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  1. ADMISSION CONFERENCE Patricia Amolenda

  2. General Data • A.B. • 18 month old/female • Roman Catholic • DOA: March 27, 2011

  3. Chief Complaint • Tongue-tied

  4. History of Present Illness • Born to a 35 year-old, G3P3 (3003) • During pregnancy, she had no known medical illness and had regular prenatal check ups at UST OPD-OB. • No exposure to radiation, viral exanthems and teratogenic drugs. • Non smoker, non alcohol beverage drinker and no illicit drug use

  5. History of Present Illness • Born via NSD, cephalic, term at USTH-CD, with a birth weight of 3.2 kg • No complications after birth • Newborn and Hearing screening were negative.

  6. History of Present Illness 2 months PTA • noted by her parents to have be less talkative compared to other children. (only able to say “mama” and ”papa”) • consult at a private physician • OAE: passed, bilateral • Noted short lingual frenulum • Was referred to UST OPD ENT • UST OPD, ENT: Advised surgery 3 weeks PTA ADMISSION

  7. Review of Systems (-) fever , (-) weight loss, (-) anorexia (-) rash, (-) pigmentation, (-) hair loss, (-) pruritus (-)cyanosis, (-)fainting spells, (-)easy fatigability, (-) chest pain (-)difficulty of breathing, (-)cough (-)nausea, (-)vomiting, (-)abdominal pain, (-)jaundice, (-)food intolerance, (-)diarrhea, (-)constipation (-)changes in urine color, (-)dysuria, (-)frequency (-)palpitations, (-)heat/cold intolerance, (-) polyuria, (-) polydipsia, (-) polyphagia (-)tremors, (-)convulsions (-) bone/joint pain, (-)swelling, (-)limitation of motion, (-)stiffness, (-)limping (-) pallor, (-)bleeding manifestations, (-)easy bruisability

  8. Feeding History • breastfed up to 3months of age, 3 oz, twice a day • started on milk formula NANHW at 1 month old, and was shifted to Promil kid at 6 months old. • currently, consumes 5 bottles of milk per day, 200mL each, with a dilution of 1:2 • started on complementary feeding at 4-6 months, beginning with cereals, then mashed fruits and vegetables

  9. Developmental History • Walks alone; Runs well • Waves bye bye • Says “mama” and “papa” only • Throws objects in and out of container • Feeds self with spoon • Scribbles well • Undresses self without help

  10. Past Illnesses • No previous surgery or hospitalization • Bronchial Asthma, last attack 1 y/o, unrecalled inhaler used PRN • No known allergies

  11. Immunization History • BCG1, HepB1 • DPT123, OPV123 • Measles vaccine

  12. Family History • HPN: mother side, father side • Asthma: mother • Ankyloglossia: brothers • No TB, cancer, heart disease, stroke

  13. Physical Examination on Admission • General:Alert, awake, ambulatory, not in cardiorespiratory distress, well-hydrated, well-nourished • Vital signs: HR: 102 bpm, regular, RR: 25cpm, regular, T 37 oC • Weight: 10kg, Height: 80cm, BMI 15.62 • Skin: Warm and moist skin, no active dermatoses, no jaundice, good skin turgor • Head: Normocephalic, black, thin hair, no hair loss, no lice and nits

  14. Physical Examination on Admission • Eyes: Pink palpebral conjunctiva, anicteric sclera, pupils 2-3mm ERTL • Ears: no tragal tenderness, non hyperemic EAC, (+) retained cerumen, AU, intact TM, AU • Nose: No nasal septum deviation, turbinates not congested, no discharge • Throat: moist buccalmucosa,no dental caries, nonhyperemic PPW, tonsils not enlarged, short, lingual frenulum attached to the tip of the tongue

  15. Physical Examination on Admission • Neck: Supple neck, no palpable cervical lymph nodes, no thyroid enlargement, no tenderness • Chest: Symmetrical chest expansion, resonant, clear and equal breath sounds • Heart: Adynamicprecordium, apex beat at 4th LICS MCL, no thrills/ heaves, S1>S2 at apex, S2>S1 at base, no murmurs • Abdomen: Flat abdomen, inverted umbilicus, NABS, tympanitic, no organomegaly, no palpable mass, no abdominal tenderness, • Extremites: Full and equal pulses on all extremities, no edema, no cyanosis

  16. Neurological Exam • Alert, awake, irritable, able to follow commands • (+) direct pupillary light reflex, able to hear spoken words • No abnormal/ involuntary movements of the extremities • No sensory deficit • No involuntary movements, no spasticity, no atrophy

  17. Salient Features • 18 month old, female • Says “mama” and “papa” only • Family history of ankyloglossia • Short, lingual frenulum attached to the tip of the tongue

  18. Assessment • Ankyloglossia

  19. Plans • CBC, Clotting Time, Bleeding Time • Chest XRray • Diet for Age • For release of tongue tie

  20. Ankyloglossia • congenital anomaly in which a short, lingual frenulum or a highly attached genioglossus muscle restricts tongue movement • the reported prevalence varies from <1 percent to 10.7 percent

  21. Clinical Features • Abnormally short frenulum, inserting at or near the tip of the tongue • Difficulty lifting the tongue to the upper dental alveolus • Inability to protrude the tongue more than 1 to 2 mm past the lower central incisors • Impaired side-to-side movement of the tongue • Notched or heart shape of the tongue when it is protruded

  22. Associated Problems • Breastfeeding problems • Articulation problems • Mechanical problems

  23. BreastfeedingProblems • breastfeeding problems (eg, poor latch, maternal nipple pain) are reported 22% more frequent among infants with ankyloglossia than without ankyloglossia

  24. Articulation Problems  • may cause articulation problems in some children, but does not prevent vocalization or delay the onset of speech • frenula that extend to the tip of the tongue and prevent the tongue from reaching the upper dental alveolus • Speech sounds that may be affected include "t," "d," "z," "s," "th," "n," "l"

  25. Mechanical Problems  •  Difficulty with oral hygiene (ie, licking the lips or sweeping food debris from the teeth) that may result in periodontal • Local discomfort • Diastasis between the lower central incisors • Difficulty licking an ice-cream cone, playing a wind instrument, or kissing

  26. MANAGEMENT • Surgery is the definitive treatment • Indications • Breastfeeding difficulty, articulation problems, psychologic problems, and periodontal disease • The optimal timing of surgery is controversial