Approach to Lingual Frenulum in Children at a Baby-Friendly University Hospital

Öz

Aim: Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that restricts the mobility of the tongue tip. Frenotomy is the primary treatment method for ankyloglossia. The aim of this study is to share our experiences with patients aged 0-18 years who underwent frenotomy for ankyloglossia in our clinic between 2012 and 2022. Material and Methods: A total of 164 patients who underwent frenotomy between 2012 and 2022 at the Department of Pediatric Surgery, Faculty of Medicine, Gazi University, were included in this study. The classification and treatment of tongue-tie were based on the Ferres- Amat classification. Patients were evaluated based on age, gender, presenting complaints, degree of tongue-tie, and surgical procedures. Additionally, the gender distribution and grade classification of tongue-tie patients were analyzed according to age groups, and the differences in grade distribution among different age groups were compared Results: In our baby-friendly hospital, 164 patients, the majority of whom were referred to our clinic by breastfeeding and speech therapy clinics with tongue-tie complaints, underwent frenotomy. The patients presenting to our center with complaints of tongue-tie are 74.4% under one year of age, and 64.6% male. The primary complaint in infants under one year of age was difficulty in sucking while breastfeeding, while in children over one year of age, it was speech disorder. Conclusion: The frenotomy procedure was typically performed by our physicians using a straight clamp to crush the frenulum, followed by excision with scissors. In some cases, bipolar cautery was required for hemostasis. Contrary to the complication rates mentioned in the literature, only two of our operated patients experienced burns on the lower lip due to bipolar cautery contact, and appropriate wound care was provided. Following the procedures performed in our clinic, complaints decreased in patients who presented with breastfeeding problems, sucking and weight gain were achieved, and at the very least, maternal anxiety was alleviated

Anahtar Kelimeler

• Ankyloglossia
• Frenotomy
• Tongue tie
• Breastfeeding
• Speech Therapy

Bebek Dostu Bir Üniversite Hastanesinde Çocuklarda Dil Altı Bağına Yaklaşım

Öz

Amaç: Ankiloglossi, dil ucu hareketliliğini kısıtlayan, dil bağı olarak da bilinen konjenital bir oral anomalidir. Frenotomi işlemi başlıca tedavi yöntemi olarak uygulanmaktadır. Bu çalışmamızın amacı; 2012-2022 yılları arasında kliniğimizde ankiloglossi tanısı ile frenotomi işlemi uygulanan 0-18 yaş arası hastalardaki deneyimlerimizi paylaşmaktır. Gereç ve Yöntemler: Çalışmaya 2012-2022 yılları arasında kliniğimizde frenotomi yapılmış olan toplam 164 hasta dahil edilmiştir. Dil bağının sınıflaması ve tedavisi Ferres -Amat klasifikasyonuna göre yapılmıştır. Hastalar yaş, cinsiyet, başvuru şikâyetleri, dil bağı derecesi ve cerrahi prosedürleri dikkate alınarak değerlendirilmiştir. Ayrıca dil bağı hastalarının yaş gruplarına göre cinsiyet dağılımı ve evreleri incelenmiş, farklı yaş gruplarındaki evre dağılımlarının karşılaştırması yapılmıştır. Bulgular: Bebek dostu hastanemizde çoğunluğu yenidoğan polikliniği, emzirme destek merkezi relaktasyon ünitesi, dil ve konuşma terapisi bölümü tarafından kliniğimize dil altı bağı nedeniyle yönlendirilmiş olan 164 hastaya frenotomi operasyonu uygulanmıştır. Bu hastaların %74,4’ü bir yaş altı, %64,6'sı erkek çocuklardan oluşmaktadır. Asıl şikayet bir yaş altı bebeklerde emme güçlüğü, bir yaş üstü çocuklarda konuşma bozukluğu olduğu tespit edilmiştir. Sonuç: Frenotomi işlemi merkezimiz hekimleri tarafından genellikle düz klemp yardımı ile frenulumun ezilmesinin ardından makasla eksize ederek yapılmıştır. Bazı vakalarda ise hemostaz için bipolar koter gereksinimi olmuştur. Literatürde bahsedilen komplikasyon oranlarının aksine opere edilen iki hastada alt dudakta bipolar koter temasına bağlı yanık meydana gelmiş ve gerekli yara yeri bakımı yapılmıştır. Kliniğimizde yapılan işlemler sonrasında emzirme sorunlarıyla gelen hastaların takiplerinde şikâyetler azalmış, emme ve kilo alımı sağlanmış ve en azından annelerin kaygıları giderilmiştir

Anahtar Kelimeler

• Ankiloglossi
• frenotomi
• dil bağı
• emzirme
• konuşma terapisi

Etik Beyan

Etik Kurul Onamı: Gazi Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (Karar no:783, tarih: 24.10.2022).

Kaynakça

1. 1. 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(2):259-66. https://doi.org/10.1038/ s41390-020-01239-y
2. 2. Bruney TL, Scime NV, Madubueze A, Chaput KH. Systematic review of the evidence for resolution of common breastfeeding problems-Ankyloglossia (Tongue Tie). Acta Paediatr. 2022;111(5):940-47. https://doi.org/10.1111/apa.16289
3. 3. Zhao H, He X, Wang J. Efficacy of Infants Release of Ankyloglossia on Speech Articulation: A Randomized Trial. Ear Nose Throat J. 2022:1455613221087946. https://doi. org/10.1177/01455613221087946
4. 4. Ellehauge E, Jensen JS, Grønhøj C, Hjuler T. Trends of ankyloglossia and lingual frenotomy in hospital settings among children in Denmark. Dan Med J. 2020;67(5):A01200051.
5. 5. Dell’Olio F, Baldassarre ME, Russo FG, et al. Lingual laser frenotomy in newborns with ankyloglossia: A prospective cohort study. Ital J Pediatr. 2022;48(1):163. https://doi.org/10.1186/ s13052-022-01357-9
6. 6. Jamani NA, Ardini YD, Harun NA. Three case reports of infants with ankyloglossia affecting breastfeeding. Med J Malaysia. 2020;75(4):439-41.
7. 7. Kelly Z, Yang CJ. Ankyloglossia. Pediatr Rev. 2022;43(8):473- 75. https://doi.org/10.1542/pir.2020-005108
8. 8. Auychai P, Neff A, Pitak-Arnnop P. Tongue-Tie children with a severe Hazelbaker score or difficult breastfeeding greatly benefit from frenotomy or frenuloplasty with/without anaesthesia - First do or do no harm? J Stomatol Oral Maxillofac Surg. 2022;123(3):e76-e81. https://doi.org/10.1016/j.jormas. 2021.09.007

9. 9. Cetinkaya M, Oz FT, Orhan AI, et al. Prevalence of oral abnormalities in a Turkish newborn population. Int Dent J. 2011;61(2):90-100. https://doi.org/10.1111/j.1875- 595X.2011.00020.x
10. 10. Khan U, MacPherson J, Bezuhly M, Hong P. Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review. Otolaryngology- Head and Neck Surgery. 2020;163(3):428-43. https://doi. org/10.1177/0194599820917619
11. 11. Costa-Romero M, Espínola-Docio B, Paricio-Talayero JM, Díaz-Gómez NM. Ankyloglossia in breastfeeding infants. An update. Arch Argent Pediatr. 2021;119(6):e600-e609. https:// doi.org/10.5546/aap.2021.eng.e600
12. 12. Ferrés-Amat E, Pastor-Vera T, Ferrés-Amat E, Mareque-Bueno agement of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Med Oral Patol Oral Cir Bucal. 2016;21(1):e39-47. https://doi.org/10.4317/medoral.20736
13. 13. Shekher R, Lin L, Zhang R, et al. How to Treat a Tonguetie: An Evidence-based Algorithm of Care. Plast Reconstr Surg Glob Open. 2021;9(1):e3336. https://doi.org/10.1097/ GOX.0000000000003336
14. 14. O’Shea JE, Foster JP, O’Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017;3(3):CD011065. https://doi.org/10.1002/14651858. CD011065.pub2
15. 15. Barberá-Pérez PM, Sierra-Colomina M, Deyanova-Alyosheva N, Plana-Fernández M, Lalaguna-Mallada P. Prevalence of ankyloglossia in newborns and impact of frenotomy in a Baby- Friendly Hospital. Bol Med Hosp Infant Mex. 2021;78(5):418- 23. https://doi.org/10.24875/BMHIM.20000391
16. 16. Karabulut R, Sönmez K, Türkyilmaz Z, et al. Ankyloglossia and effects on breast-feeding, speech problems and mechanical/ social issues in children. B-ENT. 2008;4(2):81-5.
17. 17. Ata N, Alataş N, Yılmaz E, Adam AB, Gezgin B. The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia. Ear, nose, & throat journal, 2021;100(3):NP158-NP160. https://doi. org/10.1177/0145561319867666
18. 18. Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S, McPheeters M. Treatment of ankyloglossia for reasons other than breastfeeding: A systematic review. Pediatrics. 2015;135(6):e1467-74. https://doi.org/10.1542/peds.2015- 0660
19. 19. Wen Z, Walner DL, Popova Y, Walner EG. Tongue-tie and breastfeeding. Int J Pediatr Otorhinolaryngol. 2022;160:111242. https://doi.org/10.1016/j.ijporl.2022.111242
20. 20. Jensen D, Wallace S, Kelsay P. LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs. 1994;23(1):27-32. doi:10.1111/j.1552-6909.1994. tb01847.x
21. 21. Bhandarkar KP, Dar T, Karia L, Upadhyaya M. Post Frenotomy Massage for Ankyloglossia in Infants-Does It Improve Breastfeeding and Reduce Recurrence? Matern Child Health J. 2022;26(8):1727-31. https://doi.org/10.1007/s10995-022- 03454-x
22. 22. Kim TH, Lee YC, Yoo SD, Lee SA, Eun YG. Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: A prospective randomized study. Int J Pediatr Otorhinolaryngol. 2020;136:110146. https://doi.org/10.1016/j.ijporl.2020.110146
23. 23. Rajain T, Tsomu K, Saini N, Namdev R. Lingual Frenuloplasty for Ankyloglossia in Children: A Case Series. Contemp Clin Dent. 2021;12(4):447-50. https://doi.org/10.4103/ccd. ccd_660_20 J, Prats-Armengol J, Ferrés-Padró E. Multidisciplinary man