Reduced Tongue Mobility: An Unrecognised Risk Factor of Childhood Obstructive Sleep Apnoea

Study Objectives Childhood obstructive sleep apnoea (OSA) is an important and prevalent disease. A short lingual frenulum is a risk factor for OSA, but whether tongue mobility also plays a role in OSA aetiology remains unknown. This study aimed to examine tongue mobility in children with and without OSA. We hypothesized that reduced tongue mobility was associated with OSA. We also evaluated the relationship between tongue mobility and craniofacial profile. Methods This was a cross-sectional case-control study. Prepubertal Chinese children aged 5-12 years, suspected to have OSA were recruited from our sleep disorder clinic. All subjects underwent overnight polysomnography (PSG). The lingual frenulum was evaluated based on tongue mobility and free tongue length. Craniofacial measurements were assessed by lateral cephalometry. Results Eighty-two subjects (mean age: 8.32 ± 1.70 years, 57 males) were recruited. The mean tongue mobility was 58.2 (±19)% and 67.4 (±15)% (p=0.019) in subjects with and without OSA, respectively. Tongue mobility was inversely correlated with OAHI (r=-0.218, p=0.049). In multivariate logistic regression, low tongue mobility was independently associated with a higher risk of OSA after adjustment for age, sex, BMI z-score, presence of large tonsils and turbinates and nocturnal oral breathing (odds ratio=3.65, 95% CI= 1.22-11.8). Tongue mobility was found to correlate with the cranial base angle (Ba-S-N) (r=0.262, p=0.018), which determines the relative position of the mandible. Conclusions In pre-pubertal children, reduced tongue mobility is associated with the occurrence and severity of OSA. Assessing tongue mobility is recommended in childhood OSA management.

Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents—Preliminary Report and Step-by-Step Technique Showcase

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.

Prevalência de alteração do frênulo de língua em cantores com disfonias comportamentais / Prevalence of language frenulum alteration in singers with behavioral dysphonies

Introdução: A qualidade de uma voz depende da fonte produtora e do filtro. Características da voz devem estar adequadas como, por exemplo, a ação da fonte com o filtro e a frequência, pois se estiverem alteradas e se essa voz for utilizada de forma inadequada, pode causar várias alterações vocais, que são chamadas de disfonias comportamentais. Essas disfonias ocorrem por conta do mau uso ou abuso vocal. Objetivo: Verificar se há maior prevalência de alterações de frênulo de língua em cantores com disfonia comportamental atendidos no Ambulatório de Artes Vocais da Santa Casa de São Paulo quando comparados a população. Método: participaram 18 cantores com idades entre 18 e 40 anos e 11 meses, de ambos os sexos que possuíam diagnóstico de disfonia comportamental e 23 indivíduos da população geral, da mesma faixa etária sem queixa de disfonia. A presença da disfonia comportamental foi verificada após análise do prontuário do Ambulatório de Artes Vocais da Santa Casa de São Paulo. Os dois grupos foram submetidos a avaliação clínica do frênulo de língua por meio de protocolo descrito por Marchesan (2010). Resultados: a média de idade dos cantores foi de 35,4 anos e da população geral de 26,57 anos. As medidas realizadas com paquímetro com a boca aberta e com a ponta da língua na papila palatina geram uma média que auxilia na avaliação do frênulo de língua. Em nosso estudo, 63,8% dos cantores e 71,1% da população geral apresentaram média superior a 50%, o que é considerado normal. As alterações apresentadas nos dois grupos foram: 5 cantores e 6 indivíduos da população geral apresentaram alteração nas provas de mobilidade de língua, 2 cantores e 9 indivíduos da população geral apresentaram alguma alteração em relação a praxia de língua e quanto a alteração de frênulo de língua, 5 cantores e 6 indivíduos da população geral apresentaram alguma alteração. Conclusão: Não houve diferença significativa entre os dois grupos nos aspectos avaliados. Desta maneira, não podemos concluir que há maior prevalência de alteração de frênulo de língua no grupo de cantores. Palavras chave: Frênulo da língua, Disfonia, Voz, PrevalênciaABSTRACT Introduction: The quality of a voice depends on the producing source and the filter. Voice characteristics must be appropriate, such as the action of the source with the filter and the frequency, because if they are altered and if this voice is used inappropriately, it can cause various vocal alterations, which are called behavioral dysphonias. These dysphonias occur because of vocal misuse or abuse. Objective: to verify if there is a higher prevalence of tongue frenulum alterations in singers with behavioral dysphonia seen at the Vocal Arts Outpatient Clinic of Santa Casa de São Paulo when compared to the general population. Method: 18 singers aged 18-40 years and 11 months, of both sexes who were diagnosed with behavioral dysphonia, after analysis of the medical records of the Vocal Arts Outpatient Clinic of Santa Casa de Sao Paulo and 23 individuals from the general population in the same age group without complaints of dysphonia. Both groups underwent clinical evaluation of the tongue frenulum using the protocol described by Marchesan (2010). Results: the mean age of the singers was 35.4 years and the mean age of the general population was 26.57 years. The measurements taken with a pachymeter with an open mouth and with the tip of the tongue on the palatal papilla generate an average that assists in the assessment of the tongue frenulum. In our study, 63.8% of singers and 71.1% of the general population had an average greater than 50%, which is considered normal. The alterations seen in both groups were: 5 singers and 6 individuals from the general population had altered tongue mobility tests; 2 singers and 9 individuals from the general population had some alteration in relation to tongue praxis, and as for tongue frenulum alterations, 5 singers and 6 individuals from the general population had some alteration. Conclusion: There was no significant difference between the two groups in all the aspects evaluated. Thus, we cannot conclude that there is a higher prevalence of tongue frenulum alteration in the group of singers. Keywords: Lingual frenum, Dysphonia, Voice, Prevalence

Global Motor, Oral and Deglutition Characteristics in Children with Cerebral Palsy

Cerebral palsy (CP) is a disorder in postural and movement tone resulting from involvement in the motor centers of the immature brain. Thus, this work sought to expose the global motor, oral, and deglutition characteristics in children with CP. To this end, it performed a cross-sectional study of 100 children with CP. The data collection consisted in the detection of the main global motor and oral alterations, their repercussions on the deglutition process, and the main manifestations of dysphagia according to different consistencies of food and types of cerebral palsy. All children exhibited global motor and oral alterations. There were significant differences between age and global motor alterations. Alterations in the tongue mobility were more present in spastics (p=<0.031). The main manifestations of dysphagia, in decreasing order of occurrence were: premature liquids spillage (70%), cough (60%), decreased bolus formation in solids (57,9%), presence of food residues in the oral cavity (47,4%), increased pasty oral transit (47,1%) and presence of wet voice after the liquids swallowing (30%). Therefore, the influence of pelvic instability and compensatory patterns was observed in the presence of clinical signs of tracheal aspiration. Regardless the type of CP, the global and oral motor alterations lead to deglutition disorders. Keywords: Cerebral Palsy. Child. Deglutition Disorders. Posture ResumoA paralisia cerebral (PC) é uma desordem no tônus postural e de movimento decorrentes de um acometimento nos centros motores do cérebro imaturo. Com isso buscou apresentar as características motoras globais, orais e de deglutição em crianças com PC. Assim, realizou um estudo transversal com amostra de 100 crianças com PC. A coleta de dados consistiu na detecção das principais alterações motoras globais e orais, a repercussão na dinâmica da deglutição e as principais manifestações disfágicas em diferentes consistências alimentares. Todas as crianças apresentaram comprometimentos motores globais e orais. Houve diferença significante entre a idade e as alterações globais. Alteração na mobilidade da língua esteve mais presente em espásticos (p=<0,031). As principais manifestações disfágicas, em ordem decrescente de ocorrência, foram: escape anterior de líquidos (70%), tosse (60%), diminuição da formação do bolo alimentar no sólido (57,9%), presença de resíduos alimentares na cavidade oral após a deglutição de sólidos (47,4%), aumento do trânsito oral de pastoso (47,1%) e presença da voz molhada após a deglutição de líquidos (30%). Então, observou-se a influência das alterações tônicas e posturais na presença de sinais clínicos de aspiração traqueal. Alterações tônicas e posturais com comprometimentos motores orais acarretam transtornos da deglutição em crianças com PC. Palavras-chave: Paralisia Cerebral. Criança. Transtornos da Deglutição. Postura

The Effectiveness of Frenotomy on Speech in Adults

There is no publication concerning tongue-tie (TT) in adults, surprisingly. It is generally known that TT is mainly diagnosed in newborns and infants. It seems unlikely that TT does not cause functional disorders in adults, especially considering that TT has been present in organism since childhood. Thus, there is insufficient information about the influence of TT on adults′ speech production. The purpose of this study was the functional evaluation of lingual frenotomy on tongue mobility and speech in the adult Polish population. Methods: Methods were based on visual observation and examination of the oral cavity accompanied by visual and auditory examination of articulation. Χ2 test, Kruskal–Wallis, analysis of variance (ANOVA), and Student’s t-test were used for statistical analyses. Conclusions: Tongue-tie is a serious condition in adults. Implementing surgical procedures to treat it improves the tongue′s mobility in every direction and improves speech clarity. The frenotomy should be implemented in patients suffering from malocclusion because the equilibrium of all the face muscles and skeleton is often disturbed and may lead to unstable functional effects of orthodontic and orthognathic treatment.

The Effect of Frenotomy on the Tongue Length, Motion, and Speech According to Age

Background and Objectives Ankyloglossia often results in articulation disorders, which depends on age, articulation ability, and mobility of the tongue. A primary treatment strategy includes surgery and/or speech therapy. This study aimed to evaluate the changes of the tongue length, tongue mobility, and percentage of consonants correct (PCC) after frenotomy. We investigated the optimal surgery timing for ankyloglossia.Subjects and Method A total of 136 patients underwent frenotomy for the tongue tie between January 2016 and December 2019. There were 90 males and 46 females, with the mean age of 5.23, which ranged from 2 to 10 years. The length of the tongue was measured for all patients during the operation preoperatively and postoperatively. The mobility of the tongue and PCC were performed preoperatively and 1 month after surgery by two speech therapists. Patients were divided according to age into three groups: 2-3 years, 4-5 years, and over 6 years old.Results The mean tongue length of all age groups was significantly elongated after surgery (<i>p</i><0.05). After frenotomy, the mobility of tongue, including horizontal protrusion, protrusion with upward pointing, circumlocution, and lateral movement, was improved. Also, PCCs of all age groups were significantly improved after surgery (<i>p</i><0.05).Conclusion Frenotomy can be an effective procedure for children with ankyloglossia in all age groups. After frenotomy, length of the tongue, mobility of the tongue and PCC were significantly improved.