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Arena M, Micarelli A, Guzzo F, Misici I, Jamshir D, Micarelli B, Castaldo A, di Benedetto A, Alessandrini M. Outcomes of tongue-tie release by means of tongue and frenulum assessment tools: a scoping review on non-infants. Acta Otorhinolaryngol Ital 2022; 42:492-501. [PMID: 36654515 PMCID: PMC9853103 DOI: 10.14639/0392-100x-n2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/17/2022] [Indexed: 01/18/2023]
Abstract
Objective To evaluate outcomes of the surgical and rehabilitative procedures devoted to release the tongue-tie in non-infants when implementing the most commonly used quantitative/qualitative structured tools for tongue and frenulum assessment. Methods A scoping review and meta-analysis were conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. Results The systematic search retrieved 603 (Pubmed), 893 (Scopus), and 739 (ISI Web of Science) articles from January 2011 to December 2021. A total of 50 articles were retrieved for full-text review of which 7 were selected and included based on inclusion criteria. The majority of treatment options have been found to significantly improve the anatomical limitation of the tongue with clear benefits on descending functionality. Conclusions The review highlights an overall improvement in terms of clinical and functional outcomes when using validated tongue assessment tools both before and after frenulum release. This highlights the need for their rigorous implementation in research and clinical practice.
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Affiliation(s)
- Martina Arena
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy
| | - Alessandro Micarelli
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy,Correspondence Alessandro Micarelli Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy E-mail:
| | - Federico Guzzo
- Unit of Dentistry and Oral Health, UNITER ONLUS, Rome, Italy
| | - Ilaria Misici
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy
| | - Diana Jamshir
- Unit of Dentistry and Oral Health, UNITER ONLUS, Rome, Italy
| | - Beatrice Micarelli
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy
| | | | - Adriano di Benedetto
- Unit of Neuroscience, Rehabilitation and Sensory Organs, UNITER ONLUS, Rome, Italy, Occupational Therapy Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, ENT Unit, University of Rome Tor Vergata, Rome, Italy
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Wang J, Yang X, Hao S, Wang Y. The effect of ankyloglossia and tongue-tie division on speech articulation: A systematic review. Int J Paediatr Dent 2022; 32:144-156. [PMID: 33964037 DOI: 10.1111/ipd.12802] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
AIM Ankyloglossia is a common congenital malformation characterized by a short, thick, or tight tongue frenulum, and its effect on speech articulation remains controversial. This study aimed to evaluate (a) the association between ankyloglossia and speech disorders, and (b) the effectiveness of surgical interventions on the articulation of patients with ankyloglossia. MATERIAL AND METHODS A comprehensive search of PubMed was conducted. Randomized control trials (RCTs), cohort studies, case-control studies, and case series with more than five cases were included. RESULT Of the 16 included studies, except for one cross-sectional study, all studies were small in sample size. The evidence quality was generally low, with an average of 3.88 in a 7-point system. Three studies investigated the occurrence of speech disorders in the ankyloglossia population and obtained different results. Fifteen studies assessed the effectiveness of surgery, among which eight self-control studies observed significant postoperative improvement, whereas three of four cohort studies with untreated controls reported no significant differences. Three RCTs compared surgical techniques and one pointed out the advantage of frenuloplasty over frenulotomy. CONCLUSION There was no clear connection between ankyloglossia and speech disorders. More widely accepted uniform grading systems and well-designed clinical studies are needed.
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Affiliation(s)
- Jiahe Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyu Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Siyuan Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Baris HE, Gunhan H, Kucuk S, Durmus Kocaaslan FN, Boran O. Impact of ankyloglossia on the language development of children. Marmara Medical Journal. [DOI: 10.5472/marumj.1006047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim TH, Lee YC, Yoo SD, Lee SA, Eun YG. Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: A prospective randomized study. Int J Pediatr Otorhinolaryngol 2020; 136:110146. [PMID: 32540779 DOI: 10.1016/j.ijporl.2020.110146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the surgical outcomes of simple frenotomy and the 4-flap Z-frenuloplasty according to the articulation test values and tongue-tie classification in patients with ankyloglossia with articulation difficulty. STUDY DESIGN prospective randomized study. SETTING Tertiary academic center. SUBJECTS and methods: Children with ankyloglossia with articulation difficulty were randomly divided into 2 groups for surgical treatment. Patients were evaluated for the tongue-tie classification and articulation test before surgery. Three months after the operation, the frenulum classification and articulation test were re-evaluated to compare the differences in surgical outcome between the two surgical methods. RESULTS Out of 37 patients, 19 underwent the 4-flap Z-frenuloplasty and 18, the simple frenotomy. No differences were observed in the baseline characteristics of the patients assigned to both groups. Changes in the tongue-tie classification and improvement in the articulation test results were observed with both the surgical methods. Both surgical groups had significant improvement in the speech articulation test (consonants) but there was no difference in the speech outcomes between the surgical groups. CONCLUSION Although there was no significant difference in the surgical outcome between the two surgical methods, ankyloglossia patients showed improvement in a Korean speech articulation test 3 months after undergoing surgery to release the lingual frenulum.
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Salt H, Claessen M, Johnston T, Smart S. Speech production in young children with tongue-tie. Int J Pediatr Otorhinolaryngol 2020; 134:110035. [PMID: 32298924 DOI: 10.1016/j.ijporl.2020.110035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Tongue-tie, or ankyloglossia, occurs in 4-10% of the population. Treatment of tongue-tie has increased by 420% in Australia between 2006 and 2016 and 866% in the United States between 1997 and 2012. Despite limited evidence, it has been suggested that tongue-tie can result in speech sound disorder (SSD). This study aimed to investigate tongue mobility and speech production outcomes in children with and without tongue-tie diagnoses. METHOD Fifty-nine children aged 2; 1 to 4; 11 years were recruited and formed three groups: treated tongue-tie (TTT), untreated tongue-tie (UTT) and no tongue-tie (NTT). Measures of lingual frenulum structure and function, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected. RESULTS No statistically significant differences were found between the TTT, UTT and NTT groups for tongue mobility, speech production or intelligibility. Significantly more UTT children had a history of speech pathology attendance than participants in the NTT group. CONCLUSION This study provides preliminary evidence of no difference between tongue mobility and speech outcomes in young children with or without intervention for tongue-tie during infancy. This study assists with clinical decision making and makes recommendations for families not to proceed with surgical intervention for tongue-tie during infancy, for the sole outcome of improving speech production later in life.
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Affiliation(s)
- Holly Salt
- Curtin University, Kent St, Bentley, WA, Australia, 6102.
| | - Mary Claessen
- Curtin University, Kent St, Bentley, WA, Australia, 6102.
| | - Timothy Johnston
- IKids Paediatric Dental Care, 94 Stirling Hwy, North Fremantle, WA, Australia, 6159.
| | - Sharon Smart
- Curtin University, Kent St, Bentley, WA, Australia, 6102.
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Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg 2020; 162:597-611. [PMID: 32283998 DOI: 10.1177/0194599820915457] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements. METHODS An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. CONCLUSION This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
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Affiliation(s)
- Anna H Messner
- Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | | | | | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Scott E Brietzke
- Nemours Specialty Care, Wolfson Children's Hospital, St. Johns, Florida, USA
| | | | | | - Jessica Levi
- Boston University and Boston Medical Center, Boston, Massachusettes, USA
| | - Anna K Meyer
- UCSF School of Medicine, San Francisco, California, USA
| | - Sanjay Parikh
- University of Washington Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey P Simons
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel L Wohl
- Pediatric Otolaryngology Associates, LLC, Jacksonville, Florida, USA
| | - Erin Lambie
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa Satterfield
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Schlatter S, Schupp W, Otten J, Harnisch S, Kunze M, Stavropoulou D, Hentschel R. The role of tongue-tie in breastfeeding problems-A prospective observational study. Acta Paediatr 2019; 108:2214-2221. [PMID: 31265153 DOI: 10.1111/apa.14924] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
AIM We evaluated what determined breastfeeding problems in a non-selected mother-infant cohort, with special reference to tongue-tie and improvements in breastfeeding following frenulotomy. METHODS This 2014-2015 prospective, observational study was carried out in a tertiary level maternity unit affiliated to the University of Freiburg, Germany, using a breastfeeding questionnaire, standardised breastfeeding scores and the Assessment Tool For Lingual Frenulum Function (ATLFF). The standard intervention was breastfeeding support, a frenulotomy for tongue-tie was performed if necessary. All cases of breastfeeding problems and, or tongue-tie, were followed up by telephone 2.5 weeks after birth. RESULTS We enrolled 776 newborn-mother dyads: 345 had breastfeeding problems, 116 had a tongue-tie and 30 underwent a frenulotomy. In the multivariate analysis, severe breastfeeding problems were more frequent in newborn infants with tongue-tie, with an odds ratio (OR) of 2.6 (P= 0.014). Other risk factors were: no breastfeeding experience (OR 4.4, P = 0.001), low birth weight (OR 2.9, P = 0.001), prematurity (OR 3.6, P = 0.000) and Caesarean section (OR 1.6, P = 0.023). There was a significant reduction in breastfeeding problems after frenulotomy (P = 0.01). CONCLUSION Tongue-tie had a significant impact on breastfeeding and so did low birth weights and prematurity. Frenulotomy proved helpful when breastfeeding problems were reported.
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Affiliation(s)
- Sara‐Maria Schlatter
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
| | - Wiebke Schupp
- Center for Dental Medicine, Division of Oral and Maxillofacial Surgery, Medical Center University of Freiburg Freiburg Germany
| | - Jörg‐Elard Otten
- Center for Dental Medicine, Division of Oral and Maxillofacial Surgery, Medical Center University of Freiburg Freiburg Germany
| | - Sabine Harnisch
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center University of Freiburg Freiburg Germany
| | - Dimitra Stavropoulou
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
| | - Roland Hentschel
- Division of Neonatology/Intensive Care Medicine, Department of General Pediatrics, Medical Center University of Freiburg Freiburg Germany
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9
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Daggumati S, Cohn JE, Brennan MJ, Evarts M, McKinnon BJ, Terk AR. Caregiver perception of speech quality in patients with ankyloglossia: Comparison between surgery and non-treatment. Int J Pediatr Otorhinolaryngol 2019; 119:70-74. [PMID: 30677630 DOI: 10.1016/j.ijporl.2019.01.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Our objective was to determine if there are differences in caregiver perception of speech for patients that undergo frenulectomy compared to patients that were not surgically treated. INTRODUCTION Ankyloglossia is a controversial topic without standardized treatment guidelines. Although there have been several studies suggesting that breastfeeding does improve after frenulectomy, there is a paucity of literature that investigates the relationship between ankyloglossia and speech. METHODS A retrospective chart review was conducted to identify patients with ankyloglossia. Patients were categorized into surgical treatment (frenulectomy) and non-treatment groups. Caregivers of both groups were contacted by phone and surveyed on speech quality and tongue mobility using Likert scores. Mann Whitney-U testing was used to determine if there were significant differences in perceived speech quality between the surgical and non-surgical groups. RESULTS The caregivers of seventy-seven patients participated in the phone survey: 46 (60%) children in the surgical group and 31 (40%) children in the non-surgical group who participated in the phone survey. There were no differences in difficulty with speech (p = 0.484) and tongue mobility (p = 0.064) between the two groups. However, patients that underwent surgical intervention for ankyloglossia reported less difficulty with tongue tasks (p < 0.001) compared to those who were not surgically treated. Additionally, 50% of patients that underwent surgery had a documented family history of ankyloglossia which was significantly higher than 16.1% in the non-surgical group (p = 0.002). CONCLUSIONS It appears that children with ankyloglossia might have similar speech quality following frenulectomy in comparison to speech quality without treatment. Children who undergo frenulectomy may experience improvements in tongue tasks. This data should encourage further research on the management of speech concerns in children with ankyloglossia.
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Affiliation(s)
- Srihari Daggumati
- Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA, 19129, USA.
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA, 19131, USA.
| | - Matthew J Brennan
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA, 19131, USA.
| | - Marissa Evarts
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA, 19131, USA.
| | - Brian J McKinnon
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA.
| | - Alyssa R Terk
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA.
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Daggumati S, Cohn JE, Brennan MJ, Evarts M, McKinnon BJ, Terk AR. Speech and Language Outcomes in Patients with Ankyloglossia Undergoing Frenulectomy: A Retrospective Pilot Study. OTO Open 2019; 3:2473974X19826943. [PMID: 31236536 PMCID: PMC6572914 DOI: 10.1177/2473974x19826943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/08/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022] Open
Abstract
Ankyloglossia is a controversial topic with no standardized treatment guidelines. A retrospective chart review was conducted to identify children who underwent lingual frenulectomy for speech and language impairment. Impairment severity was recorded pre- and postoperatively as mild, mild to moderate, moderate, moderate to severe, or severe. Variables were tested with chi-square analysis for their statistical relationship to improvements in speech and language. Children with preoperative moderate and moderate-to-severe speech and language impairment attained better speech and language outcomes after frenulectomy as compared with children with mild and mild-to-moderate impairment (100% vs 82%, P = .015). Sutured closure after frenulectomy was associated with better speech and language improvements (100% vs 83%, P = .033). One could consider observation of patients with mild and mild-to-moderate speech and language impairments. Sutured closure might result in better improvements in speech and language impairments. This pilot study sheds light on the potential impact of a larger study currently underway.
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Affiliation(s)
- Srihari Daggumati
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew J Brennan
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Marissa Evarts
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Brian J McKinnon
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Drexel University, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Alyssa R Terk
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Drexel University, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
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Abstract
ABSTRACT Purpose: to analyze the compensatory strategies used by subjects with ankyloglossia for the production of the consonantal alveolar flap sound /ɾ/. Methods: a cross-sectional analytic observational comparative study was conducted with 88 subjects, 44 being diagnosed with ankyloglossia and 44 with normal lingual frenulum, matched by age and gender. They were asked to repeat the syllable /ra/ five times in a row. Video recordings of the speech were taken. Frame by frame analysis of all recordings were performed to verify tongue, lip, and mandible movements during the production of the alveolar flap. The analysis of the films was performed by two Speech Language Pathologists specialized in Orofacial Myofunctional Disorder. Fisher’s Exact Test was used for statistical treatment (p≤0.05.) Results: the frame by frame analysis of the alveolar flap production of subjects with and without ankyloglossia showed that subjects with ankyloglossia performed several compensatory strategies when producing this sound. There was a statistically significant difference (p=0.001) when subjects with and without ankyloglossia were compared. Conclusion: subjects with ankyloglossia used several lip, tongue, and mandible compensatory strategies to produce the Brazilian Portuguese consonantal alveolar flap /ɾ/.
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Hentschel R. Breastfeeding problems should be the only relevant criteria for deciding whether to carry out a frenotomy in infancy. Acta Paediatr 2018; 107:1697-1701. [PMID: 29873840 DOI: 10.1111/apa.14439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/05/2018] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
Abstract
Performing a frenotomy on tongue-tied infants is controversial, particularly with regard to breastfeeding issues. This paper reviews the literature to bring together clinical experiences and scientific evidence in this field. I found that some tongue-tied babies may exhibit breastfeeding problems, while others may feed perfectly. The literature suggests that medical breastfeeding-related problems should be the only relevant criteria to guide the decision-making for a frenotomy in infancy. The advantages and disadvantages of either a wait and see position or surgical approach are addressed. CONCLUSION The cornerstones for best practice are the meticulous examination, correct diagnosis and classification of tongue-tied infants.
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Affiliation(s)
- Roland Hentschel
- Department of General Pediatrics; Divsions of Neonatology/Intensive Care Medicine; Faculty of Medicine & Medical Center; University of Freiburg; Freiburg Germany
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13
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Martinelli RLDC, Marchesan IQ, Gusmão RJ, Honório HM, Berretin-Felix G. The effects of frenotomy on breastfeeding. J Appl Oral Sci 2015; 23:153-7. [PMID: 26018306 PMCID: PMC4428459 DOI: 10.1590/1678-775720140339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/10/2014] [Indexed: 11/23/2022] Open
Abstract
Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals.
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Affiliation(s)
| | | | - Reinaldo Jordão Gusmão
- Department of ENT, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Giédre Berretin-Felix
- Department of Speech-Language Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Ito Y, Shimizu T, Nakamura T, Takatama C. Effectiveness of tongue-tie division for speech disorder in children. Pediatr Int 2015; 57:222-6. [PMID: 25142274 DOI: 10.1111/ped.12474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to determine the effectiveness of tongue-tie division (frenuloplasty/ frenulotomy) for speech articulation disorder in children with ankyloglossia (tongue-tie). METHODS Articulation test was done in five children (3-8 years old) with speech problems who underwent tongue-tie division. The test consisted of 50 pictures of common Japanese words with 2-3 syllables. The patients were interviewed by a speech therapist and asked to pronounce what the picture card showed. Misarticulations of substitution, omission, and distortion were assessed. The preoperative results were compared with postoperative examinations at 1 month, 3-4 months, and 1-2 years. RESULTS Nineteen substitutions that were observed in four patients preoperatively decreased to 10 in three patients at 1 month, 7 in three patients at 3-4 months, and 1 in one patient at 1-2 years postoperatively. Five omissions that were observed in four patients preoperatively decreased to 3 in three patients at 1 month, 2 in two patients at 3-4 months, and 1 in one patient at 1-2 years postoperatively. Thirteen distortions that were observed in five patients preoperatively decreased to 8 in four patients at 3-4 months but increased to 11 in three patients at 1-2 years postoperatively. CONCLUSIONS Substitution and omission improved relatively early after tongue-tie division and progressed to distortion, which is a less-impaired form of articulation disorder. Thus, distortion required more time for improvement and remained a defective speaking habit in some patients.
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Affiliation(s)
- Yasuo Ito
- Department of Pediatrics and Pediatric Surgery, International University of Health and Welfare Atami Hospital, Atami, Japan
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15
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Abstract
Tongue tie or ankyloglossia is a congenital variation characterised by a short lingual frenulum which may result in restriction of tongue movement and thus impact on function. Tongue tie division (frenotomy) in affected infants with breastfeeding problems yields objective improvements in milk production and breastfeeding characteristics, including objective scoring measures, weight gain and reductions in maternal pain. For the majority of mothers, frenotomy appears to enhance maintenance of breastfeeding. Tongue tie division is a safe procedure with minimal complications. The commonest complication is minor bleeding. Recurrence leading to redivision occurs with rates of 0.003-13% reported; this appears to be more common with posterior than anterior ties. There are limited reports indicating that prophylactic frenotomy may promote subsequent speech development; however, evidence is currently insufficient to condone this practice and further good quality research into this area is warranted.
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Affiliation(s)
- Alastair Brookes
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, United Kingdom.
| | - Douglas M Bowley
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, United Kingdom.
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Abstract
OBJECTIVES Tongue tie (ankyloglossia) describes a short lingual frenulum that can lead to breastfeeding difficulties. It affects between 4% and 10% of infants and can be treated by frenulotomy. We developed a nurse-delivered frenulotomy service at a tertiary pediatric hospital and audited our results. STUDY DESIGN Observational study. SETTING Tertiary pediatric hospital. SUBJECTS AND METHODS An outpatient tongue tie clinic was set up by an ear, nose, and throat consultant. Tongue tie division was undertaken using a standard technique without the need for anesthesia or analgesia, as per National Institute for Health and Care Excellence guidelines. Subsequently, a senior nurse was trained to undertake the clinic independently and saw most referrals. Patient satisfaction data were collected via questionnaires. RESULTS Referrals to the service increased from 57 (2009) to 296 (2012). Outcome data from outpatient frenulotomy are discussed. Parent satisfaction measures were similar for both nurse- and doctor-delivered treatment. If all frenulotomies were undertaken in nurse-delivered clinics, a total of £3830 could have been saved in 2012, compared with the cost of doctor-delivered care. CONCLUSION A nurse-delivered outpatient frenulotomy service is a safe and cost-effective method of delivering such care. We have demonstrated reduced costs and reduced waiting times without compromising patient satisfaction or the quality of care provided.
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Affiliation(s)
- Katie Rose
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Alison Flynn
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sujata De
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Walls A, Pierce M, Wang H, Steehler A, Steehler M, Harley EH. Response to the Letter to the Editor regarding: Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. Int J Pediatr Otorhinolaryngol 2014; 78:1195-6. [PMID: 24794416 DOI: 10.1016/j.ijporl.2014.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/29/2014] [Indexed: 11/22/2022]
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Walls A, Pierce M, Wang H, Steehler A, Steehler M, Harley EH. Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. Int J Pediatr Otorhinolaryngol 2014; 78:128-31. [PMID: 24315215 DOI: 10.1016/j.ijporl.2013.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 10/31/2013] [Accepted: 11/09/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate parental speech outcomes and tongue mobility in children with ankyloglossia who underwent frenotomy by an otolaryngologist during the neonatal period. STUDY DESIGN Cohort study and retrospective telephone survey. STUDY SETTING University Hospital. SUBJECTS AND METHODS Neonates previously diagnosed with congenital ankyloglossia were separated into Surgical Intervention (N=71) and No Surgical Intervention (N=15) Groups. A Control Group (N=18) of patients was identified from the hospital medical record database, which were not diagnosed with congenital ankyloglossia. A survey provided by a certified speech pathologist utilized a Likert scale to assess speech perception and tongue mobility by parental listeners. The questionnaire also analyzed oral motor activities and the medical professionals that identified the ankyloglossia shortly after birth. Statistical analyses were performed with the Wilcoxon Rank Sum Test and Fischer's Exact Test in order to determine an effect size=1. RESULTS There was significantly improved speech outcomes designated by parents in the Surgical Intervention Group when compared to the No Surgical Intervention Group [p<0.0001, p<0.0001], respectively. Furthermore, parents designated no difference in speech outcomes between the Surgical Intervention Group when analyzed against the Control Group [p=0.3781, p<0.2499], respectively. CONCLUSIONS There was a statistically significant improvement in speech outcomes and tongue mobility in children who underwent frenotomy compared to individuals who declined the operation. As a result of the data presented within this study, there appears to be a long-term benefit beyond feeding when frenotomy is performed in newborns with ankyloglossia.
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Affiliation(s)
- Andrew Walls
- Georgetown University School of Medicine, Washington, DC 20007, United States.
| | - Matthew Pierce
- Department of Otolaryngology - Head & Neck Surgery, Georgetown University Hospital, Washington, DC 20007, United States
| | - Hongkun Wang
- Department of Biostatistics - Georgetown University Medical Center, Georgetown University, Washington, DC 20007, United States
| | - Ashley Steehler
- The River School, Speech Pathology, Washington, DC 20007, United States
| | - Matthew Steehler
- Ear, Nose, & Throat Associates of Corpus Christi, Otolaryngology - Head and Neck Surgery, Corpus Christi, TX 78411, United States
| | - Earl H Harley
- Georgetown University School of Medicine, Washington, DC 20007, United States; Department of Otolaryngology - Head & Neck Surgery, Georgetown University Hospital, Washington, DC 20007, United States
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Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol 2013; 77:635-46. [PMID: 23537928 DOI: 10.1016/j.ijporl.2013.03.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/28/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically review the outcomes of tongue-tie division procedures in patients with ankyloglossia with the goal of (1) deriving clinically oriented insights into the effect of tongue-tie division procedures and (2) identifying needs in knowledge to stimulate further research. DATA SOURCES Medline, EMBASE, and Cochrane databases were searched without any limitations, for studies published between 1966 and June 2012. REVIEW METHODS Studies were included (level 4 evidence or above) if subjects of any age had ankyloglossia and underwent tongue-tie release. Outcome measures of interest were any subjective or objective measures of breastfeeding and speech outcomes, or reports of adverse events. RESULTS In all, 378 abstracts were generated from the literature searches; 20 studies met the criteria for data extraction and analysis. Of those, 15 studies were observational and 5 were randomized controlled trials. Tongue-tie division provided objective improvements in the following: LATCH scores (3 studies); SF-MPQ index (2 studies); IBFAT (1 study); milk production and feeding characteristics (3 studies); and infant weight gain (1 study). Subjective improvements were also noted in maternal perception of breastfeeding (14 studies) and maternal pain scores (4 studies). No definitive improvements in speech function were reported. The only significant adverse events were recurrent tongue-ties that required repeat procedures. CONCLUSION Ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breastfeeding; however, there was a limited number of studies available with quality evidence. There are no significant data to suggest a causative association between ankyloglossia and speech articulation problems. Aspects of ankyloglossia that would benefit from further research are described, and recommendations for tongue-tie release candidacy criteria are provided.
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Affiliation(s)
- Amanda N Webb
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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