Ankyloglossia (tongue ties and lip ties) Flashcards
What is the lingual frenum?
A dynamic structure formed by a central fold of fascia that spans the floor of the mouth and together with the overlying oral mucosa it forms the roof of the sublingual space, the fascia connects around the anterior and lateral ventral surfaces of the tongue to stabilize the tongue position.
What is ankyloglossia?
Restricted movement of the tongue causing functional limitations accompanied by a visually restricted lingual frenum.
Which disorders can affect feeding early in life?
Congenital abnormalities: metabolic disorders, neurological disorders, syndromes, premature birth, and conditions such as cleft lip and palate
Oral dysfunctions: Weak rooting and sucking reflexes, inverted lip position, biting patterns, excessive oral tension and altered tongue position
Miscellanious: Natal or neonatal teeth, use of orogastric or nasogastric tubes
How is breastfeeding affected by ankyloglossia?
High prevalence of nipple pain for mothers whose infant has ankyloglossia (36 - 80%)
80% of tongue-tied infants were breast-feeding normally within one week
What is the recommendation for parents when breastfeeding their children?
breastfeeding for 6 months and then breastfeeding with complementary foods until 2 years.
How common is bottle feeding in babies with tongue ties?
Tongue-tied babies were 3 times as likely as non to be bottlefed
What is the hazelbaker assessment tool?
The hazelbaker assessment tool for lingual frenulum function. Has a moderate reliability when assessing breastfeeding problems.
It is used to quantify the risk of ankyloglossia negatively impacting on breastfeeding
What features are looked at when assessing ankyloglossia via the hazelbaker assessment tool?
Lateralization
Lift of the tongue
Extension of the tongue
Spread of anterior tongue
Cupping
Peristalsis
Snapback
What assessment tools are used for lingual frenum assessment?
Hazelbaker
Tongue-tie and breastfed babies (TABBY)
What assessment tools are used for breastfeeding?
The latch system helps in documenting the breastfeeding (looks at breastfeeding session)
infant breastfeeding assessment tool (looks at sucking and biting motion of the child)
How do paediatricians and otolaryngologists feel about the connections between ankyloglossia and breastfeeding problems?
90% of paediatricians and 70% of otolaryngologists opined that ankyloglossia never or rarely causes breastfeeding problems (In a 2000 study by Messner and lalakea)
How should ankyloglossia managed?
As conservatively as possible.
Surgical management through frenotomy and frenectomy
How should ankyloglossia be diagnosed?
Anatomical appearance of oral frena can demonstrate variability without functional issues. Shouldn’t be based entirely on anatomic appearance. Pre-requisites for diagnosis are:
Thorough case history
Objective functional assessment of tongue function using a diagnostic system
Complete assessment of functional issues impacted by suspected ankyloglossia by a qualified professional.
What is posterior ankyloglossia and is it reliably proven to exist?
A condition where lingual frenulum is not entirely prominent on inspection but thought to be tight on manual palpation or abnormally prominent, short, thick, or cord-like with the use of a grooved director.
it’s been poorly defined and associated with higher rates of surgical revision(i.e used to justify surgery)
What is a maxillary lip tie?
High labial frenal attachment
This attachment is right, restricts upper lip movement and can attach really high at the incisive papilla and can cause midline diastema to form.
This is known as a maxillary or upper lip tie.
