Ankyloglossia: controversies in management

Messner, Anna H.; Lalakea, M. Lauren

doi:10.1016/s0165-5876(00)00359-1

Cited by 179 publications

(179 citation statements)

References 14 publications

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“…Tongue-tie (more formally known as ankyloglossia) is a congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict mobility of the tongue tip [5].…”

Section: Introductionmentioning

confidence: 99%

Ankyloglossia among Children of Regular and Special Schools in Karnataka, India: A Prevalence Study

Bai

Vaz

2014

JCDR

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“…Tongue-tie (more formally known as ankyloglossia) is a congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict mobility of the tongue tip [5].…”

Section: Introductionmentioning

confidence: 99%

Ankyloglossia among Children of Regular and Special Schools in Karnataka, India: A Prevalence Study

Bai

Vaz

2014

JCDR

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“…A minority of surveyed pediatricians (10%) and otolaryngologists (30%) believe ankyloglossia commonly affects feeding, whereas 69% of lactation consultants feel that it frequently causes breastfeeding problems. 3 Therefore, depending on the audience, enthusiasm for its treatment varies. Currently, the National Health Service and the Canadian Pediatric Society recommend treatment if ankyloglossia interferes with breastfeeding.…”

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confidence: 99%

Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review

Krishnaswami²,

2015

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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, longerterm 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 motherreported improvements in breastfeeding, and potentially in nipple pain, but with small, shortterm studies with inconsistent methodology, strength of the evidence is low to insufficient. Dr Francis conceptualized and designed the study, and drafted the initial manuscript; Dr McPheeters conceptualized and designed the study, carried out the initial analyses, and reviewed and revised the manuscript; Dr Krishnaswami carried out the initial analyses, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Despite these studies, consensus on the role of ankyloglossia in breastfeeding difficulties is lacking. A minority of surveyed pediatricians (10%) and otolaryngologists (30%) believe ankyloglossia commonly affects feeding, whereas 69% of lactation consultants feel that it frequently causes breastfeeding problems. 3 Therefore, depending on the audience, enthusiasm for its treatment varies. Currently, the National Health Service and the Canadian Pediatric Society recommend treatment if ankyloglossia interferes with breastfeeding. 4 However, a standard definition of "interference" with breastfeeding is not provided, leaving room for interpretation and variation in treatment thr...

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“…1 The controversy involves not only the management but also the definition of this anomaly. A tight lingual frenulum is considered a minor malformation by some investigators.…”

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confidence: 99%

Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad

Auer²,

2002

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ABSTRACT. Objective. Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls.Methods. We examined 2763 breastfeeding inpatient infants and 273 outpatient infants with breastfeeding problems for possible ankyloglossia and assessed each infant with ankyloglossia, using the Hazelbaker Assessment Tool for Lingual Frenulum Function. We then observed each dyad while breastfeeding. When latch problems were seen, we asked the mother to describe the sensation and quality of the suck at the breast. When pain was described, we asked the mother to grade her pain on a scale of 1 to 10. When lingual function was impaired, we discussed the frenuloplasty procedure with the parent(s) and obtained informed consent. After the procedure, the infants were returned to their mothers for breastfeeding. Infant latch and maternal nipple pain were reassessed at this time.Results. Ankyloglossia was diagnosed in 88 (3.2%) of the inpatients and in 35 (12.8%) of the outpatients. Mean Hazelbaker scores were similar for the presenting symptoms of poor latch and nipple pain. Median infant age (25th and 75th percentiles) at presentation was lower for poor latch than for nipple pain: 1.2 days (0.7, 2.0) versus 2.0 days (1.0, 12.0), respectively. All frenuloplasties were performed without incident. Latch improved in all cases, and maternal pain levels fell significantly after the procedure: 6.9 ؎ 2.31 down to 1.2 ؎ 1.52.Conclusion. Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia. Pediatrics 2002;110(5). URL: http://www. pediatrics.org/cgi/content/full/110/5/e63; ankyloglossia, tongue-tie, nipple pain, poor latch, failure to thrive, problem breastfeeding, frenuloplasty/frenotomy.ABBREVIATION. SD, standard deviation.

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Ankyloglossia: controversies in management

Cited by 179 publications

References 14 publications

Ankyloglossia among Children of Regular and Special Schools in Karnataka, India: A Prevalence Study

Ankyloglossia among Children of Regular and Special Schools in Karnataka, India: A Prevalence Study

Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review

Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad

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