Oral cavity morphology among children at risk of sleep disordered breathing

Systematic Review of Tongue Tie Publications: Exponential Rise in Publications Without Exponential Increase in Evidence

OBJECTIVE

Ankyloglossia and lingual frenotomy in young children and infants remains an area of debate, with a body of research with poor quality-but increasing number-of studies, a trend that has continued into the present day. To systematically review the published literature to identify the number, type, and quality of studies on the evaluation, diagnosis, and treatment of ankyloglossia.

DATA SOURCES

In this Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review, a literature search of PubMed, Embase, and Ovid MEDLINE was conducted in 2024 using keywords related to ankyloglossia and frenotomy.

REVIEW METHODS

Studies from 2017 to 2024 were assessed by two independent reviewers. Articles were included if they focused on ankyloglossia in children and in the English language.

RESULTS

Overall, 462 articles were included for full-text extraction, of which cohort studies were the most common (179, 38.7%), and randomized controlled trials (RCTs; 13, 2.8%) were among the least common. Studies on different frenotomy techniques were common, despite no evidence suggesting that no intervention may be superior. There was an overall lack of study endpoints with objective measures such as breastfeeding duration or infant growth rates postprocedure. Despite the presence of several classification systems for ankyloglossia, none of those described in the literature focuses primarily on function as opposed to appearance or other factors.

CONCLUSION

This systematic review provides an update demonstrating the continued exponential rise of publications focused on ankyloglossia and lingual frenotomy without a rise in evidence clarifying the controversies surrounding these important topics. Future studies in this area should be quality RCTs with meaningful outcome measures.

Does Ankyloglossia Surgery Promote Normal Facial Development? A Systematic Review

Background: Ankyloglossia is a congenital, abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility, which may impair the development of the lower face morphology, namely the occlusion and skeleton. Objective: The aim of this study was to evaluate whether and how the lingual frenotomy benefits the occlusion and lower face skeleton development. Search methods and selection criteria: The authors, independently and in duplication, performed searches of PubMed, Cochrane Library, Medline, Web of Science, and Embase, introducing the following keywords: tongue tie, ankyloglossia, and short lingual frenum/frenulum, combined with malocclusion, lower face skeleton, and hyoid bone. Data collection and analysis: Relevant articles were assessed for quality according to the Cochrane guidelines and the data extracted for further analysis of the risk of bias and the evidence strength. Results: Seven articles including 1349 patients with ankyloglossia and 90 in the control group underwent the detailed analysis. The quality of the included studies was assessed as low. The strongest evidence of studies reporting the relationship of ankyloglossia with lower face abnormalities concerns the reduction in the intercanine and intermolar widths in either the maxilla or the mandible, as well as Class III occurrence. Limitations: The drawbacks of the analysed papers are mainly composition and number of participants. There is also a lack of good-quality prospective studies, particularly randomised clinical trials, in the literature. Conclusions: Although the lack of high-quality studies dictates that we must treat our results cautiously, the gathered evidence conditionally allow us to state the following: 1. ankyloglossia may be one of the factors contributing to maxillary constriction, Class III malocclusion, and mandibular incisor crowding; 2. the patient's age is relevant when it comes to frenotomy timing. Possible indications for the procedure depend on the patient's malocclusion.

Relationship of ankyloglossia and obstructive sleep apnea: systematic review and meta-analysis

PURPOSE

Recent studies have highlighted the potential role of a short lingual frenulum as a risk factor for pediatric obstructive sleep apnea syndrome. A shortened frenulum may contribute to abnormal orofacial development, leading to increased upper airway resistance and susceptibility to upper airway collapsibility during sleep. Recognizing early indicators, such as a short lingual frenulum, is crucial for prompt intervention. This systematic review aims to evaluate the association between a short lingual frenulum and the risk of obstructive sleep apnea syndrome in children.

METHODS

This systematic review adheres to PRISMA criteria for a quantitative analysis. A comprehensive search was conducted on five databases until January 2024 to identify relevant studies. The selected articles underwent rigorous analysis, considering study design, sample characteristics, lingual frenulum characterization, sleep assessment methods, and key findings.

RESULTS

A total of 239 references were initially identified. Finally, six studies were included in the qualitative synthesis, with four studies eligible for the quantitative synthesis. The Newcastle-Ottawa scale was employed to assess study quality. Meta-analysis, supported by a moderate evidence profile according to the GRADE scale, revealed statistically significant differences, with odds ratios of 3.051 (confidence interval: 1.939 to 4.801) for a short frenulum and 12.304 (confidence interval: 6.141 to 24.653) for a high-arched palate.

CONCLUSION

This systematic review and meta-analysis provide evidence supporting the association between ankyloglossia and obstructive sleep apnea in children. Nevertheless, it is crucial to consider additional factors such as tongue mobility and the presence of a high-arched palate in further evaluations.