Abstract
Introduction and aim: Tongue-tie or ankyloglossia is a congenital anomaly characterized by a short lingual frenulum which can be defined as restriction of tongue movement and thus impact on function. The exact cause of ankyloglossia is unknown.
Prevalence varies in 7% of men and 4% of women. Tongue-tie is reported to be the cause of breastfeeding difficulties.
It also causes speech and articulation problems, can be one of the causes of poor oral hygiene and often does not allow the patient to play wind instruments. The aim of the study was to assess in the clinical, anatomical and histological image, the indication for the surgical procedure, and the possible invasiveness with respect to the following rehabilitation of tongue movement.
Material and methods: The group included 13 generally healthy patients with ankyloglossia - seven girls, and six boys - with mean age at the time of surgery of 8.3 years. An informed consent to participate in our study was signed in accordance with the Declaration of Helsinki.
The anonymity of the data obtained was strictly observed. Approval for the study was obtained from the Ethics Committee of the 2nd Medical Faculty of Charles University and the Motol University Hospital.
Tongue frenulectomy using a scalpel was always used for the procedure itself. Patients and parents were instructed on the type and nature of surgery in order to achieve the greatest possible cooperation.
Local anesthesia was applied, 1-2 ml of Supracain. The sublingual frenulum was then cut with a scalpel to release the tip of the tongue.
Soft tissues around the sublingual bridle were loosened and mobilized, and tongue mobility was checked. After wound revision and toilet, suturing was performed with absorbable material.
Results: Histological evaluation was performed using an optical microscope Olympus CH30. The type of superficial covering epithelium, its thickness (magnification 100x), the proportion of fibrosis, vascular and nerve structures, inflammatory elements and especially the presence of striated muscle were evaluated and calculated.
Conclusion: In the study it was clinically proven that the main indication for treatment were speech and articulation difficulties of older children. Tongue frenulectomy using a scalpel was clinically and histologically a very gentle method, the preschool age of the child was optimal, which already allowed easy rehabilitation of the fibrous scar.
As we have shown, the optimum is early surgery, followed by functional rehabilitation of the tongue and then by speech therapy. During the histological examination of a lingual frenulum we proved a presence of the squamous epithelium which can be also parakeratotic, fibrous tissue, striated muscle, nerves and blood vessels.