Comparative Evaluation of Z-Plasty and Linear Closure in Ankyloglossia Patients: A Randomized Study of Effects on Speech Articulation and Airway Volume.
Summary
In a randomized pediatric trial of Kotlow Grade III/IV ankyloglossia, z-plasty closure after lingual frenuloplasty produced significantly greater gains in percentage of correct vowels and consonants and speech intelligibility than linear closure. Both groups increased oropharyngeal airway volume, with a larger percentage increase in the z-plasty group.
Key Findings
- Z-plasty yielded larger PCVC improvement than linear closure (26.47 ± 2.94 vs 17.26 ± 2.18; P < .001).
- Speech intelligibility improvement was greater with z-plasty (2.06 ± 0.45 vs 1.2 ± 0.67; P < .001).
- Both groups increased oropharyngeal airway volume; z-plasty showed a larger mean percentage increase (12.11 ± 2.33% vs 10.43 ± 1.47%; P = .026).
Clinical Implications
Surgeons should consider z-plasty closure following lingual frenuloplasty to maximize speech gains and airway volume improvements, and incorporate these data into shared decision-making with families.
Why It Matters
This RCT provides high-level evidence favoring z-plasty closure to optimize functional speech outcomes and airway metrics, directly informing surgical technique selection.
Limitations
- Single-center study with a relatively small sample size (n=30)
- Long-term durability and real-world functional outcomes beyond the postoperative period are not detailed in the abstract
Future Directions
Larger multicenter RCTs with longer follow-up should assess durability, impacts on feeding, sleep-disordered breathing, and patient-reported outcomes.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial comparing two surgical closures in pediatric ankyloglossia.
- Study Design
- OTHER