Wright J E
Department of Paediatric Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
J Paediatr Child Health. 1995 Aug;31(4):276-8. doi: 10.1111/j.1440-1754.1995.tb00810.x.
To review the presenting features of tongue-tie in childhood and indications for frenulotomy, drawing conclusions from a retrospective study of patients encountered in paediatric surgical practice and from the literature.
A disease index was kept enabling histories to be selected for analysis. All patients were seen by the author and all operations performed by the author or a registrar under supervision in a standard manner. Patients were reviewed 2 weeks after operation.
During 18 years of practice, 287 patients with simple tongue-tie were encountered (two others with true ankyloglossia were not included in this study) and 158 frenulotomies were performed. The presenting symptoms were related to sucking or swallowing (13%), speech (32%), mechanical problems related to restricted tongue movements (14%) and to other problems (3%). In 38% the asymptomatic tongue-tie was noted incidentally.
It is concluded that there is no place for division of tongue-tie without anaesthesia in the newborn. Speech difficulties related to tongue-tie are over-rated and mechanical problems are underestimated. The indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument. There may be rare instances in infancy where problems with feeding and suction can be helped by frenulotomy but evidence for this is anecdotal. Operation requires general anaesthesia except in older, co-operative teenagers in whom local anaesthetic is appropriate.
回顾儿童舌系带过短的表现特征及舌系带切开术的适应证，通过对小儿外科实践中遇到的患者进行回顾性研究并结合文献得出结论。
建立疾病索引以便选择病史进行分析。所有患者均由作者诊治，所有手术均由作者或在监督下的住院医师以标准方式进行。术后2周对患者进行复查。
在18年的临床实践中，共遇到287例单纯舌系带过短患者（本研究未纳入另外2例真正的舌粘连患者），并进行了158例舌系带切开术。主要症状与吸吮或吞咽有关（13%）、与言语有关（32%）、与舌运动受限相关的机械问题（14%）以及其他问题（3%）。38%的患者舌系带过短无症状，是偶然发现的。
得出结论，新生儿期在无麻醉情况下进行舌系带切开术是不可取的。与舌系带过短相关的言语困难被高估，而机械问题被低估。舌系带切开术的适应证包括经言语病理学家确诊的发音困难、机械性限制，如无法舔嘴唇、进行口腔内部清洁或吹奏管乐器。在婴儿期，可能有极少数情况下，舌系带切开术有助于解决喂养和吸吮问题，但这方面的证据多为轶事。除了年龄较大、配合的青少年适合局部麻醉外，手术需要全身麻醉。
