Effectiveness of tongue‐tie assessment tools in diagnosing and fulfilling lingual frenectomy criteria: a systematic review

Abstract

It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose of this systematic review is to determine and evaluate any association between tongue-tie severity, as measured by pre-treatment assessment tools, and post-operative outcome following tongue-tie division. PubMed, EMBASE, and the Cochrane search engines were used to retrieve articles published between 1947 and 2021. Included studies consisted of patients with symptomatic tongue-tie, assessment by either the Coryllos, Kotlow, or Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) classification tool, and tongue-tie division. A total of 205 abstracts were identified; 31 studies met the criteria for a full-text review, of which, only 14 studies met the criteria for data extraction and analysis. Six studies used the HATLFF, 2 studies used the Kotlow, 5 studies used the Coryllos, and 1 study used a combination of both Kotlow and Coryllos methods. Significant heterogeneity was evident across all studies. No statistical correlation between the two variables could be determined. Although tongue-tie division procedures appear to provide benefits in breastfeeding and speech, there are no data to suggest a statistically significant association between the severity of tongue-tie, and the correct identification of patients who would benefit from tongue-tie division.

Ankyloglossia, Syndactyly and Polydactyly in the Pediatric Patient

“…Despite the increasing number of articles related to ankyloglossia or “tongue-tie,” it remains uncertain how effective the classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria [ 2 ]. For example, in Norway, there was an increase of seven times more diagnoses of ankyloglossia, and 13 times more lingual frenotomy surgeries, between 2008 and 2019 [ 15 ].…”

“…On the other hand, a systematic review [ 2 ] was recently conducted to identify a possible significant correlation between pre-treatment statistical scores of tongue-tie and post-treatment outcomes in breastfeeding and speech, by a group of researchers from the University of Adelaide, Australia. It was found that patients may improve their function related to breastfeeding and speech.…”

“…However, due to the lack of consensus regarding pre-treatment assessment methods, diverse outcome measures, and poor study design and methodology, precise quantification of any improvement cannot be calculated. In this article, the most used classification systems were the ATLFF [ 10 ] and Coryllos [ 11 ], nevertheless, the ATLFF protocol is the only one that can suggest surgical intervention [ 2 ]. The AAPD reinforces that surgical treatment of ankyloglossia needs to be individualized and discussed with the family and within a multidisciplinary team of health professionals [ 1 ].…”

“…In recent years, interest in the topics of lingual frenulum and ankyloglossia in the scientific community has increased, due to its impact on the motor function and development of the oral cavity. The American Academy of Pediatric Dentistry (AAPD) defines ankyloglossia as a congenital alteration in the development of the tongue characterized by the presence of a short or thick lingual frenulum, which leads to a limitation in its movements [ 1 , 2 ]. Mills et al [ 3 ] classify the lingual frenulum as a dynamic structure formed by a fold in the fascia of the oral floor, with significant morphological variability in the fixation of this same fascia in the midline.…”

“…Currently, there is an associative inconsistency between ankyloglossia and complications with breastfeeding, speech, swallowing, breathing, or the development of orofacial structures, with many published articles indicating the need for more studies of the high scientific impact of this topic [ 1 , 2 , 4 ].…”