Comparative Evaluation of Z-Plasty and Linear Closure in Ankyloglossia Patients: A Randomized Study of Effects on Speech Articulation and Airway Volume.

Abstract

Background: Tongue-tie (ankyloglossia) is a congenital tongue anomaly that may be associated with speech articulation defects, impacting social integration and self-confidence in affected children. Intervention is aimed at improving functional speech outcomes and potentially mitigating orofacial developmental disturbances. Ankyloglossia has also been implicated in altering upper airway anatomy due to its restrictive nature.

Purpose: The primary objective was to compare the effectiveness of z-plasty closure versus linear closure following lingual frenuloplasty in improving speech articulation. The secondary objective was to assess changes in oropharyngeal airway volume following surgical correction.

Study design, setting, and sample: This was a prospective randomized controlled study conducted at the dedicated cleft and craniofacial surgery unit of a tertiary academic center. Subjects were children with Kotlow Grade III/IV ankyloglossia and documented speech articulation defects, with exclusion criteria including developmental delay, syndromic diagnoses, or cleft lip/palate.

Predictor variable: The predictor variable was the surgical technique used post-lingual frenuloplasty:z-plasty closure or linear closure.

Outcome variables: The primary outcome was speech articulation, which was measured using the percentage of correct vowels and consonants (PCVC) and speech intelligibility (SI) scores. The secondary outcome was change in oropharyngeal airway volume, as quantified by cone beam computed tomography (CBCT).

Covariates: The covariates were age and sex.

Results: There was no significant difference in age (z-plasty: 6.46 ± 2.16 years vs linear closure: 6.80 ± 2.04 years; P = .6) or sex distribution (male/female: 8/7 vs 9/6; P = .7) between groups. Postoperatively, the z-plasty group demonstrated significantly greater improvement in percentage of correct vowels and consonants (mean change: 26.47 ± 2.94 vs 17.26 ± 2.18; P < .001) and SI scores (mean change: 2.06 ± 0.45 vs 1.2 ± 0.67; P < .001). Both groups showed increased oropharyngeal airway volume, with a larger mean percentage increase in the z-plasty group (12.11 ± 2.33% vs 10.43 ± 1.47%; P = .026).

Conclusion and relevance: Lingual frenuloplasty using z-plasty closure yields superior speech articulation outcomes and a greater increase in oropharyngeal airway volume compared to linear closure, likely attributable to enhanced tissue mobilization and reduced contracture. These findings support z-plasty as the preferred surgical approach for functional rehabilitation in ankyloglossia.