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Everything You Need to Know About Ankyloglossia
- 1. ANKYLOGLOSSI A Check out ppt download link in description Or Download link : https://userupload.net/h9ig9byum706
- 2. 17-05-06 Ankyloglossia 2 Cont ent s Arjun’s ankyloglossia Definition & controversies Developmental deviation Incidence & association Clinical symptoms & assessment Sequlae Management Conclusion References
- 3. 17-05-06 Ankyloglossia 3 Arjun – 2yr old male child Inability to protrude tongue Inability to swallow food properly Difficulty in speech
- 4. 17-05-06 Ankyloglossia 4 All of the following are correct spellings: Fre nulum , fre nulum s, fre nula Fre num , fre num s, fre na Fre no to m y, fre ne cto m y To ng ue -tie , to ng ue -tie d All spellings can be found in medical dictionaries
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- 6. 17-05-06 Ankyloglossia 6 Definition a congenital anomaly characterized by an abnormally short lingual frenum, which may restrict tongue tip mobility Controversy???? Range??
- 7. 17-05-06 Ankyloglossia 7 Development al Deviat ion During fetal development, cords of tissue called frenula form in the front- center of the mouth, beginning as early as 4 weeks of gestation. "frenulum" -- Latin word for bridle --used to guide a horse. frenula guide development of the structures of mouth. Early in development, frenula --strong imp cords, which recede over time. After birth, they continue to guide position of incoming decicuous teeth The cord/ strand of tissue b/w base of tongue & floor of mouth or lower gum is called lingual frenulum In some kids, the lingual frenulum is short and taut after birth, partially restricting movement of the tongue. In most of these children, the frenulum continues to recede during the entire first year. Ankyloglossia is often hereditary, and there is no means of prevention
- 8. 17-05-06 Ankyloglossia 8 Incidence of ankyloglossia—0.02%--4.8% effects more males at almost a 3:1 ratio 1/4 of breastfed infants had difficulty breastfeeding Associated with Orofacial digital syndrome Beckwith-Wiedmann syndrome X-linked cleft palate Inferences Tongue-tie is common It may affect breastfeeding adversely Messner AH, Ankyloglossia: Incidence and Associated feeding difficulties, Arch Otolaryngol Neck Surg 2000
- 9. 17-05-06 Ankyloglossia 9 Ankyloglossia Symptoms Heart shape of tongue when raised V-shaped notch in tip of tongue Inability to protrude or elevate tongue Tongue curves down when extended Usually leads to a deviate swallow Possible speech problems May have trouble swallowing pills May have digestive problems Difficulty in licking ice-cream cones Difficulty in kissing
- 10. 17-05-06 Ankyloglossia 10 Clinical Assessment in inf antInspection of tongue and its functions Examine tongue’s appearance when it is lifted as the infant cries or tries to extend tongue Frenal attachment should be On tongue-- normally 1 cm posterior to the tongue tip On alveolar ridge– proximal to or into the genioglossus muscle on the floor of the mouth Mother to be interviewed regarding infant’s ability to breastfeed…. Does the infant demonstrate frustration at the breast? Experience inability to sustain a good latch to the nipple? Does the mother experience any nipple pain or discomfort if while the infant nurses?
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- 12. Mechanism of breast f eeding
- 13. 17-05-06 Ankyloglossia 13 Illustration from Ros Escott article, Positioning, Attachment and Milk Transfer, Breastfeeding Review, 1989, p.35.
- 14. 17-05-06 Ankyloglossia 14 Ankyloglossia and Breastfeeding Nipple trauma and pain Compression against gum pad instead of tongue Inefficient, inadequate suckling, poor seal Limited action of tongue Lengthy feedings Failure to thrive Often switched to bottle
- 15. 17-05-06 Ankyloglossia 15 Habitual tongue posture of newborn infant Tip of tongue extends over and past the gum pad
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- 17. 17-05-06 Ankyloglossia 17 If tongue tie interferes with a baby’s feeding, feeding difficulties may include problems in breastfeeding and sucking, poor weight gain for the baby, and poor milk supply for the mother In such cases, early intervention is usually warranted
- 18. 17-05-06 Ankyloglossia 18 3 month old who was weaned because of breastfeeding difficulties.
- 19. 17-05-06 Ankyloglossia 19 Clinical assessment in preschooler/ school age pat ient In Toddlers and OlderChildren Mobility –evaluated by measuring in millimeters the tip of the tongue extended past the lower dentition Elevation—measured by recording the interincisal distance with the tongue tip maximally elevated and in contact with the upper teeth Protrusion & elevation values AG children ----15 mm or less, Normal children –20 to 25 mm or greater
- 20. 17-05-06 Ankyloglossia 20 Speech –Around age of 3 yrs, speech problems, especially articulation of the sounds - l, r, t, d, n, th, sh, and z may be noticeable If elevation restricted, 1 or more of the tongue sounds– such as “t”, “d”, “l”, “th” and “s” –will not be accurate AG is not a cause of speech delay, but interferes with articulation Following associated characteristics are common: V-shaped notch at the tip of the tongue Inability to stick out the tongue past the upper gums Inability to touch the roof of the mouth Difficulty moving the tongue from side to side A simple test is to observe if the child can lick an ice cream cone or lollipop without much difficulty
- 21. 17-05-06 Ankyloglossia 21 Classif icat ion based on “Free Tongue” Lengt h --By Lawrence A Kotlow Free tongue —length of tongue from insertion into the base of the tongue to the tip of the tongue. Used in older patients and infants Clinically acceptable, normal range of free tongue =>16mm Class I : Mild ankyloglossia= 12-16 mm Class II : Moderate ankyloglossia= 8-11 mm Class III : Severe ankyloglossia= 3-7 mm Class IV: Complete ankyloglossia= <3mm
- 22. 17-05-06 Ankyloglossia 22 Hazelbaker’s “t he assessment t ool f or lingual f renulum f unct ion” Function items Appearance items Lateralization Appearance of tongue when lifted Lift of tongue Elasticity of frenulum Extension of tongue Length of lingual frenulum when tongue lifted Spread of anterior tongue Attachment of lingual frenulum to tongue Cupping of tongue Attachment of lingual frenulum to inferior alveolar ridge Peristalsis Snap back
- 23. 17-05-06 Ankyloglossia 23 Funct ion I t ems Lateralization 2=complete 1=body of tongue, but not tongue tip 0=none Lift of tongue 2=tip to mid mouth 1=only edges to mid mouth 0=tip stays at alveolar ridge or tip rises only to mid mouth with jaw closure
- 24. 17-05-06 Ankyloglossia 24 Extension of tongue 2=tip over lower lip 1=tip over lower gum only 0=neither of the above or anterior or mid tongue humps
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- 26. 17-05-06 Ankyloglossia 26 Spread of anterior tongue 2=complete 1=moderate or partial 0=little or none Cupping of tongue 2=entire edge, firm cup 1=side edges only, moderate cup 0=poor or no cup
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- 28. 17-05-06 Ankyloglossia 28 Peristalsis 2=complete anterior to posterior (originates at tip) 1=partial: originating posterior to tip 0=none or reverse peristalsis Snap back 2=none 1=periodic 0=frequent or with each suck
- 29. 17-05-06 Ankyloglossia 29 Appearance it ems Appearance of tongue when lifted 2=round or square 1=slight cleft in lip apparent 0=heart shaped Elasticity of frenulum 2=very elastic 1=moderately elastic 0=little or no elasticity
- 30. 17-05-06 Ankyloglossia 30 Length of frenulum when tongue lifted 2=>1cm or embedded in tongue 1= 1 cm 0= <1 cm Attachment of lingual frenulum to tongue 2=posterior to tip 1=at tip 0=notched
- 31. 17-05-06 Ankyloglossia 31 Attachment of lingual frenulum to inferior alveolar ridge 2=attached to floor of mouth or well below ridge 1=attached just below ridge 0=attached at ridge
- 32. 17-05-06 Ankyloglossia 32 Trying to talk, e at, o r swallo w with a tig ht ling ualfre num is like trying to run a m aratho n with yo ur sho e s tie d to g e the r… . !!! You will NEVER win a race until you are told about your problem!
- 33. 17-05-06 Ankyloglossia 33 Scoring in Hazelbaker ’s Assessment 14=perfect scores ( regardless of appearance item score) 11=acceptable if appearance item score is 10 <11=function impaired; frenotomy should be considered if management fails Frenotomy is necessary if function score is <11 and appearance score is <8
- 34. 17-05-06 Ankyloglossia 34 Tight lingual frenum seen Arj un’s Case
- 35. 17-05-06 Ankyloglossia 35 Hazelbaker’s assessment f or lingual f renulum f unct ion in Arj un Function items Appearance items Lateralization=1 Appearance of tongue when lifted=0 Lift of tongue=1 Elasticity of frenulum=1 Extension of tongue=1 Length of lingual frenulum when tongue lifted=1 Spread of anterior tongue=1 Attachment of lingual frenulum to tongue =0 Cupping of tongue=1 Attachment of lingual frenulum to inferior alveolar ridge=0 Peristalsis=1 Snap back=1
- 36. 17-05-06 Ankyloglossia 36 Arj un’s case Function Score=7 (<11) Appearance Score=2 (<8) Frenotomy was deemed mandatory
- 37. 17-05-06 Ankyloglossia 37 Potential effects of tongue tie Speech development– inaccurate articulation Dental health--caries Periodontic health--gingivitis Oral hygiene--halitosis Eating and digestion – messy eaters Appearance Oral play Self esteem
- 38. 17-05-06 Ankyloglossia 38 Sequlae Lower incisor deformity Gingival recession Malocclusions Habit forming Breast feeding difficulties Interference with articulation Teasing by peers Social issues—licking ice cream, playing a musical wind instrument, and even kissing
- 39. 17-05-06 Ankyloglossia 39 Surgical Indications Breastfeeding difficulties Speech impediments Dental problems Medical problems Indigestion Snoring and sleep apnea Personal / Social reasons Licking ice-cream cones Kissing
- 40. 17-05-06 Ankyloglossia 40 Treatment Options Frenotomy No anesthetic needed No suturing Frenectomy Local or general anesthetic used Sutures placed Z-plasty More complex Sutures placed Laser Frenectomy Simpler, lesser time, swelling & discomfort No anesthetic needed No suturing
- 41. 17-05-06 Ankyloglossia 41 Clinical Reasons for a frenotomy Painful attachment at breast Nipple trauma / nipple breakdown Failure to thrive / poor milk transfer
- 42. 17-05-06 Ankyloglossia 42 Frenotomy technique Parent/ Assistant holds & stabilizes head Stabilize and elevate tongue Clip center of frenum (~1 cm) Frenum is poorly vascularized Frenum is poorly innervated Infant can breastfeed immediately
- 43. 17-05-06 Ankyloglossia 43 Infant at 10 weeks old -started thriving Tongue lifter. - used to be quite common in birthing surgical packs 8 week old infant with tight frenum - 7 oz under birth weight
- 51. Z Plast y Closure
- 54. 17-05-06 Ankyloglossia 54 One year post operatively protrusion and elevation
- 57. 17-05-06 Ankyloglossia 57 Laser Frenect omy Using a carbon dioxide laser set at 7 watts in pulsating mode, frenum is outlined In continuous mode frenum is excised Relaxing incisions at floor of mouth and ventral surface of tongue Hemostasis by defocussing the beam and lasering the bed No sutures required Wound heals by epithelization and contraction Advised soft diet for a week
- 59. 17-05-06 Ankyloglossia 59 Post- operative Exercises Not intended to increase muscle-strength, but to: Develop new muscle movements– elevation and protrusion Increase kinaesthetic awareness of full range of movements the tongue and lips can perform Encourage tongue movements related to cleaning the oral cavity
- 60. 17-05-06 Ankyloglossia 60 Exercises Encourage oral play generally, and get a selection of the following exercises done, in any order, in 3 to 5 minute bursts, once or twice daily for 3 or 4 weeks post-operatively. Stretch tongue up towards nose, then down towards chin. Repeat. Above exercises can be varied and made more interesting by putting a dab of food in various positions above the top lip, to be retrieved with the tongue tip Open mouth widely. Touch big front teeth with tongue with mouth still open Can they FEEL how tough their teeth are? Look in mirror. Still with mouth open wide, say dar-dar-dar, now say nar-nar-nar, now say tar-tar. Look in the mirror to see what your tongue is doing Can they FEEL where it is?
- 61. 17-05-06 Ankyloglossia 61 Lick whole top lip from one side to the other and vice versa Lick whole bottom lip from one side to the other & vice versa See how many times you lips can lick right around. Poke tongue out as far as it will go. Shut the mouth and poke it into the left cheek to make a lump. Do the same on the other side. Now see if top lip can be made fat without opening the mouth. Can the child go in-out-in-out-in-out with your tongue? (demonstrate) Put tongue behind teeth and shut the mouth. Can the big top teeth be found with the tongue while the mouth is still shut? FEEL how tough your teeth are.
- 62. 17-05-06 Ankyloglossia 62 Complications Recurrence of tongue tie Tongue swelling Bleeding Infection Damage to ducts of salivary glands
- 63. 17-05-06 Ankyloglossia 63 Frenum Recommendations Include the significance of frenums and the importance of breastfeeding in the curriculum of health care schools Train all OBs and pediatricians and pediatric dentists how to perform the surgeries Refer out if not comfortable doing the surgeries Anyone who can do a circumcision should be able to do a frenotomy
- 64. Conclusion
- 65. 17-05-06 Ankyloglossia 65 Ref erences P Dent 2005:27; pg 40-6 QI 1999:30; pg 259-62 Pediatric oral and maxillofacial surgery—Kaban & Troulis PCNA2003;50;381-97 www.brianpalmerdds.com www.bandolier.com www.members.tripod.com/~Caroline_Bowen/tonguetie.h tml www.medela.com/NewFiles/Tonguetied.html
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Editor's Notes
- Speech – While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. Around the age of three, speech problems, especially articulation of the sounds - l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a three–year–old child’s speech is not understood outside of the family circle. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common: V-shaped notch at the tip of the tongue Inability to stick out the tongue past the upper gums Inability to touch the roof of the mouth Difficulty moving the tongue from side to side As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. If the answer is no, they cannot, then it may be time to consult a physician.
- 1. Speech developmentIt is important to note that tongue tie does not necessarily impair speech. Many individuals compensate well and have normal sounding speech, even those with the fraenum attached very close to the tongue tip under the tongue. Some individuals may have imprecise articulation, especially at speed. 2. Dental healthCavities (&apos;dental caries&apos;) can occur due to food debris not being removed by the tongue’s action of sweeping the teeth and spreading saliva.3. Periodontic healthGingivitis (gum disease) can develop, for the reason stated above.4. Oral hygieneHalitosis (bad breath) may be present, due to caries and food debris.5. Eating and digestionSome children with tongue tie are messy eaters due to a restricted ability to tidy up inside and outside of their mouths while they are having a meal. Some are unable to circle their lips with their tongues in order to fully lick their lips. In extreme cases poor oral hygiene can lead to digestive complaints.6. Sexual function Restricted tongue movements may affect sexual expression.7. AppearanceThe tongue can be unduly obvious or unusual looking in some individuals, particularly when they are close up, or appear on video, film or TV.8. Oral playChildren in particular may not be able to participate in play routines involving tongue movements and gestures.9. Self esteemIt has been noted clinically that occasionally an older child or adult will be self-conscious, embarrassed or resentful about their tongue tie.
- 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 kinaesthetic awareness of the full range of movements the tongue and lips can perform. In this context, kinaesthetic awareness refers to knowing where a part of the mouth is, what it is doing, and what it feels like. 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
- Discuss these suggested exercises with YOUR child&apos;s speech-language pathologist before commencing them. The SLP will modify them according to your child&apos;s age and requirements. Encourage oral play generally, and do a selection of the following exercises, in any order, in 3 to 5 minute bursts, once or twice daily for 3 or 4 weeks post-operatively. Have a torch and hand-mirror handy. Make it fun. Stretch your tongue up towards your nose, then down towards your chin. Repeat. You can vary the exercise above and make it more interesting by putting a dab of food in various positions above the top lip, to be retrieved with the tongue tip (You could call this game &quot;Elephant Tongue&quot; and read books about elephants (e.g. &quot;Babar&quot;) to stimulate your child&apos;s interest in playing the &quot;tongue games&quot; spontaneously at other times - not just when you are there. Open your mouth widely. Touch your big front teeth with your tongue with your mouth still open. Can you FEEL how tough your teeth are? Look in the mirror. Still with your mouth open wide, say dar-dar-dar, now say nar-nar-nar, now say tar-tar. Look in the mirror to see what your tongue is doing. Can you FEEL where it is? Lick your whole top lip from one side to the other. Now go back the other way. Lick your whole bottom lip from one side to the other. Go back the other way. See how many times you can lick your lips right around. Poke your tongue out as far as it will go. Shut your mouth and poke it into your left cheek to make a lump. Do the same on the other side. Now see if you can make your top lip fat without opening your mouth. Can you go in-out-in-out-in-out with your tongue? (demonstrate) Put your tongue behind your teeth and shut your mouth. Can you find your big top teeth with your tongue while your mouth is still shut? FEEL how tough your teeth are.