Peds ENT Health Series Part 1

February is Kids ENT Health Month!

This month, I’d like to tackle common complaints that bring kiddos to an ENT office.
I am fortunate to work at an ENT practice that sees both children and adults. Although I’m generally on the rhinology/allergy side of the clinic, I occasionally get to float over and help out in pediatrics.

frenulum

One of the most common cases I routinely see in peds ENT is ankyloglossia (ang-kuh-loh-GLOS-ee-uh) aka tongue-tie. So what exactly is a tongue tie? Underneath the tongue is a band of connective tissue that connects the tongue to the floor of the mouth called the lingual frenulum.  Although there are different several types of frenulum ties (gums, upper lip), this post will focus on tongue-ties!

Chief Complaint:

  • Newborn/ young infants that have difficulty latching on to bottle or breastfeed. Mom might also complain of prolonged feedings or failure to thrive.
  • Toddler/young child with speech and language development. Certain speech sounds that may be affected include lingual sounds such as “t,” “d,” “z,”, “s,” “th,” “n,” and “l.”
  • Older child/Adolescent: After adding Cardi B to a presentation recently, one of my coworkers likes to joke and state that Cardi B’s tongue shenanigans have also driven kids to come to the clinic after discovering they have restricted tongue movement. These kids are unable to stick their tongue past the lower lip, or touching their tongue to their upper teeth or find themselves in embarrassing social situations with difficulty in kissing.

Physical Exam:
heartshapedtonguepng-1As we discussed previously, on physical exam, you’ll find a shortened lingual frenulum, inability to stick the tongue past the lower lip or the upper teeth, as well as notching of the tongue when protruded that appears heart-shaped.
Photo cred: Carmen Fernando – tonguetie.net

 

Management:

  • If a newborn comes in with a thin or more anterior frenulum, we may consider performing a frenulectomy (frenectomy), a simple snip in the office without general anesthesia.
  • However, due to risks of bleeding and complications of a thicker/posterior frenulum, most cases are performed as an out-patient procedure (repositioning of the attachment of the lingual frenulum) with general anesthesia.

frenulectomy-1

Surgical techniques for the treatment of ankyloglossia in children: A case series
Article in Journal of applied oral science: revista FOB 22(3):241-248 · June 2014 DOI: 10.1590/1678-775720130629·

  • We often work closely with our peds speech pathologists (SLPs) to further assess for the need of surgery (yay – insurance).
  • Following surgery,  we recommend these patients continue follow up with SLPs to work on articulation as well as postoperative “tongue exercises” (massaging or stretching of the tongue and floor of mouth).
  • Of note, lingual frenectomy are often performed by dentists and non-ENT specialties. Dental offices typically use lasers to cut the frenulum vs. electrosurgical scissors.

Well isn’t that a tongue-twister! Ha ha. Sorry, I couldn’t help myself.
I hope you enjoyed this #TeachingTuesday comeback!

Stay tuned for more peds topics!

Xx,
Ngan

Resource: http://www.uptodate.com/contents/ankyloglossia-tongue-tie-in-infants-and-children

 

 

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