Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects

Abstract

We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. "Functional" ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50-80%, grade 3 < 50%, grade 4 < 25%.

Tongue position for lingual frenulum assessment

“…Several lingual frenulum assessment tools for infants, children, adolescents, and adults have been published by professionals, such as dentists, lactation consultants, midwives, speech-language pathologists [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

“…Most authors recommend tongue elevation for diagnosing ankyloglossia [5][6]8,[12][13][14][17][18][19][20][21][22] . A few authors propose tongue protrusion for assessing the lingual frenulum 7,11,15 .…”

Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional – morphological study

“…Our methods of measuring MIO and MOTTIP have previously been published (Figure ). Briefly, functional TRMR as related to MIO grading scale is rated as follows: Grade 1 = >80% (complete tongue mobility), Grade 2 = 50%‐80% (average to mildly restricted tongue mobility), Grade 3 = <50% (moderately restricted tongue mobility), Grade 4 = < 25% (severely restricted tongue mobility) (Figure ). Kotlow free tongue measurement is obtained by measuring the length of the ventral surface of the tongue (while in full extension) from the insertion of the lingual frenulum to the tongue tip…”

Oral dysfunction as a cause of malocclusion

“…Ankyloglossia has been correlated with reduced inter‐canine and inter‐molar width, SMA, HNP, AOB, overjet and incisor spacing . The vertical lift to the hard palate, and not horizontal extension past the incisors, is the most accurate measure of normal lingual function …”

“…19 The vertical lift to the hard palate, and not horizontal extension past the incisors, is the most accurate measure of normal lingual function. 20 The existence of labial frenula is not a symptom of dysmorphology, but variations in the insertion points, thickness and its contribution to trapping liquid and food can have a negative impact on oral and dental development. Maxillary labial ties can make breastfeeding difficult and painful for the mother when the upper lip does not create enough of a flange to adequately draw in more of the nipple.…”