Introduction

The recent increase in breastfeeding has brought an increased awareness of potential causes for breastfeeding difficulties. Many parents are choosing frenectomy or laser revision for their infants with tongue-tie (ankyloglossia). This study aims to identify somatic dysfunctions commonly found in infants with tongue-tie as a first step in distinguishing infants with feeding issues caused by somatic dysfunction from infants with feeding issues directly related to tongue-tie. Since somatic dysfunction of the cranial base and occiput have direct implications for impacting the hypoglossal nerve, which provides motor control of intrinsic tongue musculature, it is our hypothesis that infants with tongue-tie and feeding issues will have a high incidence of cranial base dysfunction.

Methods

A retrospective chart review was performed on 48 charts of infants diagnosed with tongue-tie who had been seen from June 2012 to January 2017 at a multispecialty practice. Thirty-one charts were excluded and 17 charts are reviewed here.

Results

Of the 17 infants with tongue-tie whose charts were included in the review, 76.4% had difficulties with latching and 35.3% had difficulty with suck or coordination of suck. All of the infants (100%) had occipital condylar dysfunction, 94.1% had restriction of at least 1 cranial suture, 94.1% had atlantooccipital (OA) joint dysfunction, and 23.5% had dysfunction at the sphenobasilar synchondrosis.

Conclusions

All of the infants with tongue-tie had somatic dysfunction at the cranial base. This again raises the question of whether or not the feeding issues were directly related to the tongue-tie or to the somatic dysfunction or to a combination of both. This study was limited by sample size and limited diversity of patient sampling. Further studies are necessary.

IRB #2017-007

Background

Zink’s Common Compensatory Pattern (CCP) is a pattern of somatic dysfunction that can be observed in the spinal transitional zones. The CCP can be described as left/right/left/right rotation in the regions of C0/C1/C2, C7/T1, T12/L1, and L5/S1, respectively. It has been proposed that Zink’s pattern can be identified by both myofascial and segmental assessments. This retrospective study investigates myofascial restrictions and spinal somatic dysfunctions to determine whether an agreement exists between myofascial rotation restrictions and osteopathic structural exam findings.

Methods

Osteopathic manipulative medicine (OMM) screening exams were completed for incoming first-year osteopathic medical students at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in August 2012. In this retrospective study, there were 208 participants, of which 15 had documented significant previous medical history. For the structural exam, rotational restrictions were assessed at OA, C7, T12, and L5. Myofascial restrictions were assessed at the craniocervical, cervicothoracic, thoracolumbar, and lumbosacral transitional zones.

This method of assessment creates 8 separate variables. These variables were recorded using a simple binomial system with 3 options: R for right rotation, L for left rotation, and O for lack of rotational restriction. The authors then evaluated these variables using kappa statistical analysis and the Fisher’s exact test to determine if there was any statistically or clinically significant correlation present between the structural findings and the myofascial restrictions.

Results

Of the 208 participants, 14 individuals (6.731%) matched all 4 of the structural exam restrictions with the myofascial restrictions, 24 (11.538%) matched 3 of the 4 transition zones, 62 (29.808%) matched 2 zones, 73 (35.096%) matched 1, and 35 (16.827%) exhibited 0 matches.

Of the 15 individuals with documented significant previous medical history, 2 individuals (13.333%) had all 4 matches, 1 (6.667%) had 3 matches, 6 (40%) had 2 matches, and 6 (40%) had 1 match.

Of the 198 individuals without significant limitations, 12 individuals (6.218%) had all 4 matches, 23 (11.917%) had 3 matches, 56 (29.016%) had 2 matches, 67 (34.715%) had 1 match, and 35 (18.135%) lacked any agreement between structural and myofascial findings.

On initial kappa analysis with all 208 participants, the authors found a total of 325 matches within the data, yielding a kappa value of 0.0527 with a 95% confidence interval of 0.0025 to 0.1028. For the 15 participants with medical limitations, the authors found the kappa value to be 0.2450 with a 95% confidence interval of 0.0615 to 0.4284 (P=0.0063). For the 198 individuals without limitations, the authors found the kappa value to be 0.0373 with a 95% confidence interval of -0.0147 to 0.0893 (P=0.1488).

Conclusion

Regarding the group of 208 participants, there is a weak, but statistically significant correlation between all data points. For the 15 individuals with significant medical limitations, there is a statistically significant correlation between structural and myofascial exam findings, excluding the lumbosacral transition zone. For the remaining 198 individuals, there is no statistically significant correlation between structural and myofascial findings.

Ambiguity of significant medical limitations and lack of interrater reliability should be addressed in future research. With the limitations of this retrospective pilot study, the authors hope to further investigate the correlation between myofascial restrictions and structural exam findings.