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Torn frenulum and non-accidental injury in children

Three Part Question

In [a child] with [a torn frenulum] what [is the sensitivity and specificity of this sign as an indicator of non-accidental injury]?

Clinical Scenario

A 2 year old child is brought to the department with bleeding from a mouth injury. His father states that he fell over pushing his dummy into his mouth. The child has no other obvious injury and although the mechanism of injury sounds plausible you find a torn frenulum on examining his mouth. Remembering this as an indicator of non-accidental injury you wonder whether this injury alone is sensitive/specific enough to support this diagnosis.

Search Strategy

Medline 1966-10/04 using the Ovid interface.
[exp Labial Frenum OR exp lingual frenum OR OR OR exp lip OR] AND [exp Child abuse, sexual OR exp Child abuse OR OR exp Battered child syndrome OR batter$.af OR exp Violence OR violen$.af OR OR OR OR OR exp Sucking Behavior/ OR exp Pacifiers OR] LIMIT to human AND English language.

Search Outcome

Altogether 104 papers found none of which answer the three part question.

Clinical Bottom Line

There appears to be no evidence for the sensitivity/specificity of torn frenulum in the investigation of non-accidental injury.