Beruflich Dokumente
Kultur Dokumente
Volume2014(2014),ArticleID871460,6pages
http://dx.doi.org/10.1155/2014/871460
Case Report
Abstract
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INTRODUCTION
Etymologically, ankyloglossia originates from the Greek words agkilos (curved) and
glossa (tongue). The same term is used for very different clinical situations: When the
tongue is fused to the floor of the mouth, but also if the lingual frenulum is only short and
thick with slight impairment of tongue mobility. The first use of the term ankyloglossia in the
medical literature dates back to the 1960s, when Wallace[1] defined tongue-tie as a
condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth
because of a short frenulum linguae, often containing scar tissue.
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CASE REPORT
A 24-year-old male was reported in the department of Periodontics with difficulty in speech
since birth. The ENT and general physical examination was normal. On intraoral
examination, it was found that the individual had ankyloglossia (tongue-tie) and was
classified as Class III by utilizing Kotlow's assessment [Figure 1] and was able to protrude
the tongue up to the lower lip [Figure 2]. There were no malocclusion and recession present
lingual to mandibular incisors. The patient was undertaken for a frenectomy procedure under
local anesthesia with 2% lignocaine hydrochloride and 1:80,000 adrenaline by using a scalpel
method; first a curved hemostat was inserted to the bottom of the lingual frenum at the depth
of the vestibule and clamped into position followed by giving two incisions at the superior
and the inferior aspect of the hemostat. This way, we removed the intervening frenum and got
a diamond shaped wound. Then with the help of the same hemostat, we released the muscle
fibers so as to achieve a good tension free closure of the wound edges [Figures
[Figures33 and and4]4] after which the wound edges were approximated with (4-0) black
braided silk sutures [Figure 5] for the tissues to heal by primary intention thereby minimizing
the scar tissue formation, antibiotic Cap. Amoxicillin (500 mg) thrice a day for 3 days and
non-steroidal anti-inflammatory drug Tab. Ketorolac DT (10 mg) thrice a day for 3 days was
prescribed to prevent post-operative infection and pain. The post-operative period was
uneventful with no delayed hemo-rrhage. Sutures were removed after 1 week [Figure 6]
which showed no scar tissue formation following which the patient was sent for speech
therapy sessions. After a follow-up of 6 months, the tongue showed good healing [Figure 7],
protrusion several mm beyond the lower lip [Figure 8], and normal speech.
Figure 1
Pre-operative view showing ankyloglossia
Figure 2
Pre-operative view showing extension of tongue
Figure 3
Frenectomy incision using scalpel
Figure 4
Completion of frenectomy
Figure 5
Sutures
Figure 6
Post-operative view 1 week
Figure 7
Post-operative view 6 months
Figure 8
Post-operative view 6 months showing adequate extension of tongue
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DISCUSSION
Ankyloglossia is an uncommon congenital oral anomaly that can cause difficulty with breastfeeding, speech articulation.[2] For many years, the subject of ankyloglossia has been
controversial with practitioners of many specialties having widely different views regarding
its significance and management. In many individuals, ankyloglossia is asymptomatic; the
condition may resolve spontaneously or affected individuals may learn to compensate
adequately for their decreased lingual mobility. Some individuals, however, benefit from
surgical intervention frenotomy, frenectomy or frenuloplasty for their tongue-tie. Patients
should be educated about the possible long-term effects of tongue-tie so that they may make
an informed choice regarding possible therapy.[2,3] The prevalence of ankyloglossia reported
in the literature varies from 0.1% to 10.7%. The prevalence is also higher in studies[4]
i.e., removal of the whole frenulum. Frenuloplasty involves various methods to release the
tongue-tie and correct the anatomic situation. There is no sufficient evidence in the literature
concerning surgical treatment options for ankyloglossia to favor any one of the three main
techniques.
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CONCLUSION