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The Cochrane Database of Systematic... Mar 2017Tongue-tie, or ankyloglossia, is a condition whereby the lingual frenulum attaches near the tip of the tongue and may be short, tight and thick. Tongue-tie is present in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tongue-tie, or ankyloglossia, is a condition whereby the lingual frenulum attaches near the tip of the tongue and may be short, tight and thick. Tongue-tie is present in 4% to 11% of newborns. Tongue-tie has been cited as a cause of poor breastfeeding and maternal nipple pain. Frenotomy, which is commonly performed, may correct the restriction to tongue movement and allow more effective breastfeeding with less maternal nipple pain.
OBJECTIVES
To determine whether frenotomy is safe and effective in improving ability to feed orally among infants younger than three months of age with tongue-tie (and problems feeding).Also, to perform subgroup analysis to determine the following.• Severity of tongue-tie before frenotomy as measured by a validated tool (e.g. Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF) scores < 11; scores ≥ 11) (Hazelbaker 1993).• Gestational age at birth (< 37 weeks' gestation; 37 weeks' gestation and above).• Method of feeding (breast or bottle).• Age at frenotomy (≤ 10 days of age; > 10 days to three months of age).• Severity of feeding difficulty (infants with feeding difficulty affecting weight gain (as assessed by infant's not regaining birth weight by day 14 or falling off centiles); infants with symptomatic feeding difficulty but thriving (greater than birth weight by day 14 and tracking centiles).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL up to January 2017, as well as previous reviews including cross-references, expert informants and journal handsearching. We searched clinical trials databases for ongoing and recently completed trials. We applied no language restrictions.
SELECTION CRITERIA
Randomised, quasi-randomised controlled trials or cluster-randomised trials that compared frenotomy versus no frenotomy or frenotomy versus sham procedure in newborn infants.
DATA COLLECTION AND ANALYSIS
Review authors extracted from the reports of clinical trials data regarding clinical outcomes including infant feeding, maternal nipple pain, duration of breastfeeding, cessation of breastfeeding, infant pain, excessive bleeding, infection at the site of frenotomy, ulceration at the site of frenotomy, damage to the tongue and/or submandibular ducts and recurrence of tongue-tie. We used the GRADE approach to assess the quality of evidence.
MAIN RESULTS
Five randomised trials met our inclusion criteria (n = 302). Three studies objectively measured infant breastfeeding using standardised assessment tools. Pooled analysis of two studies (n = 155) showed no change on a 10-point feeding scale following frenotomy (mean difference (MD) -0.1, 95% confidence interval (CI) -0.6 to 0.5 units on a 10-point feeding scale). A third study (n = 58) showed objective improvement on a 12-point feeding scale (MD 3.5, 95% CI 3.1 to 4.0 units of a 12-point feeding scale). Four studies objectively assessed maternal pain. Pooled analysis of three studies (n = 212) based on a 10-point pain scale showed a reduction in maternal pain scores following frenotomy (MD -0.7, 95% CI -1.4 to -0.1 units on a 10-point pain scale). A fourth study (n = 58) also showed a reduction in pain scores on a 50-point pain scale (MD -8.6, 95% CI -9.4 to -7.8 units on a 50-point pain scale). All studies reported no adverse effects following frenotomy. These studies had serious methodological shortcomings. They included small sample sizes, and only two studies blinded both mothers and assessors; one did not attempt blinding for mothers nor for assessors. All studies offered frenotomy to controls, and most controls underwent the procedure, suggesting lack of equipoise. No study was able to report whether frenotomy led to long-term successful breastfeeding.
AUTHORS' CONCLUSIONS
Frenotomy reduced breastfeeding mothers' nipple pain in the short term. Investigators did not find a consistent positive effect on infant breastfeeding. Researchers reported no serious complications, but the total number of infants studied was small. The small number of trials along with methodological shortcomings limits the certainty of these findings. Further randomised controlled trials of high methodological quality are necessary to determine the effects of frenotomy.
Topics: Ankyloglossia; Breast Feeding; Female; Gestational Age; Humans; Infant, Newborn; Lingual Frenum; Mastodynia; Nipples; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 28284020
DOI: 10.1002/14651858.CD011065.pub2 -
American Journal of Speech-language... Nov 2023The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo... (Review)
Review
OBJECTIVE
The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo tongue-tie release (frenotomy) during infancy.
DATA SOURCES
This study contains data from PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar (1961-January 2023).
REVIEW METHOD
The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Experimental and observational studies were eligible if they reported baseline outcomes associated with ankyloglossia in children above a year of age. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded.
CONCLUSIONS
Twenty-six of 1,568 screened studies (> 1,228 patients) were included. Six studies were high quality and 20 were medium quality. Studies identified various symptoms that may be partially attributable to ankyloglossia after infancy, including speech/articulation difficulties, eating difficulties, dysphagia, sleep-disordered breathing symptoms, dental malocclusion, and social embarrassment such as oral hygiene issues. Multiple comparative studies found associations between ankyloglossia and risk factors for obstructive sleep apnea; a randomized controlled trial found that frenotomy may attenuate apnea severity. Ankyloglossia may also promote dental crowding.
IMPLICATIONS FOR PRACTICE
Ankyloglossia may be associated with myriad effects on children's quality of life that extend beyond breastfeeding, but current data regarding the impact are inconclusive. This review provides a map of symptoms that providers may want to evaluate as we continue to debate the decision to proceed with frenotomy or nonsurgical therapies in children with ankyloglossia. A continuing need exists for controlled efficacy research on frenotomy for symptoms in older children and on possible longitudinal benefits of early frenotomy for maxillofacial development.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.23900199.
Topics: Female; Humans; Child; Infant; Ankyloglossia; Breast Feeding; Lingual Frenum; Quality of Life; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37606583
DOI: 10.1044/2023_AJSLP-23-00169 -
Journal of Stomatology, Oral and... Dec 2019Ankyloglossia, also known as tongue-tie, is an embryological anatomical malformation of the tongue, characterized by an abnormally short and a thick lingual frenum.... (Review)
Review
Ankyloglossia, also known as tongue-tie, is an embryological anatomical malformation of the tongue, characterized by an abnormally short and a thick lingual frenum. Tongue-tie restricts the physiologic movements of the tongue and results in various functional, behavioral and speech abnormalities along with the development of frontal and lateral lisps. Ankyloglossia in infants is also linked with the difficulty in breastfeeding difficulty, gagging, choking or vomiting food, delayed development or deterioration of speech and behavioral issues. A lingual frenectomy is a common oral surgical procedure done to correct an ankylosed lingual frenum by severing the abnormal frenal attachment on the ventral surface of the tongue. However, lingual frenectomy is associated with few complications that should be addressed to achieve a good overall prognosis. Though a lot of research is available on the various techniques and rationale to correct ankyloglossia, no paper has yet highlighted the surgical complications associated with lingual frenectomy. Therefore, the present paper for the first time review and highlight the common intraoperative and postoperative complications following lingual frenectomy.
Topics: Ankyloglossia; Breast Feeding; Humans; Infant; Lingual Frenum; Tongue; Tongue Diseases
PubMed: 31255827
DOI: 10.1016/j.jormas.2019.06.003 -
Nutrients Aug 2021Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in... (Review)
Review
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
Topics: Ankyloglossia; Body Composition; Breast; Breast Feeding; Child Development; Female; Gastrointestinal Microbiome; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Lactation; Male; Milk, Human
PubMed: 34578947
DOI: 10.3390/nu13093071 -
Acta Paediatrica (Oslo, Norway : 1992) May 2022Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is... (Meta-Analysis)
Meta-Analysis Review
AIM
Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is conflicting. We conducted a systematic review and meta-analysis to examine the effectiveness of tongue-tie treatment on breastfeeding difficulties.
METHODS
We searched peer-reviewed and grey literature in MEDLINE (OVID), PubMed, CINAHL Plus, EMBASE and PsycINFO, from 01/1970 to 09/2019.
INCLUSION
randomised and non-randomised clinical trials, and quasi-experimental study designs, involving breastfeeding interventions for full-term singleton infants, using standardised measure of breastfeeding difficulty.
EXCLUSION
qualitative and purely observational studies, lacked operational definition of breastfeeding difficulty, lacked control/comparison group. We assessed risk of bias, summarised study quality and results and conducted meta-analysis using random effects modelling.
RESULTS
Six studies on tongue-tie division were included (4 randomised and 2 non-randomised). Meta-analysis of standardised mean differences in breastfeeding difficulty scores in four studies showed statistically significant differences in favour of frenotomy (Pooled SMD +2.12, CI:(0.17-4.08)p = 0.03). Similarly, a statistically significant difference in favour of frenotomy was observed for pain (Pooled SMD -1.68, 95% CI: (-2.87- -0.48).
CONCLUSION
Results support that infant frenotomy is effective for improving standardised scores on breastfeeding difficulty and maternal pain scales and could improve breastfeeding outcomes.
Topics: Ankyloglossia; Breast Feeding; Female; Humans; Infant; Lingual Frenum; Pain; Pain Measurement
PubMed: 35150472
DOI: 10.1111/apa.16289 -
Clinical Anatomy (New York, N.Y.) Sep 2019Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed...
Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in-situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a "cord" or "submucosal band" of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in-situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo-documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm-like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749-761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
Topics: Ankyloglossia; Cadaver; Dissection; Humans; Lingual Frenum; Mandible; Mouth Mucosa
PubMed: 30701608
DOI: 10.1002/ca.23343 -
Australian Dental Journal Sep 2022It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose... (Review)
Review
It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose of this systematic review is to determine and evaluate any association between tongue-tie severity, as measured by pre-treatment assessment tools, and post-operative outcome following tongue-tie division. PubMed, EMBASE, and the Cochrane search engines were used to retrieve articles published between 1947 and 2021. Included studies consisted of patients with symptomatic tongue-tie, assessment by either the Coryllos, Kotlow, or Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) classification tool, and tongue-tie division. A total of 205 abstracts were identified; 31 studies met the criteria for a full-text review, of which, only 14 studies met the criteria for data extraction and analysis. Six studies used the HATLFF, 2 studies used the Kotlow, 5 studies used the Coryllos, and 1 study used a combination of both Kotlow and Coryllos methods. Significant heterogeneity was evident across all studies. No statistical correlation between the two variables could be determined. Although tongue-tie division procedures appear to provide benefits in breastfeeding and speech, there are no data to suggest a statistically significant association between the severity of tongue-tie, and the correct identification of patients who would benefit from tongue-tie division. © 2022 Australian Dental Association.
Topics: Ankyloglossia; Australia; Breast Feeding; Female; Humans; Lingual Frenum; Speech
PubMed: 35689515
DOI: 10.1111/adj.12921 -
Clinical Anatomy (New York, N.Y.) Sep 2019The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is...
The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered "normal" lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal "band" or "string" and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824-835, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
Topics: Ankyloglossia; Cadaver; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Lingual Frenum; Lingual Nerve; Male
PubMed: 31116462
DOI: 10.1002/ca.23410