Organization of Tongue Movements Before and After Frenotomy For Posterior Tongue-Tie: An Ultrasound Analysis

3/21/2015
Organization of tongue movements

before and after frenotomy for
posterior tongue-tie: an ultrasound
analysis
Normal Tongue
Movements
lateralization
Catherine Watson Genna BS, IBCLC

Analysis by David Elad DSc
elevation
Restricted elevation
Extension/
protrusion
Restriction of
tongue motions
from
ankyloglossia
Restrictive frenulum
twisting on lateralization
Restricted extension
Restricted grooving
Failure to thrive
Breastfeeding Problems
Associated with Tongue-tie
Copyright 2015 Catherine Watson Genna
3/21/2015
Nipple wounds
Difficulty
Maintaining
Latch
Difficulty
latching
Type 3 tongue tie appears WNL,

may perform very poorly.
Posterior Tongue-tie and

Treatment
3 views of same
infants tongue
Bunched
configuration
Mid-tongue pulled down during

extension
3/21/2015
Type 4 fibrous attachment,

asymmetry of tongue movement,
narrow palate
Appearance Prefrenotomy
(type 3/50%)
Thick posterior frenulum

requires multiple snips
After
treatment
(similar
case)
Type 4 pre and post frenotomy
3/21/2015
Submental approach, intracavity probe
Ultrasound examination of
sucking during breastfeeding
Analog or digital recording
Adapted from Lorili Jacobs 2004
Courtesy of Brian Palmer

www.brianpalmerdds.com
Normal Sucking
From
Elad et al
PNAS
2014
3/21/2015
NORMAL
NORMAL
Current Study
Objective analysis of ultrasounds
previously recorded
9 infants, 6 from Tel Aviv, 3 from NY
One treating physician (NY) / pediatric
dentist (Tel Aviv) per site
Scissors frenotomy
Immediate (Tel Aviv) or delayed (NY)
post-frenotomy scan
Findings
Nipple to hard-soft palate

junction distance decreases
after frenotomy
Further information:
Anterior tongue amplitude and

rhythm are irregular
Posterior tongue movements are
neither synchronized nor peristaltic
These issues resolve after frenotomy
http://www.cwgenna.com/clinicalcornerpage.html
Ultrasound Research
References
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3/21/2015

Organization of tongue movements

Catherine Watson Genna BS, IBCLC

Copyright 2015 Catherine Watson Genna

Type 3 tongue tie appears WNL,

Posterior Tongue-tie and

Mid-tongue pulled down during

Copyright 2015 Catherine Watson Genna

Type 4 fibrous attachment,

Thick posterior frenulum

Type 4 pre and post frenotomy

Copyright 2015 Catherine Watson Genna

Submental approach, intracavity probe

Analog or digital recording

Adapted from Lorili Jacobs 2004

Courtesy of Brian Palmer

Copyright 2015 Catherine Watson Genna

Nipple to hard-soft palate

Anterior tongue amplitude and

Copyright 2015 Catherine Watson Genna

Burton P, et al, Real-time 3D ultrasound imaging of infant tongue movements during

Chu, M. W. and D. C. Bloom. "Posterior ankyloglossia: A case report." Int.J

Elad D et al., Biomechanics of milk extraction during breastfeeding.

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