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بسم الله الرحمن الرحيم

ANKYLOGLOSSIA. Done by:. Abdullah Almuttawa. Pediatric Surgery Intern 2011. Tuesday, September 27, 2011. 2. Abdullah Almuttawa. objectives. Introduction.. Epidemiology.. Potential effects.. Diagnostic clues..

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بسم الله الرحمن الرحيم






Presentation on theme: "بسم الله الرحمن الرحيم"— Presentation transcript:

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بسم الله الرحمن الرحيم

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ANKYLOGLOSSIA

Done by:

Abdullah Almuttawa

Pediatric Surgery Intern 2011

Tuesday, September 27, 2011

2

Abdullah Almuttawa

Slide3

objectives

Introduction.

Epidemiology.

Potential effects. Diagnostic clues.

Surgery?.Tuesday, September 27, 2011Abdullah Almuttawa3

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The Tongue

*The most important articulator for speech production is undoubtedly the tongue.

*During speech, the amazing range of movements the tongue can make include tip-elevation, grooving, and protrusion.

*Relatively short at birth, the tongue grows longer, and thinner at the tip, as we get older.

Tuesday, September 27, 2011Abdullah Almuttawa

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What’s is Ankyloglossia ??

Commonly known as tongue-tie.

It is a congenital anomaly in which a short, lingual frenulum or a highly attached genioglossus muscle restricts tongue movement.

 It is characterized by partial fusion-or in rare cases, total fusion-of the tongue to floor of the mouth.

Tuesday, September 27, 2011Abdullah Almuttawa5

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What’s frenulum ?

By definition, a

frenulum

, which is a small

frenum, is a narrow fold of mucous membrane connecting a moveable part to a fixed part. Its purpose is to stabilize and check movement of that part. The lingual frenulum is generally under the mid-portion of the tongue. As such, it can help to stabilize the base of the tongue but does not interfere with tongue tip movement. With

ankyloglossia, however, the lingual frenulum has an anterior attachment near the tip of the tongue and may also be unusually short

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Frenulum time line !!!

Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a

frenulum

. After birth, the lingual

frenulum continues to guide the position of incoming teeth. As we grow, it recedes and thins. In some children, the frenulum is especially tight or fails to recede and may cause tongue these mobility problems.Tuesday, September 27, 2011Abdullah Almuttawa

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Tuesday, September 27, 2011

Abdullah Almuttawa

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Epidemiology

Research at the University of Cincinnati, USA, published in 2002, found that around 16 percent of babies experiencing difficulty with breastfeeding had a tongue tie.

Another study at Southampton General Hospital, UK, found that 10 percent of babies born in the area had a tongue tie.

Most studies identify an increased frequency in boys with a male-to-female ratio of 1.5-2.6 to 1 

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Genetic factors and tongue tie

Tongue tie often runs in families. Some relatives may only have mild effects or no apparent symptoms while others show a severe impact on structure and function.

Tongue tie sometimes occurs together with other congenital conditions which affect the structure of the mouth, such as cleft lip or palate. It can also occur together with conditions such as severe hearing loss or cerebral palsy.

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Abdullah Almuttawa11

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Classification

class

severity

length

Class IMild ankyloglossia12 to 16 mm free tongue Class IIModerate ankyloglossia

8 to 11 mm free tongue

Class III

Severe

ankyloglossia

3 to 7 mm free tongue

Class IV

Complete

ankyloglossia

less than 3 mm free tongue

The term 

free-tongue

 is defined as the length of tongue from the insertion of the lingual frenum into the base of the tongue to the tip of the tongue.

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Potential effects of tongue tie

1. Speech development

It is important to note that tongue tie does not 

necessarily

 impair speech, in fact, it rarely appears to do so. Many individuals compensate well and have normal sounding speech, even those with the frenulum attached very close to the tongue tip under the tongue. Some individuals with tongue tie may have imprecise articulation, especially at speed.In a recent survey, Messner and Lalakea (2000) found that 60% of ENTs, 50% of SLPs, and 23% of pediatricians believed that ankyloglossia is likely to cause speech problems.Speech sounds that may be affected include sibilants and lingual sounds (eg, "t," "d," "z," "s," "th," "n," "l").2.Mechanical problems*Difficulty with oral hygiene (ie, licking the lips or sweeping food debris from the teeth) that may result in periodontal disease.*Local discomfort .*Diastasis between the lower central incisors.Tuesday, September 27, 2011

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3. Eating and digestion due to a restricted ability to tidy up inside and outside of their mouths while they are having a meal. 

Although approximately 25% of newborns with ankyloglossia will have some trouble latching on to a nipple for sucking the majority have no early feeding problems

4.Cosmetics and personal interactions

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Clinical featuresTuesday, September 27, 2011

Abdullah Almuttawa

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Abnormally short frenulum, inserting at or near the tip of the tongue

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Difficulty lifting the tongue to the upper dental alveolus

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Inability to protrude the tongue more than 1 to 2 mm past the lower central incisors

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Notched or heart shape of the tongue when it is protruded

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Surgical Options

The goal of surgery is to increase the mobility of the tongue, not to improve its contour.

Even after surgery, the tip of the tongue may retain a heart shape.

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Frenotomy of neonates(tongue clipping)

Snipping the frenum, This procedure, carried out as an out-patient procedure at the Southampton General Hospital, UK, is described as follows by Mr Mervyn Griffiths, a neonatal and paediatric surgeon, and requires no anaesthetic or analgesic.

Results were described as: improving breastfeeding immediately - 57%, and feeding better by 24 hours - 80%

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lingual frenectomy

involves more than just a simple clipping or a quick snip, but more involved tissue resection under general anaesthetic.

It is therefore not recommended unless there is a good (speech, dental or other) justification for doing it.

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An assistant elevates the tip of the tongue to expose the lingual frenulum. The frenulum is divided in the coronal plane with bipolar electrosurgical scissors.

Dissection is sometimes carried into the genioglossus muscle fibers to complete the ankyloglossia release.

A diamond-shaped mucosal defect results.

The mucosa is closed with multiple absorbable sutures in the sagittal plane.

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Revision by Electrocautery

This method does not require a general anesthetic and can be performed as an outpatient service with a local anesthetic.

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Laser Surgery

This relatively new option is suitable for neonates, older children and adults. No general anaesthetic is used, but an analgesic gel might be applied.

no bleeding, no pain, no risk of infection and the healing period can be as short as 2 hours.

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To Clip or Not to Clip? That's the Question.

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Slide29

Indications for surgery may include breastfeeding difficultyArticulation problems.

Psychologic problems.

Periodontal disease.

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When

ankyloglossia

is noted at birth, one option is to leave it alone and let nature take its course, unless there are early feeding problems.

If the child demonstrates any of the problems noted above, a

frenulectomy (surgical release of the tongue) can be done. In past times, midwives used a sharpened fingernail to slit the frenulum immediately after birth.Tuesday, September 27, 2011Abdullah Almuttawa30

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Perspectives on Tongue-Tie and Speech

"Most experienced speech-language pathologists would conclude that frenulectomy is rarely indicated for speech reasons unless it is very severe or there are oral-motor problems."

 

Ann W. Kummer

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“Delayed speech is not an indication for surgical release of tongue tie; children with ankyloglossia are expected to acquire speech and language at the normal rate”, Glenn C Isaacson, MD, FAAP, FACS

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post-operative exercises

The purpose of post-operative exercises

 

Post-operative exercises following tongue-tie surgery are not intended to increase muscle-strength, but to Develop new muscle movements, particularly those involving tongue-tip elevation and protrusion, inside and outside of the mouth.

Increase awareness of the full range of movements the tongue and lips can perform.. Encourage tongue movements related to cleaning the oral cavity, including sweeping the insides of the cheeks, fronts and backs of the teeth, and licking right around both lips.Tuesday, September 27, 2011Abdullah Almuttawa

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recourses

UpToDate.com

“Tongue Tie – from Confusion to Clarity”by Carmen Fernando.

speech-language-therapy.comThe American Speech-Language-Hearing Association (ASHA).

 American Academy of Otolaryngology — Head and Neck Surgery.Tuesday, September 27, 2011Abdullah Almuttawa34