The growth of the basal unit of the mandible was studied by plotting the position, relative to the median plane, of the oval, mandibular and mental foramina in immature and adult skulls of Man, chimpanzee and gorilla. In Man, the basal unit was found to grow out along a constant logarithmic spiral. In the apes, the basal unit grew along a constant logarithmic spiral, the amount of unfolding being greater in the gorilla than in the chimpanzee. It is argued that the mode of growth seen in the apes evolved, as these forms became more prognathous, because it requires less compensatory rotation of the mandible, while the mode seen in Man is probably closer to that which occurred in common ancestral form.
Introduction/AimAnkyloglossia, or ‘tongue-tie’, is a common congenital anomaly in which a short lingual frenulum or genioglossus muscle restricts tongue movement. Ankyloglossia can be graded from 1 (most severe) to 4 (least severe). The effects of ankyloglossia can include breastfeeding and articulation issues; however, many infants will have no symptoms or developmental problems. The surgical intervention for ankyloglossia is frenotomy. This can be performed in the outpatient setting in small infants. Ankyloglossia referrals in neonates and small infants necessitate an urgent referral to the ear nose and throat (ENT) clinic in order to facilitate breast feeding and weight gain. We sought to analyse the ankyloglossia service in a district general hospital setting from referral to outpatient clinic. MethodsWe retrospectively analysed a consecutive cohort of babies referred to the Ear Nose and Throat service for consideration of frenotomy over an 18 month period, We analysed data from referral including demographics and clinical information, we recorded information from the clinical consultation and procedure details if frenotomy was performed.ResultsBetween 1 January 2019 and 31 January 2021 referrals were made for consideration of frenotomy, all appointments were seen within 2 weeks. 55.3% of referrals were sent from public health nurses, 25.5% from primary care, 10.6% from lactation consultants and 8.5% from paediatric consultants. Of 47 referrals, a frenotomy was performed in 30 babies. All frenotomies were performed without complications.ConclusionInformation on ankyloglossia is varied and available information is conflicting, without any clear standardised guideline or treatment algorithm. Referral indications can be unclear and result in unnecessary clinic appointments in an already heavily burdened service. Frenotomy can be performed safely by a trained clinician in an outpatient setting with minimal equipment.
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