Treatments for Ankyloglossia and Ankyloglossia with Concomitant Lip-tie

Project Summary Title and Description

Treatments for Ankyloglossia and Ankyloglossia with Concomitant Lip-tie
Objectives. We systematically the reviewed the literature on surgical and nonsurgical treatments for infants and children with ankyloglossia and ankyloglossia and concomitant lip-tie. Data Sources. We searched MEDLINE (PubMed), PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL®) and EMBASE (Excerpta Medica Database) as well as the reference lists of included studies and recent systematic reviews. We conducted the searches between September 2013 and May 2014. Review Methods. We included studies of interventions for ankyloglossia published in English. Two investigators independently screened studies against predetermined inclusion criteria and independently rated the quality of included studies. We extracted data into evidence tables and summarized them qualitatively. Results. We included 52 unique studies comprising six RCTs (three good, one fair, two poor quality), three cohort studies (all poor quality), 28 case series, 14 case reports, and one unpublished thesis. Most studies assessed the effects of frenotomy on breastfeeding-related outcomes. Four RCTs reported improvements in breastfeeding efficacy using either maternally reported or observer ratings, while two RCTs found no improvement with observer ratings. Although mothers consistently reported improved breastfeeding effectiveness after frenotomy, outcome measures were heterogeneous and short term. Future studies could provide additional data to confirm or change the measure of effectiveness; thus we consider the strength of the evidence (SOE; confidence in the estimate of effect) to be low at this time. Pain outcomes improved for mothers of frenotomized infants compared with control in one study of 6-day old infants but not in studies of infants a few weeks older. Given these inconsistencies and the small number of comparative studies and participants, the SOE is low for an immediate reduction in nipple pain. Three studies with significant limitations reported improvements in other feeding outcomes with frenotomy, and three poor quality studies reported some improvements in articulation but mixed results related to fluent speech. Three poor quality comparative studies noted some improvements in social concerns and gains in tongue mobility in treated participants. SOE for all of these outcomes is insufficient. SOE is moderate for minor and short-term bleeding following surgery and insufficient for other harms (reoperation, pain). Conclusions. A small body of evidence suggests that frenotomy may be associated with improvements in breastfeeding as reported by mothers, and potentially in nipple pain, but with small, short-term studies, inconsistently conducted, SOE is generally low to insufficient. Research is lacking on nonsurgical interventions as well as on outcomes other than breastfeeding.
Authors of Report
Methodology description
Funding Source
Agency for Healthcare Research and Quality Contract No. 290-2012-00009-I

Key Questions

1. (Key Question 1) KQ1. What are the benefits of various treatments in breastfeeding newborns and infants with ankyloglossia intended to improve breastfeeding outcomes? Surgical treatments include frenotomy (anterior and/or posterior), frenuloplasty (transverse to vertical frenuloplasty), laser frenulectomy/frenulotomy, and Z-plasty repair. Nonsurgical treatments include complementary and alternative medicine (CAM) therapies (e.g. craniosacral therapy), lactation intervention, physical/occupational therapy, oral motor therapy, and stretching exercises/therapy.
2. (Key Question 2a) What are the benefits of various treatments in newborns, infants, and children with ankyloglossia intended to prevent, mitigate, or remedy attributable medium and longterm feeding sequelae including trouble bottle feeding, spilling and dribbling, difficulty moving food boluses in the mouth and deglutition?
3. (Key Question 2b) What are the benefits of various treatments in infants and children with ankyloglossia intended to prevent, mitigate, or remedy attributable medium and longterm other sequelae including articulation disorders, poor oral hygiene, oral and oropharyngeal dysphagia, sleep disordered breathing, orthodontic issues including malocclusion, open bite due to reverse swallowing, lingual tipping of the lower central incisors, separation of upper central incisors, crowding, narrow palatal arch, and dental caries?
4. (Key Question 3)What are the benefits of various treatments for ankyloglossia in children up to 18 years of age intended to prevent or address social concerns related to tongue mobility (i.e., speech, oral hygiene, excessive salivation, kissing, spitting while talking, and self-esteem)?
5. (Key Question 4) What are the benefits of simultaneously treating ankyloglossia and concomitant tight labial frenulum (lip-tie) in infants and children up to age 18 intended to improve or remedy breastfeeding, articulation, orthodontic and dental, and other feeding outcomes? What are the relative benefits treating only ankyloglossia when tight labial frenulum (lip-tie) is also diagnosed?
6. (Key Question 5) What are the harms of treatments for ankyloglossia or ankyloglossia with concomitant lip-tie in neonates, infants, and children up to age 18?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Audit of tongue-tie division in neonates with breastfeeding difficulties: how we do it.2011
Lingual frenotomy for breastfeeding difficulties: a prospective follow-up study.2014
Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study.2006
Review of tongue-tie release at a tertiary maternity hospital.
Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.2002
A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding.2012
A measure of success: audit of frenulotomy for infant feeding: problems associated with tongue-tie.2003
Efficacy of neonatal release of ankyloglossia: a randomized trial.
Ankyloglossia correction: Z-plasty combined with genioglossus myotomy.2011
Speech disorders encountered in routine ENT practice and the role of speech therapy in its effective management2013
Evaluation of speech intelligibility in children with tongue-tie.2011
Understanding the experiences of mothers who are breastfeeding an infant with tongue-tie: a phenomenological study.2013
Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie.2014
Early lingual frenectomy assisted by CO2 laser helps prevention and treatment of functional alterations caused by ankyloglossia.2004
Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound.2008
Frenuloplasty with a buccal mucosal graft.1994
Do tongue ties affect breastfeeding?2004
Improved ankyloglossia correction with four-flap Z-frenuloplasty.2005
Randomized, controlled trial of division of tongue-tie in infants with feeding problems.-- Not Found --
Review of tongue-tie release at a tertiary maternity hospital.2005
Defining ankyloglossia: a case series of anterior and posterior tongue ties.2010
Nipple pain at presentation predicts success of tongue-tie division for breastfeeding problems.2009
Pediatric tongue-tie division: indications, techniques and patient satisfaction.2009
Ankyloglossia: the adolescent and adult perspective.2003
Lingual frenulum: changes after frenectomy.2012
Developing a frenotomy policy at one medical center: a case study approach.1996
The effect of ankyloglossia on speech in children.2002
Division of tongue tie as an outpatient procedure. Technique, efficacy and safety.
A quick snip - A study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding.2010
The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding.
Use of carbon dioxide laser in lingual frenectomy.2011
A tongue-tie clinic and service2009
Benefits of frenulotomy in infants with ankyloglossia.2013
Ankyloglossia in breastfeeding infants: the effect of frenotomy on maternal nipple pain and latch.2006
A retrospective review of frenotomy in neonates and infants with feeding difficulties.2012
Tongue tie division in infants with breast feeding difficulties.2006
Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy.2014
Outpatient division of tongue-tie without anesthesia in infants and children.2008
Developing a Nurse-Delivered Frenulotomy Service.2014
Office frenotomy for neonates: resolving dysphagia, parental satisfaction and cost-effectiveness.2014
Overcoming tongue-tie.2014
Effectiveness of tongue-tie division for speech disorder in children.2014
Tongue-tie and breastfeeding in newborns-mothers' perspective.2014

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