Article Figures & Data
Tables
- Table 1
Point system for assessing quality of the 6 studies that addressed the effectiveness of frenotomy for treatment of ankyloglossia
STUDY POPULATION Patient selection 0—Not described 1—Any reason given 2—Only exclusion criteria given 3—Both inclusion and exclusion criteria given Study design 1—Case report 2—Case series 3—Cohort study 4—Retrospective case-control study 5—Prospective case-control study 6—Randomized controlled trial Sample size 1—<100 2—100–1000 3—>1000 Number of patients with ankyloglossia 1—<20 2—20–100 3—>100 Number of patients having frenotomy 0—0 1—<10 2—10–100 3—>100 Patient characteristics at baseline (1 point per criterion) -
Age
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Sex
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Severity of tongue-tie
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Severity of nipple pain
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Severity of nipple trauma
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Infant well-being (weight gain)
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Latch or suck evaluation
Drop-outs 0—Not reported 1—Reported, drop-outs >0 2—Reported, drop-outs = 0 3—Reported with reason given Losses to follow up 0—Not reported 1—Reported and >20% 2—Reported and <20% INTERVENTION Description of treatment (1 point per criterion) -
Type of surgery: clipping or z-plasty
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Anesthesia or not
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Follow-up assessment of breastfeeding
MEASUREMENT OF EFFECT Outcome measures (1 point per criterion) -
Duration of breastfeeding
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Complications
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Latch or suck evaluation
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Breastfeeding pain or trauma
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Objective assessment of tongue mobility
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Speed of infant weight gain
Duration of follow-up 1—<3 weeks 2—3–14 weeks 3—14 weeks-3 months ANALYSIS AND RESULTS Adequate analysis 0—None 1—Verbally described 2—Tabulated 3—Any statistical analysis 4—Formal systematic analysis Adequate presentation of data 0—No data presented 1—Some data presented 2—All data presented -
AUTHOR YEAR CRITERIA Hogan et al5 2005 Frenulum extending along 25%–100% of tongues’ total length Ricke et al9 2005 Hazelbaker’s assessment tool17 for lingual frenulum function Griffiths6 2004 Frenulum thick; tongue heart-shaped when protruded Ballard et al8 2002 Hazelbaker’s assessment tool17 for lingual frenulum function Messner et al7 2000 Frenulum abnormally short Messner and Lalakea11 2000 Frenulum abnormally short; decreased mobility of tongue tip Masaitis and Kaempf3 1996 Tongue heart-shaped when protruded; inability to bring tongue over lower gum ridge; abnormally short, thick frenulum; maternal nipple trauma Harris et al20 1992 Frenulum short, thick, and fibrous; frenulum extends to the papillated surface of tongue Marmet et al2 1990 Inability to bring tongue over lower gum ridge; normal breastfeeding sucking motion inhibited; tongue heart-shaped when protruded Notestine12 1990 Frenulum <1 cm in length; tongue heart-shaped when protruded; tight feeling when finger placed under tongue along midline; tongue cannot reach gum line when protruded Fleiss et al19 1990 Tongue tip cannot reach top of gums; tongue tip cannot swing from one corner of mouth to the other; tongue displays notching when protruded; tongue cannot be protruded beyond lower gum Jorgenson et al21 1982 Frenulum prevents protrusion of tongue; frenulum extends to papillated surface of tongue; frenulum fissures tongue tip during normal movements STUDY YEAR N COUNTRY TYPE OF STUDY DIAGNOSTIC METHOD DAYS POSTPARTUM PREVALENCE N (%) (95% CONFIDENCE INTERVAL) Messner et al7 2000 1041 United States Prospective trial None; subjective impression with clinical correlate Not applicable 50 (4.8) (3.6–6.3) Ballard et al8 2002 3036 United States Uncontrolled case series Hazelbaker’s assessment tool17 for lingual frenulum function 2–3 127 (4.2) (3.5–5.0) Griffiths6 2004 521 United Kingdom Prospective uncontrolled cohort study None; subjective impression with clinical correlate 18 All patients in study had ankyloglossia Hogan et al5 2005 1866 United Kingdom Randomized controlled trial None; subjective impression with clinical correlate 3–70(median 15) 201 (10.7) (6.6–14.74) Ricke et al9 2005 3490 United States Case-controlstudy Hazelbaker’s assessment tool17 for lingual frenulum function Both 1 and 30 days 148 (4.24) (1.1–7.42) CRITERIA HOGAN ET AL5 BALLARD ET AL8 GRIFFITHS6 MASAITIS AND KAEMPF3 MARMET ET AL2 NOTESTINE12 FLEISS ET AL19 Study population • Drop-outs 3 2 2 1 2 NA NA • Losses to follow-up 2 2 0 0 NA NA NA Intervention • Description of treatment 3 3 3 3 3 2 0 Measurement of outcome • Outcome measures 2 2 3 4 2 2 1 • Duration of follow-up 3 1 2 3 2 NA NA Analysis and results • Adequate analysis 4 3 3 2 2 0 1 • Adequate presentation of data 1 1 0 0 0 0 0 TOTAL 40 31 31 28 21 11 9 -
NA—Not applicable.
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STUDY YEAR N TYPE OF STUDY OUTCOME Hogan et al5 2005 1866: 201 with ankyloglossia; 56 had frenotomy Randomized controlled trial 54/56 had improved breastfeeding mechanics and reduced nipple pain with frenotomy; 79% improved immediately, and an additional 16% improved within 48 h Griffiths6 2004 519 had frenotomy(215 were <3 mo) Prospective uncontrolled cohort study 124/215 (57%) had improved feeding immediately; 174/215 (80%) had improved feeding at 24 h; 139/215(65%) were still breastfed at 3 mo; 204/215 could extend tongue out of mouth at 3 mo Ballard et al8 2002 3036: 123 with ankyloglossia; 35 had frenotomy Uncontrolled case series Decreased mean maternal pain score from 6.9 (± 2.31) to 1.2 (± 1.52); increased comfort for 31/35 breastfeeding mothers Masaitis and Kaempf3 1996 2450: 36 had frenotomy Case report 32/36 (89%) were breastfeeding 1 wk after procedure; 33/36 (92%) had normal tongue motion; 34/36 (94%) had appropriate growth at 3 mo; 36/36 (100%) reported normal criteria; 19/36 (53%) continued breastfeeding; 2/36 (0.5%) were weaned early due to breastfeeding problems Marmet et al2 1990 13: 7 had frenotomy Case report 5/7 had improved latch and decreased nipple pain and had resolved slow weight gain and milk-supply difficulties; 1/7 had improved suck dynamics; and 1/7 showed no improvement Fleiss et al19 1990 3: 2 had frenotomy Case report 1 showed improved sucking, and weight gain normalized; 1 developed a lisp Notestine12 1990 2: 2 had frenotomy Case report 1 mother had increased nipple comfort and less nipple trauma; 1 had increased comfort, and nipple distortion was resolved