Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic

ObjectivesRecent studies have shown an association between ankyloglossia (tongue tie) and upper-lip ties to breastfeeding difficulties. Treatment is commonly multidisciplinary involving lactation consultants and surgical management with tongue tie and upper lip tie release. There is currently limited data looking at posterior ankyloglossia and upper lip ties.MethodsConsecutive patients seen at an ENT outpatient clinic for ankyloglossia and upper-lip ties from May 2014–August 2015 were assessed for an outpatient frenotomy. Breastfeeding outcomes were assessed following the procedure.Results43 babies were seen and 34 patients had a procedure carried out. Babies ranged from 2 to 20 weeks old with the median age being 6.6 weeks. The most common presenting complaint was latching issues (85%) with mothers' painful nipples being the second (65%). 21 patients (62%) had a tongue tie release, 10 (29%) had both a tongue tie and upper lip tie divided, whereas 3 (9%) had an upper-lip tie alone divided. 29 (85%) of the patients who had a procedure carried out had an immediate improvement in breastfeeding, while 28 (82%) had a continued improvement at 2 weeks follow up.ConclusionsFrenotomy for posterior ankyloglossia and upper lip ties is a simple procedure that can be carried out in an outpatient setting with apparent immediate benefit. Otolaryngologists are likely to have an increasing role to play in the evaluation and management of ankyloglossia and upper lip ties in babies with breastfeeding difficulties.     

顶舌法联合刮舌法对舌系带过短患儿术后舌尖音训练效果的分析

目的：探讨顶舌法联合刮舌法对舌系带过短患儿术后舌尖音训练效果的影响。方法采用随机对照研究设计,将50例舌系带过短术后仅有舌尖音发音障碍的患儿（4～8岁）随机分为实验组25例,对照组25例。实验组在常规语音训练的基础上配合顶舌刮舌法训练,对照组采用常规语音训练,分别测试两组患儿在语音治疗前和治疗3个疗程后的语音清晰度,比较两组结果。结果实验组及对照组患儿治疗前的语音清晰度分别约为37．91％、37．69％,治疗后分别为87．69％、72．99％,两组患儿治疗前语音清晰度差异无统计学意义（t＝0．726,P ＞0．05）,治疗后两组患儿语音清晰度均较治疗前明显提高,差异有统计学意义（P ＜0．001）,且实验组患儿语音清晰度显著高于对照组。结论顶舌法联合刮舌法可以促进舌系带过短患儿术后仅有舌尖音发音障碍患儿语音清晰度的提高。     

Palatal fusion - where do the midline cells go? A review on cleft palate, a major human birth defect

Formation of the palate, the organ that separates the oral cavity from the nasal cavity, is a developmental process characteristic to embryos of higher vertebrates. Failure in this process results in palatal cleft. During the final steps of palatogenesis, two palatal shelves outgrowing from the sides of the embryonic oronasal cavity elevate above the tongue, meet in the midline, and rapidly fuse together. Over the decades, multiple mechanisms have been proposed to explain how the superficial mucous membranes disappear from the contact line, thus allowing for normal midline mesenchymal confluence. A substantial body of experimental evidence exists for cell death, cell migration, epithelial-to-mesenchymal transdifferentiation (EMT), replacement through new tissue intercalation, and other mechanisms. However, the most recent use of gene recombination techniques in cell fate tracking disfavors the EMT concept, and suggests that apoptosis is the major fate of the midline cells during physiological palatal fusion. This article summarizes the benefits and drawbacks of histochemical and molecular tools used to determine the fates of cells within the palatal midline. Mechanisms of normal disintegration of the midline epithelial seam are reviewed together with pathologic processes that prevent this disintegration, thus causing cleft palate.     

两种术式治疗婴幼儿期舌系带过短的效果比较

目的在临床上比较舌系带剪断术和舌系带矫正术治疗舌系带过短患儿的效果。方法选择的研究对象为在2007年2月—2014年2月期间,该院收治的200例舌系带过短的患儿,将这200例患儿随机分为给予舌系带矫正术治疗的对照组和给予舌系带剪断术实验组,每组100例,然后将对照组患儿与实验组患儿术后出血、感染以及发音等情况进行比较。结果实验组患儿在术后出现出血、感染发生率明显低于对照组患儿,组间差异有统计学意义（P〈0.05）,有4例患儿有轻度构音障碍,高于对照组患儿,但组间差异无统计学意义（P〉0.05）。结论两种手术均可应用于舌系带过短的治疗,应用舌系带剪断术治疗舌系带过短的患儿,在术后出血、感染以及肿胀等方面的发生率上低于舌系带矫正术,但在患儿发音的改善上弱于上舌系带矫正术。     

儿童舌系带过短矫正术手术效果观察

目的：探讨不同病症程度与外观特征的舌系带过短患儿矫正术后的临床疗效。方法选取2011年1月-2013年3月收治的98例儿童舌系带过短患者,对其进行矫正手术治疗,对比不同病症程度与外观特征的患儿术后治疗总有效率。结果98例患儿中Ⅰ、Ⅱ、Ⅲ度治疗总有效率分别为84.8%、94.0%、100.0%,组间差异无统计学意义;薄膜型与粗厚型总有效率分别为100.0%、80.5%,组间差异有统计学意义（P〈0.01）。结论儿童舌系带过短会对儿童发音造成障碍,及时对儿童进行矫正手术治疗和语音训练将能够明显提高临床治疗效果。     

386例婴幼儿舌系带过短矫正术的临床分析

目的：了解舌系带过短对患儿造成的不良影响,探讨舌系带过短小儿手术治疗的理想时期。方法：收集2002～2008年在福建省宁德市闽东医院口腔科接受舌系带过短手术的患儿386例（年龄为出生后3天至8岁）,根据年龄不同将患儿分成五组,比较各组患儿在舌系带肥厚率、术中缝合率、术中配合程度及术中出血量的区别,并且评估每组的手术安全性及术后护理的难易程度。结果：3～6个月年龄组的肥厚率、术中缝合率、术中出血量均较低,手术配合程度较佳,而手术安全性相对较高,术后护理较为容易。结论：小儿舌系带过短手术是安全有效的,手术最佳时期为出生后3～6个月。     

Unusual Presentation of Caustic Ingestion and its Surgical Treatment: A Case Report

Treatment and reconstruction of oral scar contracture, is always a challenging procedure to restore structure and functions of the oral cavity. We present a case of a patient with limited mouth opening who sustained extensive oral scar contracture with complete adhesion of tongue to floor of mouth following ingestion of caustic soda without his knowledge 4 years back. We performed a surgical release of the scar contractures from buccal mucosa on both sides, along with a release of the tongue from the floor of the mouth, followed by reconstruction of all sites using split skin grafts. Adequate mouth opening and tongue movement was achieved. There was a follow up period of 1 month with excellent mouth opening and tongue function.     

Pediatric tongue-tie division: Indications, techniques and patient satisfaction

Objective

To study the characteristics and outcome of paediatric tongue-tie division.

Patients and methods

Retrospective analyses of 317 paediatric tongue-tie divisions (frenotomy or frenuloplasty).

Results

Based on a questionnaire returned by 159 (51%) of patients (or guardians) the most common indication was speech/articulation problems (64%). Other indications included restricted movement (18%) and lactation/nutrition problems (8%). 84% of patients (or guardians) reported benefit from the operation. The initial surgical technique was frenotomy (no or local anaesthesia) for 34%, frenotomy (general anaesthesia) for 16%, frenuloplasty (no or local anaesthesia) for 5% and frenuloplasty (general anaesthesia) for 46% of the patients. Almost one-third of children treated with frenotomy under no or local anaesthesia needed re-operation compared to one out of 181 (0.6%) treated with frenotomy or frenuloplasty under general anaesthesia. There were no postoperative complications.

Conclusions

Frenotomy under no or local anaesthesia is safe and cost-effective, but one-third of children need re-operation. Adequate division of the frenulum is more important than the technique (frenuloplasty vs. frenotomy) used and seems to be easier to achieve under general anaesthesia.     

Defining ankyloglossia: A case series of anterior and posterior tongue ties

Introduction

Ankyloglossia is a congenital condition in which tongue mobility is limited due to an abnormality of the lingual frenulum. The impact of ankyloglossia on breastfeeding is poorly understood but there is a recent trend toward more recognition of this condition and early intervention when needed. Currently, there lacks clear definition of ankyloglossia and different subtypes have been proposed with no clinical correlation.

Objective

To determine the prevalence of anterior versus posterior ankyloglossia in a large series of consecutive patients and to assess clinical outcomes after frenotomy.

Methods

Retrospective chart review of patients from July 2007 to July 2009 who were diagnosed with ankyloglossia and underwent office frenotomy. Baseline characteristics, specific feeding issues, type of ankyloglossia, and clinical outcomes after frenotomy were reviewed.

Results

Of the 341 total patients, 322 (94%) had anterior ankyloglossia and 19 (6%) had posterior ankyloglossia. Median age at presentation was 2.7 weeks (range 1 day of life to 24 weeks); 227 were males and 114 were females. Revision frenotomy rates were significantly higher for the posterior ankyloglossia group (3.7% anterior and 21.1% posterior, p = 0.008).

Conclusion

Anterior ankyloglossia is much more common and readily managed when compared to posterior ankyloglossia. Posterior ankyloglossia is a poorly recognized condition that may contribute to breastfeeding difficulties. The diagnosis is difficult due to the subtle clinical findings but relevant health care providers should be aware of this condition. Frenotomy is a simple, safe, and effective intervention for ankyloglossia which improves breastfeeding.