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Pediatrics Jun 2015Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this... (Review)
Review
OBJECTIVE
Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this study was to systematically review literature on surgical and nonsurgical treatments for infants with ankyloglossia.
METHODS
Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched up to August 2014. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics and outcomes and assigned quality and strength-of-evidence ratings.
RESULTS
Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. We included comparative studies published in English. The evidence base is limited, consisting of small studies, short-term outcomes, and little information to characterize participants adequately. No studies addressed nonsurgical interventions, longer-term breastfeeding or growth outcomes, or surgical intervention compared with other approaches to improve breastfeeding, such as lactation consultation.
CONCLUSIONS
A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient.
Topics: Ankyloglossia; Breast Feeding; Child; Humans; Mouth Abnormalities; Treatment Outcome
PubMed: 25941303
DOI: 10.1542/peds.2015-0658 -
PloS One 2023Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have...
BACKGROUND
Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. This study aimed to review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants.
METHODS
We searched the databases MEDLINE, EMBASE, Cochrane CENTRAL, and Scopus. We searched for observational, and interventional studies, and systematic reviews investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. The search was registered on PROSPERO on 01/12/2022, ID: CRD42022375862.
RESULTS
The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia. This study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question.
CONCLUSIONS
Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.
Topics: Female; Pregnancy; Infant; Humans; Ankyloglossia; Case-Control Studies; Folic Acid; Dietary Supplements; Neural Tube Defects; Tongue
PubMed: 37922258
DOI: 10.1371/journal.pone.0294042 -
International Journal of Nursing Studies Mar 2019Tongue-tie (ankylglossia) occurs when there is an anterior attachment near the tip of the tongue resulting in restricted tongue movement. It is reported to be a cause of... (Review)
Review
BACKGROUND
Tongue-tie (ankylglossia) occurs when there is an anterior attachment near the tip of the tongue resulting in restricted tongue movement. It is reported to be a cause of poor breastfeeding in infants and nipple pain in breastfeeding mothers.
OBJECTIVES
The objectives of the study were to determine whether frenotomy is safe and effective in improving ability to feed orally among infants.
INTERVENTION/METHODS
Frenotomy may correct the restriction of tongue movement and allow improved breast feeding and reduced maternal nipple pain. Randomised, quasi-randomised cluster-randomised controlled trials that compared frenotomy verses no frenotomy or frenotomy verses sham procedure were included in the review. Participants were infants with tongue-tie experiencing feeding problems, or whose breast feeding mothers were experiencing nipple pain.
RESULTS
Five studies (N = 302) met the inclusion criteria. Pooled analysis of two studies showed no change 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 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). Pooled analysis of three studies (n = 212) 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). These studies had serious methodological shortcomings.
CONCLUSION
Investigators did not find a consistent positive effect on infant breastfeeding following frenotomy. A short-term reduction in breast pain was found among breastfeeding mothers. Small trial numbers and methodological issues meant no definitive benefit for frenotomy in infants with tongue-tie could be proved.
Topics: Adult; Ankyloglossia; Breast Feeding; Female; Humans; Infant, Newborn; Lingual Frenum; Nipples; Pain; Surgical Procedures, Operative; Treatment Outcome
PubMed: 30001811
DOI: 10.1016/j.ijnurstu.2018.03.022 -
Pediatrics Jun 2015Children with ankyloglossia, an abnormally short, thickened, or tight lingual frenulum, may have restricted tongue mobility and sequelae, such as speech and feeding... (Review)
Review
BACKGROUND AND OBJECTIVE
Children with ankyloglossia, an abnormally short, thickened, or tight lingual frenulum, may have restricted tongue mobility and sequelae, such as speech and feeding difficulties and social concerns. We systematically reviewed literature on feeding, speech, and social outcomes of treatments for infants and children with ankyloglossia.
METHODS
Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two investigators independently extracted data on study populations, interventions, and outcomes and assessed study quality.
RESULTS
Two randomized controlled trials, 2 cohort studies, and 11 case series assessed the effects of frenotomy on feeding, speech, and social outcomes. Bottle feeding and social concerns, such as ability to use the tongue to eat ice cream and clean the mouth, improved more in treatment groups in comparative studies. Supplementary bottle feedings decreased over time in case series. Two cohort studies reported improvement in articulation and intelligibility with treatment. Other benefits were unclear. One randomized controlled trial reported improved articulation after Z-frenuloplasty compared with horizontal-to-vertical frenuloplasty. Numerous noncomparative studies reported speech benefits posttreatment; however, studies primarily discussed modalities, with outcomes including safety or feasibility, rather than speech. We included English-language studies, and few studies addressed longer-term speech, social, or feeding outcomes; nonsurgical approaches, such as complementary and alternative medicine; and outcomes beyond infancy, when speech or social concerns may arise.
CONCLUSIONS
Data are currently insufficient for assessing the effects of frenotomy on nonbreastfeeding outcomes that may be associated with ankyloglossia.
Topics: Ankyloglossia; Breast Feeding; Child; Humans; Mouth Abnormalities; Treatment Outcome
PubMed: 25941312
DOI: 10.1542/peds.2015-0660 -
Journal of Clinical and Translational... Apr 2021Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties...
BACKGROUND AND AIM
Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties reported by mothers; assess possible factors that may interfere with breastfeeding.
METHODS
A cross-sectional study was conducted with 391 pairs of mothers/newborns at a university hospital. A pediatric dentist examined the oral cavity of the newborns for the occurrence of ankyloglossia. We analyzed medical records and the mothers answered a self-administered questionnaire to assess birth variables, breastfeeding difficulties, and sociodemographic factors. We calculated prevalence ratios (PRs) of breastfeeding difficulties according to the independent variables.
RESULTS
The mean age of the newborns was 2.5±2.9 days and 52% were male. The prevalence of ankyloglossia was 15% and 91.4% of mothers reported not having breastfeeding difficulties. Ankyloglossia was not associated with breastfeeding difficulties (PR: 0.5; 95% CI: 0.2-1.4). Mothers with a low income (PR: 0.5; 95% CI: 0.3-0.8), those who received instructions on breastfeeding (PR: 0.4; 95% CI: 0.2-0.9), and those who breastfed exclusively (PR: 0.3; 95% CI: 0.1-0.8) had fewer breastfeeding difficulties.
CONCLUSION
Successful breastfeeding was more dependent on being born at full term, the family income, receiving guidance with regard to breastfeeding, and exclusive breastfeeding. Although ankyloglossia was not associated with breastfeeding, future prospective studies should evaluate the long-term factors that may interfere with breastfeeding.
RELEVANCE FOR PATIENTS
This study brings a new perspective on the importance of assessing ankyloglossia and breastfeeding difficulties, reinforces the benefits of exclusive breastfeeding and the need for breastfeeding instructions, as well as the need to evaluate breastfeeding before making a decision regarding frenectomy.
PubMed: 34104830
DOI: No ID Found -
International Journal of Pediatric... Jul 2021To investigate and identify the concerns and opinions expressed in both parental and provider posts on social media about ankyloglossia.
OBJECTIVES
To investigate and identify the concerns and opinions expressed in both parental and provider posts on social media about ankyloglossia.
METHODS
In this study, posts on Twitter between 1/1/2008 and 12/31/2018 were collected using search terms and hashtags specific to pediatric ankyloglossia. The search terms included a primary phrase to indicate ankyloglossia along with a pediatric identifier. Tweets that met inclusion criteria were analyzed qualitatively via conventional content analysis. After all tweets were categorized, descriptive statistics were completed to determine frequency of each theme.
RESULTS
In total, 5951 tweets were retrieved. Parents authored 982 (16.5%) of tweets, and 782 (13.1%) were by providers. The remaining 4187 tweets did not fit criteria for either the parent or provider groups. Amongst parents, the most common themes mentioned were feeding problems (309 tweets [32.4%]), followed by lip tie (215 [22.5%]), anxiety or emotion (207 [21.7%]), and maternal breastfeeding complications (127 [13.3%]). The number of tweets about ankyloglossia and frenotomy in 2018 had increased by 2395% since 2009. Amongst providers, 215 tweets were judged by the coders to provide an opinion on ankyloglossia, of which 94.4% had a pro-frenotomy sentiment. When a specialty was identified, tweets were most often by dentists (250 [31.9%]), followed by lactation consultants and International Board Certified Lactation Consultants (IBCLCs) (157 [29.7%]) and non-otolaryngologist physicians (79 [10.1%]). Otolaryngologists accounted for 8.7% (68 tweets) of posts about ankyloglossia.
CONCLUSION
Our findings demonstrate the spectrum of opinions that exist among both parents and providers about ankyloglossia. This can aid in shared-decision making by enabling the counseling provider to guide recommendations based on medical evidence with the understanding that there is a large amount of non-scientific information and opinions disseminated that may be shaping decisions.
Topics: Ankyloglossia; Breast Feeding; Child; Female; Humans; Lingual Frenum; Parents; Social Media
PubMed: 33964675
DOI: 10.1016/j.ijporl.2021.110741 -
International Journal of Pediatric... Jul 2023To investigate the prevalence and management of ankyloglossia for infants in Central Australia.
PURPOSE
To investigate the prevalence and management of ankyloglossia for infants in Central Australia.
METHOD
Retrospective chart review consisting of a medical file audit of infants (n = 493) <2 years old diagnosed with ankyloglossia from January 2013 to December 2018 in the primary hospital in Central Australia. Patient characteristics, reason for diagnosis, reason for procedure and outcomes of procedures routinely recorded in the patient clinical files were recorded.
RESULTS
The overall prevalence of ankyloglossia in this population was 10.2%. Frenotomy was performed in 97.9% of infants diagnosed with ankyloglossia. Infants with ankyloglossia were more likely to be male (58% vs 42%), diagnosed and managed with a frenotomy on the third day of life. Most ankyloglossia diagnoses were identified by a midwife (>92%). Most frenotomy procedures were completed by lactation consultants who were also midwives (99%) using blunt-ended scissors. More infants were classified with posterior ankyloglossia than anterior ankyloglossia (23% vs 15%). A frenotomy procedure resolved feeding issues in 54% of infants with ankyloglossia.
CONCLUSIONS
The prevalence of ankyloglossia and rate of frenotomy procedures were high when compared to previous reports in the general population. Frenotomy for ankyloglossia in infants with breastfeeding difficulties was found to be effective in more than half of the reported sample, improving breastfeeding and decreasing maternal nipple pain. A standardised approach and validated screening or comprehensive assessment tool for the identification of ankyloglossia is indicated. Guidelines and training for relevant health professionals on non-surgical management of the functional limitations of ankyloglossia are also recommended.
Topics: Female; Infant; Humans; Male; Child, Preschool; Ankyloglossia; Lingual Frenum; Retrospective Studies; Prevalence; Treatment Outcome; Breast Feeding; Australia
PubMed: 37224737
DOI: 10.1016/j.ijporl.2023.111604 -
The British Journal of Oral &... Apr 2019During the last decade, increasing awareness of breastfeeding and its health benefits has not been reflected in the provision of lingual frenotomy in neonates with... (Review)
Review
During the last decade, increasing awareness of breastfeeding and its health benefits has not been reflected in the provision of lingual frenotomy in neonates with tongue-tie. This could be because of inconsistencies in our understanding of the importance and treatment of ankyloglossia. In this review, we discuss the current clinical guidance on diagnosis and management, and the future of such a service in the early postpartum period.
Topics: Ankyloglossia; Breast Feeding; Female; Humans; Infant, Newborn; Lingual Frenum
PubMed: 30910412
DOI: 10.1016/j.bjoms.2019.03.004 -
Facial Plastic Surgery Clinics of North... Feb 2024Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact... (Review)
Review
Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact on breathing, feeding, speech, dentition, and craniofacial growth. This review discusses the interdependent and coordinated development of both the tongue and mandible, the functional impacts of these disorders, and appropriate management strategies.
Topics: Humans; Child; Tongue; Macroglossia; Mandible
PubMed: 37981411
DOI: 10.1016/j.fsc.2023.08.002 -
Current Opinion in Otolaryngology &... Jun 2024The purpose of this review is to examine the current research of the posterior tongue tie and how it relates to breast feeding, solid feeding, and speech.
PURPOSE OF REVIEW
The purpose of this review is to examine the current research of the posterior tongue tie and how it relates to breast feeding, solid feeding, and speech.
RECENT FINDINGS
Recent findings show that the posterior tongue tie may play a role in effective breast feeding.
SUMMARY
Ankyloglossia is the term used for the restriction of the movement of the tongue that impairs certain functions such as breastfeeding or bottle feeding, feeding with solids, and speech. Cadaver studies have shown that there can be a restriction of the tongue and oral tissues in some people relative to others. In some breast-feeding studies, releasing the posterior tie has been shown to improve certain aspects of tongue movement. There is little evidence for or against posterior tongue ties contributing to other problems such as speech and solid feeding. This article goes into depth about the current studies on posterior ankyloglossia.
PubMed: 38869616
DOI: 10.1097/MOO.0000000000000982