Method for comprehensive treatment of ankyloglossia

Abstract

FIELD: medicine.SUBSTANCE: invention relates to surgical dentistry, functional orthodontics, speech therapy, and maxillofacial surgery. Preoperative psychological preparation of the patient is conducted. Myofunctional gymnastics is performed before surgery for 6–8 weeks. The frenuloplasty of the tongue is conducted in combination with plastic surgery of the mouth floor behind the lower incisors with optical magnification of surgical fields. The wound is sutured with self-absorbable material along the edge of the wound, starting with matching the apex of the first triangle and the base of the second, after which the apex of the second triangle and the base of the first are matched, without tension or stretching the tissues. Then a relaxing incision is made on the oral side of the lower jaw in the area of the floor of the mouth. Using a scalpel and a monopolar electrocoagulator, the attachment of the strands is separated from the body of the lower jaw. A protective dressing with a keratoplastic preparation is applied to the wound. Postoperative myofunctional gymnastics is performed 48 hours after the operation for 20 days in parallel with massage with probes and hands for 10 days.EFFECT: method allows for achieving high precision in surgical treatment while minimizing trauma to blood vessels and nerve endings during frenuloplasty, improving the quality and effectiveness of treatment for ankyloglossia and associated myofunctional disorders in patients, preventing relapses, restoring the structure and function of the tongue, reducing the risk of developing cicatricial deformities under the tongue, and shortening the rehabilitation period for patients.8 cl, 4 dwg, 1 tbl, 1 ex

Description

[0001] The invention relates to the field of medicine, surgical dentistry, functional orthodontics, speech therapy, maxillofacial surgery, and can be used in practical dentistry and pedagogy for performing frenuloplasty of the tongue in combination with plastic surgery of the floor of the mouth.

[0002] Recently, orthodontists are increasingly encountering dental pathologies caused by an abnormal lingual frenulum. Limited tongue mobility leads to persistent orofacial dysfunctions, which speech therapists cannot fully address. Incorrect tongue function not only interferes with jaw development and growth but also hinders orthodontic treatment and can lead to relapse. Classic frenulotomy often partially frees the tongue, but subsequent scarring can further limit tongue mobility. Speech therapists and orthodontists have tried to avoid surgery, resorting to manual techniques and retention measures. Therefore, there is a need to develop a method for completely freeing the tongue with minimal consequences.

[0003] Among the most common methods of treating ankyloglossia are frenulotomy (an operation aimed at cutting the oral mucosa in the area of ​​the frenulum of the tongue without fixing the edges of the wound with suture material or transverse dissection with a laser) and plastic surgery of the frenulum of the tongue using the method of counter triangles according to the method of A.A. Limberg (an operation in which, after cutting the oral mucosa in the area of ​​the frenulum of the tongue, two triangular flaps are cut out and fixed with sutures).

[0004] The disadvantage of these methods, in our opinion, is the repeated restriction of tongue mobility in the postoperative period and the insufficient range of motion necessary for full tongue function. While the free edge of the tongue is visually enlarged, the dorsal motion remains limited. Rehabilitation after such procedures is not generally recommended, or is recommended 2-4 weeks after the procedure, by which time the scarring process is already complete.

[0005] A method of frenuloplasty is known, which includes vertical pulling of the upper lip and removal of the frenulum, characterized in that the removal of the frenulum and, according to indications, the connective tissue strand is carried out by evaporation with a contactless focused laser beam of 5-6 W power, provided that the beam is directed perpendicular to the surface of the tissues being removed [RU 2180194 C1, A61B 17 / 24, published 10.03.2002].

[0006] A method of plastic surgery of a short frenulum of the tongue is known, characterized in that an incision is made along the line of attachment of the frenulum of the tongue to its lower surface, the mucomuscular block of the frenulum is cut off from the tongue along with the underlying muscles and moved to the base of the tongue, and the resulting wound is sutured onto itself with frequent sutures with catgut to a new, lower position of the frenulum [RU 2232552 C2, A61B 17 / 24, published 20.07.2004].

[0007] The disadvantage of existing treatment methods is the lack of a comprehensive approach to the treatment of ankyloglossia in patients, since patients do not undergo proper preparation before surgery, and do not receive adequate rehabilitation in the postoperative period, which leads to limited tongue mobility, cicatricial deformities and recurrence of orthodontic problems.

[0008] A known method for the rehabilitation treatment of tongue dysfunction after frenuloplasty in patients using removable orthodontic appliances, consists in the fact that for 2 hours a day and for the period of classes with a speech therapist, a removable individual replaceable myogymnastic element (RIMGE) is fixed in the blind canals of the palatal plate of the removable orthodontic appliance. The RIMGE is a curved orthodontic wire taking into account individual characteristics and a multifaceted bead put on it; while the patient performs actions with the tongue: touches the bead and moves it in different directions along the trajectory indicated by the wire; as the range of motion increases, the RIMGE is replaced with a new one with a complex wire trajectory and a bead of a smaller diameter; classes continue until language function is restored [RU 2523692 C1, IPC A61C7 / 36, 19 / 06, published 2014].

[0009] The disadvantage of this rehabilitation method is that in most cases, orthodontic treatment begins after lingual frenuloplasty, meaning the bead plate will be fabricated after the rehabilitation is complete. Not all children are suitable for such orthodontic appliances. For children with existing orthodontic appliances on the palate, myophrenuloplasty is recommended after the appliance is removed, as it hinders proper rehabilitation: there is no room for tongue positioning, and there is no contact between the tongue mucosa and the mucosa of the hard palate.

[0010] It is known that tongue frenuloplasty is performed in conjunction with myofunctional therapy to correct a short lingual frenulum (Soroush Zaghi et al. Lingual Frenuloplasty With Myofunctional Therapy: Exploring Safety and Efficacy in 348 Cases. Laryngoscope Investigative Otolaryngology. 2019 Aug 26;4(5):489-496). This source is accepted as the closest analogue of the claimed method.

[0011] However, this method performs surgical intervention in a single surgical site by dissecting the frenulum. It does not require a combined surgical approach, i.e., two surgical sites. The presence of a second surgical site, behind the lower incisors, provides additional relief along the floor of the mouth, even if the frenulum was not attached to the gum.

[0012] The claimed method of treating ankyloglossia allows for the simultaneous combination of surgical orthodontic treatment in two surgical fields and myofunctional correction of patients with a short lingual frenulum before surgery and after frenuloplasty.

[0013] Disclosure of the essence of the invention

[0014] The objective of the invention is to develop a method for the comprehensive treatment of ankyloglossia by means of frenuloplasty of the tongue, combined with plastic surgery of the floor of the mouth and myofunctional correction, ensuring the restoration of the structure and function of the tongue (sound pronunciation, chewing, swallowing, breathing), the formation of skull structures, achieving maximum lengthening of the tongue, eliminating the development of relapse of orthodontic treatment and speech therapy correction, reducing the risk of developing cicatricial deformities under the tongue, eliminating the cause of the development of orofacial dysfunctions, malocclusion, snoring and sleep apnea, and a number of interrelated ENT diseases.

[0015] The stated problem is solved by implementing the proposed method of complex treatment of ankyloglossia, where the method of frenuloplasty of the tongue is combined with plastic surgery of the floor of the mouth behind the lower incisors and myofunctional correction of the articulatory apparatus in the pre- and postoperative period.

[0016] The technical result consists of high precision and effectiveness of surgical treatment, low trauma while minimizing damage to blood vessels and nerve endings during tongue frenuloplasty; improved quality and effectiveness of treatment for ankyloglossia and associated myofunctional disorders; prevention of relapses, early rehabilitation of patients, while restoring the structure and function of the tongue, and reducing the risk of developing cicatricial deformities under the tongue.

[0017] The specified technical result is achieved by the fact that:

[0018] carry out preoperative psychological preparation of the patient;

[0019] conduct myofunctional gymnastics before surgery for 6-8 weeks;

[0020] Frenuloplasty of the tongue is performed in combination with plastic surgery of the floor of the mouth behind the lower incisors with optical magnification of the surgical fields, while:

[0021] a horizontal incision is made with surgical scissors in the area of ​​the middle third of the frenulum of the tongue, then the surgical field is expanded with a scalpel by vertical incisions towards the tip of the tongue - the first incision line, and the floor of the oral cavity to the sublingual ridges - the second incision line; the mucous membrane in the area of ​​the frenulum of the tongue is mobilized; triangular flaps are cut out in the area of ​​the middle third of the wound, wherein the first triangle is isolated by an incision between the lower and middle thirds of the wound at an angle of at least 60 degrees between the first incision line and its upper end, and the second triangle is isolated by an incision between the upper and middle thirds of the wound, at an angle of at least 60 degrees between the first incision line and its lower end; Next, 4 bundles of the genioglossus muscle are dissected, after which the edges of the wound are sutured with a 5 / 0 self-absorbable suture material using a piercing needle;

[0022] The wound is sutured with self-absorbable material along the edge of the wound, starting with matching the apex of the first triangle and the base of the second, after which the apex of the second triangle and the base of the first are matched, without tension or stretching the tissues;

[0023] Then a relaxing incision is made on the oral side of the lower jaw in the area of ​​the floor of the oral cavity, and the attachment of the strands is separated from the body of the lower jaw using a scalpel and a monopolar electrocoagulator;

[0024] Apply a protective dressing with a keratoplastic preparation to the wound;

[0025] Postoperative myofunctional gymnastics is performed 48 hours after the operation for 20 days in parallel with probe massage for 10 days and manual massage for 10 days.

[0026] Myofunctional correction: performing the first set of exercises, in particular: Ladder, Swing, Jam, Brushing Teeth, Painter, Woodpecker, Horse, Mushroom, Accordion, Sail, which are performed sequentially for 1 minute each exercise once a day, for 4-6 weeks.

[0027] Myofunctional correction includes performing a second set of exercises following the first set of exercises aimed at training the strength and endurance of the styloglossus and longitudinal muscles of the tongue, facilitating their inclusion in work immediately after surgery and the ability to take the correct position of the tongue on the palate, which are performed sequentially for 1 minute each, once a day, for 2 weeks.

[0028] 5 days before surgery, the patient increases the repetition frequency from 1 to 3 times per day.

[0029] The operation is performed using an optical-dental microscope or other systems with at least 3-fold magnification of the surgical fields.

[0030] The keratoplastic drug is sea buckthorn oil, Solcoseryl, Asepta or Reso-Pak.

[0031] The next day after the operation, the patient makes single movements with the tongue - up, down, left, right up, down, left, right - every 2 hours, and also begins to glue the tongue positioners to the resting point.

[0032] Postoperative myofunctional exercises and massage with sea buckthorn oil probes are performed by the patient for 2 minutes, twice a day for 10 days. The patient then performs manual massage of the tongue and sublingual area for 1 minute, once a day, for 10 days, and then moves on to myofunctional exercises for tongue positioning, according to an individual plan.

[0033] The claimed method is performed using an optical-dental microscope, muscle manipulation, flap cutting techniques, and electrocoagulation suturing. Thanks to high-precision microsurgical manipulation, trauma is minimal, pain is significantly reduced, and the patient can begin early rehabilitation.

[0034] The stated objective and technical result are achieved by combining myotherapy techniques as preparation for surgery, tongue frenuloplasty in combination with floor of mouth plasty, and rehabilitation measures immediately after surgery. The high effectiveness of this method for treating ankyloglossia is achieved due to the depth of surgical intervention and the minimal trauma of the procedure, which allows for high-quality early rehabilitation by a myotherapist, reducing the risk of relapse.

[0035] Differences between the claimed method and known analogues:

[0036] - interaction of specialists from different fields: orthodontist, dental surgeon, speech therapist - an integrated approach;

[0037] - methods of preoperative preparation of the patient (myotherapy, psychological preparation);

[0038] - a combined approach to surgical treatment (two surgical fields). The presence of a second surgical field - behind the lower incisors - provides additional relaxation along the floor of the mouth, even if the frenulum was not attached to the gum;

[0039] - The procedure is performed exclusively with surgical instruments, eliminating laser intervention, and using 3-4x magnification optics. This ensures high precision and minimizes trauma to blood vessels and nerve endings (not visible to the naked eye). Reduced trauma allows for pain medication-free surgery the next day, allowing for active rehabilitation to begin.

[0040] - without dissecting the longitudinal muscle of the tongue (as, for example, in source RU 2747126 C1, published April 28, 2021), but by peeling it away from the mucosa of the tip of the tongue. In this case, the tongue's mobility and strength, necessary for restoring its function, are preserved. The tongue is not suturing for fixation before surgery, but is held by hand through a napkin, which not only avoids unnecessary tissue trauma but also controls the tension force and range of tongue movement;

[0041] - early rehabilitation, which is carried out immediately after surgery (instead of tongue rest for 10 to 30 days, as per clinical recommendations). The mucosa heals by secondary intention in the unsutured area behind the lower incisors and adheres within the first 40 hours; in the sutured area, within the first 7 days; scarring occurs within the first 5 weeks. Therefore, it is important to begin restoring tongue mobility as early as possible.

[0042] Implementation of the invention

[0043] After ankyloglossia is diagnosed, the patient begins preparing for myophrenuloplasty, including psychological and motor preparation. During psychological preparation, it's important that the patient doesn't withdraw after the surgery and remains actively cooperative. The myotherapist explains why the surgery is necessary in their case, how it will be performed, what they will feel during and after the procedure, and what they will need to do.

[0044] Preoperative myofunctional correction and motor training. This begins with basic exercises during the initial consultation. In total, training for a patient with ankyloglossia without a neural factor takes 6-8 weeks of daily myofunctional exercises. If there are concomitant pathologies (neurological, intellectual), the training time is calculated individually.

[0045] The patient performs a set of exercises aimed at strengthening and improving control of the tongue muscles, their endurance, and increasing the mobility of the oral mucosa.

[0046] These exercises can include the following: Ladder, Swing, Jam, Brushing Teeth, Painter, Woodpecker, Horse, Mushroom, Accordion, and Sail (Exercises from the 1st set), performed sequentially for 1 minute each, once a day, for 4-6 weeks. Taking into account the individual and age characteristics of the children, the set of exercises can be divided into 2-3 parts and performed in sections.

[0047] Then, the speech therapist selects more complex exercises to develop the strength and endurance of the styloglossus and longitudinal muscles of the tongue, facilitating their activation immediately after surgery and the ability to achieve the correct tongue position on the palate (Exercises 2). The exercises are performed sequentially for 1 minute each, once a day, for 2 weeks.

[0048] Based on the results of the sessions, the speech therapist determines the patient's motor readiness for frenuloplasty. The patient continues to perform myofunctional exercises daily until the day of surgery (with an emphasis on exercises that require further development).

[0049] Five days prior to surgery, the patient increases the repetition frequency from 1 to 3 times per day. On the day of surgery, the patient takes a painkiller 40 minutes before surgery (unless anesthesia is used).

[0050] Surgical treatment: frenuloplasty of the tongue in combination with plastic surgery of the floor of the mouth. The procedure is performed under local anesthesia.

[0051] Procedure: A horizontal incision is made with surgical scissors in the area of ​​the middle third of the lingual frenulum. Next, the surgical field is expanded with a scalpel by vertical incisions towards the tip of the tongue and the floor of the mouth to the sublingual folds. The mucous membrane in the area of ​​the lingual frenulum is mobilized with pointed scissors under visual control of the surgical field. Triangular flaps are dissected in the area of ​​the middle third of the wound. The first triangle is isolated by an incision between the lower and middle thirds of the wound, at an angle of at least 60 degrees between the first incision line and its upper end. The second triangle is isolated by an incision between the upper and middle thirds of the wound, at an angle of at least 60 degrees between the first incision line and its lower end. Next, four bundles of the genioglossus muscle are dissected. This allows you to free the back of the tongue, ensure its lifting and pressing against the palate.After which the edges of the wound are sutured with a 5 / 0 self-absorbable suture material using a piercing needle.

[0052] To reduce the volume of postoperative scars, a relaxing incision is made on the oral side of the mandible in the floor of the mouth. Using a scalpel and a monopolar electrocoagulator, the attachment of the ligaments is separated from the body of the mandible, creating relaxation of the floor of the mouth and reducing the tension of the primary wound, as the outlets of the salivary glands are nearby, without suturing the wound. The operating frequencies of the device and the attachments used have been developed: a 3mm ball attachment for vascular coagulation at 40 mA, and a straight tissue knife attachment at 50 mA.

[0053] It should be noted that material that requires surgical removal causes additional trauma to the mucosa and is impossible to remove in children undergoing surgery under general anesthesia. Thinner sutures tear the mucosa when moving, while thicker ones create a rough, tightly pulled suture, resulting in more severe scarring.

[0054] Wound closure begins with aligning the apex of the first triangle with the base of the second, followed by aligning the apex of the second triangle with the base of the first. The wound edges should be sutured with minimal tension and tissue stretch.

[0055] A protective dressing with keratoplastic preparations (sea buckthorn oil, Solcoseryl, Asepta, Reso-Pak) is applied to the wound.

[0056] The technique for performing a combined surgical operation is clearly shown in the images of Fig. 1 and Fig. 2.

[0057] Immediately after surgery, apply cold compresses to the affected area, drink cold fluids frequently, and follow a diet (avoiding hard, spicy, hot, or acidic foods). The following day (the maximum tongue rest time is 2 hours after surgery), the patient performs single tongue movements—up, down, left, and right—as well as learned movements that involve pulling the back of the tongue toward the roof of the mouth. Tongue positioners are applied to the tongue resting point.

[0058] Postoperative myofunctional exercises and massage. Forty-eight hours after surgery, the first stage of treatment and rehabilitation begins with a speech therapist: massage with probes using sea buckthorn oil as a lubricant twice daily and myofunctional exercises twice daily. The massage technique is demonstrated to the patient (or their parent) for home practice. The goal of the massage is to move the mucous membrane away from the lower gum to prevent the wound edges of the second surgical site from sticking together. The wound edges are covered with fibrin, which causes the mucous membranes to adhere to each other. The roller is then moved under the tongue from the lower incisors to the throat, maximally distalizing the tongue. The massage lasts 2 minutes. The speech therapist then performs passive articulation exercises using non-woven napkins. A tongue positioner is glued to the resting point (KP-Plast, Myospot or Foxyspot), and the patient (or parent) is also taught how to fix the positioner.Next, the patient performs the entire set of exercises No. 1 under the supervision of a speech therapist (except for the Horse, which is added 3 days after the operation).

[0059] Perform massage and myogymnastics twice a day for 2 minutes for 10 days (independently or under the supervision of a specialist). The patient then performs manual massage of the tongue and sublingual area for 1 minute each time, once a day for 10 days, and then moves on to myofunctional exercises for tongue positioning.

[0060] After 10 days, during the second stage of rehabilitation (when the stitches are gone and the wounds are calm), a course of speech therapy massage or self-massage begins. The following exercises can be performed: Pinch, Pistol, Hook, and Rocket, each performed sequentially for 1 minute, once a day for 10 days. In parallel, the patient can continue myocorrection according to a personally developed program.

[0061] Example of the invention.

[0062] The parents of a patient born in 2015 consulted an orthodontist with a relapse after treatment of malocclusion: the incisors had ceased to occlude again, and the jaw width had narrowed (the old appliance was no longer the right size). The patient had already undergone tongue-tie correction with a diode laser. Speech therapy was not performed, as the cause of the incisor malocclusion (ankyloglossia) was believed to have been corrected.

[0063] The patient underwent psychological preparation for myophrenuloplasty.

[0064] The patient completed myofunctional correction by performing the prescribed myofunctional gymnastics exercises daily: Ladder, Swing, Jam, Brushing Teeth, Painter, Woodpecker, Horse, Mushroom, Accordion, and Sail, sequentially for 1 minute each, once daily, for 6 weeks. The speech therapist then selected a second (more challenging) set of exercises to train the strength and endurance of the styloglossus and longitudinal muscles of the tongue, facilitating their activation immediately after surgery and enabling the tongue to assume the correct position on the palate. The patient performed the exercises sequentially for 1 minute each, once daily, for 2 weeks.

[0065] Based on the results of the sessions, the speech therapist determined the patient's motor readiness for frenuloplasty and referred him for surgical treatment. The patient continued to perform myofunctional exercises daily until the day of surgery. Five days before surgery, the patient increased the frequency of repetitions from 1 to 3 times per day.

[0066] On the day of surgery, the patient took an anesthetic 40 minutes before surgery. The surgery was performed with the patient awake using local anesthesia and nitrous oxide / oxygen sedation (NOS).

[0067] On the day of the operation, the patient took a painkiller 40 minutes before the operation.

[0068] Surgical treatment was performed:

[0069] A horizontal incision is made with surgical scissors in the middle third of the lingual frenulum. The surgical field is then expanded with a scalpel using vertical incisions toward the tip of the tongue and the floor of the mouth, reaching the sublingual folds. The mucous membrane in the lingual frenulum area is mobilized with pointed scissors, under visual inspection of the surgical field. Triangular flaps are dissected in the middle third of the wound. The first triangle is isolated by an incision between the lower and middle thirds of the wound, at an angle of 65 degrees between the first incision line and its superior end. The second triangle is isolated by an incision between the upper and middle thirds of the wound, at an angle of 70 degrees between the first incision line and its inferior end. Next, four bundles of the genioglossus muscle are dissected, which allows the dorsum of the tongue to be released, elevated, and pressed against the palate.The wound edges were then closed with 5 / 0 absorbable suture material using a piercing needle. The wound was closed by aligning the apex of the first triangle with the base of the second, followed by aligning the apex of the second triangle with the base of the first. The wound edges were closed with minimal tension and tissue stretching.

[0070] To reduce postoperative scar volume, a relaxing incision was made on the oral aspect of the mandible in the floor of the mouth using a scalpel or monopolar electrocoagulator to a depth of 2-2.5 mm. Wound hemostasis was achieved using a monopolar coagulator in coagulation mode and a 3 mm ball attachment. A protective dressing containing the keratoplastic agent Solcoseryl was applied to the wound.

[0071] The implementation of the combined surgical technique of the operation, according to the claimed method, is clearly shown in the images of Fig. 1 and 2.

[0072] Immediately after the surgery, a cold compress was applied to the affected area, cold fluids were drunk frequently, and a diet was followed (excluding hard, spicy, hot, and acidic foods). The maximum tongue rest time after surgery was 2 hours. The following day, the patient performed single tongue movements—up, down, left, and right—as well as exercises from the learned routines, which involved pulling the back of the tongue toward the roof of the mouth.

[0073] 48 hours after surgery, the patient began massage with probes using sea buckthorn oil as a lubricant twice daily and myogymnastics twice daily for 2 minutes. A speech therapist then performed passive articulation exercises. Under the speech therapist's supervision, the patient then performed the entire set of exercises #1 (except for the Horse, which was added 3 days after surgery).

[0074] After 10 days, a course of speech therapy massage began. The patient performed postoperative myofunctional exercises and massage with sea buckthorn oil probes for 2 minutes, twice daily for 10 days. Next, the patient performed manual massage of the tongue and sublingual area for 1 minute, once daily for 10 days, and myofunctional exercises for tongue positioning. In parallel, the patient can continue myofunctional exercises according to a personalized program.

[0075] The tongue's range of motion was measured before and after surgery using the ROM scale. A 30% increase was recorded.

[0076] After 2 weeks, the orthodontist was able to begin treatment using the device, and myofunctional correction continued in parallel with wearing the device.

[0077] After 9 months, the appliance was discontinued, and breathing, swallowing, chewing, and speech functions were corrected and fully automated. At follow-up appointments, the orthodontist noted the stability and high effectiveness of the treatment, with no relapses.

[0078] Fig. 4 shows a photo of the patient's tongue before myophrenuloplasty was performed using the claimed method (see Fig. 4.1), but after frenulotomy was performed using a diode laser, and a photo of the patient's tongue 14 days after myophrenuloplasty was performed using the claimed method (see Fig. 4.2).

[0079] During 2024-2025, we performed over 500 myophrenuloplasties using a comprehensive approach, according to the stated method. 340 patients aged 3 to 55 remained under our observation for over 3 months (the rest continued orthodontic treatment and myocorrection with other specialists). We assessed the rate of wound healing after surgery, tongue movement activity during the first days of recovery, scar tissue formation, mouth opening amplitude during tongue movement, and the resolution of myofunctional symptoms.

[0080] Table 1

[0081]

[0082] These results indicate that the proposed method of combined myophrenuloplasty with mandatory myotherapy before and after surgery in the treatment of ankyloglossia allows for minimizing complications during and after surgery and quickly restoring and correcting impaired functions (position of the tongue at rest, breathing, swallowing, sound production).

[0083] Fig. 3 shows images of the patient’s treatment result before (Fig. 3.1) and 7 days later (Fig. 3.2) after myophrenuloplasty performed using the claimed method.

[0084] As a result of comprehensive treatment for ankyloglossia, patients demonstrated early recovery and no relapses after treatment. High precision and effectiveness of surgical treatment were noted, along with minimal trauma to blood vessels and nerve endings during tongue frenuloplasty. Improved quality and effectiveness of treatment for ankyloglossia and associated myofunctional disorders were observed. Furthermore, relapse prevention was observed. Early recovery was observed, with effective restoration of tongue structure and function, and a reduced risk of cicatricial deformities under the tongue.

[0085] Thus, the claimed method achieves the stated technical result. It allows for the effective elimination of the cause of myofunctional disorders that cause malocclusion; the simultaneous combination of orthodontic treatment and myofunctional correction in patients with ankyloglossia after myophrenuloplasty; and the improvement of the surgical technique, which significantly accelerates the patient's rehabilitation period.

Claims

1. A method for the comprehensive treatment of ankyloglossia, including myofunctional correction and frenuloplasty of the tongue, characterized in that carry out preoperative psychological preparation of the patient; myofunctional gymnastics is performed before surgery for 6-8 weeks; frenuloplasty of the tongue is performed in combination with plastic surgery of the floor of the mouth behind the lower incisors with optical magnification of the surgical fields, while: a horizontal incision is made with surgical scissors in the area of ​​the middle third of the frenulum of the tongue, then the surgical field is expanded with a scalpel by vertical incisions towards the tip of the tongue - the first incision line and the floor of the mouth to the sublingual ridges - the second incision line; the mucous membrane in the area of ​​the frenulum of the tongue is mobilized; triangular flaps are cut out in the area of ​​the middle third of the wound, wherein the first triangle is isolated by an incision between the lower and middle thirds of the wound at an angle of at least 60 degrees between the first incision line and its upper end, and the second triangle is isolated by an incision between the upper and middle thirds of the wound at an angle of at least 60 degrees between the first incision line and its lower end; then four bundles of the genioglossus muscle are dissected, after which the edges of the wound are sutured with a 5 / 0 self-absorbable suture material and a piercing needle; The wound is sutured with self-absorbable material along the edge of the wound, starting with matching the apex of the first triangle and the base of the second, after which the apex of the second triangle and the base of the first are matched, without tension or stretching the tissues; then a relaxing incision is made on the oral side of the lower jaw in the area of ​​the floor of the oral cavity, and the attachment of the strands is separated from the body of the lower jaw using a scalpel and a monopolar electrocoagulator; apply a protective dressing with a keratoplastic preparation to the wound; Postoperative myofunctional gymnastics is performed 48 hours after the operation for 20 days in parallel with probe massage lasting 10 days and manual massage lasting 10 days.

2. The method according to paragraph 1, characterized in that the myofunctional correction includes performing the first set of exercises: ladder, swing, jam, brushing teeth, painter, woodpecker, horse, mushroom, accordion, sail, which are performed sequentially for 1 minute each exercise once a day for 4-6 weeks.

3. The method according to paragraph 1, characterized in that the myofunctional correction includes performing a second set of exercises following the first set of exercises aimed at strengthening the styloglossus and longitudinal muscles of the tongue, which are performed sequentially for 1 minute each once a day for 2 weeks.

4. The method according to paragraph 3, characterized in that 5 days before the operation the patient increases the frequency of repetitions from 1 to 3 times per day.

5. The method according to paragraph 1, characterized in that the operation is performed using an optical-dental microscope with at least a 3-fold magnification of the surgical fields.

6. The method according to claim 1, characterized in that the keratoplastic drug is sea buckthorn oil, Solcoseryl, Asepta or Reso-Pak.

7. The method according to paragraph 1, characterized in that on the next day after the operation the patient makes single movements with the tongue - up, down, left, right every 2 hours, and also begins to glue the tongue positioners to the resting point.

8. The method according to paragraphs 1-7, characterized in that the patient performs postoperative myofunctional gymnastics and massage with probes containing sea buckthorn oil for 2 minutes 2 times a day for 10 days; then the patient performs massage of the tongue and sublingual region with his hands successively for 1 minute 1 time per day for 10 days and then performs myofunctional exercises for tongue positioning.

Images