title: Improved ankyloglossia correction with four-flap Z-frenuloplasty.
abstract: Ankyloglossia, or tongue-tie, is the result of a short, tight, lingual frenulum causing tethering of the tongue tip. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this study, we evaluated the treatment of patients greater than 3 years of age with persistent articulation problems related to ankyloglossia (n = 16). All patients underwent surgical correction either via a novel application of the 4-flap Z-frenuloplasty (n = 11) or via the more traditional horizontal-to-vertical frenuloplasty (n = 5). Frenulum length, tongue protrusion length, and speech evaluations (4-grade scaling) were documented preoperatively and at follow-up. For the 4-flap Z-frenuloplasty, 91% of patients showed at least 2 orders of improvement in speech, 64% showed complete resolution of articulation errors, and 9% demonstrated no improvement in speech. Frenulum length and tongue protrusion gained 37.5 +/- 13.5 mm (P < 0.001) (315% increase) and 36.2 +/- 7.6 mm (P < 0.001), respectively. In contrast, with the horizontal-to-vertical frenuloplasty, only 40% showed 1 order of improvement in speech, and 60% had no change in articulation. Frenulum length and tongue protrusion gained 11.2 +/- 4.15 mm (98% increase) and 13.2 +/- 2.6 mm (P = 0.0003), respectively. Our data indicated that the 4-flap Z-frenuloplasty was superior to the horizontal to vertical frenuloplasty with respect to tongue lengthening, protrusion, and articulation improvement for patients with symptomatic ankyloglossia.
authors.affiliation: Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Heller
authors.forename: Joubin
authors.initials: J
authors.lastname: Gabbay
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Hara
authors.forename: Misha
authors.initials: M
authors.lastname: Heller
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D002648:Child; D002675:Child, Preschool; D004401:Dysarthria / Q000209:etiology; D005260:Female; D006801:Humans; D008035:Lingual Frenum / Q000002:abnormalities / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014060:Tongue Diseases / Q000150:complications / Q000151:congenital / Q000601:surgery*