Population-based study からみた神経予後不良因子の検討

BACKGROUND AND OBJECTIVE: Children with ankyloglossia, an abnormally short, thickened, or tight lingual frenulum, may have restricted tongue mobility and sequelae, such as speech and feeding difficulties and social concerns. We systematically reviewed literature on feeding, speech, and social outcomes of treatments for infants and children with ankyloglossia. METHODS: Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two investigators independently extracted data on study populations, interventions, and outcomes and assessed study quality. RESULTS: Two randomized controlled trials, 2 cohort studies, and 11 case series assessed the effects of frenotomy on feeding, speech, and social outcomes. Bottle feeding and social concerns, such as ability to use the tongue to eat ice cream and clean the mouth, improved more in treatment groups in comparative studies. Supplementary bottle feedings decreased over time in case series. Two cohort studies reported improvement in articulation and intelligibility with treatment. Other benefits were unclear. One randomized controlled trial reported improved articulation after Z-frenuloplasty compared with horizontal-to-vertical frenuloplasty. Numerous noncomparative studies reported speech benefits posttreatment; however, studies primarily discussed modalities, with outcomes including safety or feasibility, rather than speech. We included English-language studies, and few studies addressed longer-term speech, social, or feeding outcomes; nonsurgical approaches, such as complementary and alternative medicine; and outcomes beyond infancy, when speech or social concerns may arise. CONCLUSIONS: Data are currently insufficient for assessing the effects of frenotomy on nonbreastfeeding outcomes that may be associated with ankyloglossia.

http://pediatrics.aappublications.org/content/pediatrics/135/6/e1467.full.pdf

Treatment of Ankyloglossia for Reasons Other Than Breastfeeding: A Systematic Review

A short lingual frenulum has been associated with difficulties in sucking, swallowing and speech. The oral dysfunction induced by a short lingual frenulum can lead to oral-facial dysmorphosis, which decreases the size of upper airway support. Such progressive change increases the risk of upper airway collapsibility during sleep. Clinical investigation of the oral cavity was conducted as a part of a clinical evaluation of children suspected of having sleep disordered breathing (SDB) based on complaints, symptoms and signs. Systematic polysomnographic evaluation followed the clinical examination. A retrospective analysis of 150 successively seen children suspected of having SDB was performed, in addition to a comparison of the findings between children with and without short lingual frenula. Among the children, two groups of obstructive sleep apnoea syndrome (OSAS) were found: 1) absence of adenotonsils enlargement and short frenula (n=63); and 2) normal frenula and enlarged adenotonsils (n=87). Children in the first group had significantly more abnormal oral anatomy findings, and a positive family of short frenulum and SDB was documented in at least one direct family member in 60 cases. A short lingual frenulum left untreated at birth is associated with OSAS at later age, and a systematic screening for the syndrome should be conducted when this anatomical abnormality is recognised.

https://openres.ersjournals.com/content/erjor/2/3/00043-2016.full.pdf

A frequent phenotype for paediatric sleep apnoea: short lingual frenulum.

Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility. A prospective cohort study of 1052 consecutive patients was evaluated during a 3-month period. Age, gender, ethnicity, height, weight, BMI, maximal interincisal mouth opening (MIO), mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP), Kotlow’s free-tongue measurement, and presence of severe tongue-tie were recorded. Secondary outcome measures include tongue range of motion deficit (TRMD, difference between MIO and MOTTIP) and tongue range of motion ratio (TRMR, ratio of MOTTIP to MIO). Results indicate that MIO is dependent on age and height; MOTTIP and TRMD are dependent on MIO; Kotlow’s free-tongue measurement is an independent measure of free-tongue length and tongue mobility. TRMR is the only independent measurement of tongue mobility that is directly associated with restrictions in tongue function. We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. “Functional” ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50–80%, grade 3 < 50%, grade 4 < 25%.

Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects.

Social support is pointed out by scholars from several areas as one of the factors able to protect and promote health. Current study constructs and validates, through factor analysis, the Perceived Social Support Scale (PSSS). The pilot version of the PSSS, composed of 29 items, was applied on 437 people - 72 men and 365 women - mean age 23.93 years. Factor analysis revealed the existence of two consistent factors which explained 47.33% of total variance. Factor 1 gathered 19 items related to practical support with Cronbach alpha 0.91, whereas factor 2 gathered 10 items related to emotional support with Cronbach alpha 0.92. Results provided evidences on PSSS as a bi-factorial scale, with two precise and consistent factors. It may be used as a diagnostic or research instrument.

/pdf/construccion-y-validacion-de-la-escala-de-percepcion-de-5e7q54w4th.pdf

Construcción y validación de la Escala de Percepción de Soporte Social

Lingual frenulum evaluation protocol for infants: relationship between anatomic and functional aspects/Protocolo de avaliacao do frenulo lingual para bebes: relacao entre aspectos anatomicos e funcionais

Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals. Objective : To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mother's complaints. Material and Methods : Oral yes/no questions about breastfeeding symptoms and sucking/swallowing/breathing coordination were answered by the mothers of 109, 30 day old infants. On the same day the infants had their lingual frenulum assessed by administering a lingual frenulum protocol. After the assessment, all tongue-tied infants were referred for frenotomy; nevertheless, only 14 underwent the surgery. Of the 109 infants, 14 infants who did not have frenulum alterations were included as controls. Birth order and gender were the criteria for recruiting the control group. The tongue-tied infants underwent lingual frenotomy at 45 days of age. At the conclusion of the frenotomy, the infants were breastfed. At 75 days old, both groups – control and post-frenotomy – were reassessed. Before the reassessment the same oral yes/no questions were answered by the mothers of the 14 infants who underwent frenotomy. The mothers of the control group answered the questionnaire only at the time of the first assessment. Data were subjected to statistical analysis. Results : After frenotomy, the number of sucks increased and the pause length between sucking decreased during breastfeeding. The controls maintained the same patterns observed in the first assessment. From the questionnaire answered by the mothers of the 14 tongue-tied infants, at 30 days and 75 days, we observed that the symptoms concerning breastfeeding and sucking/swallowing/breathing coordination were improved after lingual frenotomy Conclusions : after lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy.

/pdf/the-effects-of-frenotomy-on-breastfeeding-rzoyelz24t.pdf

The effects of frenotomy on breastfeeding

RESUMO Objetivo: verificar as propriedades psicometricas de validade e confiabilidade, bem como a sensibilidade, especificidade e valores preditivos da Triagem Neonatal proposta a partir do Protocolo de Avaliacao do Frenulo da Lingua em Bebes. Metodos: estudo experimental retrospectivo, utilizando os dados de 100 bebes. Os bebes foram avaliados nas primeiras 48 horas por meio da triagem e com 30 dias utilizando o Protocolo de Avaliacao do Frenulo da Lingua em Bebes. As imagens e dados de todos os bebes foram coletados pela fonoaudiologa (A1) e analisados pela fonoaudiologa (A2). Os casos com alteracao do frenulo foram submetidos a frenotomia, reavaliados 30 dias apos o procedimento e acompanhados ate o 6o mes. Os dados foram utilizados para as etapas de validacao: analise de concordância entre examinadores; analise de concordância intra-examinador; validade de criterio; analise da validade de construto; analise de sensibilidade, especificidade, valores preditivos positivo e negativo. Os dados foram submetidos ao tratamento estatistico. O estudo foi aprovado pelo Comite de Etica em pesquisa sob o numero CAAE 40784315.9.0000.5538. Resultados: a Triagem Neonatal identificou os bebes com alteracao do frenulo e as mudancas ocorridas apos a frenotomia e apresentou bons indices de sensibilidade, especificidade e valores preditivos. A confiabilidade entre e intra-examinadores permite afirmar que os dados obtidos com a triagem sao confiaveis e podem ser reproduzidos. Conclusao: a Triagem Neonatal do Protocolo de Avaliacao do Frenulo da Lingua em Bebes mostrou ser um instrumento valido e confiavel, assegurando acuracia no diagnostico das alteracoes do frenulo lingual em bebes.

/pdf/validade-e-confiabilidade-da-triagem-teste-da-linguinha-w3xnkbziro.pdf

Validade e confiabilidade da triagem: "teste da linguinha"

A face humana, com suas estruturas osseas e musculares, apresenta caracteristicas proprias e peculiares. Pode ser classificada em tres tipos basicos, os quais tem relacao com a variacao do formato e da configuracao craniofacial, tanto no sentido vertical como no horizontal e influenciam diretamente a oclusao dentaria, harmonia facial, musculatura orofacial e funcoes estomatognaticas. Por essa razao, diagnosticar o tipo facial e importante para a clinica fonoaudiologica. O objetivo deste estudo foi realizar uma revisao de literatura relacionada as caracteristicas dos tipos faciais e apresentar as pesquisas e os estudos mais recentes sobre o tema. Para atingir tal meta, fez-se um levantamento bibliografico nas bases de dados LILACS, SciELO, Web of Science e Google Academico, alem de livros, dissertacoes e teses sobre o assunto dos ultimos dez anos. Varias pesquisas em campo comprovaram algumas caracteristicas dos tipos faciais encontradas, principalmente, em referencias mais antigas. Alguns aspectos, porem, foram controversos ao se comparar os tipos faciais como a atividade eletromiografica do musculo masseter, modo respiratorio e o comprimento do labio superior e do filtro. Pode-se constatar que conhecer o tipo facial e correlaciona-lo as funcoes estomatognaticas, musculatura e oclusao e um fator importante para a pratica clinica, mas o profissional deve ser flexivel ao comparar as caracteristicas do paciente com a literatura. Dessa forma, pode-se evitar determinar uma anormalidade ou atipia quando nao for o caso, e ocorrer apenas uma variabilidade ou adaptacao.

/pdf/tipologia-facial-aplicada-a-fonoaudiologia-revisao-de-2bnhpn9l2e.pdf

Tipologia facial aplicada à Fonoaudiologia: revisão de literatura

Purpose to assess the anatomical characteristics of lingual frenulum in infants at first, sixth and twelfth months of life and compare the findings to the statements found in the literature. Methods video recordings of the lingual frenulum – normal or altered – of 71 infants, from both genders at the first, sixth and twelfth months of life were taken. The recordings were analyzed by two specialists in orofacial motricity who observed the following anatomical aspects: thickness, attachment to the tongue and attachment to the floor of the mouth. The data collected were compared to the literature. Results of the 71infants, the lingual frenulum of 51 infants was thin and 20 had thick lingual frenulum. 40 infants had the lingual frenulum attached to the middle of the tongue, 27 had the attachment between the apex and the middle of the tongue, and 4 to the apex. Concerning attachment to the floor of the mouth, the lingual frenulum of 42 infants was attached to the alveolar crest and 29 had the attachment between the sublingual caruncles. The characteristics of the lingual frenulum observed at the first, sixth and twelfth months of life remained the same. Conclusion contrary to what has been stated in the literature changes concerning lingual frenulum thickness, attachment to the tongue and to the floor of the mouth were not observed in the 71 infants during the first year of life. KEYWORDS : Lingual Frenulum; Anatomy; Tongue

/pdf/estudo-longitudinal-das-caracteristicas-anatomicas-do-1juzx584s7.pdf

Irene Queiroz Marchesan

Papers

Lingual frenulum evaluation protocol for infants: relationship between anatomic and functional aspects/Protocolo de avaliacao do frenulo lingual para bebes: relacao entre aspectos anatomicos e funcionais

The effects of frenotomy on breastfeeding

Validade e confiabilidade da triagem: "teste da linguinha"

Tipologia facial aplicada à Fonoaudiologia: revisão de literatura

Estudo longitudinal das características anatômicas do frênulo lingual comparado com afirmações da literatura