However, threatening developmental risk will increase the chances of reported positive outcomes post-laser surgery, because of the powerful neurobiological impact of expectation. The absence of baseline data elucidating the normal spectrum of newborn oral connective tissue diversity underscores how matters related to clinical breastfeeding support are still not a health system or research priority. This epidemic is, to my mind, a painful sign that clinical breastfeeding support is in crisis. In that sense, the tongue- and lip-tie epidemic not to mention the buccal tie epidemic is also an opportunity.
Since existing evidence is methodologically poor, all current guidelines concerning management of ankyloglossia remain of limited use.
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Contemporary definitions of tongue-tie confuse function with structure. Structure is anatomically variable, for both the tongue length and appearance, and the lingual and maxillary frenula.
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In my view, a classic tongue-tie in a newborn should receive a simple scissors frenotomy as soon as possible, in order to protect the woman from potential nipple damage. In our specialised work with breastfeeding mothers and babies at the Possums Clinic, we find no use for the diagnoses of posterior tongue-tie and upper lip-tie, not to mention buccal ties, and argue that these are misconceptions. This grading of the labial frenulum is clinically irrelevant.
Ablation of the labial frenulum in infancy may risk a worsened gap between the front teeth later in childhood, due to scarring. The use of diagnoses increases parental pressure for intervention, even if parents are advised that the diagnosed condition is harmless. I would refer to an ENT surgeon for this, who may use laser. I would advise avoiding paediatric dentists who use scissors for deep frenotomies, due to the risk of haemorrhage — I have observed babies subjected to painful sutures under the tongue or in the upper gum to control bleeding.
I propose that a simple scissors frenotomy is generally all that is required for a classic tongue-tie. Wound stretching places babies at risk of oral aversion, due to repeated uncomfortable or painful digital intrusion.
There is no scientific reason to believe that wound stretching post-laser frenotomy alters the inevitable closing of a wound or the contraction of scar tissue over time. In my collaboration with the Human Lactation Research Group at the University of Western Australia, who use ultrasound to elucidate the biomechanics of infant suck during breastfeeding, we have shown that the model of infant sucking, upon which laser surgery for posterior tongue-tie and upper lip-tie is based, is inaccurate. It certainly does not need to flange for pain-free milk transfer.
Actually, if we can see the upper lip we are inviting inefficient milk transfer, fussiness at the breast, and nipple pain for many breastfeeding pairs. The tongue does not take an active lead in infant sucking, but responds dynamically to intra-oral breast tissue volume: We have called this new understanding of the biomechanics of infant suck in breastfeeding the Gestalt model. The critical driver is a reflex depression of the jaw, which generates intra-oral vacuum. It does not strip the breast or have peristaltic movements.
Since the tongue does not need to actively grip or strip the breast, or compress the breast for milk transfer, but simply follow the jaw depression and mould around the available intra-oral breast tissue volume, we do not need to rely on unproven methods such as laser surgery to try to establish increased tongue mobility: Parents are told that the digital intra-oral manoeuvres and massage interventions of craniosacral therapy or oral myofunctional therapy stretch or relax muscles and connective tissue, and teaches the tongue new movements, but this misconception is also based on the same out-dated understanding of the biomechanics of infant suck.
Anything that directs parental financial resource and time investment away from the practice of optimal fit and hold delays the critical repair of the disrupted breastfeeding relationship, and is disempowering for women. Craniosacral therapy and related techniques simply cannot compare with healthy effects on postural alignment and functional musculoskeletal health achieved by optimal positional stability and fit and hold, repeated over and over for many hours each day. The promotion of surgical release of posterior tongue-tie, upper lip-tie and buccal tie is the latest in a series of inappropriately medicalised interventions for breastfeeding problems.
Similarly, frequent feeding, broken sleep, and marathon feeding are signs of poor milk transfer, often associated with crying due to poor satiety, but are also still commonly misdiagnosed as signs of GORD, allergy, lactose intolerance, and, most recently, oral ties. There are three very common breastfeeding problems underlying these behavioural signs, which are then so often inappropriately medicalised: Suboptimal fit and hold leads to suboptimal positional stability, which may result in nipple pain and damage, poor milk transfer, and fussing at the breast.
The neurobiological model of infant crying describes the conditioned sympathetic nervous system hyperarousal that occurs if an infant is repeatedly frustrated during breastfeeds by positional instability and poor fit and hold. To illustrate the scale of the blindspot that we have in our health system concerning clinical breastfeeding support, mothers are still widely taught the strategy of shaping or squeezing the breast with the ipsilateral hand, supporting the infant on the back of the neck with the other, and stimulating a wide gape before pushing the baby on.
However, baby-led breastfeeding is simply not enough for many of our women, who still develop nipple pain and other problems. Multiple well-conducted studies show that popular fit and hold strategies, including mammalian methods, do not improve breastfeeding outcomes.
We have not yet paid enough attention to the complexities of empowering women to fit together with their baby across our gloriously diverse anatomies for pain-free efficient milk transfer. This needs to occur across great diversities of breast shape, breast tissue elasticity, nipple shape and length and elasticity, breast-abdominal interface, and infant chin, palate, tongue, lips and oral connective tissue. In order to further research in this field, women need a teachable, reproducible and empowering approach to fit and hold in breastfeeding.
In the hope that it might be helpful for others, we have taken steps at our clinic to make the gestalt breastfeeding approach, which we find so effective in our work, widely available online for both parent self-help, and for health professionals. Gestalt breastfeeding also integrates psychological strategies for managing the difficult thoughts and feelings that arise when there are breastfeeding difficulties. More broadly, gestalt breastfeeding is one of a number of programs that comprise Neuroprotective Developmental Care in the Community.
All revenue goes towards the further development of education and research. Three experienced lactation consultants reflect on the oral ties phenomenon. Breastfeeding Review ;25 1: Reid N, Rajput N. Acute feed refusal followed by Staphylococcus aureus wound infection after tongue-tie release. Journal of Paediatrics and Child Health. Congenital tongue-tie and its impact on breastfeeding. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, Ankyloglossia and lingual frenotomy: Otolaryngology Head and Neck Surgery.
Frenotomy for tongue-tie in newborn infants Review. Cochrane Database of Systematic Reviews. Power R, Murphy J. Tongue-tie and frenotomy in infants with breastfeeding difficulties: Archives of Disease in Childhood ; Treatment of ankyloglossia and breastfeeding outcomes: Infant gastroesophageal reflux GER: International Journal of Child Health and Nutrition.
Aerophagia Induced Reflux in breastfeeding infants with ankyloglossia and shortened maxillary labial frenula tongue and lip tie. International Journal of Clinical Pediatrics. Breastfeeding improvement following tongue-tie and lip-tie release: Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic. International Journal of Otorhinolaryngology.
The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding. International Journal of Pediatric Otorhinolaryngology. Breastfeeding difficulties and oral cavity anomalies: Making sense of studies which claim benefits of frenotomy in the absence of classic tongue-tie Journal of Human Lactation.
Ghaheri BA, Cole M. True arches, as opposed to corbel arches , were known by a number of civilizations in the ancient Near East and the Levant , but their use was infrequent and mostly confined to underground structures, such as drains where the problem of lateral thrust is greatly diminished.
Untangling the tongue-tie epidemic
In , a robot discovered a long arch-roofed passageway underneath the Pyramid of Quetzalcoatl , which stands in the ancient city of Teotihuacan north of Mexico City , dated to around AD. The ancient Romans learned the arch from the Etruscans , refined it and were the first builders in Europe to tap its full potential for above ground buildings:. The Romans were the first builders in Europe, perhaps the first in the world, to fully appreciate the advantages of the arch, the vault and the dome. Throughout the Roman empire , their engineers erected arch structures such as bridges , aqueducts , and gates.
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They also introduced the triumphal arch as a military monument. Vaults began to be used for roofing large interior spaces such as halls and temples, a function that was also assumed by domed structures from the 1st century BC onwards. They were also routinely used in house construction, as in Ostia Antica see picture. In ancient China , most architecture was wooden , including the few known arch bridges from literature and one artistic depiction in stone-carved relief. The first example of an early Gothic arch in Europe is in Sicily in the Greek fortifications of Gela.
The semicircular arch was followed in Europe by the pointed Gothic arch or ogive , whose centreline more closely follows the forces of compression and which is therefore stronger.
Arch - Wikipedia
The semicircular arch can be flattened to make an elliptical arch, as in the Ponte Santa Trinita. The first examples of the pointed arch in the European architecture are in Sicily and date back to the Arab-Norman period.
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The horseshoe arch is based on the semicircular arch, but its lower ends are extended further round the circle until they start to converge. The first known built horseshoe arches are from the Kingdom of Aksum in modern-day Ethiopia and Eritrea , dating from ca. This is around the same time as the earliest contemporary examples in Roman Syria , suggesting either an Aksumite or Syrian origin for the type.
Although introduced in the 5th century, arches didn't gain prominence in the Indian architecture until 12th century after Islamic conquest. The Gupta era arch vault system was later used extensively in Burmese Buddhist temples in Pyu and Bagan in 11th and 12th centuries. Since it is a pure compression form, the arch is useful because many building materials, including stone and unreinforced concrete , can resist compression , but are weak when tensile stress is applied to them.
An arch is held in place by the weight of all of its members, making construction problematic. One answer is to build a frame historically, of wood which exactly follows the form of the underside of the arch. This is known as a centre or centring. Voussoirs are laid on it until the arch is complete and self-supporting. For an arch higher than head height, scaffolding would be required, so it could be combined with the arch support.
Arches may fall when the frame is removed if design or construction has been faulty. The first attempt at the A85 bridge at Dalmally , Scotland suffered this fate, in the s. Old arches sometimes need reinforcement due to decay of the keystones , forming what is known as bald arch. In reinforced concrete construction, the principle of the arch is used so as to benefit from the concrete's strength in resisting compressive stress.
Where any other form of stress is raised, such as tensile or torsional stress, it has to be resisted by carefully placed reinforcement rods or fibres. A blind arch is an arch infilled with solid construction so it cannot function as a window, door, or passageway. A special form of the arch is the triumphal arch , usually built to celebrate a victory in war. A famous example is the Arc de Triomphe in Paris , France.
Rock formations may form natural arches through erosion , rather than being carved or constructed. Some rock balance sculptures are in the form of an arch. The arches of the foot support the weight of the human body. Church of San Tirso, Sahagun , Spain. A rock balance sculpture in the form of an arch. Medial longitudinal arch of the human foot Gray's Anatomy. Restored Canaanite city gate of Ashkelon , Ashkelon , Israel Arch of Gallienus , Rome Arch of Hadrian , Athens , Greece The Arc de Triomphe , Paris ; a 19th-century triumphal arch modelled on the classical Roman design Gateway Arch in St.
Louis, Missouri ; a sculpture based on a catenary arch Bridge of Sighs , Venice , Italy Eiffel Tower , Paris Arch supporting the Eiffel Tower , Paris The second Wembley Stadium in London , built in St Pancras railway station , London Train shed in St Pancras railway station , London Train shed in Victoria Station , London Train shed in Lucerne railway station, Switzerland Central railway station , Frankfurt , Germany Train shed in Central railway station , Frankfurt , Germany Washington Union Station , Washington, D. Chicago Union Station , Chicago , Illinois Haus der Kulturen der Welt , Berlin , Germany The Colosseum in Rome Arches inside the Colosseum in Rome Amir Chakhmaq Complex , Yazd , Iran Stonework arches seen in a ruined stonework building — Burg Lippspringe , Germany Neuschwanstein Castle , Bavaria , Germany Arches in throne room of Neuschwanstein Castle , Bavaria , Germany photochrom print.
The Alhambra , Granada , Andalusia , Spain North facade of Chartres Cathedral , Chartres , France Arches in choir of Chartres Cathedral , Chartres , France Washington National Cathedral in Washington, D. Between and Main facade of St. Peter's Basilica , Vatican City , Rome Interior arches in St.
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Peter's Basilica , Vatican City Hagia Sophia in Istanbul , Turkey Arches inside the Hagia Sophia in Istanbul , Turkey Arches inside the western upper gallery, Hagia Sophia , Istanbul , Turkey Dome of the Rock , Old City of Jerusalem The Great Gate Darwaza-i-rauza: Winter Palace , Hermitage Museum , St. Petersburg , Russia Palace of Versailles , Versailles, Yvelines , France Palace of Westminster , City of Westminster , London Rajasthani style arches inside the 16th-century City Palace, Udaipur , India Crypt of the Popes in the Catacomb of Callixtus , Rome Natural Bridge in Rockbridge County , Virginia From Wikipedia, the free encyclopedia.
Curved structure that spans a space and may support a load.