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Otolaryngology--head and Neck Surgery :... May 2020To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy...
OBJECTIVE
To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements.
METHODS
An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery.
RESULTS
After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum.
CONCLUSION
This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
Topics: Adolescent; Ankyloglossia; Breast Feeding; Child; Child, Preschool; Delphi Technique; Humans; Infant; Infant, Newborn; Lingual Frenum; United States
PubMed: 32283998
DOI: 10.1177/0194599820915457 -
Archivos Argentinos de Pediatria Dec 2021Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There... (Review)
Review
Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50% of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients.
Topics: Ankyloglossia; Breast Feeding; Child; Female; Health Personnel; Humans; Infant; Lingual Frenum; Nipples
PubMed: 34813240
DOI: 10.5546/aap.2021.eng.e600 -
JAMA Otolaryngology-- Head & Neck... Oct 2017The influence of tongue tie, or ankyloglossia, on breastfeeding is the subject of growing debate. Restriction of tongue mobility from the frenulum varies greatly among... (Review)
Review
IMPORTANCE
The influence of tongue tie, or ankyloglossia, on breastfeeding is the subject of growing debate. Restriction of tongue mobility from the frenulum varies greatly among newborns and infants (hereinafter referred to as infants). Controversies about whether an infant has ankyloglossia and which infants need treatment are evident with wide variations in medical practice and a lack of high-quality clinical studies that provide guidance.
OBSERVATIONS
Diagnosis and management of ankyloglossia in infants can be a source of confusion and frustration for clinicians and families. Frenotomy is a low-risk procedure that is likely to be beneficial with careful patient selection, but the natural history of untreated ankyloglossia is not well documented. The variability in presentation and treatment outcomes of ankyloglossia indicate that the complexity of infant feeding and tongue development is not fully encapsulated in a simplistic ankyloglossia etiologic framework.
CONCLUSIONS AND RELEVANCE
Consistent terminology with emphasis on symptomatic ankyloglossia and a uniform grading system, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function and Coryllos grading, are needed to improve the quality of research in the future. The ability to make definitive practice guidelines is limited with our current understanding of ankyloglossia. Additional research is needed to better understand the complexity of infant feeding and the role of ankyloglossia.
Topics: Ankyloglossia; Humans; Infant; Infant, Newborn
PubMed: 28715533
DOI: 10.1001/jamaoto.2017.0948 -
International Journal of Environmental... Sep 2022Ankyloglossia is a pathology of the tongue in which the frenulum appears anchored to the floor of the mouth. The treatment of choice for this pathology is frenectomy,... (Review)
Review
Ankyloglossia is a pathology of the tongue in which the frenulum appears anchored to the floor of the mouth. The treatment of choice for this pathology is frenectomy, but myofunctional therapy is emerging in recent years as a complement to surgical intervention. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of myofunctional therapy in ankyloglossia. The Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Pubmed, Web of Science and Scopus were searched. Study quality was determined using the PEDro scale, STROBE statement and single-case experimental design scale. Eleven studies were selected. Based on the studies included in this review, surgery is more effective than myofunctional therapy, although better results are achieved if both are combined. Improvements have been found in maternal pain, weight gain of babies, duration of breastfeeding, tongue mobility, strength and endurance, sleep apnea, mouth breathing and snoring, quality of life, clenching teeth, myofascial tension, pain after surgery and speech sound production. These findings must be taken with caution because of the small number of articles and their quality. Future clinical trials using larger sample sizes and with higher methodological quality are needed.
Topics: Ankyloglossia; Breast Feeding; Female; Humans; Infant; Lingual Frenum; Myofunctional Therapy; Pain; Quality of Life
PubMed: 36231647
DOI: 10.3390/ijerph191912347 -
CoDAS Feb 2019To analyze the association between ankyloglossia and breastfeeding.
PURPOSE
To analyze the association between ankyloglossia and breastfeeding.
METHODS
A cross-sectional study was undertaken on 130 newborn infants in exclusive breastfeeding with Apgar score ≥ 8 within the first five days of life. The research was approved by the Ethics Committee on Human Research. The data collection was performed by the researcher and by three trained speech therapists of the team. The protocols applied were the Neonatal Tongue Screening Test from the Lingual Frenulum Protocol for Infants, the UNICEF Breastfeeding Observation Aid, and the collection of maternal complaints related to the difficulty in breastfeeding was also considered. The data were submitted to statistical analysis - chi-square test and Fisher's exact test, with a significance level of 5%.
RESULTS
When correlating the data, the statistical analysis revealed an association between ankyloglossia and the items of suckling category of the Breastfeeding Observation Aid. The association between complaint of difficulty in breastfeeding and ankyloglossia was also seen.
CONCLUSION
On the first days of life, ankyloglossia is associated with the mother's breastfeeding complaint and with the newborn's sucking difficulty.
Topics: Ankyloglossia; Breast Feeding; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Lingual Frenum; Neonatal Screening; Sucking Behavior
PubMed: 30810632
DOI: 10.1590/2317-1782/20182018264 -
Journal of the American Dental... Nov 2022Prevalence of ankyloglossia may vary depending on the assessment tool. This systematic review aimed to evaluate the prevalence of ankyloglossia in distinct age groups... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prevalence of ankyloglossia may vary depending on the assessment tool. This systematic review aimed to evaluate the prevalence of ankyloglossia in distinct age groups according to different assessment tools.
TYPES OF STUDIES REVIEWED
Nine electronic databases were searched from inception through November 2021 without restrictions of language or year of publication. Paired independent reviewers selected cross-sectional and cohort studies reporting the diagnosis of ankyloglossia, extracted data, and assessed methodological quality. The number of patients with ankyloglossia and the sample were extracted to calculate the overall prevalence of ankyloglossia and 95% CI. The authors calculated the prevalence of ankyloglossia per assessment tool, age group, and sex. They assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Seventy-one studies were included. Seven different diagnostic tools were used. The overall prevalence of ankyloglossia was 5% (95% CI, 4.0% to 5.0%) and ranged from 2% (using an unspecific tool) to 20% (Coryllos classification). The prevalence per age group was higher in infants (7%). The prevalence ratio was 1.34 (95% CI, 1.17 to 1.54) for boys, with very low certainty of evidence.
PRACTICAL IMPLICATIONS
The prevalence of ankyloglossia is higher among infants and differs depending on the assessment tool used for the diagnosis. It is uncertain whether boys are more affected by ankyloglossia than girls.
Topics: Infant; Male; Female; Humans; Ankyloglossia; Lingual Frenum; Prevalence; Cross-Sectional Studies; Uncertainty; Breast Feeding
PubMed: 36307175
DOI: 10.1016/j.adaj.2022.07.011 -
International Journal of Paediatric... Mar 2022Ankyloglossia is a common congenital malformation characterized by a short, thick, or tight tongue frenulum, and its effect on speech articulation remains controversial.... (Review)
Review
AIM
Ankyloglossia is a common congenital malformation characterized by a short, thick, or tight tongue frenulum, and its effect on speech articulation remains controversial. This study aimed to evaluate (a) the association between ankyloglossia and speech disorders, and (b) the effectiveness of surgical interventions on the articulation of patients with ankyloglossia.
MATERIAL AND METHODS
A comprehensive search of PubMed was conducted. Randomized control trials (RCTs), cohort studies, case-control studies, and case series with more than five cases were included.
RESULT
Of the 16 included studies, except for one cross-sectional study, all studies were small in sample size. The evidence quality was generally low, with an average of 3.88 in a 7-point system. Three studies investigated the occurrence of speech disorders in the ankyloglossia population and obtained different results. Fifteen studies assessed the effectiveness of surgery, among which eight self-control studies observed significant postoperative improvement, whereas three of four cohort studies with untreated controls reported no significant differences. Three RCTs compared surgical techniques and one pointed out the advantage of frenuloplasty over frenulotomy.
CONCLUSION
There was no clear connection between ankyloglossia and speech disorders. More widely accepted uniform grading systems and well-designed clinical studies are needed.
Topics: Ankyloglossia; Breast Feeding; Case-Control Studies; Female; Humans; Lingual Frenum; Speech
PubMed: 33964037
DOI: 10.1111/ipd.12802 -
Acta Paediatrica (Oslo, Norway : 1992) Mar 2023To evaluate breastfeeding symptoms associated with ankyloglossia/tongue-tie. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate breastfeeding symptoms associated with ankyloglossia/tongue-tie.
METHODS
Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar. Eligible studies reported baseline breastfeeding symptoms/severity from tongue-tied infants. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded. Main outcomes were weighted mean severity scores for dyads with ankyloglossia relative to reference values for successful breastfeeding. Meta-analyses used inverse-variance-weighted random-effects models.
RESULTS
Of 1328 screened studies, 39 were included (5730 infants with ankyloglossia). The mean LATCH score for patients with untreated ankyloglossia, 7.1 (95% CI: 6.7-7.4), was significantly below the good-breastfeeding threshold. The mean Infant Breastfeeding Assessment Tool score, 10.0 (8.2-11.7), was not significantly below the good-breastfeeding threshold. The mean Infant-Gastroesophageal Reflux Questionnaire-Revised score, 18.2 (10.5-26.0), was consistent with gastroesophageal reflux disease. The mean Breastfeeding Self-Efficacy Scale-Short Form score, 43.7 (39.3-48.1), indicated significant risk of cessation of exclusive breastfeeding within 1-3 months. Mean nipple pain was 4.9 (4.1-5.7) on a 0-10 scale, greater than typical scores for breastfeeding mothers without nipple damage. Total prevalence of breastfeeding difficulties was 49.3% (95% CI: 47.3-51.4%). Early, undesired weaning occurred in 20.3% (18.5-22.2%) of cases before intervention.
CONCLUSION
Ankyloglossia is adversely associated with breastfeeding success and maternal well-being.
Topics: Infant; Female; Humans; Ankyloglossia; Breast Feeding; Lingual Frenum; Prevalence; Weaning; Gastroesophageal Reflux
PubMed: 36437565
DOI: 10.1111/apa.16609 -
Developmental Period Medicine 2019Ankyloglossia is defined as a congenital malformation that alters lingual mobility and function. It is listed as one of the possible reasons behind problems with... (Review)
Review
Ankyloglossia is defined as a congenital malformation that alters lingual mobility and function. It is listed as one of the possible reasons behind problems with breastfeeding. Due to current WHO recommendations that encourage mothers to breastfeed exclusively up to 6 months of age, quick recognition of any obstacles in the suction mechanism and determining the possible reasons for problems should be a priority. A review of the literature was conducted concerning the diagnosis of ankyloglossia, possible methods of treatment and their efficacy in improving breastfeeding quality. The authors of the research cited claim that any surgical intervention should be performed only in cases of symptomatic ankyloglossia interfering with sucking mechanisms. The most frequent surgical procedure performed in newborns with symptomatic ankyloglossia is frenulotomy. It is a simple procedure with a low risk of complications. The literature gives a great number of studies confirming both the short and long-term efficacy of tongue-tie release in improving breastfeeding quality, with emphasis on decreasing mothers' discomfort, nipple pain and trauma.
Topics: Ankyloglossia; Breast Feeding; Disease Management; Humans; Infant; Infant, Newborn
PubMed: 30954985
DOI: 10.34763/devperiodmed.20192301.7985