Intervención logopédica posoperatoria del frenillo lingual en niños, adolescentes y adultos. Revisión integradora de literatura

En los últimos años ha existido un aumento significativo en el diagnóstico de la anquiloglosia, las cirugías del frenillo lingual y las publicaciones científicas. Al respecto, es necesario que los profesionales de la salud conozcan el tratamiento fonoaudiológico en estos casos. El objetivo del estudio fue describir la terapia fonoaudiológica implementada en niños, adolescentes y adultos luego de la frenotomía, frenectomía o frenuloplastia lingual, mediante una revisión integradora de literatura. Para esto, durante el segundo trimestre del 2020 las bases de datos electrónicas PUBMED, LILACS, SciELO y Cochrane, fueron consultadas utilizando las palabras claves en inglés: “Ankyloglossia”, “Tongue Tie”, “Lingual Frenulum”, “Lingual Frenum”, “Surgical Procedures”, “Frenuloplasty”, “Lingual Frenulectomy”, “Speech Therapy” y “Myofunctional Therapy”. Se seleccionaron artículos originales relacionados al tema, y fue creado un protocolo específico para la extracción de los datos. Fueron encontrados 798 artículos. 39 se incluyeron luego de la lectura de los títulos y la eliminación de duplicados, 13 luego de lectura de los resúmenes y 7 luego de la revisión de los textos completos. Finalmente, tras un análisis de referencias cruzadas 10 estudios fueron incluidos en esta revisión. Se concluye la importancia del tratamiento fonoaudiológico en el abordaje multidisciplinario del frenillo lingual, abordando aspectos de movilidad lingual, habla y otras funciones orofaciales alteradas luego del procedimiento quirúrgico.

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

Tethered Oral Tissue Release Among Breastfed Infants: Maternal Experiences

Objectives The objective was to explore mothers’ experiences breastfeeding/chestfeeding an infant diagnosed with an issue with tethered oral tissue(s), for which surgical intervention was performed (i.e., tissue was “released”). Methods This was a cross sectional, observational survey conducted online from August to September 2020. Recruitment occurred via social media. Mothers of infants <12 months of age were eligible to participate if (1) the mother was >18 years of age, (2) they had breastfed/chestfed or were currently breastfeeding/chestfeeding their infant, and (3) the infant had >1 tethered oral tissue released. The survey included demographic and breastfeeding/chestfeeding questions as well as questions about tethered oral tissue concerns/resolution. Results Of 479 screens, 226 were eligible and 115 consented to participate. Ninety-three responses were considered valid and complete. The sample was homogeneous in terms of maternal race (95% white), marital status (94% married/cohabitating), and breastfeeding status (89% providing breastmilk at time of survey). Eighty-seven (94%) mothers reported lingual frenum release; 81 (87%) reported labial frenum release; and 16 (17%) reported buccal frenula release. Seventy-four (80%) mothers reported more than one tissue was released; most frequently, this included the lingual and labial frenula (n = 58; 62%). Most mothers felt “very confident” in their ability to identify which tissues were released: lingual (94%); labial (97%); and buccal (82%). Lactation consultants were the most frequently identified source of information about tethered oral tissues (62% of mothers) and treatment referrals (42%), while pediatric dentists were most likely to perform the intervention (66%). Nearly all participants (n = 82; 88%) reported feeding improvement, post-release. Conclusions Results indicate lactation consultants are frequently serving as both information and referral sources for release of tethered oral tissues, while pediatric dentists are most frequently performing the release. Despite limited evidence supporting release of tethered oral tissues for infant-feeding concerns, mothers in this study reported multiple tissues were released and that feeding was positively affected. Funding Sources Internal professional development funds.

Ankyglossia among Population of North India-A Prevalence Pilot Study

Background: Lingual Frenulum connects the base of the tongue to the floor of the mouth. Tongue-Tie (Ankyglossia) is a congenital anomaly characterized by short lingual frenulum which restricts the mobility of tongue tip. Material and Methods: This study was done to determine the prevalence of ankyglossia among the population of North India. 500 subjects of both sexes aged between 18-70 years formed the sample size. Results: The results were obtained after classification of ankyglossia by Kotlow by measuring the length of free tongue and by measuring the length of lingual frenulum (indirect method) as suggested by Ruffoli et al. Inadequate tongue mobility was seen only in subjects with lingual frenulum<0.5mm. Conclusion: It should be stated that despite the reduced length the short lingual frenum is not always inelastic or fibrotic. It may allow a normal lingual mobility hence not necessitating a reduction intervention and also the effects of ankyglossia can be mitigated by the elasticity of the floor of the mouth and help the lingual mobility.

A Survey to Assess the Number, Shape and Attachment of the Freni in the Maxillary and Mandibular Arches in South Indian Population

Frenum is one of the most variable anatomical structures present in the oral cavity which can be defined as a “fibrous band of tissue attached to the bone of the mandible and maxillae, and is 1. present superficial to muscle attachments.”1. In the present study, hundred individuals aged 18 to 40 years were selected randomly. The patients were examined (i) To assess the number, shape and attachment of the freni in the maxillary arch and (ii) To assess the number, shape and attachment of the freni in the mandibular arch in south Indian population. It was concluded that single labial frenum was more common in both the arches, buccal frenum in maxilla were multiple. Whereas, in mandible buccal frenum had single frenal attachment. V-shaped frenal attachment was more in the maxillary and mandibular arches exception being the lingual frenum which showed prevalence pertaining to fan shape.

An Alternative Method to Treat Ankyloglossia

Ankyloglossia entails short lingual frenum, impairing satisfactory tongue movement and leading to problems related to deglutition, feeding and diction. This clinical report uses laser technology, rather than traditional surgical procedure with scalpel, to perform a lingual frenulotomy on a 9-year old child diagnosed with ankyloglossia, aiming to investigate more conservative and less traumatic dental procedures. Due to the many advantages of the laser device, such as bloodless surgical field, absence of sutures, minimal swelling and post-surgical pain, the high intensity diode laser is a viable alternative technique in soft tissue surgeries.