Tadros Sandra, Ben-Dov Tom, Catháin Éadaoin Ó, Anglin Carlita, April Max M
Division of Pediatric Otolaryngology, New York University Grossman School of Medicine, NYU Langone Health, USA.
New York University Grossman School of Medicine, NYU Langone Health, 550 1st Avenue, New York, NY, 10016, USA.
Int J Pediatr Otorhinolaryngol. 2022 May;156:111063. doi: 10.1016/j.ijporl.2022.111063. Epub 2022 Feb 26.
Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema.
To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema.
A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review.
RESULTS/DISCUSSION: Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient's medical history before referral for surgical intervention.
小儿耳鼻喉科医生越来越关注上唇系带，认为它可能是喂养困难和上颌中线间隙（MMD）形成的原因。家长通过互联网接触到有关母乳喂养的医学建议以及对孩子潜在的长期美学问题的关注，可能促使了这种关注度的增加。随后，小儿耳鼻喉科医生面临着更大的压力来实施上唇系带切除术。自2000年以来，系带切除术的报告数量增加了10倍。然而，关于上唇系带切除术在预防中线间隙方面的益处，文献中尚未达成共识。
通过系统回顾现有文献中关于上唇系带与中线间隙之间的关联，为医生和家长提供最新信息。
在MEDLINE（PubMed）、EMBASE、科学网、考克兰图书馆以及牙科和口腔科学资源库（DOSS）中进行文献检索。使用Covidence平台进行系统评价。对最初识别出的314篇文章进行系统评价，最终纳入11项研究。
结果/讨论：现有数据主要来自牙科文献，表明系带的两种亚型：乳头型和乳头穿透型系带，与上颌中线间隙有关。上唇系带切除术应推迟到恒侧切牙萌出后进行，因为这可以使生理性MMD自然闭合。当前文献建议在使用正畸方法解决间隙问题之前不要进行系带切除术，这有助于防止间隙复发。排除其他牙源性和口腔原因导致的间隙也很重要，如吮拇指、牙齿缺失和其他原因。在线信息可能并不总是完全具有代表性，在转诊进行手术干预之前，应结合患者的完整病史进行解读。
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