Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review

Abstract

Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.

The effect of ankyloglossia and tongue‐tie division on speech articulation: A systematic review

“…We found no strong evidence to support that ankyloglossia caused speech problems. Khan's article 7 in 2020, which included six studies, 4,5,17,22,23,33 among which one was excluded from our review due to the absence of speech‐related outcomes, 33 reviewed the divergence of language improvement effects among three different tongue‐tie division surgical techniques (conventional, laser, and Z‐plasty frenotomies). The results from this study pointed out the lack of unified standard measuring methods for postoperative speech changes and reported that Z‐plasty frenotomy had the benefit of preventing scar contracture.…”

“…Regardless of the indications, frenotomy is the primary surgical treatment option, which can be further classified into simple release (frenotomy, frenulotomy, or frenectomy) and suturing‐followed surgery (frenuloplasty) 7 . According to the surgical instruments, tongue‐tie division can be accomplished by conventional and laser surgical tools.…”

“…Chinnadurai et al 12 conducted a systematic review in 2015 and reported insufficient and low‐quality evidence with a high risk of bias, including differences in outcome measurements that prevent definitive conclusions to be drawn on the effect of surgical interventions on speech improvement in ankyloglossia patients. In a review article in 2020, Khan et al explained that the controversial conclusions on articulation that were drawn across the different studies were due to heterogeneity in the outcome measurements and the lack of appropriate statistical comparisons 7 . Additionally, Daggumati et al 13 pointed out the lack of accepted guidelines on the management of ankyloglossia as an additional possible factor contributing to this controversy.…”

Guidelines of management regarding frenula in pedodontic patients

“…Based on studies, laser surgery technique has been shown to be superior to classical surgical intervention in terms of reduced discomfort while speaking and chewing, shorter procedure time, better bleeding control, less intra-and postoperative pain (3,24,25). The choice of laser technique eliminates the need for suture removal and is associated with increased acceptance among patients (26).…”

“…Warto również zauważyć, że pozytywny efekt na gojenie się rany pooperacyjnej miało wstrzyknięcie kwasu hialuronowego po zabiegu (23). Na podstawie przeprowadzonych badań wykazano przewagę techniki chirurgii laserowej w stosunku do klasycznej interwencji chirurgicznej w zakresie zmniejszonego dyskomfortu podczas mówienia i żucia, krótszego czasu zabiegu, lepszej kontroli krwawienia, mniejszego bólu śród-i pooperacyjnego (3,24,25). Wybór techniki laserowej eliminuje potrzebę usuwania szwów, a także wiąże się ze wzrostem akceptacji wśród pacjentów (26).…”