Authors (including presenting author) :
Lam KY(1), Fung BKY(1), Leung RWC(1), Chan MPY(1), Kwok KL(2), Tang KC(3), Li CM(1)
Affiliation :
Physiotherapy Department(1), Department of Paediatrics (2), Kwong Wah Hospital, Department of Otorhinolaryngology, Head & Neck Surgery(3), Yan Chai Hospital, Hong Kong
Introduction :
Ankyloglossia (tongue tie) is a congenital condition in which the lingual frenulum is abnormally short and may restrict mobility of the tongue, which can lead to orofacial dysmorphosis and reduces the size of upper airway support. Such progressive change increases the risk of upper airway collapsibility during sleep. Studies show that a short lingual frenulum left untreated at birth is associated with sleep disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) at later age. Lingual frenectomy is one of the treatment options for ankyloglossia, which includes the removal of the frenal tissue. Rehabilitation is important before and after release of the frenulum in order to tone up the muscles and re-establish the tongue function and breathing patterns acquired as a result of the tongue-tie.
Objectives :
To assess the usefulness of myofunctional therapy used during the peri-frenectomy period for patient with sleep disordered breathing retrospectively.
Methodology :
Respiratory pediatrician, orthodontist, otorhinolaryngologist, maxillofacial surgeon, radiologist, physiotherapist and nurse discussed cases in monthly multidisciplinary sleep disordered breathing meeting. Physiotherapists identified patients with ankyloglossia for frenectomy. Physiotherapy services were provided in 3 phases: Pre-operative phase: 3-week pre-operative orofacial myofunctional therapy (OMT) program were provided. Intra-operative phase: Physiotherapists performed assessment and continuous evaluation of tongue function during frenectomy at the operation theatre. Post-operative phase: 3-month post-operative OMT program were provided to maximize the frenectomy effect as well as prevention of the scar adhesion. Outcome measures were captured at the first (before frenectomy) and last session as follows: 1. Degree of ankyloglossia: maximum interincisal mouth opening (MIO), mouth opening: tongue tip to incisive papilla (MOTTIP), tongue range of motion ratio (TRMR), free tongue length 2.Maximal tongue elevation strength and tongue elevation endurance: Iowa Oral Performance Instrument (IOPI) 3.Evaluation of orofacial dysfunction: Nordic Orofacial Test-Screening (NOT-S) 4.Quality of life: Obstructive Sleep Apnoea-18 (OSA-18), Pediatric sleep questionnaire (PSQ) 5.Level of daytime sleepiness: Modified Epworth Sleepiness Scales (mESS)
Result & Outcome :
Seven cases were recruited (Female: 0, Male: 7). MIO, MOTTIP and TRMR improved from 50mm (IQR 44-55) to 53mm (IQR 45-55) (p=0.058), 24mm (IQR 20-34) to 32mm (IQR 26-36) (p=0.063) and 46% (IQR 43-56) to 67% (IQR 58 to 71) (p=0.028) respectively. Free tongue length improved from 15mm (IQR 12-15) to 20mm (IQR 16-25) (p=0.016). Effect on OSAS is still under investigation. Multidisciplinary approach can be a service model for the improvement of lingual frenulum restriction.
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