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LETTER TO EDITOR
Year : 2017  |  Volume : 8  |  Issue : 4  |  Page : 117

Comment: Does absence or malformations of oral frenulae indicate orofacial developmental fields with dermatome abnormalities


Department of Periodontology, Manipal College of Dental Science, Manipal University, Manipal, Karnataka, India

Date of Web Publication29-Nov-2017

Correspondence Address:
Santhosh Kumar
Department of Periodontology, Manipal College of Dental Science, Manipal University, Manipal 576104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_39_17

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How to cite this article:
Kumar S, Anand KM. Comment: Does absence or malformations of oral frenulae indicate orofacial developmental fields with dermatome abnormalities. Dent Hypotheses 2017;8:117

How to cite this URL:
Kumar S, Anand KM. Comment: Does absence or malformations of oral frenulae indicate orofacial developmental fields with dermatome abnormalities. Dent Hypotheses [serial online] 2017 [cited 2019 Oct 15];8:117. Available from: http://www.dentalhypotheses.com/text.asp?2017/8/4/117/219450

Sir,

We had gone through the article submitted by Inger Kjaer in the Journal of Dental Hypothesis on the topic ‘Does Absence or Malformation of Oral Frenulae Indicate Orofacial Developmental Fields with Dermatome Abnormalities’.[1] The report on the cases mentioned by the author in the article is commendable. However, an important fact that has to be noted here is the embryological origin of the Philtrum. The formation of the philtrum during the fusion of intermaxillary or globular processes results in the formation of this labial fold.[2] This can be the reason for the absence of the midline frenum or a shift in the frenum in the single median maxillary central incisor (SMMCI) syndrome. Kamasaki et al.[3] while discussing the SMMCI noted that this defect occurred during the 5–9th week of gestation (the embryonic developmental period from the frontonasal process to the lateral and medial nasal processes). In a case of holoprosencephaly, the absence of frenulum was noted, and the embryonic origin of labial frenum was attributed to the medial nasal process.

In SMCCI syndrome, there is a large area of attached gingiva from the apical extent of the tooth to the coronal extent as a result of the fusion, and there is no mucosa at the midline. Hence, mucosal or papillary frenal attachment in this area may not be possible. The frenum consists of mucosa and muscle attached to the periosteum. This muscle and the mucosal attachment in the labial or the lingual frenum is known to help in the growth of muscle and organs such as the tongue towards the indented site. The tongue usually develops beyond the initial attachment of the frenum.[4] The presence of SMMCI should not be considered as a simple dental anomaly, because it may be associated with other clinical characteristics and craniofacial malformations.[5] There are also genetic causes that can cause the absence of frenum in the oral cavity. The syndromes such as Ellis–van Creveld syndrome, Pallister–Hall syndrome, orofacial digital syndrome and Ehlers–Danlos syndrome with the absence of labial and lingual frenula.[6] The high frenum or abnormal frenum is managed by employing different techniques depending on the type of frenal attachments. It can vary from a simple excision to frenotomy techniques such as V-Y plasty and Z-plasty.[4] However, the absence of the frenum may not require any treatment but may be a diagnostic sign for several other syndromes.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kjaer I. Does absence or malformations of oral frenulae indicate orofacial developmental fields with dermatome abnormalities. Dent Hypotheses 2017;8:39-41.  Back to cited text no. 1
  [Full text]  
2.
Rick MA, Jones KL. Absence of the superior labial frenulum in holoprocencephaly: A new diagnostic sign. J Pediatr 1998;133:151-3.  Back to cited text no. 2
    
3.
Kamasaki Y, Fukumoto S, Kubato K, Goto G. Clinical evaluation of a patient with single maxillary central incisor. J Clin Pediatr Dent 2002;26:181-6.  Back to cited text no. 3
    
4.
Priyanka M, Sruthi R, Ramakrishnan T, Emmadi P, Ambalavanan N. An overview of frenal attachments. J Indian Soc Periodontol 2013;17:12-5.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Machado E, Machado P, Grehs B, Grehs RA. Solitary median maxillary central incisor syndrome: Case report. Dental Press J Orthod 2010; 15. doi: 10.1590/ S2176-94512010000400009.  Back to cited text no. 5
    
6.
De Felice C, Toti P, Di Maggio G, Parrini S, Bagnoli F. Absence of the inferior labial and lingual frenula in Ehlers-Danlos syndrome. Lancet 2001;357:1500-2.  Back to cited text no. 6
[PUBMED]    




 

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