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Between 1997 and 2012, the diagnoses of ankyloglossia and the indication for frenotomy increased by ˃800%. About 38% of diagnosed cases are surgically treated. Breastfeeding promotion includes evaluating maternal hereditary and personal history of breastfeeding, breast structure, endocrinological physiology, emotional well-being of the mother, breastfeeding technique, quality and quantity of milk, and the newborn's ability to latch on and suckle. Frenotomy would be indicated when restriction of tongue function causes difficulties that have not resolved after thorough evaluation and counseling to correct other causes. Frenotomy can have complications: feeding and respiratory difficulties, pain, weight loss, vascular or nerve damage, and delayed diagnosis of other underlying pathologies. It does not always solve breastfeeding difficulties. Interdisciplinary teamwork reduces the frequency of unnecessary frenotomies.

Entre 1997 y 2012 los diagnósticos de anquiloglosia y la indicación de frenotomía aumentaron ˃800 %. Alrededor del 38 % de los casos diagnosticados son intervenidos quirúrgicamente. La promoción de la lactancia materna incluye la evaluación de antecedentes hereditarios y personales maternos de lactancia, estructura mamaria, fisiología endocrinológica, equilibrio emocional de la madre, técnica de amamantamiento, calidad y cantidad de leche, capacidad del recién nacido de prenderse y succionar. La frenotomía estaría indicada cuando la restricción de la función lingual provoca dificultades que no se han resuelto luego de una evaluación exhaustiva y del asesoramiento para corregir otras causas encontradas. Las frenotomía puede tener complicaciones: problemas en la alimentación, respiratorios, dolor, pérdida de peso, daños vasculares o nerviosos, y retraso en el diagnóstico de otras patologías subyacentes. No siempre soluciona las dificultades de la lactancia. El trabajo en equipo interdisciplinario disminuye la frecuencia de las frenotomías innecesarias.

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Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

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ABSTRACT The goal is to present a clinical case of a baby diagnosed with ankyloglossia evaluated clinically and by surface electromyography, during bottle sucking before and after 15, 30 and 60 days of lingual frenotomy. Based on the anatomofunctional evaluation of the Tongue Frenulum Assessment Protocol in Babies, interference of the lingual frenulum was identified. The tongue, during sleep, was positioned on the floor of the mouth. The initial electromyographic evaluation of the suprahyoid muscles, during bottle feeding, showed asymmetry in root mean square (RMS) values, in microvolts (μV), between the right and left suprahyoid muscles. The evaluation was repeated after 15, 30 and 60 days after lingual frenotomy. After 15 days, appropriate lip and tongue posture, coordinated sucking movements, and absence of noises or choking were observed. After 30 days, symmetry was observed between the suprahyoid muscles, which was maintained 60 days after the surgical procedure. After lingual frenotomy, the adequacy of the position of lips and tongue, during rest and sleep, was reestablished within 15 days, and after 30 days of the procedure, there was adequacy of the tongue posture, during crying, and symmetry of the electromyographic activity of the suprahyoid muscles, during sucking. The results were maintained until the end of the study.

RESUMO O objetivo é apresentar um caso clínico de um bebê diagnosticado com anquiloglossia, avaliado clinicamente e por eletromiografia de superfície na sucção de mamadeira antes e após 15, 30 e 60 dias da frenotomia lingual. Baseado na avaliação anatomofuncional do Protocolo de Avaliação do Frênulo da Língua em Bebês, identificou-se interferência do frênulo lingual. A língua, durante o sono, apresentava-se no assoalho da boca. A avaliação eletromiográfica inicial dos músculos supra-hioideos, na sucção por mamadeira, mostrou assimetria no root mean square (RMS), em microvolts (μV), entre os músculos supra-hioideos direitos e esquerdos. A avaliação foi repetida após 15, 30 e 60 dias da frenotomia lingual. Após 15 dias observaram-se postura de lábio e língua adequadas, sucção com movimentos coordenados, ausência de ruídos ou engasgos. Após 30 dias observou-se simetria entre os músculos supra-hioideos, que se manteve 60 dias após o procedimento cirúrgico. Após a frenotomia lingual, a adequação da posição de lábios e língua, durante repouso e sono, foram restabelecidas em 15 dias, e, após 30 dias do procedimento, ocorreu adequação da postura de língua no choro e simetria da atividade eletromiográfica dos músculos supra-hioideos na sucção. Os resultados foram mantidos até o fim do estudo.

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Background: Anophthalmia refers to the complete absence of an eyeball. It is a very rare congenital condition that affects all breeds of dogs, which may be unilateral or bilateral. Anophthalmia results from a severe developmental deficiency in the primitive forebrain, prior to the formation of the optic sulcus. This condition has a complex etiology, and chromosomal, monogenic, and environmental causes have already been identified. There might be an association between anophthalmia and other congenital abnormalities. This case report aimed to report the case of a male dog with bilateral anophthalmia associated with penile malformation. Case: A 3-year-old male mongrel dog was evaluated in a clinical consultation at the Veterinary Medical Teaching Hospital of the Federal University of Piauí (UFPI) - Teresina - Brazil, with signs of anemia and diarrhea. His vaccinations were not up to date (multiple and anti-rabies), presented ectoparasites (ticks), and showed inappetence. The owner reported that the animal was blind from birth, was already well adapted to its environment, had the company of other animals, and had no access to the street. On clinical examination, the animal had a good body score. The eyelids were bilaterally present with normally developed eyelashes. Both the head and face had a symmetrical appearance, without structural abnormalities, and the palpebral fissures were narrow. When opening the eyelids manually, the presence of the conjunctiva was observed bilaterally, the orbits were shallow, and neither orbit contained the eyeball. Further inspection with an ophthalmic clinical flashlight did not reveal any other ocular structures. The initial diagnosis was suggestive of bilateral anophthalmia. Ultrasound examination of the ocular region confirmed the presence of bilateral anophthalmia. A general physical examination revealed a malformed penis with a persistent penile frenulum. Regarding systemic clinical signs (apathy, inappetence, diarrhea, and anemia), clinical and laboratory examinations led to the suspicion of verminosis. Discussion: The dog in this report had a good body score; however, this type of malformation can generate non-viable puppies. Anophthalmia is an extremely rare congenital ocular malformation, both in humans and companion animals, in which there are no ocular structures in the orbits, and these structures (orbits) in affected individuals are generally small and shallow, as seen in the dog in this report. Ultrasonographic examination confirmed the bilateral anophthalmic condition, being the most accurate method of diagnosing this congenital condition. The animal in this report presented with anophthalmia associated with penile malformation. This type of association until this case report has only been described in humans and mice, and is probably caused by a mutation in the SOX2 gene, which is responsible for the protein of the same name, which makes the maturation of ocular tissues in the primitive forebrain. Thus, it is likely that such congenital alterations are the cause of the malformations observed in this animal. Maternal vitamin A deficiency, a factor known to cause ocular malformations, may also be involved in the etiology of congenital diseases. Nutritional imbalances in dogs are common in the animal's region of origin The dog in this report had a normal life. Although it is a condition that causes blindness, dogs can have a normal life and welfare, even with bilateral anophthalmia.

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El frenillo lingual corto, o anquiloglosia, puede generar problemas durante la lactancia con repercusión en el desarrollo del lactante, daño en el pezón de la madre y abandono precoz de la lactancia. Actualmente no existe homogeneidad en los criterios diagnósticos, lo que ocasiona tanto sobrediagnóstico como infradiagnóstico de esta alteración, con las consecuencias clínicas que ello conlleva. La dificultad en el abordaje radica en saber cuándo se trata de variantes anatómicas normales o de un frenillo lingual sin repercusión funcional, y cuándo los problemas de lactancia, que clásicamente se le atribuyen se deben realmente al frenillo. Alrededor del 50 % de los niños con frenillo lingual corto no presenta problemas de lactancia o estos se resuelven con apoyo y asesoramiento. En el resto de casos se puede recurrir a tratamiento quirúrgico. En este artículo se ha realizado una actualización de la clasificación y tratamiento de la anquiloglosia que permitirá a los profesionales un manejo adecuado de estos pacientes

Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50 % of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients

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Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50% of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients.

El frenillo lingual corto, o anquiloglosia, puede generar problemas durante la lactancia con repercusión en el desarrollo del lactante, daño en el pezón de la madre y abandono precoz de la lactancia. Actualmente no existe homogeneidad en los criterios diagnósticos, lo que ocasiona tanto sobrediagnóstico como infradiagnóstico de esta alteración, con las consecuencias clínicas que ello conlleva. La dificultad en el abordaje radica en saber cuándo se trata de variantes anatómicas normales o de un frenillo lingual sin repercusión funcional, y cuándo los problemas de lactancia, que clásicamente se le atribuyen, se deben realmente al frenillo. Alrededor del 50 % de los niños con frenillo lingual corto no presenta problemas de lactancia o estos se resuelven con apoyo y asesoramiento. En el resto de casos se puede recurrir a tratamiento quirúrgico. En este artículo se ha realizado una actualización de la clasificación y tratamiento de la anquiloglosia que permitirá a los profesionales un manejo adecuado de estos pacientes.

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BACKGROUND AND AIM: Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties reported by mothers; assess possible factors that may interfere with breastfeeding. METHODS: A cross-sectional study was conducted with 391 pairs of mothers/newborns at a university hospital. A pediatric dentist examined the oral cavity of the newborns for the occurrence of ankyloglossia. We analyzed medical records and the mothers answered a self-administered questionnaire to assess birth variables, breastfeeding difficulties, and sociodemographic factors. We calculated prevalence ratios (PRs) of breastfeeding difficulties according to the independent variables. RESULTS: The mean age of the newborns was 2.5±2.9 days and 52% were male. The prevalence of ankyloglossia was 15% and 91.4% of mothers reported not having breastfeeding difficulties. Ankyloglossia was not associated with breastfeeding difficulties (PR: 0.5; 95% CI: 0.2-1.4). Mothers with a low income (PR: 0.5; 95% CI: 0.3-0.8), those who received instructions on breastfeeding (PR: 0.4; 95% CI: 0.2-0.9), and those who breastfed exclusively (PR: 0.3; 95% CI: 0.1-0.8) had fewer breastfeeding difficulties. CONCLUSION: Successful breastfeeding was more dependent on being born at full term, the family income, receiving guidance with regard to breastfeeding, and exclusive breastfeeding. Although ankyloglossia was not associated with breastfeeding, future prospective studies should evaluate the long-term factors that may interfere with breastfeeding. RELEVANCE FOR PATIENTS: This study brings a new perspective on the importance of assessing ankyloglossia and breastfeeding difficulties, reinforces the benefits of exclusive breastfeeding and the need for breastfeeding instructions, as well as the need to evaluate breastfeeding before making a decision regarding frenectomy.

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ABSTRACT Purpose Verify the position of lips and tongue at rest in newborns with and without ankyloglossia. Methods Cross-sectional study, carried out with 130 newborns in University Hospital. Data collection was performed by the researcher and speech-language pathologists from the Hospital. Information on gestational age, sex, weight, height and days of life was collected. The position of the lips and tongue at rest was evaluated through visual inspection with the newborns asleep. After the newborns were awakened, Neonatal Screening of the validated Protocol for the evaluation of the lingual frenulum for infants was performed to detect the alteration of the lingual frenulum. The data obtained were described and submitted to statistical analysis using the Chi-Square test to verify the association between the position of the lips with the tongue and to compare the position of the lips and tongue with and without ankyloglossia. The Mann-Whitney test was used to verify the behavior of the variables the differed between newborns with and without ankyloglossia. The significance level of 5% was adopted. Results When comparing the data, a significant difference was found between: weight and height with and without ankyloglossia; position of lips and tongue. An association between the position of the tongue and lips with and without ankyloglossia was also found. Conclusion Newborns without alteration of the lingual frenulum have a tendency to remain with their lips closed and their tongue elevated during rest and newborns with ankyloglossia have a tendency to keep their lips parted and their tongue low during rest.

RESUMO Objetivo Verificar a posição de lábios e língua no repouso em recém-nascidos com e sem anquiloglossia. Método Estudo transversal, realizado com 130 recém-nascidos em um Hospital Universitário. A coleta de dados foi realizada pela pesquisadora e por fonoaudiólogas do Hospital. Foi coletado informações sobre idade gestacional, sexo, peso, altura, dias de vida dos recém-nascidos. Foi avaliada a posição dos lábios e língua no repouso, com os recém-nascidos adormecidos, por inspeção visual. Após os recém-nascidos serem despertos, foi realizada Triagem Neonatal do Protocolo validado de avaliação do frênulo da língua em bebês, para detecção da alteração do frênulo lingual. Os dados obtidos foram descritos e submetidos à análise estatística através do teste Qui-Quadrado, para verificar a associação entre posição dos lábios com a língua e para comparar posição de lábios e língua com e sem anquiloglossia. O teste de Mann-Whitney foi utilizado para verificar o comportamento das variáveis que diferiam entre recém-nascidos com e sem anquiloglossia. Foi adotado o nível de significância de 5%. Resultados Houve diferença significativa entre: peso e altura com e sem anquiloglossia; entre posição de lábios e língua. Encontrou-se também associação entre posição de língua e de lábios com e sem anquiloglossia. Conclusão Os recém-nascidos sem alteração de frênulo lingual têm a tendência de permanecerem com os lábios fechados e a língua elevada durante o repouso, e recém-nascidos com anquiloglossia, têm a tendência de manterem os lábios entreabertos e a língua baixa durante o repouso.

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ABSTRACT Purpose: evaluate the influence of frenotomy on the breastfeeding of newborns diagnosed with ankyloglossia. Methods: this is an intervention study performed with 50 newborns diagnosed with ankyloglossia. It was conducted in three stages: diagnosis, intervention and reassessment. In the diagnostic phase, the Protocol for the Assessment of Speech Language with Scores for Babies was applied to diagnose ankyloglossia and a questionnaire assessing the symptoms and coordination of sucking, swallowing and breathing during breastfeeding. In the intervention, frenotomy was performed, and at reassessment, the diagnostic protocol and questionnaire in order to compare the post-surgical effects. Results: of the 50 babies participating in the study, 35 (70%) were boys and 15 (30%) girls. A total of 68% of ankyloglossia cases were reported in the family, a majority (38%) involving cousins. There was a statistically significant reduction in the average protocol score in the reassessment stage, from 8.38 (7-12 points) to 0.86 (0-5 points), as well as a statistically significant improvement in all variables related to the symptoms of breastfeeding. Conclusion: surgical intervention, known as frenotomy, made it possible to improve the negative symptoms of breastfeeding in newborns diagnosed with ankyloglossia.

RESUMO Objetivo: avaliar a influência da frenotomia sobre a amamentação de recém-nascidos com diagnóstico de anquiloglossia. Método: trata-se de um estudo de intervenção realizado com 50 recém-nascidos com diagnóstico de anquiloglossia. Foi realizado em três etapas: diagnóstico, intervenção e reavaliação. Na fase diagnóstica, foram aplicados o Protocolo de Avaliação do Frênulo da Língua com Escores para Bebês para o diagnóstico de anquiloglossia e um questionário de avaliação dos sintomas e coordenação de sucção, deglutição e respiração durante a amamentação. Na intervenção, foi realizada a frenotomia e, na reavaliação, foram reaplicados o protocolo de diagnóstico e o questionário para comparação dos efeitos pós-cirúrgicos. Resultados: dos 50 bebês participantes do estudo, 35 (70%) eram do gênero masculino e 15 (30%) do gênero feminino. Foram relatados 68% dos casos de anquiloglossia na família, sendo primo (a) o grau de parentesco na maioria desses casos (38%). Houve redução estatisticamente significativa na média de pontuação no protocolo de 8,38 (7-12 pontos) para 0,86 (0-5 pontos), na etapa de reavaliação, assim como melhora estatisticamente significante em todas as variáveis relacionadas aos sintomas da amamentação. Conclusão: a intervenção cirúrgica, denominada frenotomia, possibilitou a melhora dos sintomas negativos da amamentação em neonatos com diagnóstico de anquiloglossia.

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Objetivo: 1) verificar a associação da prematuridade e baixo peso ao nascimento (BPN) com a ocorrência de lesões de mucosa oral em recém-nascidos (RN), fatores de saúde materno-infantil e socioeconômicos, por meio de um estudo transversal; e 2) avaliar a prevalência de anquiloglossia em bebês, crianças e adolescentes de acordo com diferentes critérios diagnósticos, por meio de uma revisão sistemática. Métodos: 1) O estudo contou com uma amostra de 431 pares de mães e recémnascidos. A coleta foi realizada no período de agosto de 2016 a abril de 2017. Após o nascimento, os bebês tiveram a cavidade bucal examinada para lesões de mucosa. A regressão logística bivariada e multivariada foi utilizada para a análise dos dados. O nível de significância foi de 5%. 2) Foram realizadas buscas eletrônicas em nove bases de dados até 2021. Por meio da meta-análise de efeitos aleatórios, foi avaliada a prevalência bruta de anquiloglossia e para sexo. Uma metaanálise de efeitos mistos foi usada para análise de sugrupos por critérios diagnósticos e idade. Calculamos a RP e o IC de 95% da ocorrência de anquiloglossia em meninos, em comparação com meninas e avaliamos a certeza das evidências usando a abordagem GRADE. Resultados: 1) Prematuridade e BPN foram associados com pérolas de Epstein (odds ratio [OR]: 1,7; intervalo de confiança de 95% [IC]: 1,03­3,0; OR: 1,8; IC95%: 1,1­3,2, respectivamente) e mucocele (OR: 4,6; IC95%: 1,3­16,1; OR: 3,7; IC95%: 1,1­13,1, respectivamente), mas não à anquiloglossia (OR: 1,0; IC95%: 0,5­2,1; OR: 0,7; IC95%: 0,3 -1,6, respectivamente) ou amamentação (OR: 0,5; IC95%: 0,1-2,1; OR: 1,9; IC95%: 0,2- 15,6, respectivamente). A prematuridade foi associada à gravidez de alto risco (OR: 2,3; IC 95%: 1,3­3,9), estar na incubadora (OR: 3,2; IC 95%: 1,7­5,9) e baixo nível socioeconômico (OR: 2,4; IC de 95%: 1,1-5,2). 2) Setenta e três estudos observacionais foram incluídos (72 na meta-análise). Havia cinco diferentes critérios diagnósticos validados. A prevalência geral bruta de anquiloglossia foi de 4% (IC95%: 3% - 4%) variando de 67% para o critério de Coryllos (IC95%: 40% - 94%) a 2% para estudos que usaram critérios próprios (2%; IC95% : 2% - 2%). A prevalência foi similar entre faixas etárias e sexos. Entretanto, meninos tiveram 1,29 mais risco de ter anquiloglossia do que meninas (95%IC: 1,04-1,59) com muito baixa certeza de evidência. Conclusão: 1) Recém-nascidos prematuros e com BPN foram mais propensos a ter pérolas de Epstein e mucocele do que RN à termo e com peso normal. Amamentação e anquiloglossia não foram associadas à prematuridade e BPN. A prematuridade também foi associada à gravidez de alto risco, estar na incubadora e baixo nível socioeconômico. 2) A prevalência de anquiloglossia geral foi baixa, e maior para critérios diagnósticos validados comparado aos critérios próprios usados pelos autores. A prevalência de anquiloglossia foi semelhante para grupos de idade e sexo. Com muita baixa certeza da evidência, não podemos afirmar que meninos têm mais anquiloglossia que meninas.

Objective: This thesis describes two studies with the following objectives: 1) one cross-sectional study that aimed to associate prematurity and birth weight with the occurrence of oral mucosal lesions in newborns and associated factors, and 2) one systematic review that evaluated the prevalence of ankyloglossia in babies, children and adolescents according to different diagnostic criteria. Methods: 1) In the crosssectional study, the sample comprised 431 pairs of mothers and newborns born at the University Hospital of Federal University of Minas Gerais. The study included mothers and newborns present in the hospital from August 2016 to April 2017. We excluded newborns with congenital anomalies or syndromes. A trained and calibrated dentist examined the mouth of the newborns for oral mucosal lesions (Kappa = 0.90). The lesions evaluated were dental lamina cysts, Bohn's nodules, Epstein's pearls, mucocele and ankyloglossia. Mothers answered a self-administered questionnaire related to socioeconomic indicators and prenatal habits. Medical records were evaluated to collect information about prematurity, low birth weight (LBW), pregnancy, childbirth, postpartum, maternal and newborn health conditions. Bivariate and multivariate logistic regression were used for data analysis. The level of significance was 5%. 2) For the systematic review, nine electronic databases were searched from interception up to May 2021 with no restrictions imposed regarding on year of publication or language. Paired independent reviewers selected studies, extracted data, and assessed the risk of bias. Using random-effects meta-analysis, we pooled the crude prevalence of ankyloglossia in general and by sex. Using mixed effect-meta-analysis, we subgrouped by diagnostic criteria and age. We calculated the PR and 95%CI of the occurrence of ankyloglossia in boys compared to girls, and assessed the certainty of evidence using the GRADE approach. Results: 1) Prematurity and LBW were associated with Epstein pearls (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.03­3.0; OR: 1.8; 95%CI: 1.1­3.2, respectively) and mucocele (OR: 4.6; 95%CI: 1.3­16.1; OR: 3.7; 95%CI: 1.1­13.1, respectively), but not to ankyloglossia (OR: 1.0; 95%CI: 0.5­2.1; OR: 0.7; 95%CI: 0.3­1.6, respectively) or breastfeeding (OR: 0.5; 95%CI: 0.1-2.1; OR: 1.9; 95% CI: 0.2­ 15.6, respectively). Prematurity was associated to high-risk pregnancy (OR: 2.3; 95% CI: 1.3­3.9), being in the incubator (OR: 3.2; 95% CI: 1.7­5,) and low socioeconomic status (OR: 2.4; 95% CI: 1.1-5.2). 2). 2) Seventy-three observational studies were included in the systematic review (72 in the meta-analysis). There were five different validated diagnostic criteria for ankyloglossia. The overall crude prevalence of ankyloglossia was 4% (95%CI: 3%-4%) varying from 67% for Coryllos criteria (40%- 94%) to 2% for those studies using own criteria (2%; 95%CI: 2%-2%). There was a similar prevalence for age groups and both sexes. Boys had 1.29 more risk of having ankyloglossia (95%CI: 1.04-1.59) with very low certainty. Conclusion: 1) Preterm and LBW newborns were more likely to have Epstein pearls and mucocele than full terms. Breastfeeding and ankyloglossia were not associated with prematurity and LBW. Prematurity was also associated with high-risk pregnancy, being in the incubator and low socioeconomic status. 2) The prevalence of ankyloglossia varied among all instruments used; with validated diagnostic criteria showing higher prevalence and non-validated or own criteria showing low prevalence. With low certainty, we could not affirm that boys are more prone to have ankyloglossia compared to girls.

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Introducción: el objetivo de esta revisión es responder al interrogante: ¿cuál es la metodología más eficaz de evaluación de frenillo lingual en neonatos? Bajo los pará-metros de objetividad, claridad y validación. Métodos: el estudio se realizó a través de una revisión sistemática, llevada a cabo con metodología Cochrane, en la que se utilizaron los descriptores de evaluación, frenillo lingual, anquiloglosia y recién nacido, y ejecutado en los bancos de datos Pubmed, Science Direct, Scielo. Para analizar el nivel de evidencia y grado de reco-mendación clínica, se tuvo en cuenta la clasificación GRADE y CEBM de Oxford. Resultados: por medio de la revisión se encontraron 2 evaluaciones y un tamizaje específicamente para recién nacidos, que evalúa de los 0 a los 30 días, los cuales se validan por medio de estudios de especificidad. Análisis y discusión: se identificó que los principales parámetros para diagnosti-car una alteración en el frenillo lingual son la anatomía y su funcionalidad. Conclusiones: según los estudios encontrados sí existe un método eficaz para el diagnóstico del frenillo lingual en neonatos.

Introduction: the objective of this review is to answer the question: What is the most effective methodology for assessing lingual frenulum in neonates? Under the parameters of objectivity, clarity and validation. Methods: the study was conducted through a systematic review carried out using the Cochrane methodology, in which the evaluation descriptors, lingual frenulum, ankyloglossia, and newborn were used, and developed in the Pubmed, Science Direct and Scielo data banks. To analyze the level of evidence and degree of clinical recom-mendation, the GRADE and CEBM classification of Oxford was taken into account. Results: through the review we found 2 evaluations and a screening specifically for new-borns that evaluates from 0 to 30 days, which are validated through specificity studies.Analysis and discussion: it was identified that the main parameters to diagnose an alteration in the lingual frenum are its anatomy and functionality. Conclusions: according to the studies found, there is an effective method for the diagnosis of the lingual frenulum in neonates.

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Abstract Objective: To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding. Methods: This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test). Results: The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410 mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p = 0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p = 0.028). Conclusion: Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important.

Resumo Objetivo: Caracterizar o frênulo lingual de recém-nascidos a termo, utilizando dois protocolos diferentes e verificar a relação do frênulo lingual com o aleitamento materno. Método: A amostra não probabilística foi constituída por 449 binômios mãe/bebê. Para a avaliação anatomofuncional do frênulo, utilizou-se o protocolo de avaliação do frênulo lingual para bebês "Teste da Linguinha" e o Bristol Tongue Assessment Tool. A mamada foi avaliada com o protocolo proposto pelo UNICEF. Foram criados escores (bom, regular, ruim) para avaliar cada aspecto da mamada a ser observada. Os resultados foram analisados através de estatísticas descritivas e inferenciais e testes de associação (Qui-quadrado de Pearson e Exato de Fisher). Resultados: O estudo mostrou que 14 bebês apresentaram alteração de frênulo lingual, nos quais três com dificuldade durante a sucção, necessitando de frenotomia na primeira semana de vida e 11 sem dificuldades durante a amamentação. Quanto à avaliação da mamada, 410 binômios mãe/bebê apresentaram o escore bom, 36 regular e 3 ruim. Houve associação estatisticamente significativa entre o protocolo "Teste da Linguinha" e amamentação (p = 0,028) e entre o protocolo Bristol Tongue Assessment Tool e amamentação (p = 0,028). Conclusão: Alterações no frênulo lingual estão associadas a interferências na qualidade da amamentação, sendo importante a avaliação do frênulo lingual em recém-nascidos.

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Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

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Introducción. La anquiloglosia es una condición limitante que en algunos casos no interfiere en la lactancia y genera adaptaciones anatomofisiológicas del frenillo al seno materno, el cual se presenta más elástico y menos fibroso. El objetivo fue establecer si existe relación entre las alteraciones del frenillo lingual y la lactancia materna. Materiales y métodos. Investigación descriptiva correlacional de corte transversal. La población objeto de estudio fue evaluada mediante el Protocolo de evaluación del frenillo de la lengua con puntuación para bebés. Resultados. Se identificó un 29% de prevalencia en las alteraciones del frenillo lingual. La anatomofisiología del frenillo y la succión son dependientes y estadísticamente significantes. Conclusiones. La lactancia materna y la anatomofisiología del frenillo lingual alterado, conocido como anquiloglosia, guardan una fuerte relación de dependencia, ya que ante la presencia de anquiloglosia no se produce un agarre adecuado del pezón en la cavidad oral. No obstante, en algunos casos se ha comprobado que los lactantes realizan procesos de adaptación para suplir las dificultades en la movilidad lingual y alimentarse.

Introduction. Ankyloglossia appears as a limiting condition, in some cases it does not interfere with lactation, presenting anatomophysiological adaptations of the frenulum to the mother's breast; it is more elastic and less fibrous. The objective was to establish whether there is a relationship between lingual frenulum alterations and breastfeeding. Methods. Cross-sectional correlational descriptive research. The population under study was evaluated through the "Protocol for evaluating the frenulum of the tongue with scores for babies". Results. A 29% prevalence of alterations in the lingual frenulum was identified, the anatomophysiology of the frenulum and suction are dependent and statistically significant. Conclusions. Breastfeeding and the anatomophysiology of the altered lingual frenulum known as ankyloglossia are strongly dependent, since in the presence of ankyloglossia there is not an adequate grip of the nipple in the oral cavity; however, in some cases it has been It has been proven that infants carry out adaptation processes in order to compensate for difficulties in tongue mobility and feeding.

Introdução. A anquiloglossia é uma condição limitante que em alguns casos não interfere na lactação e gera adaptações anatomofisiológicas do frênulo à mama da mãe, que é mais elástica e menos fibrosa. O objetivo foi estabelecer se existe relação entre as alterações do frênulo lingual e a amamentação. Materiais e métodos. Pesquisa descritiva e correlacional de corte transversal. A população em estudo foi avaliada por meio do protocolo de avaliação do frênulo da língua com pontuação para bebês. Resultados. Identificou-se prevalência de 29% nas alterações do frênulo lingual. A anatomofisiologia do frênulo e da sucção são dependentes e estatisticamente significativas. Conclusões. A amamentação e a anatomofisiologia do frênulo lingual alterado, conhecido como anquiloglossia, apresentam forte relação de dependência, visto que na presença de anquiloglossia não há pega adequada do mamilo na cavidade oral. No entanto, em alguns casos, descobriu-se que os bebês realizam processos de adaptação para superar as dificuldades de mobilidade da língua e alimentação.

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Muscle electrical activity analysis can aid in the identification of oral motor dysfunctions, such as those resulting from an altered lingual frenulum, which consequently impairs feeding. Here, we aim to analyze the suprahyoid muscle electrical activity of infants via surface electromyography, based on lingual frenulum attachment to the sublingual aspect of the tongue and floor of the mouth during breastfeeding. In the present study, we have studied full-term infants of both genders, aged between 1 and 4 months old. The mean muscle activities were recorded in microvolts and converted into percent values of the reference value. Associations between the root mean square and independent variables were tested by one-way analysis of variance and Student's t-test, with a significance level of 5% and test power of 95%, respectively. We evaluated 235 infants. Lower mean muscle electrical activity was observed with the lingual frenulum attached to apex/lower alveolar ridge, followed by attachment to the middle third/lower alveolar ridge, and between the middle third and apex/lower alveolar ridge. Greater suprahyoid muscle activity was observed with lingual frenulum attachment to the middle third of the tongue/sublingual caruncles, showing a coordination between swallowing, sucking, and breathing. Surface electromyography is effective in diagnosing lingual frenulum alterations, the attachment points of which raises doubt concerning the restriction of tongue mobility. Thus, it is possible to identify oral motor dysfunctions.

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OBJECTIVE: To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding. METHODS: This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test). RESULTS: The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p=0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p=0.028). CONCLUSION: Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important.

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ABSTRACT Purpose: to compare the movements of elevation and protrusion of the tongue in order to determine which position provides better lingual frenulum assessment. Methods: a database of 92 audiovisual recordings of subjects over six-years of age diagnosed with ankyloglossia was used to verify the shape of the tip of the tongue during tongue elevation and protrusion. The Chi-Square Test for Proportion was applied to verify possible differences between the postures of elevation and protrusion. The significance level of 5% (p<0.05) was adopted. Results: the statistical analysis demonstrated that both shapes, i.e., the V-shaped one and the heart-shaped one are more visible during tongue elevation than during tongue protrusion. Conclusion: elevation is the position that allows the best observation of the shape of the tip of the tongue.

RESUMO Objetivo: verificar qual a melhor posição da língua para realizar a avaliação do frênulo lingual, considerando a elevação e a protrusão. Métodos: foram analisados 92 arquivos audiovisuais de sujeitos acima de 6 anos, diagnosticados com anquiloglossia, para verificação da forma da ponta da língua nas posições de elevação e protrusão. Para análise estatística foi utilizado o Programa estatístico IBM SPSS, versão 25.0, sendo aplicado o teste Qui-quadrado para Proporções, considerando o nível de significância p<0.05. Resultados: a análise estatística evidenciou que tanto a ligeira fenda, quanto a forma de coração na ponta da língua são mais visíveis na posição de elevação do que na posição de protrusão. Conclusão: a posição de elevação permite visualizar melhor a forma da ponta da língua.

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RESUMO Objetivo: analisar os indicadores de qualidade do programa de triagem auditiva e avaliação do frênulo lingual em neonatos, quanto às taxas de cobertura, tempo de vida em que são realizadas as triagens auditivas, índices de encaminhamentos e prevalência da anquiloglossia, em um hospital universitário especializado em assistência materno-infantil. Método: trata-se de um estudo transversal, no qual foi analisado o banco de dados do programa de triagem auditiva e da avaliação do frênulo lingual em neonatos, referente aos atendimentos realizados no período de setembro de 2015 a agosto de 2016. Resultados: no período analisado, nasceram 2.345 neonatos na instituição, 1.380 (58,8%) realizaram a triagem auditiva neonatal e 1.350 (57,6%) a avaliação do frênulo lingual. A média de idade gestacional foi de 39 semanas (±1,6), peso de nascimento igual a 3.478 g (± 469,2) e 69% eram do sexo masculino. Na triagem auditiva neonatal, dos 1.380 neonatos, 95,7% receberam alta com orientação, 2,4% foram encaminhados para monitoramento auditivo e 1,9% foram encaminhados para diagnóstico auditivo. Na avaliação do frênulo lingual, dos 1.350 avaliados, 123 (9,1%) apresentaram anquiloglossia, 85 eram do sexo masculino e 47, feminino. Conclusão: os indicadores de tempo de vida em que são realizadas as triagens auditivas, índices de encaminhamentos e prevalência da anquiloglossia estão em consonância com a literatura, porém as taxas de cobertura estão inferiores ao recomendado e não seguem a legislação brasileira.

ABSTRACT Purpose: To analyze the quality indicators of the hearing screening program and to evaluate lingual frenulum in newborns, in terms of coverage rates, duration of hearing screening, referral indexes and prevalence of ankyloglossia in a university hospital specializing in mother and child care. Method: This is a cross-sectional study, in which we analyzed the database of the newborn hearing screening and lingual frenulum assessment program for the period between September 2015 and August 2016. Results: During the study period, 2,345 babies were born at the institution, 1,380 (58.8%) underwent newborn hearing screening and 1,350 (57.6%) were diagnosed with a lingual frenulum. Mean gestational age was 39 weeks (± 1.6), birth weight 3478g (± 469.2) and 69% were boys. In newborn hearing screening, 95.7% of the 1,380 babies screened were discharged with guidance, 2.4% were referred for auditory monitoring and 1.9% of babies were referred for auditory diagnosis. In lingual frenulum assessment, 123 (9.1%) of the 1,350 evaluated, had ankyloglossia, 85 were boys and 47 girls. Conclusion: The indicators of the time of life in which the hearing screening is performed, the referral indices and ankyloglossia prevalence are in line with those reported in the literature; however, coverage rates were lower than recommended and do not comply with Brazilian law.

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Objetivo: relatar uma série de casos clínicos de frenotomia lingual em bebês diagnosticados com anquilo-glossia pelo Teste da Linguinha. Relato de casos: cinco bebês, de 0 a 2 anos de idade, foram diagnosticados nas Unidade Básicas de Saúde e na Santa Casa de Misericórdia de Sobral, Ceará, com anquiloglossia mode-rada a severa. As mães relataram dificuldades de amamentação e engasgos das crianças. Os pacientes foram submetidos a procedimentos cirúrgicos de frenotomia lingual, que foram realizados na Universidade Federal do Ceará (UFC), Campus Sobral, no Grupo de Estudos em Odontopediatria (GEOP) do curso de graduação em Odontologia. As cirurgias foram realizadas com os pacientes conscientes e sob estabilização protetora. Foi administrada apenas anestesia tópica nos pacientes menores de 1 ano e anestesia infiltrativa naqueles com faixa etária maior que 1 ano. Em seguida, foi executado um pequeno corte na porção mediana do freio lingual e, quando necessário, realizada divulsão dos tecidos adjacentes. Ao final, foi feita a limpeza do local da cirurgia com a confirmação visual da efetiva liberação da língua. Por fim, as crianças receberam atestado e as mães, recomendações pós-cirúrgicas. Além disso, as crianças foram encaminhadas para consulta com o fonoaudiólogo e foram marcadas três consultas de retorno para o acompanhamento dos casos. Considera-ções finais: a frenotomia lingual mostrou-se uma técnica cirúrgica conservadora, eficaz e segura. Os bebês apresentaram excelentes resultados pós-operatórios e encontram-se em acompanhamento multiprofissional. (AU)

Objective: to report a series of clinical cases of lin-gual frenectomy in babies diagnosed with ankylo-glossia through the tongue test. Case Reports: five babies aged 0 to 2 years were diagnosed with moderate to severe ankyloglossia in Basic Health Units and in Santa Casa de Misericórdia do So-bral, Ceará, Brazil. The mothers of the children reported difficulties in breastfeeding and gagging. The patients were submitted to surgical procedu-res of lingual frenectomy, which were performed at the Federal University of Ceará (UFC), Cam-pus Sobral, in the Group of Studies in Pediatric Dentistry of the undergraduate dental course. The surgeries were performed with conscious patients under protective stabilization. Only topical anesthesia was administered in patients younger than 1 year and infiltrative anesthesia was used for those older than 1 year. Thereafter, a small cut was per-formed on the median portion of the lingual fre-nulum and, if necessary, divulsion of the adjacent tissues was performed. At the end, the surgical site was cleaned and the effective release of the tongue was confirmed visually. Finally, the chil-dren received medical certification and the mo-thers received postoperative recommendations. In addition, the children were referred to visits with a speech therapist and three follow-up ap-pointments were scheduled. Final considerations: lingual frenectomy proved to be a conservative, effective, and safe surgical technique. The babies presented excellent postoperative results and they are under multi-professional follow-up. (AU)

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The penile frenulum is a thin strip of connective tissue that connects the penis glans to the foreskin. Due to the few number of reports of this condition, this work reports the occurrence of persistent penile frenulum in a mixed breed domestic cat, of seven months old and 5.2 kg. In this particular case, penile frenulum was an incidental finding during clinical examination. The animal was in puberty, characterizing the penile frenulum. The resolution of the case occurred spontaneously prior to elective orchiectomy. Thus, the changes observed in the penis due to congenital alteration in cats are described in this report.

O frênulo peniano é uma fina faixa de tecido conectivo que une a glânde ao prepúcio que pode se romper sob a ação da testosterona quando o animal inicia a puberdade. Devido a escassez de relatos desta afecção o presente trabalho relata a ocorrência de frênulo peniano persistente em um gato doméstico, sem raça definida, de sete meses de idade e 5,2 kg. O frênulo peniano foi um achado incidental durante o exame clínico do animal. O animal já apresentavase em puberdade, caracterizando o quadro de frênulo peniano. A resolução do caso ocorreu de maneira espontânea previamente a orquiectomia eletiva. Dessa forma, as alterações observadas no pênis devido a alteração congênita em gatos são descritas neste relato.