Wędzidełko języka (podjęzykowe). Co to takiego? Kiedy jest wskazanie do jego podcięcia?

Wędzidełko języla u dziecka/niemowlaka. - blog | paniDoktor
Tym razem zajmę się tematem, który – jak wiem z doświadczenia – budzi sporo obaw wśród rodziców. Każdy z nas rodzi się z wędzidełkiem języka, którego zadaniem jest łączenie dolnej części języka z dnem jamy ustnej. Jest ono na tyle elastyczne, że na co dzień w ogóle nie odczuwamy jego obecności. Ot, po prostu jest i nikt nie zaprząta sobie nim głowy. No chyba, że pojawi się jakiś rodzaj patologii – do najczęstszych problemów związanych z tą częścią ciała zaliczamy skrócenie wędzidełka języka. Jest to dość częsta przypadłość, którą na szczęście można łatwo leczyć na drodze zabiegu operacyjnego. Więcej o wędzidełku języka, jego skróceniu i wskazaniach do podcięcia przeczytacie w moim artykule.

Czym dokładnie jest wędzidełko języka?

Wędzidełko języka, nazywane też podjęzykowym, to fałd błony śluzowej, który jest dobrze widoczny w jamie ustnej. Wystarczy unieść język ku podniebieniu, by zobaczyć w lustrze charakterystyczną błonkę. Większość osób nie ma żadnych problemów z tą częścią ciała. Dzięki niej możemy swobodnie poruszać językiem, a tym samym mówić, jeść, przełykać pokarmy czy nawet oblizywać usta i zęby oraz całować się.

Zdarza się jednak, że w obrębie wędzidełka występuje wada nazywana ankyloglossią. Potocznie określa się ją zbyt krótkim wędzidełkiem języka. Nie jest to poważny defekt, jednak może znacząco utrudnić życie pacjentowi – szczególnie małemu dziecku. Jeśli wędzidełko jest za krótkie, to naturalną konsekwencją jest ograniczenie ruchomości języka.

Wiele zależy tutaj od skali problemu – w najcięższych przypadkach w miejscu styku wędzidełka z językiem i dolną częścią jamy ustnej pojawia się silne zgrubienie, które wręcz uniemożliwia poruszanie językiem. Jest to ewidentne wskazanie do zabiegu, o którym napiszę w dalszej części artykułu.

Objawy skrócenia wędzidełka języka

Nie zawsze są one swoiste, co oznacza, że rodzicom – bo problem ten zwykle diagnozuje się u niemowląt – początkowo trudno jest powiązać różne niepokojące obserwacje właśnie ze skróceniem wędzidełka. W przypadku noworodków najbardziej charakterystycznym objawem jest utrudnione karmienie piersią i uszkodzone brodawki u mamy.

Jeśli dziecko nie może w naturalnym odruchu unieść brodawki mamy, nie może wówczas pobierać pokarmu, to zaczyna się denerwować. Mamy próbują zmieniać pozycję, zachęcają maluszka do jedzenia, starają się bardzo dokładnie podawać pierś, ale dziecko jeszcze bardziej się niepokoi. Często dopiero konsultacja z doradcą laktacyjnym pozwala wskazać źródło problemu, jakim jest właśnie skrócenie wędzidełka.

To warto wiedzieć

Zdaniem American Academy of Otolaryngology skrócenie wędzidełka jest jedną z przyczyn słabego przybierania niemowląt na wadze.

Jeśli natomiast chodzi o starsze dzieci, w wieku przedszkolnym i wczesnoszkolnym, to niepokój rodziców powinna wzbudzić przede wszystkim niewyraźna wymowa lub wręcz unikanie mówienia przez pociechę, a także niechęć do spożywania posiłków. Warto wówczas przeprowadzić prosty test i poprosić dziecko, by spróbowało dotknąć językiem nosa lub brody. Jeśli nie będzie w stanie tego zrobić, a podczas próby końcówka języka przybierze charakterystyczny sercowy kształt, należy umówić się na konsultację laryngologiczną.

Długofalowe skutki skrócenia wędzidełka językowego

Optymalnym momentem na stwierdzenie tej wady są pierwsze dni życia dziecka – wówczas można szybko wykonać zabieg, co zapobiegnie dalszym patologiom, w tym wykształceniu się nieprawidłowego odruchu ssania, żucia i połykania. Jeśli jednak z jakiegoś powodu wada nie została wykryta na wczesnym etapie, a dodatkowo rodzice bagatelizują objawy skrócenia wędzidełka, może to nieść ze sobą nieprzyjemne dla dziecka konsekwencje. Zaliczamy do nich:

  • Wady zgryzu

  • Nieprawidłową artykulację – dziecko będzie mieć duże problemy z wymawianiem głosek wymagających uniesienia języka ku podniebieniu, jak „t”, „d”, „n”, „l”, „dż” itd.

  • Nadmierne ślinienie się

  • Seplenienie

  • Wyższe ryzyko rozwoju chorób przyzębia

  • Rotacyzm (problem z wymową głoski „r”)

Leczenie skróconego wędzidełka podjęzykowego

Po zdiagnozowaniu tej wady z reguły zalecane jest leczenie operacyjne. Wykonuje się tutaj zabieg nazywany frenotomią, który polega na podcięciu wędzidełka w znieczuleniu miejscowym. Cała procedura trwa kilka do kilkunastu minut i nie niesie ze sobą żadnych poważnych skutków ubocznych. Jeżeli dotyczy to noworodka, to najlepiej, aby zabieg odbył się jeszcze w oddziale noworodkowym. Podcięcia dokonuje lekarz neonatolog. Można wykonać go również w Poradni Laktacyjnej. Dziecko starsze lub z trudnym, grubym wędzidełkiem jest kierowane na zabieg do Oddziału Laryngologii lub Chirurgii Szczękowej i wymaga niestety już znieczulenia ogólnego. Może się przez kilka dni uskarżać na delikatne pieczenie w miejscu nacięcia, na co pomaga np. ssanie kostki lodu czy picie chłodnych napojów.

Ważne!

O tym, czy w konkretnym przypadku należy przeprowadzić zabieg frenotomii, zawsze decyduje lekarz, po wnikliwej ocenie dynamiki ssania i funkcji języka.

Wykonanie zabiegu u bardzo małego dziecka (noworodka lub we wczesnym wieku niemowlęcym) praktycznie rozwiązuje problem – ewentualnie wykonuje się dodatkowo w zależności od typu wędziedełka masaże, które mają zapobiec jego bliznowaceniu.

Z kolei u starszych dzieci frenotomia jest dopiero pierwszym etapem leczenia. Po zabiegu konieczne jest regularne wykonywanie ćwiczeń logopedycznych, ze szczególnym akcentem na pionizację języka.

Ważne!

Nie każde skrócone wędzidełko języka zaburza jego funkcję i utrudnia karmienie. Pewna część dzieci potrafi efektywnie opróżniać pierś, nie ranić brodawek i przybierać na masie ciała, mimo nieprawidłowej czynności ssania.

 

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  126. Kasia pisze:

    Bardzo dziękuję że artykuł. Ja zastanawiam się z kolei czy można za mocno podciąć to wędzidełko. Mam wielkie obawy. Synek w 1 tygodniu życia miał oglądana buzke przez doradcę laktacyjnego (bardzo dobra specjalistka)- powiedziała że jest ok, oglądała do gdy miał 4 miesiące neurologopeda–mówiła że jest ok. W ubiegłym tygodniu byliśmy na obserwacji w szpitalu ( synek nie chciał jeść), oglądała go kolejna pani logopeda–stwierdziła również że ok. Z kolei przyszły 2 panie z laryngologii i stwierdziły że trzeba przyciąć! Byłam w dużym szoku. Zgody nie wyrażałam, jednak na drugi dzień laryngolog przyszła z nożyczkami, ravhu ciachu 2 minuty, podcięła I poszła. A synek teraz ciągle wystawia język. Maz twierdzi ze “go uszkodziła”. Czy można rzeczywiści e podciąć za dużo?

  127. Inez pisze:

    Czy jeśli roczne dziecko do tej pory efektywnie ssało pierś i waga dobrze przyrastała (75 centyl) to czy jest konieczność podcięcia wedzidelka? Na bilansie pediatra zwróciła uwagę na zbyt krótkie wędzidełko u córki, mieliśmy umówiona wizytę u laryngologa dziecięcego, natomiast wizyta została odwołana przez epidemie.

    • Wasza Pani Doktor pisze:

      Nie zawsze wędzidełko przeszkadza w jędzeniu. Może przeszkadzać w mówieniu, może dawać dolegliowści bólowe. Najlepiej udać się do logopedy, który oceni czy jest taka potrzeba

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