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The Pharynx and Oral Cavity
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
The lingual frenulum connects the undersurface of the tongue with the floor of the mouth. If it is unusually short or tight (anklyoglossia), tongue movement may be restricted (Figure 15.2). Parents will notice a notch at the tip of the tongue when the child protrudes the tongue, and the newborn baby may have difficulty with breastfeeding due to being unable to ‘latch’. If the frenulum is divided in the first few days of life, feeding can be greatly improved. In older children, the adverse effects of tongue tie are less certain. Whether a severe tongue tie can interfere with the development of speech is uncertain, but many children and parents will present for treatment due to perceived speech difficulties or difficulty with, for example, playing wind instruments, or with aesthetic concerns.
Tongue tie
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
It is easy to see, given that a lingual frenulum is normal anatomy, that there is a risk of overdiagnosis, which is why a thorough feeding assessment and assessment of tongue function are needed by a professional who has extensive knowledge and training in infant feeding and tongue-tie division. This is currently not happening in many services, as reflected in the huge variations in services found in a survey conducted by the National Childbirth Trust (NCT) (Wise 2015).
Introduction
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
The extrinsic muscles of the tongue, which originate outside the tongue and insert into connective tissues in the tongue, include the hyoglossus, genioglossus, and styloglossus muscles. The extrinsic muscles move the tongue from side to side and in and out to maneuver food for chewing, shape the food into a rounded mass, and force the food to the back of the mouth for swallowing. They also form the floor of the mouth and hold the tongue in position. The intrinsic muscles originate in and insert into connective tissue within the tongue. They alter the shape and size of the tongue for speech and swallowing. The intrinsic muscles include the longitudinalis superior, longitudinalis inferior, transversus linguae, and verticalis linguae muscles. The lingual frenulum, a fold of mucous membrane in the midline of the undersurface of the tongue, is attached to the floor of the mouth and aids in limiting the movement of the tongue posteriorly. If a person’s lingual frenulum is abnormally short or rigid—a condition called ankyloglossia—then eating and speaking are impaired such that the person is said to be “tongue-tied.”
Sevoflurane Inhalation Anesthesia for Uncooperative Pediatric Outpatients in the Treatment of Ankyloglossia: A Retrospective Study of 137 Cases
Published in Journal of Investigative Surgery, 2021
Medical informed consent for surgery and anesthesia was obtained prior to the procedure from their parents or guardians. Preoperative assessments were conducted by an anesthetist and an operator. No surgical contraindications were found. Patients fasted for 6–8 hours with water deprivation for 4 hours prior to surgery. Anesthesia was induced by rapid intravenous injection of 2.5 mg/kg propofol and followed by 8% sevoflurane inhalation, and was maintained by inhalation of 2%–3% sevoflurane continuously with nasal cannula, which was sealed with 3M application in bilateral nostrils. Respiration was spontaneous throughout. Heart rate (HR), respiratory rate (RR), electrocardiogram (ECG), blood pressure (BP), and peripheral blood oxygen saturation (SpO2) were monitored continuously. The patients were maintained in the recumbent position with regular disinfection. Local infiltration anesthesia with 2% lidocaine was applied before the procedure. The tongue was pull outward to stain the lingual frenulum, and the center of lingual frenulum was horizontally cut with scissors and interruptedly sutured.
A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia
Published in International Journal of Speech-Language Pathology, 2021
Alison Visconti, Emily Hayes, Kristen Ealy, Donna R. Scarborough
The overall purpose of this paper was to complete a systematic review to explore the outcomes on breastfeeding and speech production following ankyloglossia release. One of the primary challenges of comparing the results, regardless if related to breastfeeding or speech delays, is that a clear definition of ankyloglossia is lacking. Recent anatomic studies that dissected the frenulum from neonates through adults, describe the frenulum as a structure much more complex than a single cord of connective tissue on the undersurface of the tongue (Mills, Pransky, Geddes, & Mirjalili, 2019a; Mills, Keough, Geddes, Pransky, & Mirjalili, 2019b). The lingual frenulum is described instead as a “dynamic” structure that is formed by the merging of the fascia of the floor of the mouth with the oral mucosa that forms the top layer of the underside of the tongue with an interweaving of some muscle fibres. This complex anatomic architecture allows the tongue to be simultaneously secured while allowing for a wide range of movement (Mills et al., 2019a). Further, as a result, the position of the frenulum from the jaw to the ventral surface of the tongue alters the appearance of the layers of tissue and overall mobility of the anterior portion of the tongue. Thus examining this structure in the context of a bimodal – appears normal versus abnormal, should no longer be applied during a clinical examination as the anatomic components of the frenulum are much more complex than can be identified in this simplistic form. Further, the authors propose for continuity and accuracy that the frenulum no longer be described as a single structure, but the term “midline fold” be utilised which better reflects the anatomic complexity (Mills et al., 2019a).
Effectiveness of frenectomy for ankyloglossia correction in terms of breastfeeding and maternal outcomes: A critically appraised topic
Published in Evidence-Based Communication Assessment and Intervention, 2019
Hannah Butenko, Vanessa Fung, Sarahlouise White
Strategies may be implemented to manage the diagnosis and treatment of tongue tie, which may include the development or implementation of a policy to use standardized severity rating and diagnostic tool (e.g. Hazelbaker Assessment Tool for Lingual Frenulum Function). This will lead to infants with ankyloglossia being promptly identified leading to early-intervention, thus reducing the prolonged negative effects on breastfeeding and maternal nipple pain, and may also guide intervention decisions.