[Prevalence of ankyloglossia in newborns in Asturias (Spain)]

Ankyloglossia as a Barrier to Breastfeeding: A Literature Review

This is a literature review of ankyloglossia and its correlation with lactation problems. Ankyloglossia, commonly referred to as tongue-tie, brings about functional difficulties and, in some cases, may lead to early weaning. It is crucial to use breastfeeding as the exclusive food source for the first six months of an infant's life, and the interference of the tongue contributes substantially to success in this regard. Even though there are many publications about ankyloglossia, there are still many controversies about its definition, diagnosis, classification, and treatment decision determined via frenotomy. Some researchers state that the identification of ankyloglossia should be based on morphological and anatomical evidence, while others claim that a short or tight frenulum should be examined in correlation with the impact on the mother-infant dyad during breastfeeding. By encouraging and supporting mothers in coping with feeding difficulties, their lactation experiences are improved, and they can continue breastfeeding.

Ankyloglossia in Monochorionic Diamniotic and Dichorionic Diamniotic Twins: A Cross-Sectional Study

Objective: To determine the prevalence of ankyloglossia in diamniotic monochorionic and diamniotic dichorionic twins, as well as to verify the relationship between gender and type of pregnancy. Study Design: A cross-sectional observational study, carried out with 52 pairs of dichorionic/diamniotic twins and 49 monochorionic/diamniotic pairs. The data collection was carried out through the analysis of medical records and the results of the Neonatal Screening of the Tongue Frenulum Assessment Protocol in Babies, and corresponded to the period of 2 years (2020-2022). Statistical analysis of data was performed, considering the significance value of 5%. The study was approved by the Human Research Ethics Committee of the institution. Results: The statistical analysis of multiple logistic regression between the two groups of twins (Mono/Di and Di/Di) according to the socioeconomic, demographic, and clinical-epidemiological profile was statistically significant for some variables. The prevalence of ankyloglossia, according to the type of twin pregnancy, showed a statistically significant difference. There was no statistical difference in relation to sex and ankyloglossia, or between couples diagnosed with ankyloglossia according to the type of pregnancy. Conclusion: Monochorionic/diamniotic twins had a higher prevalence of ankyloglossia, regardless of gender.

Relationship between short lingual frenulum and malocclusion. A multicentre study

OBJECTIVE

Ankyloglossia is characterized by an abnormally short lingual frenulum, which impairs tongue movement. Ankyloglossia has been related to craniofacial growth disturbances and dental malocclusion. But even though there is a clear biological plausibility for this hypothesis, available evidence is scarce.

METHODS

A case-control design was followed. Patients between 4 and 14 years old were routinely screened for short lingual frenulum and recruited from the pediatric Otolaryngology consultation of 3 Spanish tertiary referral hospitals. Lingual frenulum was assessed with the Marchesan system. A cohort of cases with short lingual frenulum and a cohort of healthy controls matched for sex and age were included. Both cases and controls had pictures of occlusion. Occlusion was evaluated by an expert in orthodontics, blinded for the frenulum assessment.

RESULTS

A total of 100 participants were included, 70 males and 30 females. The proportion of malocclusion in the short lingual frenulum group was 48%, while it was 24% in the normal frenulum group. The odds ratio of malocclusion for the short lingual frenulum patients was 2.92 (CI 95% 1.15-7.56). The difference was statistically significant (p=.012). This difference was significant for patients with class III occlusion (p=.029). There was no difference for patients with class II (p=.317).

CONCLUSIONS

This work supports the hypothesis that relates class III malocclusion with a short lingual frenulum.

Prevalence of neonatal ankyloglossia in a tertiary care hospital in Spain: a transversal cross-sectional study

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 that ankyloglossia had a higher prevalence among our newborn population than previously reported. We conducted an observational, transversal cross-sectional study which included all neonates born in our center between January 1 and December 31, 2018, and actively assessed for tongue-tie. We considered "clinically significant" or "symptomatic" ankyloglossia using the Hazelbaker tool for appearance and function when the mother experienced nipple pain or bruises, or when the neonate had difficulty latching onto the breast. A total of 1392 neonates were born at our center in 2018. Tongue-tie was identified in 645 infants (46.3%), of which 453 were symptomatic (70.2%). Thus, clinically significant ankyloglossia was present in 32.5% of the neonates born in 2018. Their distribution according to Coryllos's types were as follows: 45 type 1 (7.0%), 230 type 2 (35.6%), 321 type 3 (49.8%), and 42 type 4 (6.5%).Conclusion: The prevalence of symptomatic ankyloglossia in our population is higher (32.5%) than studies have reported to date. Actively assessing for tongue-tie increases its diagnosis. What is Known: • There are four types of tongue-tie according to Coryllos (1, 2, 3, and 4), of which the two anterior types (1 and 2) are the most apparent and easy to diagnose. • The reported prevalence of ankyloglossia generally varies from < 1 to 12.1%, although some recent studies report a higher prevalence. What is New: • We found a prevalence of neonatal ankyloglossia of 46.3%, of which 70.2% was symptomatic (clinically significant ankyloglossia was present in 32.5% of the neonates born in 2018 at our hospital). • Actively assessing for ankyloglossia and posterior tongue-ties, which are likely more often undiagnosed, increases its diagnosis.

Clinical Consensus Statement: Ankyloglossia in Children

OBJECTIVE

To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements.

METHODS

An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery.

RESULTS

After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum.

CONCLUSION

This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.

Is the Occurrence of Ankyloglossia in Newborns Associated with Breastfeeding Difficulties?

Background: Ankyloglossia is characterized by abnormal tongue movements that can possibly interfere with breastfeeding due to incorrect latching, pain, nipple fissure, and ineffective suction. Objective: To determine the prevalence of ankyloglossia in newborns and its association with exclusive breastfeeding and early breastfeeding difficulties. Materials and Methods: This is an analytical cross-sectional study conducted in seven public maternity hospitals in the city of Recife, PE, Brazil. The study sample consisted of 822 mothers/newborns of both genders. The diagnosis of ankyloglossia was confirmed by comparing two previously standardized and validated lingual frenulum assessment tools. Information on the mother's socioeconomic profile and breastfeeding difficulties were also collected. The data were analyzed using bivariate and multivariate logistic regression models. Results: The prevalence of ankyloglossia was 2.6% when using the Bristol Tool and 11.7% with the Assessment Tool for Lingual Frenulum Function (Neonatal Tongue Screening Test-NTST). The agreement between the two assessment tools was 2.2%, with a significant difference between them (p < 0.001). There was an association between the occurrence of ankyloglossia and breastfeeding difficulties (odds ratio = 1.99), but no association with exclusive breastfeeding practice was found. Conclusions: The diagnostic tools used herein revealed different prevalence rates of ankyloglossia in newborns. This condition was associated with breastfeeding difficulties, and the NTST was more effective in determining such an association.

Effect of frenotomy on breastfeeding variables in infants with ankyloglossia (tongue-tie): a prospective before and after cohort study

BACKGROUND

Controversy exists regarding ankyloglossia (tongue-tie) and its clinical impact on breastfeeding, including the benefits, or otherwise, of tongue-tie release (frenotomy). As exclusive breastfeeding rates in Ireland are already considerably low (46% on discharge home from the maternity unit following birth in 2014), it is imperative to protect and support breastfeeding, including identifying the associated effects that frenotomy might have on breastfeeding variables.

OBJECTIVE

To determine the associated effects of frenotomy on breastfeeding variables in infants with ankyloglossia.

METHODS

A prospective before and after cohort study was conducted. Following ethical approval, two self-reported questionnaires were administered to women whose infants were undergoing frenotomy at seven healthcare clinics in the Republic of Ireland. Data on breastfeeding variables prior to the frenotomy procedure and at 1-month post-frenotomy were collected and compared. Descriptive statistics (frequencies and proportions) were used to analyse, separately, the pre- and post-frenotomy data. Inferential statistics (z-test scores for differences between proportions (alpha <0.05) and mean differences (MD) with 95% confidence intervals (CI)) were used for pre- and post-frenotomy comparative analyses.

RESULTS

Ninety-eight women returned the baseline questionnaire, and, of these, 89 returned the follow-up questionnaire. The most common reason for seeking a frenotomy was difficulty with latch (38%). Private lactation consultants were the main person recommending a frenotomy (31%). Rates of exclusive breastfeeding remained similar pre- and post-frenotomy (58% versus 58%), although rates of formula feeding increased two-fold at follow-up. Infants' ability to extend their tongues to the lower lip after frenotomy was significantly increased (p < 0.0001). Almost all participants (91%) reported an overall improvement in breastfeeding post-frenotomy. Pain on breastfeeding was significantly reduced post-frenotomy (MD 2.90, 95% CI 3.75 to 2.05) and overall LATCH scale scores were significantly increased (MD -0.50, 95% CI -0.67 to -0.33).

CONCLUSIONS

This study supports the hypothesis that frenotomy has a positive effect on breastfeeding variables in infants with ankyloglossia. These findings, however, are based on a relatively small number of participants from one country only where breastfeeding rates are low. Further, larger studies are required to substantiate these findings.

Incidence and Prevalence of Tongue-Tie

What is the prevalence of tongue-tie (the proportion of total cases in a population)? Is the incidence (occurrence of new cases) increasing or are clinicians simply identifying it more often? The most reliable way to estimate incidence and prevalence is through population-based epidemiological studies. So far, these are limited. However, there has been some research that allows us to approximate rates. Our expert panel offers their judgment on two questions: What is the approximate percentage of babies with tongue-tie? And is incidence increasing?

Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy

The problems of suction in newborns give rise to multiple consequences for both the mother and the newborn. The objective of this paper is to present a case of ankyloglossia ("tongue-tie") and the suction problems that were treated by a multidisciplinary team. The subject is a 17-day-old male patient, with ankyloglossia and suction problems during breastfeeding (pain in the breastfeeding mother, poor weight gain, and long breastfeeds). The patient followed the circuit established in our centre between the services of Oral and Maxillofacial Surgery and Breastfeeding and Speech Therapy and Orofacial Rehabilitation (CELERE). The evolution following the breastfeeding sessions, the myofunctional stimulation, and the lingual frenotomy was very favourable, thereby solving the suction problems that the newborn presented. All our patients receive breastfeeding sessions and myofunctional therapy as treatment. We know that a frenotomy is not always necessary and we believe that the stimulation of sucking before and after the surgical intervention is important in order to improve the final result.

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol

Background

Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients.

Material and Methods

This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years.

Results

101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%).

Conclusions

The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain.

Key words:Ankyloglossia, tongue-tie, lingual frenum.

Prevalence of breastfeeding difficulties in newborns with a lingual frenulum: a prospective cohort series

OBJECTIVE

The prevalence of a lingual frenulum in newborn infants is reportedly 0.3-12%. The purpose of this study was to describe the prevalence of a lingual frenulum based on the Coryllos classification in nonselected newborn infants after delivery, hypothesizing that it is higher than the values reported in the literature.

STUDY DESIGN

The lingual frenula of 200 healthy infants were evaluated by visual examination and palpation within the first 3 days after delivery. The frenulum was categorized according to the four Coryllos classifications. Each infant's mother responded, immediately after the examination, to a structured questionnaire on the quality and type of feeding. An additional structured telephone interview with the 179 breastfeeding mothers was conducted 2 weeks later.

RESULTS

All but one infant (n=199) had an observable or palpable lingual frenulum that was Coryllos type 1 (n=5), type 2 or 3 (n=147), or type 4 (n=47). Although our study was not powered enough to test for any correlation between the cessation of breastfeeding and the type of frenulum, we found no statistical correlation between the Coryllos type of lingual frenulum and the presence of breastfeeding difficulties.

CONCLUSIONS

A lingual frenulum is a normal anatomical finding whose insertion point and Coryllos classification are not correlated with breastfeeding difficulties. We suggest that the term "lingual frenulum" should be used for anatomical description and that the term "tongue-tie" be reserved for a lingual frenulum associated with breastfeeding difficulties in newborns.