Assessment and Classification of Tongue-Tie

Baeza, Carmela; Genna, Catherine Watson; Murphy, James; Hazelbaker, Alison K.; Kaplan, Martin M.; Martinelli, Roberta Lopes de Castro; Marchesan, Irene Queiroz; Douglas, Pamela S.; Smillie, Christina

doi:10.1891/2158-0782.8.3.93

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…The effects of surgery could be seen by the fact that the post-frenotomy motility has a much clearer dominant frequency (Figures 4c,g and 5c,g) and the movement of the tongue post-surgery had a smooth periodicity along most of the tongue (Figures 4d,h and 5d,h). Currently, the severity of such pathologies (i.e., tongue-tie and lip-tie) are determined via assessments derived from observational criteria (Baeza et al, 2017;Ghaheri et al, 2017;Martinelli et al, 2012) and there is great controversy over when frenotomy is necessary (O'Shea et al, 2017;Power & Murphy, 2015). Therefore, an objective analysis of tongue-motility, such as the method applied here, may be a useful addition to the diagnostic and follow-up toolbox.…”

Section: Discussionmentioning

confidence: 99%

“…While milk flow during breastfeeding depends on milk production in the breast and infant demand imposed by suckling, the man‐made bottle‐nipple system allows for continuous milk flow with minimal tongue and mandibular motions (Matsubara & Inoue, 2019). Increased and uncontrolled milk delivery during bottle‐feeding results in more frequent breathing interruptions (Taki et al, 2010) which leads to episodes of oxygen desaturation (Baeza et al, 2017; Chen et al, 2000; Hammerman & Kaplan, 1995).…”

Section: Introductionmentioning

confidence: 99%

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Quantitative imaging of tongue kinematics during infant feeding and adult swallowing reveals highly conserved patterns

Genna¹,

Saperstein

Siegel

et al. 2021

Physiol Rep

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Tongue motility is an essential physiological component of human feeding from infancy through adulthood. At present, it is a challenge to distinguish among the many pathologies of swallowing due to the absence of quantitative tools. We objectively quantified tongue kinematics from ultrasound imaging during infant and adult feeding. The functional advantage of this method is presented in several subjects with swallowing difficulties. We demonstrated for the first time the differences in tongue kinematics during breast‐ and bottle‐feeding, showing the arrhythmic sucking pattern during bottle‐feeding as compared with breastfeeding in the same infant with torticollis. The method clearly displayed the improvement of tongue motility after frenotomy in infants with either tongue‐tie or restrictive labial frenulum. The analysis also revealed the absence of posterior tongue peristalsis required for safe swallowing in an infant with dysphagia. We also analyzed for the first time the tongue kinematics in an adult during water bolus swallowing demonstrating tongue peristaltic‐like movements in both anterior and posterior segments. First, the anterior segment undulates to close off the oral cavity and the posterior segment held the bolus, and then, the posterior tongue propelled the bolus to the pharynx. The present methodology of quantitative imaging revealed highly conserved patterns of tongue kinematics that can differentiate between swallowing pathologies and evaluate treatment interventions. The method is novel and objective and has the potential to advance knowledge about the normal swallowing and management of feeding disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative imaging of tongue kinematics during infant feeding and adult swallowing reveals highly conserved patterns

Genna¹,

Saperstein

Siegel

et al. 2021

Physiol Rep

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“…There are several TT assessment tools that can be used in conjunction with a structured breastfeeding assessment to determine the need for frenotomy, though none are universally accepted in practice. The HATLFF has been recommended by the Academy of Breastfeeding Medicine; 15,30,31 however, the length and complexity of the tool make it challenging to apply across all practice environments 16,17 . In our health region, a decision was made to develop a new tool—the Frenotomy Assessment Tool, which was informed by the Frenotomy Decision Tool for Breastfeeding Dyads 2,18 .…”

Section: Discussionmentioning

confidence: 99%

“…One such tool that has undergone validity and reliability testing is the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF); 14,15 however, this tool is not without limitations. It has been argued that the length and complexity of the HATLFF make it challenging to use in clinical practice 16,17 . A newer tool, the Frenotomy Decision Tool for Breastfeeding Dyads, contains fewer items and involves an evaluation of both mother and baby during a breastfeeding session 2,18 .…”

Section: Introductionmentioning

confidence: 99%

A cross‐sectional study of breastfed infants referred for tongue tie assessment and frenotomy in one Canadian health region

Lee,

Bishop,

Drover

et al. 2024

Pediatric Investigation

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ImportanceTongue tie (TT) is a condition that can cause infant feeding difficulties due to restricted tongue movement. When TT presents as a significant barrier to breastfeeding, a frenotomy may be recommended. Universally accepted diagnostic criteria for TT are lacking and wide prevalence estimates are reported. New referral processes and a Frenotomy Assessment Tool were implemented in one Canadian health region to connect breastfeeding dyads with a provider for TT evaluation and frenotomy.ObjectiveTo determine the proportion of babies with TT as well as the frequency of frenotomy.MethodsThis cross‐sectional study included infants who initiated breastfeeding at birth and were referred for TT evaluation over a 14‐month period. Data were collected retrospectively by chart review and analyzed using SPSS. Factors associated with frenotomy were examined using logistic regression.ResultsTwo hundred and forty‐one babies were referred. Ninety‐two percent (n = 222) were diagnosed with TT and 66.0% (n = 159) underwent frenotomy. In the multivariate model, nipple pain/trauma, inability to latch, inability to elevate tongue, and dimpling of tongue on extension were associated with frenotomy (P < 0.05). Most referrals in our region resulted in a diagnosis of TT; however, the number of referrals was lower than expected, and of these two‐thirds underwent frenotomy.InterpretationTT is a relatively common finding among breastfed infants. Future research should examine whether a simplified assessment tool containing the four items associated with frenotomy in our multivariate model can identify breastfed infants with TT who require frenotomy.

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“…When the tongue is relaxed, the frenulum lies on the floor of the mouth, and when the tongue is elevated, the frenulum lifts with it ( 8 ). The general consensus is that tongue tie is “an embryological remnant of connective tissue underneath the tongue that failed to recede by apoptosis and that adversely impacts tongue function” ( 9 ).…”

Section: What Is Tongue Tie?mentioning

confidence: 99%

What is tongue-tie and does it interfere with breast-feeding? – a brief review

Borowitz

2023

Front. Pediatr.

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The most common symptom attributed to ankyloglossia is difficulty breast feeding due to poor latch, inefficient milk extraction and/or maternal nipple pain. During the past two decades, despite a declining birth rate, there has been a dramatic increase in the number of infants diagnosed with and treated for ankyloglossia in the United States, Canada and Australia. Despite a dramatic increase in the diagnosis and treatment of ankyloglossia in these countries, there remains no universally agreed upon definition of ankyloglossia and none of the published scoring systems have been rigorously validated. However ankyloglossia is defined, the majority of infants with ankyloglossia are asymptomatic. Perhaps, infants with ankyloglossia have a greater incidence of difficulty breast feeding. Lingual frenulotomy may decrease maternal pain and at least transiently improve the quality of breast feeding in some infants however no published studies take into account the fact that sucking and feeding are soothing to infants and the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself. While there are almost certainly some infants in whom tongue-tie interferes with breast-feeding, there is currently no good evidence lingual frenulotomy leads to longer duration of breast-feeding. Frenulotomy appears to be a generally safe procedure however there are reports of serious complications. Finally, there are no studies of long-term outcomes following frenulotomy during infancy and given traditional thinking that the lingual frenulum is a cord of connective tissue tethering the tongue to the floor of the mouth may be incorrect and the frenulum contains motor and sensory branches of the lingual nerve, the procedure may be less benign than previously thought.

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Assessment and Classification of Tongue-Tie

Cited by 7 publications

References 9 publications

Quantitative imaging of tongue kinematics during infant feeding and adult swallowing reveals highly conserved patterns

Quantitative imaging of tongue kinematics during infant feeding and adult swallowing reveals highly conserved patterns

A cross‐sectional study of breastfed infants referred for tongue tie assessment and frenotomy in one Canadian health region

What is tongue-tie and does it interfere with breast-feeding? – a brief review

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