Figures
- FIGURE 1
Measurement of the frenulum using the commercially available Quick Tongue Tie Assessment Kit (Neo Health Services Inc., Coconut Creek, FL, USA). a) Normal frenulum [9]; b) free tongue [7]. Complete clinical protocols for lingual frenulum investigations for infants [13] and children–adolescents [25] have been published.
- FIGURE 2
a–h) Examples of short frenula in children and teenagers. Consideration was given only to shortness of the frenulum and not difference in presentation of the frenulum. Histological studies have shown that different types of fibres may be present, depending on the individual. Short frenula were found in e) a 40-year-old mother and f) her 14-year-old daughter. The other subjects are aged 3–16 years. All subjects have obstructive sleep apnoea syndrome.
Tables
- TABLE 1
Demographic and clinical presentation of children with obstructive sleep apnoea syndrome with short and normal lingual frenula
Subjects Short frenulum Normal frenulum p-value Subjects 150 63 87 Age years mean±sd (n/N) 150 9.88±3.21 (63/150) 8.05±3.59 (87/150) 0.0015 Females 58 29/63 (46) 29/87 (33) 0.1288 Symptoms Fatigue 147 61/63 (96) 86/87 (98) 0.5725 EDS 73 35/63 (55) 38/87 (43) 0.1859 Inattention/hyperactivity 90 43/63 (68) 47/87 (54) 0.0926 Anatomy High and narrow palatal vault 63 56/70 (80) 7/80 (8.75) 0.0001 Friedman tonsil score 150 1.8±0.9 3.2±0.9 0.0001 Mallampati scale score 150 3.4±0.6 2.9±0.7 0.0001 Past medical history 150 Difficulty sucking 6 0 Difficulty swallowing 4 0 Speech problems 31 0 Data are presented as n, n/N (%) or mean±sd, unless otherwise stated. Feeding and swallowing difficulties were poorly recollected, except in a few cases where the problem was mentioned as “important”; the speech problems were better recalled and were described as “lisp”, “stutter” or having led to speech therapy, mostly in school (n=15). Despite speech therapy, the presence of a short lingual frenulum had not been investigated or mentioned to parents. EDS: excessive daytime sleepiness.
