Lingual Frenulum: Changes After Frenectomy

Purpose: To describe the changes after frenectomy concerning mobility and functions of the tongue. Methods: Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. Results: Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. Conclusion: Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.244409412Suter, V.G.A., Ankyloglossia: facts and myths in diagnosis and treatment (2009) J Periodontol, 80 (8), pp. 1204-1219Hooda, A., Rathee, M., Yaday, S., Gulia, J., Ankyloglossia: a review of current status (2010) The Internet Journal of Otorhinolaryngology, 12 (2)Johnson, P.R.V., Tongue-tie - exploding the myths (2006) Infant, 2 (3), pp. 96-99Lee, H.J., Park, H.S., Park, B.S., Choi, J.W., Koo, S.K., The Improvement of tongue mobility and articulation after frenotomy in patient with ankyloglossia (2010) J Otorhinolaryngol Head Neck Surg, 53, pp. 491-496Hong, P., (2012) Ankyloglossia (tongue-tie), , Published ahead of print October 15. DOI:10.1503/cmaj.120785Marchesan, I.Q., Protocolo de avaliação do frênulo da lingual (2010) Rev CEFAC, 12 (6), pp. 977-989Darshan, H.E., Pavithra, P.M., Tongue tie: from confusion to clarity - a review (2011) Int J Den Clin, 3 (1), pp. 48-51Braga, L.A.S., Silva, J., Pantuzzo, C.L., Motta, A.R., Prevalência de alteração no frênulo lingual e suas implicações na fala de escolares (2009) Rev CEFAC, 11 (3), pp. 378-390Oredsson, J., Törngren, A., Frenotomy in children with ankyloglossia and breast-feeding problems A simple method seems to render good results (2010) Lakartidningen, 107 (10), pp. 676-678Knox, I., Tongue tie and frenotomy in the breastfeeding newborn (2010) Neoreviews, 11, pp. 513-519Ostapiuk, B., Tongue mobility in ankyloglossia with regard to articulation (2006) Ann Acad Med Stetin, 52 (3), pp. 37-47Marchesan, I.Q., Lingual frenulum: classification and speech interference (2004) Int J Orofacial Myology, 30, pp. 31-38Chaubal, T.V., Dixit, M.B., Ankyloglossia and its management (2011) J Indian Soc Periodontol, 15 (3), pp. 270-27

Clinical, Endoscopical And Manometric Evaluation Of Swallowing In Patients With Myasthenia Gravis [avaliação Clínica, Endoscópica E Manométrica Da Deglutição Em Pacientes Com Miastenia Grave Autoimune Adquirida]

Dysphagia, or difficulty swallowing, is a common problem following myasthenia gravis (MG) and may lead to aspiration of saliva, food or liquids. We herein present 22 MG patients, with complaint of dysphagia, evaluated by phonoaudiological evaluation, nasofibrolaryngoscopical analysis and manometry of upper esophageal sphincter. The main objective was to evaluate the phases of the swallowing process and anatomical and functional aspects of oropharyngeal musculature. The age of patients varied from 19 to 74 years; being 19 female and 3 male. The main data were: (1) statistically significant relation between the phonoaudiological clinical evaluation and nasofibrolaryngoscopical one; (2) stomatognatical system disorders present in 100%; (3) swallowing and chewing disorders present in 100%, when clinically evaluated, and in 81,8% when evaluated by the nasofibrolaryngoscopy; (4) Statistically significant relation between penetration/aspiration and antecedents of pneumonia; (5) stomatognatical muscles very altered, difficulty controlling the bolus, collection of food in the pharynx or larynx and presence of penetration and/or aspiration showed significant correlation with weakness of a pharyngeal muscles. These findings justify the necessity to evaluate clinically the swallowing phases in MG patients, with the main purpose to prevent both aspiration and dehidration from inadequate oral intake.604986995Osserman, K.E., Genkins, G., Studies in myasthenia gravis: Review of a twenty-year experience in over 1200 patients (1971) Mt Sinai J Med, 38, pp. 497-537Khan, O.A., Campbell, W.W., Myasthenia gravis presenting as dysphagia: Clinical considerations (1994) Am J Gastroenterol, 89, pp. 1083-1085Kahrilas, P.J., Anatomy, physiology and pathophysiology of dysphagia (1994) Acta Oto-rhino-laryngol Belg, 48, pp. 97-117Ertekin, C., Yuceyar, N., Aydogdu, I., Clinical and electrophysiological evaluation of dysphagia in myasthenia gravis (1998) J Neurol Neurosurg Psychatry, 65, pp. 848-856Huang, M.H., King, K.L., Chien, K.Y., Esophageal manometric studies in patients with myasthenia gravis (1988) J Thorac Cardiovasc Surg, 95, pp. 281-285Lorenz, R., Jorysz, G., Tornieporth, N., The gastroenterologist's approach to dysphagia (1993) Dysphagia, 8, pp. 79-82Buccholz, D.W., Dysphagia associated with neurological disorders (1994) Acta Oto-rhino-laringol Belg, 48, pp. 143-155Linden, P., Siebens, A.A., Dysphagia: Predicting laryngeal (1983) Arch Phys Med, 64, pp. 282-284Langmore, J.A., Schatz, K., Olsen, N., Fiberoptic endoscopic examination of swallowing safety: A new procedure (1988) Dysphagia, 2, pp. 216-219Ranieri, D.M., (1996) Da Nasofibrolaringoscopia Para Avaliação da Deglutição e Suas Disfunções em Pacientes com Doença Neurológica, , Tese de Mestrado, UNIFESP/EPM, São PauloOlsson, R., Castell, J., Ekberg, O., Castell, D.O., Videomanometry of the pharynx in dysphagic patients with laryngeal barium penetration during swallowing (1998) Acta Radi, 39, pp. 405-409Chiappetta, A.L.M.L., Oda, A.L., A atuação da fonoaudiologia em doenças neuromusculares (2001) Atuação Fonoadiológica no Ambiente Hospitalar, pp. 101-108. , Hernandez AM, Marchesan IQ. (Eds.). São Paulo: Editora RevinterMacedo-Filho, E.D., Avaliação endoscópica da deglutição no diagnóstico da disfagia orofaríngea (1998) Temas em Deglutição e Disfagia: Abordagem Multidisciplinar, pp. 77-82. , Costa MMB, Leme EMO, Koch HA (Eds.). Rio de Janeiro: PAEDDSears, V.W., Castell, J.A., Castell, D.O., Radial longitudinal asymmetry of human pharyngeal pressures swallowing (1991) Gastroenterology, 101, pp. 1559-1563Castell, J.A., Castell, D.O., The upper esophageal sphincter (1994) Esophageal Motility Testing, pp. 13-26. , Castell, D.O. e Castell, JA (Eds.). Norwalk: Appleton&LangeOda, A.L., Chiappetta, A.L.M.L., Annes, M., Oliveira, A.S.B., (2001) Análise Comparativa Entre Avaliação Fonoaudiológica e Queixa Referida por Pacientes com Miastenia Grave. Tema Livre Apresentado no Congresso Brasileiro de Fonoaudiologia, , Guarapari-ESBuchholz, D.W., Robbins, J., Neurologic diseases affecting oropharyngeal swallowing (1997) Deglutition and Its Disorders: Anatomy, Physiology, Clinical Diagnosis and Management, , Pearlman AL, Schulze-Delrieu K. (Eds.). New York: Singular Publishing Group IncWeijnen, F.G., Van der Bilt, A., Wokke, J.H., Kuks, J.B.M., Glas, H.W., Bosman, F., What's in a smile? Quantification of the vertical smile of patients with myasthenia gravis (2000) J Neurol Sci, 173, pp. 124-128Douglas, C.R., Patofisiologia oral (1998) Pancast, pp. 163-184Silva, R.G., Quais os critérios de classificação do grau de comprometimento das disfagias orofaríngeas? (2000) Tópicos em GastroenterologiaDeglutição e Disfagia, , Castro LP, Savassi-Rocha PR, Melo JRC, Costa MMC. (Eds.). São PauloMEDSIDouglas, C.R., Fisiologia da deglutição. Tratado de fisiologia aplicada às ciências da saúde (1994) São Paulo: Robe Editorial, pp. 895-910Willig, T.N., Paulus, J., Lacau Saint Guily, J., Beon, C., Navarro, J., Swallowing problems in neuromuscular disorders (1994) Arch Phys Med Rehabil, 75, pp. 1175-1181Kelly, J.H., Buchholz, D.W., Nutritional management of the patient with a neurologic disorder (1996) Ear Nose Throat, 75, pp. 293-300Carpenter, R.J., Mc Donald, T.J., Howard, F.M., The otolaryngologic presentation of myasthenia gravis (1979) Laryngoscope, 89, pp. 922-928Weijnen, F.G., Van Der Bilt, A., Wokke, J.H., Wassenberg, M.W., Oudenaarde, I., Oral functions of patients with myasthenia gravis (1998) Ann NY Acad Sci, 841, pp. 773-776St Guily, J.L., Périé, S., Willig, T.N., Chaussade, S., Eymard, B., Angelard, B., Swallowing disorders in muscular diseases functional assessment and indications of cricopharyngeal myotomy (1994) Ear Nose Throat, 73, pp. 34-40Manrique, D., (1998) Avaliação da Deglutição em Crianças com Paralisia Cerebral Tetraespáastica: Análise Nasofibrolaringoscópica, , Tese de Mestrado, UNIFESP. São PauloCosta, M.M.B., Moscovici, M., Pereira, A.A., Koch, H.A., Avaliação videofluoroscópica da transição faringo-esofágica (esfíncter superior do esôfago) (1993) Radiol Bras, 26, pp. 71-80Logemann, J.A., (1998) Evaluation and Treatment of Swallowing Disorders, , San Diego: College Hill PressJacob, P., Kahrilas, P.J., Logemann, J.A., Shah, V., Há, T., Upper esophageal sphincter opening and modulation during swallowing (1989) Gastroenterology, 97, pp. 1469-1478Martens, L., Cameron, T., Simonsen, M., Effects of a multidisciplinary management program on neurologically impaired patients with dysphagia (1990) Dysphagia, 5, pp. 147-15