calculated using conditional logistic regression models, all expressed for +1 standard deviation (SD). RESULTS Thirty-two deceased children were matched to 64 living control children. Mean ages were 5.0 and 5.3 months, respectively. Twenty-eight cases were considered to have died as a result of SIDS. The mean heights of the hard palate were significantly higher in the deceased children [4.1 (± 0.7) millimeters (mm)] than in the living children [3.2 (± 0.6) mm], with OR (+1SD) = 4.30 (95% confidence interval [CI], 2.04-9.06, P = 0.0001). The mean widths of the hard palate were 21.0 (± 1.9) mm and 23.2 (± 2.1) mm, respectively, with OR = 0.15 (95% CI, 0.06-0.40, P = 0.0001). The mean sagittal angles were significantly more acute in deceased children [134.5° (± 9.3)] than in living children [142.9° (± 8.1)], with OR = 0.28 (95% CI, 0.14-0.56, P = 0.0003). The mean height/width ratios were 19.8 (± 3.7) and 14.1 (± 3.3), respectively, with OR = 6.10 (95% CI, 2.50-14.9, P = 0.0001). The hard palate was subjectively considered as ogival in 59.4% (19/32) of the cases versus 12.5% (8/64) of the controls. CONCLUSION Radiological features of the ogival palate were strongly associated with SUDI. This observation still needs to be confirmed and the corresponding clinical features must be identified.
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Affiliation(s)
- Mathilde Ducloyer
- Department of Forensic Medicine, University Hospital, Nantes, France.,Department of Radiology, University Hospital, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Charlotte Medo
- Department of Radiology, University Hospital, Nantes, France
| | - Pierre-Antoine Gourraud
- CHU de Nantes, INSERM CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Renaud Clement
- Department of Forensic Medicine, University Hospital, Nantes, France
| | - Karine Levieux
- Department of Pediatrics, University Hospital, Nantes, France
| | | | - Pierre Corre
- Department of Oral and Maxillo-Facial Surgery, University Hospital, Nantes, France
| | - Caroline Rambaud
- Department of Pathology and Forensic Medicine, AP-HP University Hospital Raymond Poincaré, University of Paris-Saclay, Garches, France
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