Chapter 56 ■ Relocation of a Dislocated Nasal Septum 395

References

1. Kawalski H, Spiewak P. How septum deformities in newborn

occur. Int J Pediatr Otorhinolaryngol. 1998;44:23.

2. Tasca I, Compradretti GC. Immediate correction of nasal septum

dislocation in newborns. Am J Rhinol. 2004;18:47.

3. Podoshin L, Gertner R, Fradis M, et al. Incidence and treatment

of deviation of the nasal septum in newborns. Ear Nose Throat

J. 1991;70:485.

4. Silverman SH, Leibow SG. Dislocation of the triangular cartilage

of the nasal septum. J Pediatr. 1975;87:456.

5. Jeppesen F, Windfield J. Dislocation of nasal septal cartilage in

the newborn. Acta Obstet Gynecol Scand. 1972;51:5.

6. Bhattacharjee A, Uddin S, Purkaystha P. Deviated nasal septum

in the newborn—a 1 year study. Indian J Otolaryngol Head Neck

Surg. 2005;57:304.

7. Kent SE, Rock WP, Nahl SS, et al. The relationship of nasal septal deformity and palatal asymmetry in neonates. J Laryngol Oto.

1991;105:424.

8. Kent SE, Reid AP, Brain DJ, et al. Neonatal septal deviations. J R

Soc Med. 1988;81:132.

9. Pentz S, Pirsig W, Linders H. Long-term results of neonates with

nasal deviation: a prospective study over 12 years. Int J Pediatr

Otorhinolaryngol. 1994;28:183.

10. Gola R, Cheynet F, Guyot L, et al. Nasal injuries during labor and

in early childhood. Etiopathogenesis, consequences, and therapeutic options. Rev Stomatol Chir Maxillofac. 2002;103:41.

396

Kathleen A. Marinelli

57 Lingual Frenotomy

A. Definitions

1. Lingual frenulum—a fold of mucosa connecting the

midline of the inferior surface of the tongue to the floor

of the mouth (1)

Generally thin, membranous, and avascular in the

newborn (Fig. 57.1)

2. Ankyloglossia (tongue tie)—a congenital oral abnormality, characterized by an abnormally short, thick,

and/or tight lingual frenulum (1–3)

a. “Ankyloglossia” derives from the Greek agkylos—

crooked, and glossa—tongue.

b. Many different variations of tongue tie

c. Differing degrees of severity

d. May restrict mobility of the tongue tip

3. Anterior tongue tie—anterior position of the lingual

frenulum, usually very thin and membranous, with

resultant restricted tongue tip movement

By far the most common (one study reports 94% of

tongue ties) (4).

4. Posterior tongue tie—more subtle, and thus more difficult to diagnose, as anterior tongue tip usually has free

movement (4,5) (Fig. 57.2).

Thick fibrous band, which, if not visible, can be

palpated with gloved finger as “bump” or thick band at

the back of the tongue.

Increasingly associated with breast-feeding difficulties. Reported incidence of posterior tongue tie in one

series 6% of all tongue ties (4).

5. Lingual frenotomy (tongue clipping)—a minor surgical procedure, appropriate for treatment of significant

ankyloglossia in infants

a. “Frenotomy” means to cut—no tissue is removed

b. Can be accomplished at the bedside in the neonatal

intensive care unit or postpartum unit, or in an outpatient clinic setting by a trained physician or dentist (6–8)

6. Frenuloplasty or frenectomy—more complicated surgical procedures employing Z-plasty technique or with

removal of tissue

a. Reserved for older children, adults, or infants with a

complicated lingual frenulum, such as a thickened

frenulum containing genioglossus muscle or a

“complete” ankyloglossia in which tongue is fused

to the floor of the mouth

b. Performed in the operating room, by an otolaryngologist or oral surgeon, under conscious sedation

or general anesthesia

B. Purpose

1. Lingual frenotomy—performed when the presence of

ankyloglossia restricts or impedes an infant’s ability to

suckle successfully

a. Most common in breast-feeding infants

b. Occasionally seen in infants using an artificial teat

2. Other problems related to ankyloglossia that may manifest in older children and adults, for which prophylactic

frenotomy in infancy (when procedure is relatively simple and safe) should be considered (2,3,9–13).

a. Mechanical problems

Gingival recession, mandibular diastema, malocclusion, prognathism, difficulty with intraoral toilet

(licking the lips, sweeping food debris off teeth)

b. Articulation errors in speech

c. Social effects

(1) Difficulty playing a wind instrument, licking an

ice cream cone or lollipop, social interactions

(kissing, etc.)

(2) Can lead to social embarrassment and the need

for the more complicated frenuloplasty procedure outside the neonatal period

C. Background

1. There is much controversy surrounding ankyloglossia

regarding.

a. Definitions

(1) Range from vague descriptions of a tongue that

functions with a less than normal range of activity to specific description of a frenulum that is

short, thick, muscular, or fibrotic (3) (Figs. 57.1

and 57.2)