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![Types of ankyloglossia according to Coryllos [8]. Type 1: insertion of the frenulum to the tip of the tongue. Type 2: insertion of the frenulum slightly (2 to 4 mm) behind the tip of the tongue. Type 3: thickened frenulum attached to the mid-tongue and the middle of the floor of the mouth, usually tighter and less elastic. Type 4: thick, shiny, and very inelastic submucosal frenulum that restricts movement at the base of the tongue. Types 1 and 2, considered “classical” tongue-tie, are the most common and obvious tongue-ties. Types 3 and 4 are less common, and since they are more difficult to visualize, they are the most likely to go untreated. Photographs taken by Dr. Luis Ruiz-Guzmán after obtaining written permission from the infants’ parents](profile/Silvia-Maya-Enero/publication/343677587/figure/fig1/AS:960141704839171@1605927029722/Types-of-ankyloglossia-according-to-Coryllos-8-Type-1-insertion-of-the-frenulum-to.png)
Types of ankyloglossia according to Coryllos [8]. Type 1: insertion of the frenulum to the tip of the tongue. Type 2: insertion of the frenulum slightly (2 to 4 mm) behind the tip of the tongue. Type 3: thickened frenulum attached to the mid-tongue and the middle of the floor of the mouth, usually tighter and less elastic. Type 4: thick, shiny, and very inelastic submucosal frenulum that restricts movement at the base of the tongue. Types 1 and 2, considered “classical” tongue-tie, are the most common and obvious tongue-ties. Types 3 and 4 are less common, and since they are more difficult to visualize, they are the most likely to go untreated. Photographs taken by Dr. Luis Ruiz-Guzmán after obtaining written permission from the infants’ parents
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Ankyloglossia, or tongue-tie, is a congenital anomaly in which a short lingual frenulum or a highly attached genioglossus muscle restricts tongue movement. The reported prevalence of neonatal ankyloglossia varies between less than 1 and 12.1% depending upon the study population and criteria used to define and grade ankyloglossia. Our hypothesis was...
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The objective of this study was to demonstrate that frenotomy can help improve breastfeeding, tongue movement, and the mother’s comfort, if the assessment criteria are respected and the infant’s function and age are observed. Frenotomy was performed on two babies with breastfeeding difficulties who came to CEPAE - Center for Research and Dental Car...
Many authors cite the importance of interdisciplinary treatment of the short lingual frenulum and the role of the physician as who decides on the possible need for surgery. This article aims to collect current knowledge about the lingual frenulum. Papers written in Slovene, English and Italian published until April 2021 were included. Existing clas...
Purpose
The relationship between ankyloglossia and speech is controversial. Our objective in the present study was to determine the most appropriate intervention and optimal timing for infants with speech articulation caused by ankyloglossia.
Patients and Methods
A total of 341 pediatric patients (aged 2 to 5 years) being referred for speech conce...
Introduction: Ankyloglossia is defined as a developmental anomaly of the tongue characterized by an abnormally short, thick lingual frenulum resulting in limitation of tongue movement. Ankyloglossia or tongue-tie affects speech, feeding, oral hygiene as well as social environment also. Case History: A 2 years old male patient was brought by his par...
Aim: The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy...
Citations
... Ankyloglossia or tongue-tie (TT) is a condition where a congenital shortened and/or thickened frenulum limits movement of the tongue. It is a common problem in neonates with an overall estimated incidence ranging between 4 and 16% [1][2][3][4][5]. TT has been recognized as a signi cant cause of di culty in establishing breastfeeding and causing distress to both infants and mothers [2,3]. ...
Purpose: Frenotomy is the procedure of choice for treating ankyloglossia. The literature reports that readhesion of the frenulum occurs in 2.6-13% of cases. There is no published evidence to support performing tongue exercises to prevent this readhesion. We routinely recommend that parents perform them. We aimed to determine the recurrence rate of ankyloglossia necessitating a refrenotomy and the benefits of massage in the prevention of readhesion. Methods: Prospective, observational study of neonates who underwent a frenotomy between January and August 2024. Following the frenotomy, we recommended that all parents perform a series of exercises 6-8 times daily over 15 days. We followed the patients 10-15 days afterwards and assessed for ankyloglossia using the Hazelbaker tool, comparing pre- and post-frenotomy scores. Results: We enrolled 212 patients and observed a global rate of readhesion of 33.5% (71 cases), of which 17.9% were asymptomatic. Thirty patients underwent a refrenotomy due to persistent ankyloglossia (14.1%). Only 33 dyads mother/neonate continued to have symptoms following the first frenotomy (15.6%); all of them had readhesion. Thirty-nine mothers referred nipple pain post-frenotomy (18.4%). The appearance and function Hazelbaker scores were lower pre- than post-frenotomy in all cases. Only 59% of the families performed post-frenotomy exercises on the advised frequency. Most neonates were exclusively breastfed (142/212, 66.7%), whereas 61/212 were partially breastfed (28.6%) 10-15 days post-frenotomy. Conclusion: Recurrence of ankyloglossia was higher than published (33.5%), and higher when post-operative exercises were not correctly performed (72.7%). The Hazelbaker scores were lower pre-frenotomy, regardless of the performance of such exercises.
... Ankyloglossia, commonly known as tongue-tie (TT) is characterized by a functional restriction of tongue movement from a restricted lingual frenulum (Australian Dental Association (ADA), 2000; Fernando, 1998). Prevalence rates for TT vary, ranging from 0.1% to 32.5% depending on age and diagnostic criteria (Hill, Lee & Pados;Maya-Enero et al., 2021;Suter & Bornstein, 2009). An increase in surgical interventions globally over the past two decades correlates with increased breastfeeding rates and heightened awareness of TT (Chinnadurai et al., 2015;Kapoor et al., 2018;. ...
Purpose: Speech-language pathologists (SLPs) are essential in evaluating tongue structure and function. Due to limited psychometrically validated assessment tools, evidence-based practitioners often rely on clinical expertise to inform their assessment and clinical decision-making. This study aimed to explore how SLPs assess tongue structure and function in children aged 1 to 10 years suspected of having a tongue-tie by examining global practice patterns. Methods: A total of 194 practicing, English-speaking SLPs participated in a global online survey. The survey gathered information on participant demographics, classification tools used, and methods for assessing tongue structure and function, oral motor function and speech production in children with suspected tongue-tie. Results: Participants reported using various measures, including case history, oral examination, and clinical assessment. These measures encompassed evaluation of tongue structure, oral motor tasks and functional measures, including observation of speech, feeding, and swallowing. Notably, 40% of participants indicated they did not use any published assessment tool. While over 90% of participants evaluated feeding skills through parent questionnaires, only 55% observed feeding during mealtimes. Additionally, SLPs in the United States reported using different classification tools for tongue-tie compared to their counterparts in Australia, the United Kingdom and other countries. Conclusion: There is a global trend of limited use of published tongue-tie assessment tools in clinical practice. Most clinicians rely on various measures to evaluate tongue structure and function in children with suspected tongue-tie. These findings highlight the need for a specialized assessment tool that is designed and validated for evaluating tongue structure and function in children beyond infancy.
... Currently, there is a lack of agreement about the diagnosis and treatment of ankyloglossia (tongue-tie) [4], which leads to a great difference in the condition's prevalence between countries (1% to 12.1%) [5]; however, scientific publications on this subject have been recently increasing. In Norway, for example, when comparing figures from 2008 to 2019, there were seven times more diagnoses and 13 times more surgical procedures relating to the lingual frenulum in 2019 than in 2008 [6]; meanwhile, a study in Spain found an ankyloglossia prevalence of 46.3% in neonates [5]. ...
... Currently, there is a lack of agreement about the diagnosis and treatment of ankyloglossia (tongue-tie) [4], which leads to a great difference in the condition's prevalence between countries (1% to 12.1%) [5]; however, scientific publications on this subject have been recently increasing. In Norway, for example, when comparing figures from 2008 to 2019, there were seven times more diagnoses and 13 times more surgical procedures relating to the lingual frenulum in 2019 than in 2008 [6]; meanwhile, a study in Spain found an ankyloglossia prevalence of 46.3% in neonates [5]. ...
Ankyloglossia can be related to a number of complications, such as breastfeeding difficulties or alterations in craniofacial development. Treatment can involve surgery to correct the altered lingual frenulum and can be performed by various techniques. The purpose of this paper is to present two case reports of ankyloglossia in pediatric patients of different ages, the diagnostic criteria, and the treatment decision rationale, which led to a lingual frenotomy performed with a diode laser.
... These are distinguished by how the mucosa, fascia, and/or fibers of the genioglossus muscle are present in the lingual frenulum when lingual movements occur [4]. The prevalence of ankyloglossia in newborns varies between 1% and 32.5%, depending on the population studied, its definition and classification criteria [1,5,6]. ...
Ankyloglossia is a congenital alteration in the development of the tongue characterized by the presence of a short or thick lingual frenulum, which leads to a limitation in its movements. There is an associative inconsistency between ankyloglossia and complications with breastfeeding, speech, swallowing, breathing, and the development of orofacial structures, and it is urgent to make more scientific research in this area. In the presence of polydactyly and syndactyly may be also present ankyloglossia. The purpose of this paper is to present two ankyloglossia cases with finger alterations, without a syndromic disease, and lead the medical team to research this topic and make an improved treatment plan for these cases.
... The diagnosis and treatment of ankyloglossia are still controversial [4][5][6][7]. According to the methods used for diagnosis, the incidence of ankyloglossia varies between less than 1% and 46.3% [8][9][10]. Sometimes, the diagnosis may go unnoticed, and patients encounter treatment delays and clinical problems; in other instances, the patients may receive unnecessary interventions [11]. ...
... This rate is considerably higher than the 0.3% ankyloglossia rate in the study conducted by Çetinkaya et al. in 2011 examining general oral cavity anomalies [8]. In addition, different rates are seen in various studies, ranging from less than 1% to 46.3% [8,9,15,16]. These differences are due to varying diagnostic methods and criteria. ...
... These differences are due to varying diagnostic methods and criteria. For example, in the study conducted by Maya-Enero et al., a similarly planned study to ours, the rate was 46.3% [9]. Maya-Enero et al. reported symptoms in 70.2% of patients [9]. ...
Ankyloglossia is a condition of limited tongue mobility caused by a short lingual frenulum. The diagnosis and treatment of ankyloglossia are still controversial. The main clinical problems encountered during breastfeeding are difficulty in sucking and its clinical reflections. This study aims to evaluate the infant population born with ankyloglossia and to determine the results of frenotomy. We conducted an observational, cross-sectional study among infants born in a tertiary hospital. We included all infants born between 1 January and 30 June 2022. The neonatal follow-up protocol for ankyloglossia was determined before the defined dates, and data were recorded during the screening period. The recorded data were retrospectively collected from the files. Within six months, 705 infants were born. Due to additional problems and other conditions that prevent breastfeeding, evaluable data of 207 (29.3%) infants could not be provided. Of the remaining 498 infants, 234 (33.2%) had ankyloglossia. While none of the infants without ankyloglossia had a breastfeeding problem after appropriate training, 28.6% of the ankyloglossia group had a breastfeeding problem (p < 0.001). The need for frenotomy differed significantly between Coryllos groups (p < 0.001). Breastfeeding was unsuccessful before frenotomy in 12 Coryllos type-1 patients, and all had difficulty in sucking. Frenotomy was performed within the three-month follow-up period in all patients with complaints of inability to firmly grasp the breast, nipple slipping from the mouth, and nipple biting during the first 24 h. In terms of breastfeeding problems, regardless of the anatomical typology, frenotomy can be performed safely in early life with successful results. If deficiencies or difficulties in breastfeeding are noticed in ankyloglossia patients even at the first control, frenotomy should be recommended in clinical conditions.
... 1,[28][29][30] Also lesser when compared to study reported in India 17.7%, in UK 10.7%, in US 9%, in Spain 46.3%. 15,[31][32][33] In the present study, TT prevalence was high among 0-3 months age group subjects (84%) as compared to age group 4-7 months and 8-12 months which was statistically highly significant. In the present study 4.6% cases had HB score 9 and 0.6% had less than 8 (Table 3 and 5). 2 Among all TT cases 16% mothers of infants with TT faced difficulties while nursing. ...
Background: Developmental anomalies like Epstein pearl, Bohn’s nodule, gingival cyst, mucocele, natal teeth, tongue tie (TT), lip tie manifest in the neonate. A majority of them are benign and asymptomatic commonly resolving without any intervention. Some anomalies may require surgical intervention to avoid breast-feeding difficulties. Extensive clinical examination and knowledge of various lesions are essential for accurate diagnosis, management and parental advice. Aim was to determine the prevalence of developmental anomalies among infants (0-12months) and its effects on breastfeeding.Methods: After approval of IRB (Institutional Review Board), multistage sampling was performed to include the population of Mehsana district by dividing the district into 3 zones (north, central, south). 480 Infants were included and examined in the study according to selection criteria. Infants with cleft lip palate were excluded from the study. Intraoral examination was performed and assessment of TT, lip tie was done using Hazelbacker (HB) criteria and Kotlow’s classification. Informed written consent was obtained from parents. Mothers were asked about difficulties during breastfeeding via questionnaire. The option for surgical intervention was given to the parents when indicated.Results: A total of 480 infants (male 297 and female 183) were examined. The prevalence of Epstein pearls was 39.4%, Bohn’s nodule 6.5%, mucocele 1.5%, gingival cyst 0.4%, TT 5.2%, class III and class IV lip tie 94.1%, natal teeth 0.4%. The total, 14.8% infants who had lip tie, struggled to latch on to the breast while nursing which was statistically (0.02) significant.Conclusions: The prevalence of class III and class IV lip tie (94.1%) and Epstein pearls (39.4%) was high as compared to other developmental anomalies among the infants of Mehsana district.
... The diagnosis and treatment of ankyloglossia are still controversial [4][5][6][7]. According to the methods used for diagnosis, the incidence of ankyloglossia varies between less than 1% and 46.3% [8][9][10]. Sometimes, the diagnosis may get unnoticed, and patients encounter treatment delays and clinical problems; and in other instances, the patients may receive unnecessary interventions [11]. ...
... This rate is considerably higher than the 0.3% ankyloglossia rate in the study conducted by Çetinkaya et al. in 2011 examining general oral cavity anomalies [8]. In addition, different rates are seen in various studies, ranging from less than 1% to 46.3% [8,9,14,15]. These differences are due to varying diagnostic methods and criteria. ...
... These differences are due to varying diagnostic methods and criteria. For example, in the study of Maya-Enero et al., a similarly planned research to ours, the rate was 46.3% [9]. Maya-Enero et al. reported symptoms in 70.2% of patients [9]. ...
Ankyloglossia is a condition of limited tongue mobility caused by a short lingual frenulum. The diagnosis and treatment of ankyloglossia are still controversial. The main clinical problem encountered during breastfeeding is difficulty in sucking and its clinical reflections. This study aims to evaluate the newborn population born regarding ankyloglossia and to determine the results of frenotomy. We conducted an observational, cross-sectional study among newborns born in a tertiary hospital. We included all newborns born between January 1 and June 30, 2022. The study algorithm was determined before the defined dates and data were recorded during the screening period. The recorded data were retrospectively collected from the files. Within six months, 705 babies were born. Due to additional problems and other conditions that prevent breastfeeding, evaluable data of 207 (29.3%) infants could not be provided. Of the remaining 498 infants, 234 (33.2%) had ankyloglossia. Breastfeeding was unsuccessful before frenotomy in 12 Coryllos type-1 patients, and all had difficulty in sucking. Frenotomy was performed within the three-months follow-up period in all patients with complaints of inability to firmly grasp the breast, nipple slipping from the mouth, and nipple biting during the first 24 hours. In terms of breastfeeding problems, regardless of the anatomical typology, frenotomy can be performed safely in the early life with successful results. If deficiencies or difficulties in nursing is noticed in ankyloglossia patients even at the first control, frenotomy should be recommended in clinical conditions.
... However, these measures are not enough during frenotomies because they are performed in the mouth and neonates cannot suck during the procedure. We have a high prevalence of neonatal ankyloglossia (32.5%) in our center, for which frenotomy is a common treatment [18]. In a former clinical trial (NCT04877392), we compared the use of common pain control strategies (swaddling, administration of oral sucrose, and suck for 2 min prior to the procedure) with the use of those plus inhaled LEO and observed that signs of pain (duration of crying and NIPS score) were lower in the experimental group. ...
... This study was conducted at the neonatal unit of a tertiary care hospital in Barcelona, Spain, which experiences approximately 1400 births per year from a multiethnic population with Spanish, Pakistani, and Bangladeshi being the most frequent nationalities of our patients [30]. We have high breastfeeding rates: around 85% at discharge from the maternity ward (86.8% in 2018) [18], 82% at the age of 3 months, and 54% at 6 months. We assess for the presence of ankyloglossia as part of the routine neonatal evaluation and classify it based on Coryllos's criteria [31] and the Hazelbaker tool [32]. ...
... We considered a tongue-tie to be symptomatic if it scored 8 points or less in appearance and/or 11 points or less in function according to Hazelbaker and the mother experienced nipple pain or bruises, or if the neonate had problems latching onto the breast after a neonatal nurse assessed feeding and corrected other reasons for maternal pain such as retrognathia, micrognathia, incorrect positioning, insufficient mouth opening, and latching onto the nipple only. We chose type 3 tongue-ties because they are the most common in our population [18] and, due to their anatomical features (thick and submucosal), they seem to make breastfeeding more difficult. Neonates were enrolled if their parents agreed to and signed a written informed consent prior to the procedure, and then they were allocated into the experimental or the control group by simple random sampling using the program OxMAR (Online Minimization and Randomization for Clinical Trials) [33]. ...
It is necessary to treat neonatal pain because it may have short- and long-term adverse effects. Frenotomy is a painful procedure where sucking, a common strategy to relieve pain, cannot be used because the technique is performed on the tongue. In a previous randomized clinical trial, we demonstrated that inhaled lavender essential oil (LEO) reduced the signs of pain during neonatal frenotomy. We aimed to find out whether inhaled vanilla essential oil (VEO) is more effective in reducing pain during frenotomy than LEO. Randomized clinical trial with neonates who underwent a frenotomy for type 3 tongue-ties between May and October 2021. Pain was assessed using pre and post-procedure heart rate (HR) and oxygen saturation (SatO2), crying time, and NIPS score. Neonates were randomized into “experimental” and “control” group. In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for 2 min. We placed a gauze pad with one drop of LEO (control group) or of VEO (experimental group) under the neonate’s nose for 2 min prior to and during the frenotomy. We enrolled 142 neonates (71 per group). Both groups showed similar NIPS scores (2.02 vs 2.38) and crying times (15.3 vs 18.7 s). We observed no differences in HR increase or in SatO2 decrease between both groups. We observed no side effects in either of the groups.
Conclusions: We observed no appreciable difference between LEO and VEO; therefore, we cannot conclude which of them was more effective in treating pain in neonates who underwent a frenotomy.
Trial registration: This clinical trial is registered with www.clinicaltrials.gov with NCT04867824. What is Known:
• Pain management is one of the most important goals of neonatal care as it can have long-term neurodevelopmental effects.
• Lavender essential oil can help relieve pain due to its sedative, antispasmodic, and anticolic properties.
What is New:
• Lavender and vanilla essential oils are safe, beneficial, easy to use, and cheap in relieving pain in neonates who undergo a frenotomy for type 3 tongue-ties.
... However, these measures are not sufficient during frenotomies because the procedure is performed in the mouth and patients cannot suck during the procedure. We have observed a high prevalence of ankyloglossia (32.5%) among our neonates, for which frenotomy is a common treatment [16]. The aim of this study was to demonstrate that inhaled LEO is effective in reducing pain during frenotomy. ...
... The hospital experiences approximately 1400 births per year. We treat a multiethnic population at our hospital (with Spain, Pakistan and Bangladesh being the most frequent nationalities among our patients) [18], and we have breastfeeding rates at discharge from the maternity ward of about 85% (86.8% in 2018) [16] and of about 82% at the age of 3 months and of about 54% at the age of six months. ...
... The target population for this study, and thus, inclusion criteria, were healthy full-term neonates born at Hospital del Mar (Barcelona, Spain) during their stay at the maternity ward, or less than 15 days old, who underwent a frenotomy for ankyloglossia due to a type 3 tongue-tie according to Coryllos classification [19] (supplemental Fig. 1) during the study period (August 2020 to April 2021). We chose type 3 tongue-ties because they are the most common in our population [16]; and type 3 tongue-tie characterized anatomical features (thick and submucosal) seem to make breastfeeding more difficult. We excluded patients who were isolated in their hospital room due to an active maternal COVID-19 infection because those frenotomies were performed in their room instead of at the neonatal unit. ...
Background:
Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates.
Methods:
We conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the "experimental group" and "control group". In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate's nose for two minutes prior to and during the frenotomy.
Results:
We enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups.
Conclusions:
We observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies.
... 18,10 Different diagnostic methods are used to evaluate breastfeeding difficulties, which may explain the controversy regarding the treatment of ankyloglossia. 10 The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) can be used for the objective determination of the degree of ankyloglossia, but is based on subjective clinical assessments and does not address issues related to breastfeeding difficulties. 16,19 Moreover, although the HATLFF tool is validated, there are concerns regarding its reliability. 20 The Bristol Tongue Assessment Tool (BTAT) provides an objective, simple assessment of the severity of tongue attachment. ...
Background and aim:
Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties reported by mothers; assess possible factors that may interfere with breastfeeding.
Methods:
A cross-sectional study was conducted with 391 pairs of mothers/newborns at a university hospital. A pediatric dentist examined the oral cavity of the newborns for the occurrence of ankyloglossia. We analyzed medical records and the mothers answered a self-administered questionnaire to assess birth variables, breastfeeding difficulties, and sociodemographic factors. We calculated prevalence ratios (PRs) of breastfeeding difficulties according to the independent variables.
Results:
The mean age of the newborns was 2.5±2.9 days and 52% were male. The prevalence of ankyloglossia was 15% and 91.4% of mothers reported not having breastfeeding difficulties. Ankyloglossia was not associated with breastfeeding difficulties (PR: 0.5; 95% CI: 0.2-1.4). Mothers with a low income (PR: 0.5; 95% CI: 0.3-0.8), those who received instructions on breastfeeding (PR: 0.4; 95% CI: 0.2-0.9), and those who breastfed exclusively (PR: 0.3; 95% CI: 0.1-0.8) had fewer breastfeeding difficulties.
Conclusion:
Successful breastfeeding was more dependent on being born at full term, the family income, receiving guidance with regard to breastfeeding, and exclusive breastfeeding. Although ankyloglossia was not associated with breastfeeding, future prospective studies should evaluate the long-term factors that may interfere with breastfeeding.
Relevance for patients:
This study brings a new perspective on the importance of assessing ankyloglossia and breastfeeding difficulties, reinforces the benefits of exclusive breastfeeding and the need for breastfeeding instructions, as well as the need to evaluate breastfeeding before making a decision regarding frenectomy.
