PMC6437727_01
Patient sleeping with open mouth posture, noisy breathing, and incomplete lip seal (see complete video at https://tinyurl.com/Figure1Video).
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With respect to sleep, there were reports of difficulties going to sleep, waking up two to three times per night to drink water, getting up to go to the bathroom, open mouth breathing while asleep (Figure 1), snoring during sleep, and sweating more than usual during sleep.
Lingual frenulum at time of physical exam, preoperative.
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Physical examination (Figure 2) of the patient showed her to be well developed, well nourished, and to appear the stated age.
(a) Labial frenulum, preoperative. (b) Lingual frenulum, preoperative. (c) Labial frenulum, postoperative. (d) Lingual frenulum, postoperative.
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The patient was found to have a restrictive class 2 upper labial frenulum with tethering of the upper lip (Figure 3(a)) and restrictive grade 4 lingual frenulum (Figure 3(b)). A V-to-Y lip closure was performed with a 4-0 chromic suture applied in a simple interrupted fashion (Figure 3(c)). In total, the tongue was released from a grade 4 restricted range of motion to a grade 1 range of motion (Figure 3(d)).
Patient sleeping with closed mouth posture and exclusive nasal breathing (see complete video at https://tinyurl.com/Figure4Video).
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By the fourth day after surgery, the patient exhibited closed-mouth nasal breathing while asleep (Figure 4).
Lingual frenulum, 2 months postop.
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Grade 1 tongue range of motion was observed (Figure 5).