Research ArticleClinical Review

Prevalence, diagnosis, and treatment of ankyloglossia

Methodologic review

Lauren M. Segal, Randolph Stephenson, Martin Dawes and Perle Feldman
Canadian Family Physician June 2007, 53 (6) 1027-1033;

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

    • Sex

    • Severity of tongue-tie

    • Severity of nipple pain

    • Severity of nipple trauma

    • Infant well-being (weight gain)

    • 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

    • Anesthesia or not

    • Follow-up assessment of breastfeeding

    MEASUREMENT OF EFFECT
    Outcome measures (1 point per criterion)

    • Duration of breastfeeding

    • Complications

    • Latch or suck evaluation

    • Breastfeeding pain or trauma

    • Objective assessment of tongue mobility

    • 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
  • Table 2

    Criteria for diagnosing ankyloglossia

    AUTHORYEARCRITERIA
    Hogan et al52005Frenulum extending along 25%–100% of tongues’ total length
    Ricke et al92005Hazelbaker’s assessment tool17 for lingual frenulum function
    Griffiths62004Frenulum thick; tongue heart-shaped when protruded
    Ballard et al82002Hazelbaker’s assessment tool17 for lingual frenulum function
    Messner et al72000Frenulum abnormally short
    Messner and Lalakea112000Frenulum abnormally short; decreased mobility of tongue tip
    Masaitis and Kaempf31996Tongue heart-shaped when protruded; inability to bring tongue over lower gum ridge; abnormally short, thick frenulum; maternal nipple trauma
    Harris et al201992Frenulum short, thick, and fibrous; frenulum extends to the papillated surface of tongue
    Marmet et al21990Inability to bring tongue over lower gum ridge; normal breastfeeding sucking motion inhibited; tongue heart-shaped when protruded
    Notestine121990Frenulum <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 al191990Tongue 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 al211982Frenulum prevents protrusion of tongue; frenulum extends to papillated surface of tongue; frenulum fissures tongue tip during normal movements
  • Table 3

    Prevalence of ankyloglossia

    STUDYYEARNCOUNTRYTYPE OF STUDYDIAGNOSTIC METHODDAYS POSTPARTUMPREVALENCE N (%) (95% CONFIDENCE INTERVAL)
    Messner et al720001041United StatesProspective trialNone; subjective impression with clinical correlateNot applicable50 (4.8) (3.6–6.3)
    Ballard et al820023036United StatesUncontrolled case seriesHazelbaker’s assessment tool17 for lingual frenulum function2–3127 (4.2) (3.5–5.0)
    Griffiths62004521United KingdomProspective uncontrolled cohort studyNone; subjective impression with clinical correlate18All patients in study had ankyloglossia
    Hogan et al520051866United KingdomRandomized controlled trialNone; subjective impression with clinical correlate3–70(median 15)201 (10.7) (6.6–14.74)
    Ricke et al920053490United StatesCase-controlstudyHazelbaker’s assessment tool17 for lingual frenulum functionBoth 1 and 30 days148 (4.24) (1.1–7.42)
  • Table 4

    Summary of assessment of research on ankyloglossia: Best possible score was 47.

    CRITERIAHOGAN ET AL5BALLARD ET AL8GRIFFITHS6MASAITIS AND KAEMPF3MARMET ET AL2NOTESTINE12FLEISS ET AL19
    Study population
     • Drop-outs32212NANA
     • Losses to follow-up2200NANANA
    Intervention
     • Description of treatment3333320
    Measurement of outcome
     • Outcome measures2234221
     • Duration of follow-up31232NANA
    Analysis and results
     • Adequate analysis4332201
     • Adequate presentation of data1100000
    TOTAL4031312821119

    • NA—Not applicable.

  • Table 5

    Effectiveness of frenotomy for infants with ankyloglossia

    STUDYYEARNTYPE OF STUDYOUTCOME
    Hogan et al520051866: 201 with ankyloglossia; 56 had frenotomyRandomized controlled trial54/56 had improved breastfeeding mechanics and reduced nipple pain with frenotomy; 79% improved immediately, and an additional 16% improved within 48 h
    Griffiths62004519 had frenotomy(215 were <3 mo)Prospective uncontrolled cohort study124/215 (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 al820023036: 123 with ankyloglossia; 35 had frenotomyUncontrolled case seriesDecreased mean maternal pain score from 6.9 (± 2.31) to 1.2 (± 1.52); increased comfort for 31/35 breastfeeding mothers
    Masaitis and Kaempf319962450: 36 had frenotomyCase report32/36 (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 al2199013: 7 had frenotomyCase report5/7 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 al1919903: 2 had frenotomyCase report1 showed improved sucking, and weight gain normalized; 1 developed a lisp
    Notestine1219902: 2 had frenotomyCase report1 mother had increased nipple comfort and less nipple trauma; 1 had increased comfort, and nipple distortion was resolved
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Prevalence, diagnosis, and treatment of ankyloglossia
Lauren M. Segal, Randolph Stephenson, Martin Dawes, Perle Feldman
Canadian Family Physician Jun 2007, 53 (6) 1027-1033;
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