Tongue-tie Repair: Z-Plasty Vs Simple Release

Document Type: Original

Authors

1 Department of Pediatric Surgery, 22 Bahman Hospital, Islamic Azad University of Mashhad, Mashhad, Iran.

2 Clinical Fellow, Program in Global Surgery and Social Change, Boston Children’s Hospital, Harvard Medical School, Boston, USA.

3 Family physician, 22 Bahman Hospital, Islamic Azad University of Mashhad, Mashhad, Iran.

4 Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, USA.

Abstract

Introduction:
Ankyloglossia is a congenital anomaly in which the lingual frenulum is unusually short and thick, thus decreasing tongue mobility. In the context of the newborn or young infant it is a subject of ongoing controversy within and between medical specialties. The controversy involves not only the definition but also the management of this anomaly. A tight lingual frenulum is considered a minor malformation by some investigators. Usual treatments for ankyloglossia include speech therapy, as well as simple frenulotomy and frenuloplasty. The aim of this study was to compare the latter two methods with respect to postoperative results and complications.
Materials and Methods:
A total of 50 patients referred for surgical care were randomly assigned into two groups: simple release (frenulotomy ) or Z-plasty (frenuloplasty), and underwent a pre-surgical assessment. After 3 months, patients were followed with a scheduled interview and questionnaire comparing the outcomes of the two methods. The data were analyzed using SPSS version 18.
Results:
Surgery had a significant effect on all variables measured in our study (P<0.05). Z-plasty had a greater effect on articulation, breast pain, tongue movement and parent satisfaction than simple release (P<0.05). Z-plasty and simple release had the same effect on breast feeding, latching, and sucking.
Conclusion: 
Z-plasty is the preferred surgical method to address tongue-tie due to a greater improvement in mother’s breast pain, pronunciation and speech, tongue movement, and parental satisfaction.

Keywords

Main Subjects


1. Messner AH, Lalakea ML, Aby J, Macmahon J, Bair  E. Ankyloglossia: incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000; 126(1):36–9.

2. Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician 2007; 53(6):1027–33.

3. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol 2000; 54(2–3):123–31.

4. Griffiths M, Westcott C, Hogan M. A randomized controlled trial of division of tongue-tie in infants with feeding problems. Journal of Paediatrics and Child Health2005; 41(5-6):246–50.

5. Edmunds J, Miles SC, Fulbrook P. Tongue-tie and breastfeeding: a review of the literature. Breastfeed Rev 2011; 19(1):19–26.

6. Brinkmann S, Reilly S, Meara JG. Management of tongue-tie in children: A survey of pediatric surgeons in Australia.Journal of Paediatrics and Child Health 2004; 40(11): 600–5.

7.  Han SH, Kim MC, Choi YS, Lim JS, Han KT. A Study on the Genetic Inheritance of Ankyloglossia Based on Pedigree Analysis. Arch Plast Surg 2012; 39(4):329-32.

8. Pauws E, Moore GE, Stanier P. A functional haplotype variant in the TBX22 promoter is associated with cleft palate and ankyloglossia. J Med Genet 2009; 46:555–61.

9. Morowati S, Yasini M, Ranjbar R, Peivandi AA, Ghadami M. Familial ankyloglossia (tongue-tie): a case report. Acta Med Iran. 2010; 48(2):123–4.

10. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002; 110:e63.

11. Wright JE. Tongue-tie. Journal of Paediatrics and Child Health 1995; 31: 276–8.

12.  Berry J, Griffiths M, Westcott C. A Double-Blind, Randomized, Controlled Trial of Tongue-Tie Division and Its Immediate Effect on Breastfeeding 2012; 7(3): 189–95.

13. Fitz-Desorgher R. All tied up-tongue tie and its implications for breastfeeding. Pract Midwife 2003; 6(1)20–2.

14. Community Pediatrics Committee. Canadian Pediatric Society position statements: ankyloglossia and breastfeeding. J Paediatr Child Health 2002; 7: 269-70.

15. Amir LH, James JP, Kelso G, Moorhead AM. Accreditation of midwife lactation consultants to perform infant tongue-tie release. Int J Nurs Pract. 2011; 17(6):541–7.

16. Klockars T, Pitkäranta A. Pediatric tongue-tie division: indications, techniques and patient satisfaction. Int J Pediatr Otorhinolaryngol 2009; 73(10):1399–401.

17. Kupietzky A, Botzer E. Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management. Pediatr Dent 2005; 27(1):40–6.

18. Hazelbaker AK. The Assessment Tool for Lingual Frenulum Function (ATLFF): Use in a Lactation Consultant Private Practice. Pasadena, CA: Pacific Oaks College; 1993. Thesis.

19. Amir LH. James JP. Donath SM. Reliability of the Hazelbaker Assessment Tool for Lingual Frenulum Function. Int Breastfeed J. 2006;1:3 20. 20. Obladen M. Much ado about nothing: two millennia of controversy on tongue-tie. Neonatology 2010; 97(2):83–9.

21. Choi YS, Lim JS, Han KT, Lee WS, Kim MC. Ankyloglossia correction: Z-plasty combined with genioglossus myotomy. J Craniofac Surg 2011; 22(6): 2238–40.

22. Kotlow L. Diagnosis and treatment of ankyloglossia and tied maxillary fraenum in infants using Er: YAG and 1064 diode lasers. Eur Arch Paediatr Dent 2011; 12(2):106–12.

23. Glynn RW, Colreavy M, Rowley H, Gendy S. Division of tongue tie: Review of practice through a

tertiary paediatric otorhinolaryngology service. Int J Pediatr Otorhinolaryngol. 2012; 76(10):1434–6.

24. Miranda BH, Milroy CJ. A quick snip - A study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. J Plast Reconstr Aesthet Surg. 2010; 63(9):e683–5.

25. Kumar M, Kalke E. Tongue-tie, breastfeeding difficulties and the role of Frenotomy. Acta Paediatr 2012; 101(7): 687–9.

26. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg 2002; 127(6):539–45.