How to Treat a Tongue-tie: An Evidence-based Algorithm of Care

Background:. Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. Methods:. A...

Full description

Bibliographic Details
Main Authors: Rohil Shekher, MD, Lawrence Lin, MD, Rosaline Zhang, MD, Ian C. Hoppe, MD, Jesse A. Taylor, MD, Scott P. Bartlett, MD, Jordan W. Swanson, MD
Format: Article
Language:English
Published: Wolters Kluwer 2021-01-01
Series:Plastic and Reconstructive Surgery, Global Open
Online Access:http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003336
_version_ 1818866145410678784
author Rohil Shekher, MD
Lawrence Lin, MD
Rosaline Zhang, MD
Ian C. Hoppe, MD
Jesse A. Taylor, MD
Scott P. Bartlett, MD
Jordan W. Swanson, MD
author_facet Rohil Shekher, MD
Lawrence Lin, MD
Rosaline Zhang, MD
Ian C. Hoppe, MD
Jesse A. Taylor, MD
Scott P. Bartlett, MD
Jordan W. Swanson, MD
author_sort Rohil Shekher, MD
collection DOAJ
description Background:. Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. Methods:. A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway. Results:. Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy (P < 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48, P < 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire, P < 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division. Conclusions:. Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.
first_indexed 2024-12-19T10:58:47Z
format Article
id doaj.art-785dd5f0357047dd950e3519fdb2fa98
institution Directory Open Access Journal
issn 2169-7574
language English
last_indexed 2024-12-19T10:58:47Z
publishDate 2021-01-01
publisher Wolters Kluwer
record_format Article
series Plastic and Reconstructive Surgery, Global Open
spelling doaj.art-785dd5f0357047dd950e3519fdb2fa982022-12-21T20:24:43ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-01-0191e333610.1097/GOX.0000000000003336202101000-00026How to Treat a Tongue-tie: An Evidence-based Algorithm of CareRohil Shekher, MD0Lawrence Lin, MD1Rosaline Zhang, MD2Ian C. Hoppe, MD3Jesse A. Taylor, MD4Scott P. Bartlett, MD5Jordan W. Swanson, MD6From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; Philadelphia, Pa.Background:. Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. Methods:. A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway. Results:. Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy (P < 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48, P < 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire, P < 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division. Conclusions:. Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003336
spellingShingle Rohil Shekher, MD
Lawrence Lin, MD
Rosaline Zhang, MD
Ian C. Hoppe, MD
Jesse A. Taylor, MD
Scott P. Bartlett, MD
Jordan W. Swanson, MD
How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
Plastic and Reconstructive Surgery, Global Open
title How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_full How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_fullStr How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_full_unstemmed How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_short How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_sort how to treat a tongue tie an evidence based algorithm of care
url http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003336
work_keys_str_mv AT rohilshekhermd howtotreatatonguetieanevidencebasedalgorithmofcare
AT lawrencelinmd howtotreatatonguetieanevidencebasedalgorithmofcare
AT rosalinezhangmd howtotreatatonguetieanevidencebasedalgorithmofcare
AT ianchoppemd howtotreatatonguetieanevidencebasedalgorithmofcare
AT jesseataylormd howtotreatatonguetieanevidencebasedalgorithmofcare
AT scottpbartlettmd howtotreatatonguetieanevidencebasedalgorithmofcare
AT jordanwswansonmd howtotreatatonguetieanevidencebasedalgorithmofcare