Changes in the incidence and surgical treatment of ankyloglossia in Canada

Abstract

A desire to increase rates of breast feeding initiation and absence of standardized criteria for the diagnosis of ankyloglossia have resulted in runaway rates of frenotomy for newborn infants in some parts of Canada.

Clinical Consensus Statement: Ankyloglossia in Children

“…As there is increasing awareness, diagnosis, and treatment of ankyloglossia globally, there is a need for common definitions. 3,4,6,[13][14][15][16] With regard to defining ankyloglossia, this panel mirrors the disagreements and uncertainty of the medical community. The panel achieved clear consensus in describing ankyloglossia as a ''condition of limited tongue mobility caused by a restrictive lingual frenulum'' ( Table 1).…”

“…Over the last decade-with the more expansive description of tongue-tie including anterior and posterior tongue-tie and with a broader range of attributed symptoms, as well as a lack of standardized diagnostic criteria-many more children are being diagnosed with ankyloglossia. [3][4][5]14,31 The panel reached consensus that, in some communities, infants and children are being overdiagnosed with ankyloglossia and having unnecessary surgery ( Table 1). Additional potential factors that have led to more children being diagnosed with ankyloglossia include (1) an increased focus on the benefits of breastfeeding; (2) an increased awareness that ankyloglossia can negatively affect breastfeeding; (3) an increase in the number of lactation consultants who identify infants with possible ankyloglossia; (4) an increase in social media and websites related to tongue-tie, and (5) an increase in the number of medical practitioners, particularly dentists, who treat ankyloglossia.…”

“…Additional potential factors that have led to more children being diagnosed with ankyloglossia include (1) an increased focus on the benefits of breastfeeding; (2) an increased awareness that ankyloglossia can negatively affect breastfeeding; (3) an increase in the number of lactation consultants who identify infants with possible ankyloglossia; (4) an increase in social media and websites related to tongue-tie, and (5) an increase in the number of medical practitioners, particularly dentists, who treat ankyloglossia. [3][4][5] Oral sucrose has been shown to decrease pain response in infants undergoing procedures and can be given to an infant prior to undergoing frenotomy.…”

Defining the anatomy of the neonatal lingual frenulum

“…It has become a source of conflict within breastfeeding support communities, when beliefs around the diagnosis of ankyloglossia and promotion of frenotomy become divergent. With a dramatically increasing rate of diagnosis and concomitant surgical intervention for ankyloglossia reported in extensive audits in a number of countries (Joseph et al, ; Lisonek et al, ; Kapoor et al, ), there is concern that this reflects a trend for potential over‐diagnosis, such that a number of infants with a normal anatomy and tongue function are being recommended for intervention.…”

Profile of Scientific Production on Ankyloglossia

“…En cambio, de 1991 a 2019 (28 años), el número de estudios publicados ascendió a 614 (promedio de 22 artículos por año), mostrando que la publicación anual aumentó, en promedio, 7333,3%. Estos datos pueden explicar el aumento de las tasas de diagnóstico de anquiloglosia y la realización de frenotomía lingual en Estados Unidos (Walsh et al, 2017), Australia (Kapoor et al, 2018) y Canadá (Lisonek et al, 2017), tomando en consideración lo reportado por Kapoor et al (2018), quienes consideraron que el impacto de la anquiloglosia en la lactancia materna fue descuidado durante años.…”