Description, Causes and Risk Factors:
Ankyloglossia is an uncommon congenital oral anomaly that can cause difficulty with breast-feeding, speech articulation. For many years, the subject of ankyloglossia has been controversial with practitioners of many specialties having widely different views regarding its significance and management. In many individuals, ankyloglossia is asymptomatic; the condition may resolve spontaneously or affected individuals may learn to compensate adequately for their decreased lingual mobility. Some individuals, however, benefit from surgical intervention frenotomy, frenectomy or frenuloplasty for their tongue-tie.
The prevalence of ankyloglossia reported in the literature varies from 1.1% to 20.7%. The prevalence is also higher in studies investigating neonates (5.72% to 18.7%) than in studies investigating children, adolescents, or adults (0.1% to 2.08%).
There is some evidence that ankyloglossia can be a genetically transmissible pathology. It is unknown which genetic components regulate the phenotype and penetrance in the patients affected. More basic research is needed to clarify the exact etiopathogenesis of ankyloglossia. Ankyloglossia was also found associated in cases with some rare syndromes such as X-linked cleft palate syndrome, Kindler syndrome, Van Der Woude syndrome, and Opitz syndrome. Nevertheless, most ankyloglossias are observed in persons without any other congenital anomalies or diseases. Speech problems can occur when there is limited mobility of the tongue due to ankyloglossia.
The ankyloglossia is in 4 classes so far based on Kotlow's assessment as follows; Class I: Mild ankyloglossia: 12 to 16 mm, Class II: Moderate ankyloglossia: 8 to 11 mm, Class III: Severe ankyloglossia: 3 to 7 mm, Class IV: Complete ankyloglossia: Less than 3 mm.
Patients should be educated about the possible long-term effects of ankyloglossia so that they may make an informed choice regarding possible therapy.
Signs and symptoms of ankyloglossia include the following, but not limited to,
Limited mobility of the tongue.
Most commonly ankyloglossia is associated with speech defects. Lisping and the difficulty with pronouncing certain sounds are very common in patients with this disease. The ability to enunciate alphabets such as “T”, “D”, “N”, “L” and syllables such as “AS” or “TA” are generally hampered in these affected individuals. Recurrent tongue biting is also very common in these patients. Difficulties in chewing certain types of foods are also commonly experienced. In infants ankyloglossia can lead to feeding and nursing problems, as it creates difficulty maintaining suction inside the oral cavity.
The fusion of the frenum can be complete or partial. When the patient attempts to stick the tongue out a “V” shaped notch may be visible at the tip of the tongue. There is mild-to-moderate spacing is present between lower central incisors. The individuals with tongue tie also tend to lick the lower lip more frequently. The long term effects of tongue tie include malocclusions such as open bite and lower jaw prognathism. The oral hygiene is also compromised due to the tongue tie.
Ankyloglossiais typically diagnosed during a physical exam. For infants, the doctor might use a screening tool to score various aspects of the tongue's appearance and ability to move.
Class III and IV types of ankyloglossia should be given special consideration because they severely restrict the tongue's movement. More studies, especially controlled clinical trials, are needed to establish a clear correlation between malocclusion and ankyloglossia. If there is no feeding difficulty in the infant, it would be best to have a wait-and-see approach since the frenum naturally recedes during the process of an individual's growth between six months and six years of age. After completion of growth and also during infancy, if the individuals have a history of speech, feeding, or mechanical/social difficulties surgical intervention should be carried out. Therefore, surgery should be considered at any age depending on the patient's history of speech, feeding, or mechanical/social difficulties. Surgical techniques for the therapy of tongue-ties can be classified into three procedures. Frenotomy is a simple cutting of the frenum. Frenectomy is defined as complete excision, i.e., removal of the whole frenum. Frenuloplasty involves various methods to release the ankyloglossia and correct the anatomic situation. There is no sufficient evidence in the literature concerning surgical treatment options for this disease to favor any one of the three main techniques.
Treatment is accomplished in the dental office after administration of a local anesthetic. General anesthesia or deep sedation is not usually necessary unless an extensive revision or a muscle reattachment procedure is required. Infants are treated with only a local anesthetic solution. Older children may be given a sedative such as chloral hydrate and hydroxyzine, in combination with nitrous oxide or other suitable regimens with appropriate monitoring.
The frenum is revised with the following surgical procedure:
A local anesthetic is infiltrated into the frenum area.
After the anesthesia is completed, a hemostat is used to clamp the frenum, and an electrosurgical instrument is used to release the frenum.
The area is sutured with #4-0 gut suture.
The patient is discharged with postoperative instructions.
A topical anesthetic is applied to the underside of the tongue.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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