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Ministry of Health of the Republic of Moldova

IP State University of Medicine and Pharmacy "Nicolae Testemitan

Faculty of StomatologyMaxillo-facial surgery, edodontics and orthodontics

 

Management of !nyloglossia

Student# Manole Mihai Scientific !dvisor# $u%th &ear Student Proffesor, Ph'(rou# S))*+

hi inu +*).ș

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Materials and Methods:

Includes accurate and verifia0le facts, selected from literatand a clinical study on the medical records of the atients 4eu0lican linical 5osital for hildren 63milian o7aga8+*)1-+*)% eriod/ For advanced studies 9ere taen 1 atfrom +*)./

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(eneral information#

The terms frenulum, $atin for small 0ridle, and frenum, $atin for 0r0een used synonymously for years, the Nomina !natomica, deriveSixth and Seventh International ongresses of !natomists, Paris and Ne9 &or, ):.*, chose the term frenulum/ !ccordingly, the vemucous mem0rane fold under the midline of the tongue is roerlyfrenulum linguae/

$ingual frenulum is a 0and of fi0roelastic tissue/ $ingual frenulumoriginating from the floor of the mouth and insert the tongue 0ase/

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 !nchiloglosia

 !nyloglossia is a condition that affects +-%; of ne90orn/

It is caused 0y the short lingual frenulum or the fusion of the ventralsurface of the tongue 9ith the floor of the oral cavity/

The diagnosis is 0ased on clinical signs 0y assessing the imossi0ilreaching the alate 9ith the tongue or rotruding the ti 0eyond the teeth/

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Etiology

 !nyloglossia , commonly no9n as tongue tie, has a revalence oto )*// !nyloglossia is also inherited as a fcondition either isolated or associated 9ith other anomalies lie ?-l

cleft alate mutation of gene encoding transcrition factor T@?++ A%CindlerDs syndrome A.B and Eander oude syndrome A

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lassifications

Horton (1969)- )*+ cases.

Milf anyloglossia

Moderate anyloglossia

omlete anyloglossia

otlo! (1999)- !natomical measurement classification (length of tongue from of the lingual frenulum into the 0ase of the tongue to the ti of tongue )

lass I# mild anyloglossia  )+-).mm

lass II# moderate anyloglossia G-))mm

lass III# severe anyloglossia 1-

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Incidence

Source Nr/ )

4eorted revalence varies from )/

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"iagnosis

The clinician should examine the tongues aearance 9hen the tothe infant cries or tries to extend the tongue/ hile lifting the infantfrenum should 0e alated and its elasticity etermined/ The attachmfrenum to the tongueshould normally 0e aroximately ) cm osterior to the tongues tiattachment to the inferior alveolar ridge should 0e roximal to or intgenioglossus muscle on the floor of the mouth/

If the elevation of the tongue ti is restricted, the articulation of ) ortongue soundsJsuch as 6t,8 6d,8 6l,8 6th,8 and 6s8J9ill not 0e accura9ho can roduce these sounds accurately is ro0a0ly not a candidcorrection/

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#linical sy$pto$s

'isorders caused 0y anyloglossia remain a controversia !mong the issues found in the literature can 0e listed #

'ificult 0reast-feedingK

Seech disordersK

 'eformation of the lo9er incisorsK

 (ingival recessionsK

 Malocclusion/

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%reat$ent

Frenotomy

The frenotomy rocedure is defined as the cutting or division of the frenum/

Frenectomy

The frenectomy rocedure is defined as the excision or removal of the frenum

Fig/ ) Schematic illustration of 6L8-lasties

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4esults

Mor0idity 0y addressa0ility

(ender of atients

 !ge of atients

Place of residence

lassification 0y symtoms

Severity of athology

 !ssociation of short lingual and la0ial frenulum

The duration of hositaliation

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Mor0idity 0y addressa0ility, +*)1-+*)%

2013 2014 2015 Total0

1000

2000

3000

4000

5000

6000

15   27   17   59

1749   1724   1733

5206

Morbiditatea după adresabilitate

Pacienți cu anchiloglosie Pacienți adresați

Fig/ + Mor0idity 0y addressa0ility, +*)1-+*)%

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(ender of atients

4atio of +/% to ), these data are close to those given 0y some sources in the literature that

a ratio of 1 to )/

16

43

e!ul pacienților

"e#inin Masculin

Fig 1 (ender of atients

27$

73$

e!ul Paciențilo

"e#inin Masculi

  Fig 2 (ender of atients=;>

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Severity of athology

%o r#a usoara %o r#a #oderata %o r#a se&era %o r#a co#pleta0

5

10

15

20

25

30

9

25

19

6

"or#a Patologiei

Fig/ % Severity of athology

%or#a usoara %or#a #oderata %or0'00$

5'00$

10'00$

15'00$

20'00$

25'00$

30'00$

35'00$

40'00$

45'00$

15'25$

42'37$

"or#a Patologie

Fig/ . Severity of athology=;>

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lassification 0y symtoms

0

10

20

30

40

50

60

(cu)ele Pacienților

Fig/ < lassification 0y symtoms

0'00$

10'00$

20'00$

30'00$

40'00$

50'00$

60'00$

70'00$

*0'00$

90'00$

(cu)ele Pacienți

Fig/ G lassification 0y symtoms=;>

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#linical case &r 1.

Patient# ?

(ender# male

'ate month year of 0irth # )%/*./+*)1

Place of residence# 4ural

 !dmission date # +1/*1/+*).

'iagnosis of reference # Short lingual and la0ial frenulum

The diagnosis on admission # Short lingual frenulum and lo9 insertionla0ial frenululum/

linical diagnosis# Short lingual frenulum and lo9 insertion of uer lafrenululum/

'atient co$plaints: Seech dissorders, 0ad ronunciation of sound

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linical diagnosis #

@ased on clinical examination data, and atient comlaints 9e can esta0lish the d

Short lingual frenulum, lass II# moderate anyloglossia/ $o9 insertion of uer frenululum/

%reat$ent plan:

Surgical treatment # frenectomy

urgery protocol #

The first hase of the oeration, tongue frenulum frenectomy #

Processing the surgical field 9ith antisetic solutions/

Incision of the fi0rous mem0rane of the frenulum carefully not to deviate from the

 ! suture is assed through the ti of the tongue to lift it, and rovide a good visu

Mucosal edges are removed 9ith 0lunt scissors, also the muscular fi0res of genmuscle are divided/

The flas are then sutured in transverse osition, carefully not to damage the saducts/

Processing the ostsurgical 9ound/

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Fig/ : Short lingual frenulum, lass II# moderateanyloglossia

Fig/ )* Incision of the fi0rous mem0rane of carefully not to deviate from the midline/

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Fig )) ! suture is assed through the ti of the tongue to lift it, and rovide a good visual field/

 

Fig/ )+ Mucosal edges are removed 9 also the muscular fi0res of genioglos

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/ Fig )1 The flas are then sutured in transverse osition, carefully not to damage salivary gland ducts/

%he secon stage o* the operation upper lip *renulu$ *renuloplasty :

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%he secon stage o* the operation+ upper lip *renulu$ *renuloplasty :

Incision of the fi0rous mem0rane of the frenulum

3xcision of excess fi0rous tissue from the interincisal sace/

Mucosal edges are removed 9ith 0lunt scissors/

The flas are then sutured in transverse osition/

Fig/ )2 $o9 insertion of uer la0ial frenululum.

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Fig/ )2 3xcision of excess fi0rous tissue from the interincisalsace/ Fig/ )% Suturing the 9ound edges

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Fig/ )< The flas are then sutured in transverse osition/

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Clinical case Nr. 2

Patient# ?

(ender# male

'ate month year of 0irth # +G/*2/+*)%

Place of residence # 4ural

 !dmission date # )G/*1/+*).

'iagnosis of reference# $a0ial cleft

The diagnosis on admission # $a0ial cleft associated 9ith Short lingufrenulum

linical diagnosis# $a0ial cleft associated 9ith Short lingual frenulum

'atient co$plaints: 'ificult 0reast-feeding/

linical diagnosis #

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linical diagnosis #

@ased on clinical examination data, and atient comlaints 9e can esta0lish th

$a0ial cleft. Short lingual frenulum, lass II# moderate anyloglossia.

%reat$ent plan:

Surgical treatment # frenectomyurgery protocol #

Processing the surgical field 9ith antisetic solutions/

Incision of the fi0rous mem0rane of the frenulum carefully not to deviate fromidline/

 ! suture is assed through the ti of the tongue to lift it, and rovide a good

Mucosal edges are removed 9ith 0lunt scissors, also the muscular fi0res ofgenioglossus muscle are divided/

The flas are then sutured in transverse osition, carefully not to damage thgland ducts/

Processing the ostsurgical 9ound/

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Fig/)G $a0ial cleft, ostsurgery/ Fig/ ): Incision of the fi0rous mem0rancarefully not to deviate from the midlin

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Fig/ +* $ingual artery ligation, inured during the mucosal edges removal / ='ue to its suerficial anatomical osition>

 

Fig/ +) ! suture is assed through th and rovide a good visual field

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Fig ++ Suturing the 9ound edges 

Fig/ +1 The flas are then sutured in tracarefully not to damage the salivary gla

#onclu,ii:

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#onclu,ii:

)/  !s a result of the scientific research 9e 9ere a0le to confirm the data fromscientific 9ors 9hich indicate a mor0idity of */+-)*;/ !nalying data on tatients diagnosed 9ith anyloglossia 9ithin the deartment of ediatric m

surgery of the 5osital for hildren "3milian o7aga" for the eriod +*)1-resulting in )/); of aeals 9ere atients 9ith short lingual frenulum/

+/ Studying many sources of secialied scientific articles, text0oos, medica9e 9ere a0le to highlight a set of characteristic clinical manifestations of a$iterature data 9ere largely confirmed 0y analying comlaints and clinicamanifestations in atientsD medical files exosed/ linical cases have also

income to sulement the information given a0ove/

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1/ 'uring the study 9e 9ere a0le to highlight all functional disorders 9hich m9ithin the given disease/ In literary sources 9e managed to find descri0ed

follo9ing# 'ificult 0reast-feeding +/Seach disorders K 1/ Strain the lo9er in(um recessionsK 2/ Malocclusion/ !nalying medical records of the 4eu05osital for hildren "3milian o7aga" for the years +*)1-+*)% 9e 9ere ahighlight the follo9ing disorders# seech defects in the num0er of %* cases'ificult 0reast-feeding , chronic trauma 1 cases, lo9er front malocclusion +

2/  !nchiloglosia is a athology solved surgically 9ithout the existence of a cosolutions/ In this 9or 9e 9ere a0le to descri0e all surgical methods used

efficient, as 9ell as those at ris of relase, according to literary sources/ Smethod demonstrated in clinical cases exosed the contemorary vision thused 9orld9ide/

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