Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases

Abstract

Background Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer‐reviewed evidence. Here, we explore the safety and efficacy of lingual frenuloplasty and myofunctional therapy for the treatment of these conditions in a large and diverse cohort of patients with restricted tongue mobility. Methods Four hundred twenty consecutive patients (ages 29 months to 79 years) treated with myofunctional therapy and lingual frenuloplasty for indications of mouth breathing, snoring, dental clenching, and/or myofascial tension were surveyed. All procedures were performed by a single surgeon using a scissors and suture technique. Safety and efficacy was assessed >2 months postoperatively by means of patient‐reported outcome measures. Results In all, 348 surveys (83% response rate) were completed showing 91% satisfaction rate and 87% rate of improvement in quality of life through amelioration of mouth breathing (78.4%), snoring (72.9%), clenching (91.0%), and/or myofascial tension (77.5%). Minor complications occurred in <5% of cases including complaints of prolonged pain or bleeding, temporary numbness of the tongue‐tip, salivary gland issues, minor wound infection or inflammation, and need for revision to excise scar tissue. There were no major complications. Conclusion Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates. Further studies with objective measures are merited. Level of Evidence 3

Tongue position for lingual frenulum assessment

“…The range in the lingual frenulum morphology is created by variabilityon a spectrum -of several factors 1,2 . Ankyloglossia is characterized by a restriction of tongue movements 1,3 .…”

“…Tongue movements are essential for the performance of orofacial functions. It must be highlighted that tongue elevation is needed for proper tongue rest posture, for adequate nasal breathing, swallowing and production of the sounds [t], [d], [n], [l] e [ɾ] 3,4 . An important aspect to remember is that protrusion of the tongue is not required for sucking, swallowing, breathing, chewing, and speaking.…”

Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study

“…14 Ankyloglossia has been linked to sleep difficulties and sleep apnea in children and adults. [15][16][17] A tongue-tie prevents the tongue from resting on the palate. This lack of tongue to palate suction, especially during sleep, allows the tongue to fall into the pharynx at night and restrict or obstruct the airway and leads to sleep-disordered breathing or sleep apnea.…”

“…This lack of tongue to palate suction, especially during sleep, allows the tongue to fall into the pharynx at night and restrict or obstruct the airway and leads to sleep-disordered breathing or sleep apnea. 17,18 In a recent systematic review, myofunctional therapy was shown to retrain the tongue to properly rest on the palate and prevent it from occluding the airway. 19 Children achieved a 62% decrease in the apnea-hypopnea index (AHI), and adults attained a 50% decrease in the AHI.…”

Lacking Consensus: The Management of Ankyloglossia in Children

“…Furthermore, studies left out of the CCS may have helped otolaryngologists understand the importance of tongue physiology, appreciate updated techniques and treatment protocols to achieve improved results, and better understand outcomes. 2-5…”