[Congenital palatal ankyloglossia as the dominant member of a complex of multiple abnormalities; on the pathogenesis of ankyloglossia superior].
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Abnormalities, Multiple↗
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[A pathological consideration of ankyloglossia and lingual myoplasty].
Despite the curious role of tongue in the development of oro-facial structures the tongue remains as rather quiescent organ without bony skeleton. But it is said that neuro-muscular complex of tongue is important in the developmental and functional process. Ankyloglossia and macroglossia are occasionally implicated in the oral diseases. Many authors supposed that the ankyloglossia and macroglossia might produce various abnormal oro-facial growth, such as bimaxillary or mandibular protrusion and anterior open bite, etc. We have designed the classification of ankyloglossia by measuring the median lingual frenum length with lingual frenum ruler. It is well known that every people has a lingual frenum to some degree. So we analyse that the group showing less than 10mm of median frenum length is belong to mild ankyloglossia, the group showing from 10mm to 15mm of median frenum length is belong to moderate ankyloglossia, the group showing more than 15mm of median frenum length is belong to type 1 severe ankyloglossia, and the group showing clinically severe ankyloglossia but having less than 15mm of median frenum length is belong to type 2 severe ankyloglossia. We have experienced that the mild ankyloglossia usually causes no clinical complication to receive dental treatments. In the present study we investigated different clinical complications under this classification. We also recognized that the most retracted tongue position is a comparable criterion of tongue movement. The severer ankyloglossia showing thick lingual frenum is the more frequently associated with macroglossia and occlusal disharmony, and its most retracted tongue position is prone to locate high-anterior direction. Among 130 cases receiving lingual myoplasty 106 cases (81.5%) showed various malocclusions, 37 cases (28.5%) showed conspicuous speech problem, and 14 cases (19.8%) showed severe oro-facial deformity. The lingual myoplasty consists of two steps, the first is the same with frenectomy, and the second is the procedure of re-equilibrium of extrinsic tongue muscles mainly between genioglossus muscle and hyoglossus muscle. 130 cases which were belong to the group of moderate and severe ankyloglossia were selected for the lingual myoplasty, and the patients were ordered to keep on self training by the method of Dr. Lim's tongue movement. In three months after lingual myoplasty there was no relapse of ankyloglossia and the most retracted tongue position changed to inferior and posterior direction effectively (Tab. 6, 7, 8), and on gross finding the size of tongue seems to be decreased.(ABSTRACT TRUNCATED AT 400 WORDS)
Humans↗
Ankyloglossia: incidence and associated feeding difficulties.
OBJECTIVES: To determine the incidence of ankyloglossia (tongue-tie) in the well-baby population, and to determine whether patients with ankyloglossia experience breastfeeding difficulties. DESIGN: Prospective controlled study. SETTING: Tertiary care children's hospital. PATIENTS: A total of 1041 neonates in the well-baby nursery were screened for ankyloglossia. Those positively identified were invited to participate in the study. Mothers of newborns with ankyloglossia and mothers of a matched control group of unaffected newborns were contacted by telephone on a monthly basis for 6 months after their children were discharged from the hospital to determine the presence of breastfeeding difficulties. MAIN OUTCOME MEASURES: Incidence of ankyloglossia, percentage of infants successfully breastfed, and incidence of breastfeeding difficulties. RESULTS: Fifty newborns were identified with ankyloglossia, for an incidence of 4.8% The male-female ratio was 2.6:1.0. Of the 36 mothers of affected infants who were followed up and who intended to breastfeed, 30 (83%) successfully breastfed their infants for at least 2 months, compared with 33 (92%) of the 36 mothers of infants in the matched control group (P = .29). Breastfeeding difficulties were experienced by 9 (25%) of the mothers of infants with ankyloglossia compared with 1 (3%) of the control mothers (P<.01). CONCLUSION: Ankyloglossia, which is a relatively common finding in the newborn population, adversely affects breastfeeding in selected infants.
Breast Feeding↗
Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.
OBJECTIVE: Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls. METHODS: We examined 2763 breastfeeding inpatient infants and 273 outpatient infants with breastfeeding problems for possible ankyloglossia and assessed each infant with ankyloglossia, using the Hazelbaker Assessment Tool for Lingual Frenulum Function. We then observed each dyad while breastfeeding. When latch problems were seen, we asked the mother to describe the sensation and quality of the suck at the breast. When pain was described, we asked the mother to grade her pain on a scale of 1 to 10. When lingual function was impaired, we discussed the frenuloplasty procedure with the parent(s) and obtained informed consent. After the procedure, the infants were returned to their mothers for breastfeeding. Infant latch and maternal nipple pain were reassessed at this time. RESULTS: Ankyloglossia was diagnosed in 88 (3.2%) of the inpatients and in 35 (12.8%) of the outpatients. Mean Hazelbaker scores were similar for the presenting symptoms of poor latch and nipple pain. Median infant age (25th and 75th percentiles) at presentation was lower for poor latch than for nipple pain: 1.2 days (0.7, 2.0) versus 2.0 days (1.0, 12.0), respectively. All frenuloplasties were performed without incident. Latch improved in all cases, and maternal pain levels fell significantly after the procedure: 6.9 +/- 2.31 down to 1.2 +/- 1.52. CONCLUSION: Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.
Adult↗
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.
Anthropometry↗
Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study.
PURPOSE: Ankyloglossia ("tongue-tie") occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms. METHODS: Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breast-feeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother. RESULTS: There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06). CONCLUSION: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.
Breast Feeding↗
Ankyloglossia: the adolescent and adult perspective.
OBJECTIVES: We sought to characterize examination findings and functional limitations due to ankyloglossia in adolescents and adults and to evaluate frenuloplasty in this group. Study design A prospective study was conducted of 15 individuals with ankyloglossia aged 14 to 68 years. Baseline symptoms were recorded by questionnaire, and tongue mobility measures were compared with that of 20 control subjects. Six subjects were reassessed postfrenuloplasty. RESULTS: Thirteen of 14 patients with uncorrected ankyloglossia (93%) noted symptoms including speech problems (50%) and mechanical limitations (57%), such as difficulty licking the lips. Mean tongue protrusion and elevation at baseline measured 15.5 +/- 6.0 mm and 13.6 +/- 8.0 mm, respectively, for patients and 32.0 +/- 3.9 mm and 30.3 +/- 4.9 mm for control subjects (P < 0.001). Postfrenuloplasty, tongue function improved both subjectively and objectively in 6 of 6 patients, with a mean gain of 9.2 mm for protrusion (P < 0.05) and 13.0 mm for elevation (P < 0.001). CONCLUSION: Symptoms related to ankyloglossia are prevalent in this age group and respond favorably to frenuloplasty.
Adolescent↗
The effect of ankyloglossia on speech in children.
OBJECTIVE: We wanted to determine whether ankyloglossia is associated with articulation problems and the effect of frenuloplasty on speech and tongue mobility. STUDY DESIGN: We conducted a prospective study of 30 children aged 1 to 12 years with ankyloglossia undergoing frenuloplasty. Outcomes were assessed by measurements of tongue mobility, speech evaluation, and parent questionnaires. RESULTS: Mean tongue protrusion improved from 14.2 mm preoperatively to 25.8 mm postoperatively (P < 0.01). Similarly, mean tongue elevation improved from 5.2 to 22 mm (P < 0.01). Preoperative speech pathology evaluation documented articulation problems thought due to ankyloglossia in 15 of 21 children. Postoperative evaluation in 15 of these children showed improvement in articulation in 9, no change in 4 who had normal speech preoperatively, and an ongoing articulation disorder in 2. Parent perception of speech intelligibility on a scale of 1 to 5 improved from 3.4 to 4.2 (P < 0.01). CONCLUSION: Tongue mobility and speech improve significantly after frenuloplasty in children with ankyloglossia who have articulation problems.
Articulation Disorders↗
X-linked cleft palate and ankyloglossia in an Icelandic family.
Information was available on 293 family members and spouses of seven generations in an Icelandic family with high frequency of cleft of secondary palate and ankyloglossia. The authors have personally investigated 182 individuals in generations IV-VII and have drawn blood from over 100 members for genetic marker studies. The senior author, Dr. Björnsson, has operated on two-thirds of the affected individuals. Twenty-six family members had cleft palate (CP) and, of these, 19 (17 male and two females) had ankyloglossia as well (CP + A). Twenty females and one male had only ankyloglossia (A). All mothers in one of two branches of the family who had sons with CP + A had ankyloglossia themselves. This was not the case in the other branch, in which the mothers of affected sons were themselves unaffected. Fathers affected with CP, CP + A, or high vaulted palate (HVP) never had affected sons. As reported earlier, the condition has been mapped to the q13-q21 region of the X chromosome using restriction fragment length polymorphism (RFLP) techniques (Moore et al, 1987). Our conclusion is that this midline defect is X-linked but varies in the severity of expression.
Chromosome Mapping↗
Ankyloglossia: does it matter?
Ankyloglossia is an uncommon oral anomaly that can cause difficulty with breast-feeding, speech articulation, and mechanical tasks such as licking the lips and kissing. For many years the subject of ankyloglossia has been controversial, with practitioners of many specialties having widely different views regarding its significance. In many children, ankyloglossia is asymptomatic; the condition may resolve spontaneously, or affected children may learn to compensate adequately for their decreased lingual mobility. Some children, however, benefit from surgical intervention (frenotomy or frenuloplasty) for their tongue-tie. Parents should be educated about the possible long-term effects of tongue-tie while their child is young (< 1 year of age), so that they may make an informed choice regarding possible therapy.
Child↗
Improved ankyloglossia correction with four-flap Z-frenuloplasty.
Ankyloglossia, or tongue-tie, is the result of a short, tight, lingual frenulum causing tethering of the tongue tip. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this study, we evaluated the treatment of patients greater than 3 years of age with persistent articulation problems related to ankyloglossia (n = 16). All patients underwent surgical correction either via a novel application of the 4-flap Z-frenuloplasty (n = 11) or via the more traditional horizontal-to-vertical frenuloplasty (n = 5). Frenulum length, tongue protrusion length, and speech evaluations (4-grade scaling) were documented preoperatively and at follow-up. For the 4-flap Z-frenuloplasty, 91% of patients showed at least 2 orders of improvement in speech, 64% showed complete resolution of articulation errors, and 9% demonstrated no improvement in speech. Frenulum length and tongue protrusion gained 37.5 +/- 13.5 mm (P < 0.001) (315% increase) and 36.2 +/- 7.6 mm (P < 0.001), respectively. In contrast, with the horizontal-to-vertical frenuloplasty, only 40% showed 1 order of improvement in speech, and 60% had no change in articulation. Frenulum length and tongue protrusion gained 11.2 +/- 4.15 mm (98% increase) and 13.2 +/- 2.6 mm (P = 0.0003), respectively. Our data indicated that the 4-flap Z-frenuloplasty was superior to the horizontal to vertical frenuloplasty with respect to tongue lengthening, protrusion, and articulation improvement for patients with symptomatic ankyloglossia.
Child↗
Tongue-tie (ankyloglossia) and breastfeeding: a review.
Tongue-tie (partial ankyloglossia) is a congenital condition in which the membrane under the tongue is too short or may be attached too near the tip of the tongue, thereby preventing tongue protrusion. Considerable controversy among health professionals persists regarding the appropriate treatment of partial ankyloglossia. Therefore, lactation consultants need to be aware of tongue-tie and its potential negative impact on breastfeeding. This discussion examines issues relating to the possible need for treatment and the role of the lactation consultant in the evaluation and care of the infant who presents with ankyloglossia.
Breast Feeding↗
Ankyloglossia (tongue-tie): a diagnostic and treatment quandary.
The tongue is an important oral structure that affects speech, the position of teeth, periodontal tissue, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia (tongue-tie) limits the range of motion of the tongue, impairing its ability to fulfill its functions. In this article, diagnostic criteria needed to evaluate and treat ankyloglossia are suggested, and a method for classifying ankyloglossia is proposed.
Adolescent↗
Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management.
Since the recommended time for a child's first dental visit is early, it is essential that pediatric dentists be familiar with all possible pathologies occurring during this early period of life. The parents of infants and toddlers who notice in their child a "tongue-tie" (ankyloglossia) are likely to turn first to their pediatric dentist for advice and help. Treatment options such as observation, speech therapy, frenotomy without anesthesia, and frenectomy under general anesthesia have all been suggested in the literature. The purposes of this report are to describe ankyloglossia, its clinical significance, and the timing of treatment. The frenotomy procedure is presented for the pediatric dentist with clinical suggestions for the diagnosis and management of ankyloglossia.
Articulation Disorders↗
Linkage analysis of X-linked cleft palate and ankyloglossia in Manitoba Mennonite and British Columbia Native kindreds.
A locus (CPX) responsible for X-linked cleft palate and ankyloglossia was previously mapped to the proximal long arm of the X chromosome through DNA marker linkage studies in two large kindred: an Icelandic family and a British Columbia (B.C.) Native family. In this study, additional linkage analyses have been performed in the B.C. family and in a newly identified Manitoba Mennonite family with X-linked cleft palate and ankyloglossia. The Manitoba CPX locus maps to the same region as Icelandic and B.C. CPX. Two-point disease-to-marker linkage analyses in the Manitoba family indicate a maximum lod score (Zmax) between CPX and DXS349 (Zmax = 3.33 at theta = 0.0). In multipoint linkage analysis, combined data from the B.C. and Manitoba families suggest that the most likely location for CPX is at DXS447 in Xq21.1 (multipoint Z = 13.5). The support interval for CPX at DXS447 extends approximately from PGK1 to DXYS1 and includes a newly isolated polymorphic locus DXS1109.
Autoradiography↗
Ankyloglossia: controversies in management.
PURPOSE: To determine current beliefs regarding ankyloglossia and its treatment. DESIGN: Anonymous written survey. PARTICIPANTS: Otolaryngologists (OTO, n=423), pediatricians (PD, n=425), speech pathologists (SP, n=400), and lactation consultants (LC, n=350) were randomly selected from professional membership lists, with a response rate of 209 (49%), 235 (55%), 150 (37.5%), and 203 (58%), respectively. CLINICAL FINDINGS: Sixty-nine percent of LCs, but a minority of physician respondents, believe tongue-tie is frequently associated with feeding problems. Sixty percent of OTOs, 50% of SPs, but only 23% of PDs believe tongue-tie is at least sometimes associated with speech difficulties. Sixty-seven percent of OTOs versus 21% of PDs believe tongue-tie is at least sometimes associated with social/mechanical issues. Surgery is recommended at least sometimes for feeding, speech, and social/mechanical issues by 53, 74, and 69% of OTOs, respectively, but by only 21%, 29%, and 19% of PDs. CONCLUSION: The significance of ankyloglossia in children remains controversial, both within, and between, specialty groups.
Adult↗
[Ankyloglossia in an Anatolian Shepherd dog].
Ankyloglossia, commonknown as tongue-tie, is a rare congenital oral anomaly in dogs. A complete attachment of the lingual frenulum to the floor of the oral cavity leads to limited mobility of the tongue including problems during eating and swallowing. In humans ankyloglossia is a common anomaly in newborn infants. In our report a 5-month old Anatolian Shepherd dog was surgically treated and full function of the tongue could be achieved with a horizontal-to-vertical frenuloplasty.
Animals↗
Craniofacial expression of human and murine TBX22 correlates with the cleft palate and ankyloglossia phenotype observed in CPX patients.
Cleft palate with ankyloglossia (CPX; MIM 303400) is inherited as a Mendelian, semidominant X-linked disorder and has been described in several large families from different ethnic origins. It is a useful genetic model for non-syndromic cleft palate, a common congenital disorder. Recently, the underlying genetic defect in CPX was identified, where unique mutations were found in the T-box-containing transcription factor TBX22. Here we report two new familial cases with novel missense and insertion mutations, each occurring within the T-box domain and highlighting the functional significance of this DNA-binding motif. We describe TBX22 expression in early human development, where expression is found in the palatal shelves and is highest prior to elevation to a horizontal position above the tongue. mRNA is also detected in the base of the tongue in the region of the frenulum that corresponds to the ankyloglossia seen in CPX patients. Other sites of expression include the inferior portion of the nasal septum that fuses to the palatal shelves, the mesenchyme from which tooth buds develop, and the tooth buds themselves. We have also identified the orthologous mouse Tbx22 gene and performed expression analysis in E12.5-E17.5 mouse embryos. The location of mRNA expression closely correlates between mouse and human, while at later stages of development, we also detected expression in mouse lung and whisker follicles. We conclude that expression of TBX22 is entirely consistent with the CPX phenotype and that the mouse should provide a useful model for elucidating its role in craniofacial development.
Amino Acid Sequence↗