경구 진정요법하에 시행한 설소대 절제술 = LINGUAL FRENECTOMY UNDER ORAL SEDATION

다국어 초록 (Multilingual Abstract)

Tongue-tie is a congenital anomaly characterized by an abnormally short lingual frenum, which may restrict tongue tip mobility, In the neonate and infant, tongue-tie was said to cause difficult breast-feeding, In the older infant, toddler and young child, poor speech has been frequently listed because movement of tongue tip is limit ed. Also as a abnormal tongue position, various orthodontic problems, later mechanical and social manifestations could be developed.
Treatment options such as observation, speech therapy, frenotomy and frenectomy have been suggested. The optimal timing for the surgery has not been determined, but early intervention may be appropriate for the children with significant tongue-tie who has the significant potential to speech difficulties and later social and mechanical problems.
Sedation is an effective method for incapable of cooperative and the handicapped children, necessary to early intervention.
We report three cases, using oral sedation for the frenectomy in young children with severe tongue-tie. After treatments, we could find out sufficient tongue movement and improved speech ability.

국문 초록 (Abstract)

설유착증(tongue-tie)은 비정상적으로 짧은 설소대로 인하여 혀의 움직임이 제한되는 것을 의미한다. 영유아에서 심한 설유착증은 수유곤란을 야기하기도 하고, 증상이 지속적으로 존재할 때는 혀의 운동범위가 제한되어 발음문제를 야기할 수 있다. 또한 비정상적인 혀의 위치로 인해 여러 가지 교정적인 문제를 초래 할 뿐만 아니라, 기능적, 사회적 장애요소로 작용할 수도 있다.
설유착증의 치료방법으로는 관찰, 언어치료, 단순절개술 그리고 절제술 등이 있는데, 수술시기에 대한 논란은 있지만 정도가 심하여 장기간 언어장애가 지속되거나 교정적인 문제를 야기 할 것으로 판단되는 경우 조기수술이 권장되고 있다.
진정요법은 조기치료가 필요한 나이가 어리고 비협조적인 환아들이나, 신체적, 정신적 이유로 통상적 인 치과진료에 어려움이 있는 환아들에게 효과적으로 사용될 수 있는 방법이다.
본 증례는 설유착증으로 수술이 필요하나 협조전단계인 환아를 대상으로 경구투여를 이용한 진정요법으로 소대절제술을 시행하여 양호한 결과를 얻었기에 이를 보고하는 바이다.

참고문헌 (Reference)

1 안소연, "어린이의 치과치료시 약물에 의한 진정요법 사용에 대한 실태조사" 대한소아치과학회 32 (32): 444-453, 2005

2 김종빈, "소아환자의 깊은 진정요법 하에서 근단변위 판막술을 이용한 거대 협소대의 치료" 26 : 69-76, 1999

3 임창윤, "설유착증과 설근성형술의 병리적 고찰" 27 : 287-303, 1999

4 이지영, "설유착증 환자에서의 Z-plasty를 이용한 치료증례" 23 : 697-705, 1996

5 이주경, "설유착증 환아의 언어병리학적 평가" 대한악안면성형재건외과학회 30 (30): 447-456, 2008

6 이상철, "구강악안면 영역의 소수술" 27-32, 1993

7 Berg KL, "Tongue-tie(Ankyloglossia) and breastfeeding: a review" 109-112 6 : 109-112, 1990

8 McEnerge ET, "Tongue-tie in infants and children" 18 : 252-, 1941

9 Wallace AF, "Tongue-tie" 2 : 377-378, 1963

10 Catlin Fl, "Tongue-tie" 94 : 548-557, 1971

11 Horton CE, "Tongue-tie" 6 : 8-23, 1969

12 Wright JE, "Tongue-tie" 31 : 276-278, 1995

13 Wright JE, "Tongue tie" 31 : 276-278, 1995

14 Wright GZ, "The use of sedation agents by Canadian pediatric dentists" 9 : 308-311, 1987

15 Notestine GE, "The importance of the identification of ankyloglossia(short lingual frenulum) as a cause of breastfeeding problems" 6 : 113-115, 1990

16 Messner AH, "The effect of ankyloglossia on speech in children" 127 : 539-545, 2002

17 Finck A, "Oral findings in a group of newborn Swedish children" 4 : 67-73, 1994

18 Zalzal GH, "Non-cleft disorders of the oral cavity and oropharynx" 1169-1188, 1993

19 Marmet C, "Neonatal frenotomy may be necessary to correct breastfeeding problems" 6 : 117-121, 1990

20 Brickmann S, "Management of tongue-tie in children: a survey of paediatric surgeons in Australia" 40 : 600-605, 2004

21 Fletcher SG, "Lingual function and relative length of the lingual frenulum" 2 : 382-390, 1968

22 Paradise JL, "Evaluation and treatment for ankyloglossia" 262 : 2371-, 1990

23 Whitman CL, "Diagnosis and management of ankyloglossia" 47 : 423-428, 1961

24 Mcdonald RE, "Dentistry for the child and adolescent 5th ed" Mosby Co 1987

25 Gray SD, "Congenital malformations of the mouth and pharynx" 989-991, 1996

26 Nathan JE, "Comparison of chloral hydrate-hydroxyzine with and without meperidine for management of the difficult pediatric patient" 54 : 437-444, 1987

27 Duncan WK, "Chloral hydrate and other drugs used in sedating young child: a survey of American Academy of Pedodontics Diplomates" 5 : 252-256, 1983

28 Wilson S, "Chloral hydrate and its effects on multiple physiological parameters in young children: a dose-response study" 14 : 171-177, 1992

29 Sams DR, "Behavior assessment of two drug combinations for oral sedation" 15 : 186-190, 1993

30 Williams WN, "Assessment of lingual function when ankyloglossia(tongue-tie) is suspected" 110 : 353-356, 1985

31 Messner AH, "Ankyloglossia: incidence and associated feeding difficulties" 126 : 36-39, 2000

32 Lalakea ML, "Ankyloglossia: does it matter?" 50 : 381-397, 2003

33 Messner AH, "Ankyloglossia: controversies in management" 54 : 123-131, 2000

34 Ruffoli R, "Ankyloglossia: a morphofunctional investigation in children" 11 : 170-174, 2005

35 Fleiss PM, "Ankyloglossia: a cause of breastfeeding problems?" 6 : 128-129, 1990

36 Kotlow LA, "Ankyloglossia(tongue-tie): a diagnostic and treatment quandary" 30 : 259-262, 1999

37 Kupietzky A, "Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management" 27 : 40-46, 2005

38 Tuerk M, "Ankyloglossia" 24 : 271-276, 1959

39 최재남, "4세 설소대 단축증 아동과 정상 아동의 혀의 최대 신장길이 및 혀의 운동성에 따른 치조음 발음 양상의 비교" 15 : 145-152, 2004