Yetişkin Hastada Şiddetli Ankiloglossinin Miyofrenuloplasti Tekniği ile Tedavisi: Olgu Sunumu

Öz

Ankiloglossi, anormal bir lingual frenulum ile karakterize olup, dil hareketlerini kısıtlayan ve konuşma, yutma ve çiğneme gibi oral fonksiyonları etkileyen bir durumdur. Genellikle doğuştan gelen bu anomali, bazen edinsel olarak da görülebilir ve Ehlers-Danlos veya Beckwith-Wiedemann gibi sendromlarla ilişkili olabileceği gibi izole bir bulgu olarak da ortaya çıkabilir. Doğru tanı, dilin klinik muayenesi ve fonksiyonel değerlendirilmesi ile konulmaktadır. Tedavi seçenekleri, hastanın yaşı ve durumun ciddiyetine bağlı olarak frenotomi, frenektomi, Z-plasti ve miyofrenuloplasti gibi çeşitli cerrahi teknikleri içermektedir. Bu çalışmada, şiddetli ankiloglossiye bağlı konuşma zorlukları yaşayan 25 yaşındaki bir kadın hastanın cerrahi tedavisi sunulmaktadır. Miyofrenuloplasti tekniği kullanılarak, anterior genioglossus kas liflerinin kısıtlayıcı etkisi hedef alınmış ve sublingual yapılar korunarak başarılı bir cerrahi müdahale gerçekleştirilmiştir. Ameliyat sonrası iyileşme sorunsuz ilerlemiş ve dil hareketliliğinde belirgin iyileşme sağlanmıştır. Hasta, fonksiyonel sonuçları artırmak ve postoperatif skar komplikasyonlarını önlemek amacıyla konuşma terapisine yönlendirilmiştir. Bu vaka, anatomik ve fonksiyonel değerlendirmelere dayalı uygun cerrahi teknik seçiminin önemini vurgulamaktadır. Ayrıca, postoperatif rehabilitasyonun konuşma terapisi ile entegre edilmesi, sonuçların optimize edilmesi ve uzun vadeli başarının sağlanması açısından kritik öneme sahiptir.

Anahtar Kelimeler

• ankiloglossi
• lingual frenektomi
• miyofrenuloplasti

Treatment of Severe Ankyloglossia in an Adult Patient Using the Myofrenuloplasty Technique: a Case Report

Abstract

Ankyloglossia, characterized by an abnormal lingual frenulum, is a condition that restricts tongue mobility and impacts oral functions such as speech, swallowing, and chewing. This congenital anomaly, occasionally acquired, may present as an isolated finding or in association with syndromes like Ehlers-Danlos or Beckwith-Wiedemann. Proper diagnosis requires clinical examination and functional assessment of the tongue. Various surgical techniques, including frenotomy, frenectomy, Z-plasty, and myofrenuloplasty, are utilized depending on the severity and age of the patient. This study presents the case of a 25-year-old female with severe ankyloglossia causing speech difficulties. A detailed surgical intervention using the myofrenuloplasty technique was performed, targeting the restrictive anterior genioglossus fibers while preserving sublingual structures. Postoperative recovery was uneventful, with significant improvement in tongue mobility. The patient was subsequently referred for speech therapy to enhance functional outcomes and prevent postoperative scarring complications. This case underscores the importance of selecting appropriate surgical techniques based on anatomical and functional assessments. Furthermore, integrating postoperative rehabilitation with speech therapy is essential for optimizing outcomes and ensuring long-term success in ankyloglossia management.

Keywords

• ankyloglossia
• lingual frenectomy
• miofrenuloplasty

References

1. Mills N, Pransky SM, Geddes DT, et al. What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clin Anat. 2019; 32: 749-61.
2. Mills N, Keough N, Geddes DT, et al. Defining the anatomy of the neonatal lingual frenulum. Clin Anat. 2019; 32: 824-35.
3. Hill RR, Lee CS, Pados BF. The prevalence of ankyloglossia in children aged <1 year: a systematic review and meta-analysis. Pediatr Res. 2021; 90: 259-66.
4. Tsaousoglou P, Topouzelis N, Vouros I, et al. Diagnosis and treatment of ankyloglossia: A narrative review and a report of three cases. Quintessence Int. 2016; 47: 523-34.
5. Yousefi J, Tabrizian Namini F, Raisolsadat SM, et al. Tongue-tie repair: Z-plasty vs simple release. Iran J Otorhinolaryngol. 2015; 27: 127-35.
6. Brookes A, Bowley DM. Tongue tie: the evidence for frenotomy. Early Hum Dev. 2014; 90: 765-8.
7. Pompéia LE, Ilinsky RS, Ortolani CLF, et al. Ankyloglossia and its influence on growth and development of the stomatognathic system. Rev Paul Pediatr. 2017; 35: 216-21.
8. Khairnar M, Pawar B, Khairnar D. A novel surgical pre-suturing technique for the management of ankyloglossia. J Surg Tech Case Rep. 2014; 6: 49-54.

9. Chinnadurai S, Francis DO, Epstein RA, et al. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics. 2015; 135: E1467-74.
10. Kotlow LA. Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence Int. 1999; 30 :259-62.
11. Becker S, Brizuela M, Mendez MD. Ankyloglossia (Tongue-Tie). In: StatPearls. StatPearls Publishing, 2023.
12. Bargiel J, Gontarz M, Gąsiorowski K, et al. Miofrenuloplasty for full functional tongue release in ankyloglossia in adults and adolescents-preliminary report and step-by-step technique showcase. Medicina (Kaunas). 2021; 57: 848.
13. González Garrido MDP, Garcia-Munoz C, Rodríguez-Huguet M, et al. Effectiveness of myofunctional therapy in ankyloglossia: a systematic review. Int J Environ Res Public Health. 2022; 19: 12347.
14. Oganyan S, Khamidova M, Davtyan A, et al. Comparative analysis of methods for surgical treatment of ankyloglossia: a review article. Open Dent J. 2023; 16: 65-75.
15. O’Connor-Reina C, Rodriguez Alcala L, Bosco G, et al. Clinical consequences of ankyloglossia from childhood to adulthood: support for and development of a three-dimensional animated video. Int J Orofac Myol Myofunctional Ther. 2025; 51: 5.
16. Srinivasan A, Al Khoury A, Puzhko S, et al. Frenotomy in infants with tongue-tie and breastfeeding problems. J Hum Lact. 2019; 35: 706-12.
17. Ghaheri BA, Cole M, Mace JC. Revision lingual frenotomy improves patient-reported breastfeeding outcomes: a prospective cohort study. J Hum Lact. 2018; 34: 566-74.
18. Varadan M, Chopra A, Sanghavi AD, et al. Etiology and clinical recommendations to manage the complications following lingual frenectomy: a critical review. J Stomatol Oral Maxillofac Surg. 2019; 120: 549-53.