International Journal of Pediatric Otorhinolaryngology
Ankyloglossia: controversies in management☆
Introduction
The diagnosis and management of ankyloglossia has long been and continues to be a controversial topic. Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by an abnormally short lingual frenulum, which may result in a varying degree of decreased tongue tip mobility. Opinions range widely regarding the significance of this anomaly; some feel that ankyloglossia is only rarely symptomatic [1], [2], [3], while others feel that it may lead to a host of problems. Possible consequences of ankyloglossia include infant breast-feeding difficulties, speech disorders, and various mechanical and social issues such as an inability to lick the lips, play a wind instrument, and ‘french kiss’ [4], [5], [6], [7], [8], [9], [10].
The current study was conducted to determine the prevailing opinion and practice regarding ankyloglossia among four groups of medical professionals, including otolaryngologists (OTOs) pediatricians (PDs) lactation consultants (LCs) and speech pathologists (SPs). Information was sought relating to (1) incidence of ankyloglossia; (2) associated feeding, speech, and mechanical disorders; (3) recommendations for surgical intervention; and (4) surgical outcomes.
Section snippets
Materials and methods
Four groups of medical professionals were chosen to participate in the current study. These included US and Canadian members of the American Academy of Otolaryngology/Head and Neck Surgery (AAO-HNS), American Academy of Pediatrics (AAP), International Lactation Consultant Association (ILCA), and speech pathologist members of the American Speech-Language Hearing Association (ASHA). A representative sample of OTOs, PDs, LCs, and SPs from these groups was obtained in the following manner. Names of
Participants
Of the 1598 questionnaires mailed, 831 were returned from all groups combined. Thirty-four of the returned surveys were eliminated, either because the respondent indicated that he/she was not currently in practice, or because the survey was grossly incomplete, or, in the case of SPs, when the respondent indicated that children made up less than 10% of their practice. This resulted in an overall response rate of 50%. LCs had the highest response rate (203/350 or 58%), followed by PDs (235/425 or
Comment
A survey format has obvious limitations for determining the importance and effects of ankyloglossia. Sampling error and bias are risks of any survey in which not all members of a group respond, and in which practitioners are asked to recall information and offer personal opinion. Nonetheless, the present study does provide useful information regarding prevailing opinion and management practices for ankyloglossia among those providers who encounter it most frequently.
Ankyloglossia is uncommon,
Conclusion
This study highlights the controversial nature of ankyloglossia both within and between specialty groups. There is currently no consensus among otolaryngologists, pediatricians, speech pathologists, and lactation consultants regarding the significance of ankyloglossia and indications for its treatment.
References (21)
- et al.
Tongue-tie in infants and children
J. Pediatr.
(1941) Tongue-tie
Lancet
(1963)Evaluation and treatment for ankyloglossia
JAMA
(1990)- M. Ulshen, Clinical manifestations of gastrointestinal disease, in: R.E. Behrman, R.M. Kliegman, A.M. Arvin (Eds),...
- et al.
Tongue-tie
Cleft Palate J.
(1969) - et al.
Neonatal frenotomy may be necessary to correct breastfeeding problems
J. Hum. Lact.
(1990) - et al.
Lingual function and relative length of the lingual frenulum
J. Speech Hearing Res.
(1968) Tongue-tie
J. Paediatr. Child Health.
(1995)Ankyloglossia: a cause of breastfeeding problems?
J. Hum. Lact.
(1990)- et al.
Ankyloglossia with psychological implications
J. Dent. Child.
(1974)
Cited by (164)
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2021, International Journal of Pediatric OtorhinolaryngologyAnkyloglossia and Tight Maxillary Frenula
2021, Cummings Pediatric OtolaryngologyIs Public Interest Associated with Real-World Management of Ankyloglossia?
2024, Otolaryngology - Head and Neck Surgery (United States)Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis
2024, Pediatric ResearchInfluence of Shortened Tongue Frenulum on Tongue Mobility, Speech and Occlusion
2023, Journal of Clinical Medicine
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Presented at the American Academy of Pediatrics, San Franciso, CA, October 18, 1998.