Transverse arch changes in cases of ankyloglossia [Elektronische Ressource] / vorgelegt von: Małgorzata Łysiak-Seichter

Edyta

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• Gesundheit

Informations

• Publié par: ernst-moritz-arndt-universitat_greifswald
• Publié le: 01 janvier 2008
• Nombre de lectures: 26
• Langue: Deutsch
• Poids de l'ouvrage: 8 Mo

Extrait

Aus der Poliklinik für Kieferorthopädie,
Präventive Zahnmedizin und Kinderzahnheilkunde
(Direktor: Univ.- Prof. Dr. med. dent. habil. T. Gedrange)
im Zentrum für Zahn-, Mund- und Kieferheilkunde
(Geschäftsführender Direktor: Univ.- Prof. Dr. Dr. h.c. G. Meyer)
der Medizinischen Fakultät der Ernst-Moritz-Arndt-Universität Greifswald






Transverse arch changes in cases of ankyloglossia


Inaugural – Dissertation

zur

Erlangung des akademischen Grades

Doktor der Zahnmedizin
(Dr. med. dent.)

der

Medizinischen Fakultät

der

Ernst-Moritz-Arndt-Universität
Greifswald




vorgelegt von: Małgorzata Łysiak-Seichter
geb. am: 31.10.1976
in: Toruń/Polen























Dekan: Prof. Dr. rer. nat. Heyo K. Kroemer

1. Gutachter: Prof. Dr. med. dent. T. Gedrange

2. Gutachter: Prof. Dr. med. A. Wree

Tag der Disputation: 28.06.2008












































Dedication
To my husband Adam














Table of contents
1. Introduction and aim of the study…………………………………….1
1.1. Definition………………………………………………………………2
1.2. Anatomy and histology of the frenum…………………………...…3
1.3. Diagnostic criteria of ankyloglossia……………………………….16
1.4. The incidence……………………………………………………….24
1.5. The clinical consequences of ankyloglossia…………………….25
1.5.1. The influence on tongue resting position………………………25
1.5.2. The influence on tongue function…….…………………………26
1.5.2.1. Sucking………………………………………...………………..26
1.5.2.2. Swallowing…..27
1.5.2.3. Speech……….28
1.5.2.4. Chewing…………………………………………………………29
1.5.2.5. Mechanical problems………………………………………….30
1.5.2.6. Social problems………………………………………………...31
1.5.3. The influence on stomatognathic system morphology……….32
1.5.3.1. Palate……………………………………………………………32
1.5.3.2. Jaw, alveolar and dental position (malocclusion)…...…..….32
1.6. Treatment………6
1.7. Arch dimensions evaluation……………………………………….42
1.8. Aim of the study…………………………………………………….47
2. Material and method..49
2.1. Sample selection……………………………………………………49
2.2. Characteristics of group A and B…………………………………50
2.3. Study models analysis……………………………………………..53
3. Results…………………………………………………………………56
3.1. Age structure………………………………………………………..56
3.2. Sex structure…….61
3.3. Free tongue length distribution……………………………………65
3.4. Angle Class structure………………………………………………69
3.5. Maxillary intermolar width structure………………………………73
3.6. Mandibular intermolar width structure…7
3.7. Molar difference structure………………………………………….81
3.8. Intergroup comparisons……………………………………………85
4. Discussion……………………………………………………………..89
4.1. Tongue vs. dental arch and facial morphology………………….89
4.2. Transverse arch dimensions and their changes………………...93
4.3. Conclusions…………………………………………………………96
5. Summary……………………………………………………………....97
6. References…………………………………………………………..100
7. Curriculum vitae……………………………………………………..118
8. Acknowledgements…………………………………………………120


1 Introduction

A condition in which lingual frenum is shortened (Delaney 1995),
called ankyloglossia or tongue-tied, is a frequent seen anomaly in the
practice of any orthodontist. Ankyloglossia is an oral anomaly well
know since ancient times. Historical reference to this condition may
be found even in the bible “the string of his tongue loosened and he
spoke plain” (Mark 7:35) (Lalakea and Messner 2003). Although the
authors present their attitudes toward ankyloglossia in the medical
literature for decades, there are still controversies about this subject
(Messner and Lalakea 2000). The lack of unified method of
classification of ankyloglossia causes different values of the
incidence of the condition in the literature. There is a wide range of
opinions regarding the frequency and significance of clinical features
associated with ankyloglossia. Research revealed that about 30% of
otolaryngologists believe that ankyloglossia leads to feeding
problems, and only 10% of pediatricians agree with this (Messner
and Lalakea 2000). Conversely, while about 80% of pediatricians
state that ankyloglossia rarely, if ever, causes speech problems, only
50% of speech therapists and 40% of otolaryngologists agree with
this statement (Messner and Lalakea 2000). Thus the condition of
ankyloglossia is a very interesting problems not only in terms of
anatomical structure but in many aspects of functional disturbances
as well.





1
1.1 Definition

The term ankyloglossia comes from Greek words ankilos- immobile
articulation, glossa-tongue and implies that the tongue is fused with
oral cavity wall (Ruffoli et al. 2005). Terms ankyloglossia, tongue-tie,
ankyloglossia inferior or linqua accreta are related to fusion of the
tongue with the floor of the mouth, which is the most common
congenital abnormality of the tongue, although it can be the
posttraumatic scarring effect (Varkey et al. 2006). Epiankyloglossia
or ankyloglossia superior consist of fusion of the tongue with the
palate. In the medical literature the term ankyloglossia is often
identified with the most common -congenital lingual frenum
shortening or fusion with the mouth floor. The severity of
ankyloglossia is variable and can range from a light degree –slight
shortening of frenum without clinical significance, to a rare complete
ankyloglossia with the lack of frenulum -tongue is fixed to the floor of
the mouth. Summing up ankyloglossia implies some abnormality, a
condition outside of the range of normal anatomic or functional
capacity.









2
1.2 Anatomy and histology of the frenum

The floor of the mouth is a small horseshoe-shaped region beneath
the movable part of the tongue and above the muscular diaphragm
produced by the mylohyoid muscles (Fig.1).

Fig. 1: Inferior surface of the tongue and the floor of the mouth
(Berkovitz and Moxham 1988)
The main muscle forming the floor of the mouth is mylohyoid (Fig.2).
Immediately above it is geniohyoid. Mylohyoid lies superiorly to the
anterior belly of digastric and, with its contralateral fellow, forms a
muscular floor for the oral cavity. It is a flat, triangular sheet attached
to the whole length of the mylohyoid line of the mandible. The
posterior fibres pass medially and slightly downwards to the front of
the body of the hyoid bone near its lower border. The middle and
anterior fibres from each side decussate in a median fibrous raphe
that stretches from the symphysis menti to the hyoid bone. The
median raphe is sometimes absent, in which case the two muscles
from a continuous sheet, or it may be fused with the anterior belly of
digastric. In about one-third of subjects there is a hiatus in the muscle
3
trough which a process of the sublingual gland protrudes. Relations
among anatomical structures can be described in several layers. The
inferior (external) surface is related to platysma, anterior belly of
digastric, the superficial part of the submandibular gland, the facial
and submental vessels, and the mylohyoid vessels and nerve. The
superior (internal) surface is related to geniohyoid, part of hyoglossus
and styloglossus, the hypoglossal and lingual nerves, the
submandibular ganglion, the sublingual gland, the deep part of the
submandibular gland and its duct, the lingual and sublingual vessels
and, posteriorly, the mucous membrane of the mouth. Mylohyoid
receives its arterial supply from the lingual branch of the lingual
artery, the maxillary artery, via the mylohyoid branch of the inferior
alveolar artery, and submental branch of the facial artery. As far as
innervation is concerned, mylohyoid is supplied by the mylohyoid
branch of inferior alveolar nerve. The actions of mylohyoid is
important in the first stage of deglutition as it elevates the floor of the
mouth. It may also elevate the hyoid bone or depress the mandible
(Fried 1976, Standring 2005).

Fig. 2: Coronal section through the floor of the mouth (Berkovitz and
Moxham 1988)
Geniohyoid is a narrow muscle which lies above the medial part of
mylohyoid. It arises from the inferior mental spine (genial tubercule)
4
on the back of the symphysis menti, and runs backwards and slightly
downwards to attach to the anterior surface of the body of the hyoid
bone. The paired muscles are contiguous and may occasionally fuse
with each other or with genioglossus. The blood supply to geniohyoid
is derived from the sublingual artery