Short Lingual Frenulum and Obstructive Sleep Apnea in Children

Background: Abnormal short lingual frenulum may lead to impairment of orofacial growth in early childhood. This may reduce the width of the upper airway—a pliable tube—increasing its risk of collapse, particularly during sleep.

Study: A retrospective study of prepubertal children referred for suspicion of obstructive sleep apnea, found 27 subjects with non-syndromic short lingual frenulum. The children had ndings associated with enlarged adenotonsils and/or orofacial growth changes.

Results: Children with untreated short frenulum developed abnormal tongue function early in life with secondary impact on orofacial growth and sleep disordered breathing (SDB).

After presence of SDB, analysis of treatment results revealed the following: The apnea-hypopnea index (AHI) of children with adenotonsillectomy (T&A) performed without frenectomy improved, but surgery did not resolve fully the abnormal breathing. Similar results were noted when frenectomy was performed simultaneously with T&A. Finally, frenectomy on children two years or older without enlarged adeno tonsils also did not lead to normalization of AHI. The changes in orofacial growth related to factors including short lingual frenulum lead to SDB and mouth-breathing very early in life. Recognition and treatment of short frenulum early in life—at birth, if possible—would improve normal orofacial growth. Otherwise, myofunctional therapy combined with education of nasal breathing is necessary to obtain normal breathing during sleep in many children.

Conclusion: Short lingual frenulum may lead to abnormal orofacial growth early in life, a risk factor for development of SDB. Careful surveillance for abnormal breathing during sleep should occur in the presence of short lingual frenulum.