Lingual short frenulus: definition
From the anatomical point of view, the thin fibrous-mucosal tissue lamina connecting the ventral wall of the tongue to the mucosa of the oral floor is defined as the lingual frenum . When the lingual frenulum is particularly short compared to the norm, we speak of a "short frenulum": it is a congenital anomaly, which occurs, therefore, from birth. The short lingual frenulum does not represent a true pathology, rather it constitutes an anatomical anomaly that can cause significant repercussions on the word, since, being the tongue practically anchored to the lingual floor, its protrusion beyond the lower incisor teeth is prevented.
In medical terms, the brevity of the lingual frenulum is known as an ankyloglossia or tongue-tie.
Incidence
Some research shows that the condition of the brevity of the lingual frenulum is particularly frequent among newborns.
Towards the end of the eighties of the twentieth century, an epidemiological survey was carried out to estimate the incidence rate of subjects with a short frenulum: starting from a sample of 1, 100 eight-year-old children, it was calculated that approximately 7 % of these had tongue-tie (corresponding to 78 small patients).
Currently, it is estimated that the short frenulum affects 3-5% of newborns and that, between the two sexes, males are the most at risk (prevalence: 2 males, 1 female).
Classification
Congenital anomalies affecting the short lingual frenulum are generally categorized according to the degree of severity of the anatomical condition. Four possible classifications have been identified:
- Rare form: the lingual raphe is completely fixed to the floor of the buccal cavity (the presence of the lingual frenulum is not noticed): grade F0
- The frenulum connects the sub-lingual caruncle to the lower region of the tongue: grade F1
- The frenulum joins the sublingual caruncle to half the space present between the plane of the lips and that of the tongue: grade F2
- The frenulum begins at the level of the mandibular alveolar margin and ends near the median raphe of the tongue. In this case, tongue motility is only partially reduced. Grade F3
Glossary
| Floor of the buccal cavity | It consists of a multilayered paved epithelium from which the tongue emerges |
| Sublingual caruncola | The excretory duct, starting from the sublingual gland in the floor, flows into the level of the caruncle |
Mandibular alveolar margin | Anatomical site consisting of holes in which the roots of the lower teeth are inserted |
Causes
We have seen that the brevity of the lingual frenulum is the result of congenital anomalies: the triggering causes responsible for the formation of the short frenulum are not yet fully clarified. However, it seems that the brevity of the frenulum is the result of apoptotic alterations, that is to say a defect in the regulation of programmed cell death: the tongue remains anchored to the buccal floor since the physiological mechanisms of apoptosis are altered, indispensable for "dividing" the tongue from the floor itself.
The inheritance of the condition has not yet been demonstrated with certainty, but it is assumed that, at least in part, the brevity of the frenulum is also influenced by the genetic predisposition.
Diagnosis
The diagnosis of a lingual short frenulum can be inferred from the study of several parameters: considering that the brevity of the frenulum could cause difficulties in the movement of the tongue, the first parameter to be evaluated is certainly the inability of the subject to touch the palate with the tip of the tongue, with an open mouth. Patients with a short lingual frenulum have a limited sublingual space: consequently, even the observation of this parameter is considered an important diagnostic criterion.
Again, the butterfly tongue and the bifid tongue represent the immediate lingual malformations due to the brevity of the frenulum: in the first condition, the butterfly tongue has a peculiar curvature at the level of the intermediate site of the tongue, such as to prevent its protrusion outside of the mouth. The bifid language, diagnosed by simple clinical examination, is due to the frenulum which, being excessively short, generates a particular lingual conformation "at heart".
The diagnosis is usually made in the first few days of life of the newborn: therefore, some doctors advise the child to undergo surgery just a few months after birth. However, other specialists recommend stalling, as it is not uncommon for the lingual short frenulum to develop within 12 months of birth. Again, some authors recommend a medical surgical intervention at the age of six years of the child: it seems, in fact, that before the age of six spontaneous regressive phenomena are continuously present. Obviously, when the child shows serious language deficits due to the brevity of the frenulum, it is advisable to contact the surgeon even before the age of six, following the indication of the speech therapist.
