Professional Documents
Culture Documents
Ankyloglossia: Case Report: RSBO January 2011
Ankyloglossia: Case Report: RSBO January 2011
net/publication/49616258
CITATION READS
1 1,557
4 authors, including:
Some of the authors of this publication are also working on these related projects:
All content following this page was uploaded by Norma Suely Falcão de Oliveira Melo on 20 May 2014.
Corresponding author:
Norma Suely Falcão de Oliveira Melo
2915/14, Martin Afonso St.– Bigorrilho – Curitiba – PR
E-mail: normamel@ufpr.br
1
Dentistry School, Federal University of Paraná – Curitiba – Paraná – Brazil
Received for publication: August 10, 2009. Accepted for publication: June 28, 2010.
Abstract
Keywords: lingual
frenum; surgery; Introduction: The lingual frenulum is an anatomic structure that
abnormalities. plays an important role in the act of suction, speech and feeding. A
short and adhered lingual frenulum obstructs the tongue movement.
This can impair the diverse functions of this structure. This alteration
is called ankyloglossia. Objective and case report: The aim of this
article is to relate a case of ankyloglossia in a female child of two-years
old who was examined in the Clinic of Child Care of the Department
of Pediatrics, Federal University of Paraná. The child was diagnosed
with type II ankyloglossia and treated by frenectomy. Conclusion: The
routine examination of the lingual frenulum permits the identification
of insertion abnormalities and enables the establishment of preventive
measures for complications during the period of breastfeeding.
fibers, with some muscular fibers, blood vessels, common. This abnormality makes the tongue’s
and fat cells, covered by a stratified pavimentous movements difficult, mainly the pronunciation of
epithelium [14]. certain consonants and labial-dental diphthongs
Ankyloglossia, so-called tongue-tie, constitutes [21]. Although it is a very much known clinical
a development a l a noma ly cha racter i zed by entity, ankyloglossia affecting children younger
a lterat ion in tongue’s frenulum result ing in than 1 year-old represents a challenge for dentists
limitations of this structure’s movements, leading regarding to its diagnosis [17]. Moreover, it interferes
to speech and deglutition changes. The change in toothbrushing process, consequently, favoring the
of the insertion occurs in the tongue’s tip up risk of plaque accumulation, tissue inflammation
to the lingual alveolar ridge, being visible at onset, and gingival recession [33].
birt h [6]. Its definit ion ra nges from since a The lingual frenulum examination should
vague description of “tongue functioning with consider the clinical and functional aspects of the
the activity extension lower than normal” up to tongue. Ballard and Kroury (2002) [3] cited the
the description of a “short, thick, muscular or lingual frenulum evaluation according to Hazelbaker
fibrous frenulum” [17]. (table I) for frenectomy indication when the child
The joint of the mouth floor with the tongue is presenting difficulty during breastfeeding with
is a rare condition; partial ankyloglossia is more pain in the mother’s nipple.
The baby’s mouth presents a small membrane Baldini et al. (2001) [2] performed a study on the
that extends from tongue to mandible’s inner surface. prevalence of the oral alterations in children aging
Such membrane maintains the tongue in correct from 0 to 2 years-old. The incidence of ankyloglossia
position during breastfeeding. After some days of in children aging from 0 to 3 months-old and
child’s development, this membrane is transformed from 4 to 12 months-old was 1.59% and 1.49%,
into the lingual frenulum, modifying its insertion. respectively. The anomaly was more recurrent in
Therefore, the child will be able of stretching the girls. According to Vieira (2004) [31], the occurrence
tongue forward. In some cases, this membrane of ankyloglossia is about 1 subject to 300 births.
becomes thicker and shorter and the tongue’s tip However, a similar study performed in Mexico, with
is confined, causing ankyloglossia [20, 29, 32]. newborn babies, demonstrated that ankyloglossia
Tongue plays an important role in deglutition. in the studied population was approximately 1%
During breastfeeding, the mother’s nipple is [10]. This same investigation pointed out that the
compressed and flattened by the baby’s tongue abnormality occurred more in male than in female
against the palatine papilla. The child apprehends subjects (male:female ratio = 1.5:1).
the nipple with the lips and tongue, performing a In a population of 621 children aging from 0
sealing composed by the upper lip, above, and by to 6 months-old, the most prevalent oral alterations
the tongue’s tip and lower lip, below [1]. Occasionally, were inclusion cysts, comprising Bohn’s nodules,
newborn and nursing babies show atypical oral Epstein’s pearls, and dental lamina cysts; there
movements of the tongue that are capable of was no case of ankyloglossia [26].
interfering in breastfeeding. These oral disturbances The aim of this study was to report a case of
may be transitory alterations of the oral function ankyloglossia in a child, emphasizing its clinical
or individual anatomical features. Tongue’s correct features and the recommended treatment.
movement favors the proper fit between the baby’s
mouth and the mother’s breast. Oral dysfunctions,
when present, result in little weight gain or early Case report
ablactation. The breastfeeding of children showing The parents of a female, Caucasian, two year-
ankyloglossia is frequently inappropriate, being old child sought for the Clinic of Child Care of
uncomfortable and painful for the mothers [27, the Department of Pediatrics, Federal University
30]. If these alterations are not corrected, they will of Paraná. The child’s mother reported the child’s
result in breastfeeding impairment [24]. difficulty in feeding and pronouncing the labial-
Frenectomy provides the lingual mobility return dental diphthongs. Moreover, the mother was
because no adherence is formed after the horizontal concerned about the child’s learning at school.
incision of the frenulum (with scissors and under During anamnesis, the mother reported difficulty
local anesthesia). In some cases, the surgical during the child’s breastfeeding due to tongue-tie,
procedure is repeated for successfully obtaining which hindered the nipple’s apprehension.
tongue articulation mobility [11, 13, 22]. According Intraoral clinical examination showed a short
to Santos et al. (2007) [25], the frenectomy should lingual frenulum limiting tongue’s movement
be executed, as early as possible, or as soon as it is amplitude, with insertion close to tongue’s tip
diagnosed. The protocol aims to prevent or reduce (figure 1). The frenulum insertion into the tongue’s
the implications related to poor tooth positioning tip and basis interfered in tongue’s protrusion
and muscle development, which are damaged. forward, resulting in tongue bending (figure 2). Such
Besides the surgical procedure, treatment should condition did not allow a normal deglutition pattern.
be completed by a speech therapist, in order to The girl showed speech difficulties associated
reestablish the normal deglutition and speech with lingual movement limitation. Frenectomy was
physiology. The authors emphasized that if the recommended as treatment, under topical anesthesia
frenectomy is delayed, patient’s psychological and on tongue’s inferior surface. After anesthesia,
social well-being will be compromised. hemostatic pliers were used for apprehend the
A st udy on t he determi nat ion of t he frenulum, and an electric-surgical instrument was
frenectomy effectivit y in children presenting used for its releasing. Surgical wound was sutured
breastfeeding difficulty, through submentual with catgut suture 4/0. Following, post-operative
ultrasonography, revealed that there was less instructions comprising measurements for avoiding
compression of the mother’s nipple by the baby’s hemorrhages and the use of non-narcotic painkillers
tongue after frenectomy, which resulted in small for controlling pain discomfort, were performed.
discomfort during breastfeeding, according to Seven days after the surgery, the surgical wound
the mothers [12]. was undergoing healing. At that moment, the
Melo et al.
96 – Ankyloglossia: case report
tongue’s function was evaluated, and there was it caused morphofunctional modifications. The
an improvement in the capacity of movimentation. child showed difficulty in speech in association
Such fact suggested an excellent prognosis for the with limitation of tongue’s movements, besides an
case. abnormal pattern of deglutition due to a short lingual
frenulum that limited the amplitude of tongue’s
movements. The child also displayed difficulty in
articulating labial-dental words.
Babies with an altered lingual frenulum may
present problems in mother’s nipple apprehension,
complicating the removal of milk and interfering in
the weight gain. Surgical releasing of the frenulum,
when carefully indicated, promotes this function
improvement [28].
The ankyloglossia correction at early ages
reduces the risks of complications to nursing babies,
and frenectomy should be performed when there is
interference in deglutition and speech [6, 13, 16].
The pediatrist, pedodontist, and general dentist
are capable of detecting abnormalities in the mouth
Figure 1 – Clinical aspect of the tongue at rest of newborn and nursing babies, and children. On
one hand, the pediatrist is responsible for the
diagnosis of the manifestations present in the
baby’s mouth in the early life. On the other hand,
the pedodontist usually examines the children at
the moment of deciduous tooth eruption (about 6
months-old). With the advent of Dentistry for babies,
early attention prior to tooth eruption potentiates
the diagnosis of oral alterations, such as neonatal
and prenatal tooth, and ankyloglossia [7].
The evaluation of lingual frenulum problems
will enable the identification of abnormalities in its
insertion and prevention of alterations in deglutition
and speech function after the surgical correction
of ankyloglossia.
Figure 2 – Tongue protrusion impaired by
ankyloglossia
Conclusion
Discussion The routine examination of the lingual frenulum
enables to both find anomalies in its insertion and
Undoubtedly, any problem affecting the tongue’s
plan preventive measurements for intercurrences
health may seriously ref lect in oral functions.
during breastfeeding. In this present case report,
A nk ylog lossia is a congenit a l ora l a noma ly
the abnormal tongue insertion altered significantly
characterized by a very short lingual frenulum
the deglutition function, tongue’s movements,
capable of resulting in variable degrees of lingual
speech, and word’s articulation. Lingual frenulum
mobility reduction.
surgery returned the tongue’s functions to patient’s
The tongue plays an important role in food stomatognathic system.
transportation and deglutition [9, 23], as well
as in words articulation [4]. Also, it influences
tooth positioning and breastfeeding. A very short References
lingual frenulum restricts the tongue movements’
amplitude, impairing the capacity of executing its 1. Andrade CF, Gullo AC. As alterações do
functions [17]. sistema motor oral dos bebês como causam das
In the case reported here, a nkyloglossia fissuras/rachaduras mamilares. Ped São Paulo.
presented a social and clinical relevance, since 1993;15:28-33.
RSBO. 2011 Jan-Mar;8(1):93-8 97
30. Váldes V, Sanchez AP, Labbok M. Técnicas de 32. Walter L, Ferelle A, Issao M. �����������������
Odontologia para
amamentação. ���������������������������������
In: Váldes V, Sanchez AP, Labbok o bebê. São Paulo: Artes Médicas; 1996.
M (eds.). Manejo
��������������������������������������
clínico da amamentação. Rio de
Janeiro: Revinter; 1996. 33. Yared KFG, Zenobio EG, Pacheco W. A
etiologia multifatorial da recessão periodontal.
31. Vieira AR. Anquiloglossia e sua relação com
o comportamento sexual futuro. RGO. 2004 Apr- R Dental Press Ortodon Ortop Facial. 2006 Nov-
Jun;52(2):72-3. Dec;11(6):45-51.
Melo NSFO, Lima AAS, Fernandes A, Silva RPGVC. Ankyloglossia: case report. RSBO. 2011 Jan-
Mar;8(1):93-8.