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Ankyloglossia, or tongue-tie, is the result of a short, tight, lingual frenulum causing tethering of the tongue tip. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this study, we evaluated the treatment of patients greater than 3 years of age with persistent articulation problems related to ankyloglossia (n = 16). All patients underwent surgical correction either via a novel application of the 4-flap Z-frenuloplasty (n = 11) or via the more traditional horizontal-to-vertical frenuloplasty (n = 5). Frenulum length, tongue protrusion length, and speech evaluations (4-grade scaling) were documented preoperatively and at follow-up. For the 4-flap Z-frenuloplasty, 91% of patients showed at least 2 orders of improvement in speech, 64% showed complete resolution of articulation errors, and 9% demonstrated no improvement in speech. Frenulum length and tongue protrusion gained 37.5 +/- 13.5 mm (P< 0.001) (315% increase) and 36.2 +/- 7.6 mm (P < 0.001), respectively. In contrast, with the horizontal-to-vertical frenuloplasty, only 40% showed 1 order of improvement in speech, and 60% had no change in articulation. Frenulum length and tongue protrusion gained 11.2 +/- 4.15 mm (98% increase) and 13.2 +/- 2.6 mm (P = 0.0003), respectively. Our data indicated that the 4-flap Z-frenuloplasty was superior to the horizontal to vertical frenuloplasty with respect to tongue lengthening, protrusion, and articulation improvement for patients with symptomatic ankyloglossia.

Patients with delusional infestations (DI), previously named delusions of parasitosis, have a fixed, false belief that they are infested with living or non-living pathogens. Patients have abnormal cutaneous symptoms such as itching, biting, or crawling sensations. They often demonstrate self-destructive behavior in an effort to rid the pathogens from under their skin, leading to excoriations, ulcerations, and serious secondary infections. This review article aims to provide an overview of DI including its clinical presentation, diagnosis, and treatment. Strategies on how to establish a strong therapeutic alliance with DI patients are discussed. In addition, antipsychotic medications used in the treatment of DI are described.