3/21/2015

Organization of tongue movements

before and after frenotomy for
posterior tongue-tie: an ultrasound
analysis

Normal Tongue
Movements

lateralization

Catherine Watson Genna BS, IBCLC

Analysis by David Elad DSc
elevation

Restricted elevation

Extension/
protrusion

Restriction of
tongue motions
from
ankyloglossia

Restrictive frenulum

twisting on lateralization

Restricted extension

Restricted grooving

Failure to thrive

Breastfeeding Problems
Associated with Tongue-tie

Copyright 2015 Catherine Watson Genna

3/21/2015

Nipple wounds

Difficulty
Maintaining
Latch

Difficulty
latching

Type 3 tongue tie appears WNL,

may perform very poorly.

Posterior Tongue-tie and

Treatment

3 views of same
infants tongue
Bunched
configuration

Mid-tongue pulled down during

extension

Copyright 2015 Catherine Watson Genna

3/21/2015

Type 4 fibrous attachment,

asymmetry of tongue movement,
narrow palate

Appearance Prefrenotomy
(type 3/50%)

Thick posterior frenulum

requires multiple snips
After
treatment
(similar
case)

Type 4 pre and post frenotomy

Copyright 2015 Catherine Watson Genna

3/21/2015

Submental approach, intracavity probe

Ultrasound examination of
sucking during breastfeeding

Analog or digital recording

Adapted from Lorili Jacobs 2004

Courtesy of Brian Palmer

www.brianpalmerdds.com

Normal Sucking

Copyright 2015 Catherine Watson Genna

From
Elad et al
PNAS
2014

3/21/2015

NORMAL

NORMAL

Current Study
Objective analysis of ultrasounds
previously recorded
9 infants, 6 from Tel Aviv, 3 from NY
One treating physician (NY) / pediatric
dentist (Tel Aviv) per site
Scissors frenotomy
Immediate (Tel Aviv) or delayed (NY)
post-frenotomy scan

Findings

Nipple to hard-soft palate

junction distance decreases
after frenotomy

Further information:

Anterior tongue amplitude and

rhythm are irregular
Posterior tongue movements are
neither synchronized nor peristaltic
These issues resolve after frenotomy

http://www.cwgenna.com/clinicalcornerpage.html

Copyright 2015 Catherine Watson Genna

Ultrasound Research
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