ADMISSION CONFERENCE

Patricia Amolenda

General Data

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

Chief Complaint

• Tongue-tied

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

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.

History of Present Illness

•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

2 months PTA

ADMISSION

3 weeks PTA

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

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

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

Past Illnesses

• No previous surgery or hospitalization• Bronchial Asthma, last attack 1 y/o,

unrecalled inhaler used PRN• No known allergies

Immunization History

• BCG1, HepB 1

• DPT123, OPV123 • Measles vaccine

Family History

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

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

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 buccal mucosa,no dental caries, nonhyperemic PPW, tonsils not enlarged, short, lingual frenulum attached to the tip of the tongue

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: Adynamic precordium, 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

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

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

Assessment

• Ankyloglossia

Plans

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

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

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

Associated Problems

• Breastfeeding problems• Articulation problems• Mechanical problems

Breastfeeding Problems

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

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"

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

MANAGEMENT

• Surgery is the definitive treatment• Indications – Breastfeeding difficulty, articulation problems,

psychologic problems, and periodontal disease• The optimal timing of surgery is controversial