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Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: What is the Connection?
Dysphagia 2019D

Abstract

Ankyloglossia, or tongue tie, and its impact on the oral phase of feeding has been studied and debated for decades. However, the impact of posterior tongue ties on the pharyngeal phase of swallowing is not well documented in the literature. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. However, in the setting of a normal MRI with normal motor development, other etiologies need to be explored. If it is not neurologic, could it be anatomic? We present a 21-month-old patient with significant pharyngeal phase dysphagia which was most saliently characterized by impaired base of tongue movement, poor pressure generation, and diffuse residue resulting in aspiration. He was eventually diagnosed with a posterior tongue tie and underwent a frenulectomy. Results via subsequent VFSS revealed significant improvement in base of tongue movement, pharyngeal pressure generation, and pharyngeal constriction, resulting in efficient movement of the bolus through the pharynx into the esophagus, no nasopharyngeal regurgitation, no aspiration, and near resolution of his pharyngeal dysphagia. Patients with impaired base of tongue movement and impaired pressure generation resulting in pharyngeal residue in the setting of a normal neurologic workup could possibly present with a posterior tongue tie which should be examined and included in the differential diagnosis.

Authors+Show Affiliations

Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA. laura.brooks@choa.org. , Atlanta, USA. laura.brooks@choa.org.Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA. Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA.Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA.Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA.Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA.Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA. Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31367903

Citation

Brooks, Laura, et al. "Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: what Is the Connection?" Dysphagia, 2019.
Brooks L, Landry A, Deshpande A, et al. Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: What is the Connection? Dysphagia. 2019.
Brooks, L., Landry, A., Deshpande, A., Marchica, C., Cooley, A., & Raol, N. (2019). Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: What is the Connection? Dysphagia, doi:10.1007/s00455-019-10040-x.
Brooks L, et al. Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: what Is the Connection. Dysphagia. 2019 Jul 31; PubMed PMID: 31367903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: What is the Connection? AU - Brooks,Laura, AU - Landry,April, AU - Deshpande,Anita, AU - Marchica,Cinzia, AU - Cooley,Anthony, AU - Raol,Nikhila, Y1 - 2019/07/31/ PY - 2019/04/22/received PY - 2019/07/20/accepted PY - 2019/06/25/revised PY - 2019/8/2/entrez KW - Ankyloglossia KW - Dysphagia KW - Feeding KW - Pediatrics KW - Quality of life JF - Dysphagia JO - Dysphagia N2 - Ankyloglossia, or tongue tie, and its impact on the oral phase of feeding has been studied and debated for decades. However, the impact of posterior tongue ties on the pharyngeal phase of swallowing is not well documented in the literature. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. However, in the setting of a normal MRI with normal motor development, other etiologies need to be explored. If it is not neurologic, could it be anatomic? We present a 21-month-old patient with significant pharyngeal phase dysphagia which was most saliently characterized by impaired base of tongue movement, poor pressure generation, and diffuse residue resulting in aspiration. He was eventually diagnosed with a posterior tongue tie and underwent a frenulectomy. Results via subsequent VFSS revealed significant improvement in base of tongue movement, pharyngeal pressure generation, and pharyngeal constriction, resulting in efficient movement of the bolus through the pharynx into the esophagus, no nasopharyngeal regurgitation, no aspiration, and near resolution of his pharyngeal dysphagia. Patients with impaired base of tongue movement and impaired pressure generation resulting in pharyngeal residue in the setting of a normal neurologic workup could possibly present with a posterior tongue tie which should be examined and included in the differential diagnosis. SN - 1432-0460 UR - https://www.unboundmedicine.com/medline/citation/31367903/Posterior_Tongue_Tie,_Base_of_Tongue_Movement,_and_Pharyngeal_Dysphagia:_What_is_the_Connection L2 - https://dx.doi.org/10.1007/s00455-019-10040-x DB - PRIME DP - Unbound Medicine ER -