Familial ankyloglossia (tongue-tie)

Relationship of ankyloglossia and obstructive sleep apnea: systematic review and meta-analysis

PURPOSE

Recent studies have highlighted the potential role of a short lingual frenulum as a risk factor for pediatric obstructive sleep apnea syndrome. A shortened frenulum may contribute to abnormal orofacial development, leading to increased upper airway resistance and susceptibility to upper airway collapsibility during sleep. Recognizing early indicators, such as a short lingual frenulum, is crucial for prompt intervention. This systematic review aims to evaluate the association between a short lingual frenulum and the risk of obstructive sleep apnea syndrome in children.

METHODS

This systematic review adheres to PRISMA criteria for a quantitative analysis. A comprehensive search was conducted on five databases until January 2024 to identify relevant studies. The selected articles underwent rigorous analysis, considering study design, sample characteristics, lingual frenulum characterization, sleep assessment methods, and key findings.

RESULTS

A total of 239 references were initially identified. Finally, six studies were included in the qualitative synthesis, with four studies eligible for the quantitative synthesis. The Newcastle-Ottawa scale was employed to assess study quality. Meta-analysis, supported by a moderate evidence profile according to the GRADE scale, revealed statistically significant differences, with odds ratios of 3.051 (confidence interval: 1.939 to 4.801) for a short frenulum and 12.304 (confidence interval: 6.141 to 24.653) for a high-arched palate.

CONCLUSION

This systematic review and meta-analysis provide evidence supporting the association between ankyloglossia and obstructive sleep apnea in children. Nevertheless, it is crucial to consider additional factors such as tongue mobility and the presence of a high-arched palate in further evaluations.

Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? Case Report and Systematic Review

Ankyloglossia (tongue-tie) is a condition of the oral cavity in which an abnormally short lingual frenulum affects the tongue's mobility. Literature on the correlation between ankyloglossia and obstructive sleep apnea (OSA) is scarce. The main objective of this study was to report our preliminary experience in adult OSA patients before and after ankyloglossia treatment, using drug-induced sleep endoscopy (DISE) to evaluate the upper airway modifications resulting after treatment, and to present a systematic review of the impact of ankyloglossia and its treatment on OSA adults. We found that, after frenotomy, regarding the DISE findings, and according to the VOTE classification, two of the three patients showed an improvement in tongue level, from 2A-P (complete anteroposterior collapse) to 1ap (partial anteroposterior collapse). The third patient showed no changes in his UA after frenotomy, neither worsening nor showing improvement. Thus, the results of this study suggest that frenotomy in OSA patients with ankyloglossia could reduce tongue collapse, probably by allowing the tongue to take into the physiological position in the oral cavity. These patients should undergo speech therapy and oropharyngeal exercises prior to any surgical procedure, in order to avoid glossoptosis and to improve the quality of life and sleep apnea results.

Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review

Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.

Binder's phenotype with ankyloglossia: Report of a rare inherited association in an Indian female

Binder's syndrome, a rare congenital malformation of nasomaxillary complex, first described in 1962, has a hexad of characteristic clinical and radiographic features consisting of arhinoid face, intermaxillary hypoplasia with malocclusion, abnormal position of nasal bones, atrophy of nasal mucosa, reduced or absent anterior nasal spine and hypoplastic/absent frontal sinus. The typical facies due to mid-face hypoplasia may also be accompanied by other midline malformations such as cleft palate, spinal, skeletal and cardiac abnormalities. It is usually sporadic, of unknown etiology although various environmental and genetic mechanisms are implicated due to few familial cases predominantly in the Swedish population. A case of inherited Binder's syndrome is presented in an Indian female patient with an unusual finding of ankyloglossia (AG). The development of the anterior nasal spine and AG are chronologically related as they both occur during the 5^th–6^th weeks of gestation. The possible etiopathogenetic mechanisms for this rare association are reviewed.

Is ankyloglossia associated with obstructive sleep apnea?

OBJECTIVES

To investigate the evidence on the association between ankyloglossia and obstructive sleep apnea.

METHODS

An integrative literature review was carried out in the databases. Observational and interventional studies that assessed the lingual frenulum in children with sleep-disordered breathing were included. As exclusion criteria: studies in animals, in vitro, letters to the editor, expert opinions, other reviews. The selected articles were analyzed regarding the study design, sample, characterization of the lingual frenulum and sleep assessment, in addition to the main results and conclusions.

RESULTS

Ninety-seven articles were identified, but only 4 met the inclusion criteria. Two retrospective studies concluded that the untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea. A prospective study concluded that there was an improvement in speech and deglutition after lingual frenectomy, in addition to improved sleep. A retrospective cohort concluded that lingual frenuloplasty combined with myofunctional therapy is effective in the treatment of snoring and mouth breathing.

CONCLUSION

The studies included in this review contribute to corroborate the association between ankyloglossia and obstructive sleep apnea.

Lingual frenotomy in neonates: past, present, and future

During the last decade, increasing awareness of breastfeeding and its health benefits has not been reflected in the provision of lingual frenotomy in neonates with tongue-tie. This could be because of inconsistencies in our understanding of the importance and treatment of ankyloglossia. In this review, we discuss the current clinical guidance on diagnosis and management, and the future of such a service in the early postpartum period.

Congenital absence of lingual frenum in a non-syndromic patient: a case report

Background

The lingual frenum is a fold of mucous membrane connecting the ventral tongue to the floor of the mouth. In general, lingual frenum serves multiple roles; its main function is to support the tongue and aid in limiting its movement in different directions. Any anatomical or functional deficiency of lingual frenum may have an impact on tongue functions based on its severity. Historically, the absence of lingual frenum was linked to multiple genetic and developmental conditions such as infantile hypertrophic pyloric stenosis, non-syndromic ankyloglossia diseases, and Ehlers–Danlos syndromes and was never reported in otherwise healthy individuals.

Case presentation

We report the absence of lingual frenum in an otherwise healthy 21-year-old Middle Eastern woman diagnosed during a routine dental examination.

Conclusion

To the best of our knowledge, this is the first case to be reported in the literature with similar clinical presentation. Even without a significant impact on tongue movement or speech, it is important for health practitioners to be aware of such conditions and evaluation steps for diagnosis and management.

A frequent phenotype for paediatric sleep apnoea: short lingual frenulum

A short lingual frenulum has been associated with difficulties in sucking, swallowing and speech. The oral dysfunction induced by a short lingual frenulum can lead to oral-facial dysmorphosis, which decreases the size of upper airway support. Such progressive change increases the risk of upper airway collapsibility during sleep.

Clinical investigation of the oral cavity was conducted as a part of a clinical evaluation of children suspected of having sleep disordered breathing (SDB) based on complaints, symptoms and signs. Systematic polysomnographic evaluation followed the clinical examination. A retrospective analysis of 150 successively seen children suspected of having SDB was performed, in addition to a comparison of the findings between children with and without short lingual frenula.

Among the children, two groups of obstructive sleep apnoea syndrome (OSAS) were found: 1) absence of adenotonsils enlargement and short frenula (n=63); and 2) normal frenula and enlarged adenotonsils (n=87). Children in the first group had significantly more abnormal oral anatomy findings, and a positive family of short frenulum and SDB was documented in at least one direct family member in 60 cases.

A short lingual frenulum left untreated at birth is associated with OSAS at later age, and a systematic screening for the syndrome should be conducted when this anatomical abnormality is recognised.

A short lingual frenulum left untreated at birth is associated with obstructive sleep apnoea syndrome at a later agehttp://ow.ly/6kMQ30163nG

Ankyloglossia among children of regular and special schools in karnataka, India: a prevalence study

BACKGROUND

Tongue-tie (more formally known as ankyloglossia) is a congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict the mobility of the tongue tip impairing its ability to fulfil its functions. Ankyloglossia is uncommon, but not rare. Incidence figures reported in the literature vary widely, ranging from 0.02% to 4.8%. Incidences of upto 10.7% have been reported. Since the literature provides no uniformity of information with regard to the incidence of tongue tie. The aim of this study was to evaluate the occurrence of tonguetie in general population and mentally challenged population, measure the grades of tongue-tie and also to determine the relations of gender with tongue-tie.

MATERIALS AND METHODS

Seven hundred school children in the age group of 9-17 years were examined for the presence of tongue-tie, 350 from regular schools and 350 from special schools. The presence of tongue-tie was evaluated, measured and graded into grades 1 to 5 according to KOTLOW's method and data subjected to statistical analysis.

RESULTS

Significantly higher incidence of 16.4% population having tongue-tie was identified, of which 18.57% were from general schools and 13.71% from special schools but the differences were not statistically significant. Males showed greater incidence than females and grades I, II, III were more predominantly seen than grade IV, but the differences were not significant statistically.

CONCLUSION

Diagnostic criteria and definitive classifying systems are needed to allow for further comparative studies.

Ankyloglossia and tongue mobility

AIM

Ankyloglossia or tongue-tie is a congenital condition of newborns when the inferior lingual fraenulum is too short and is attached to the tip of the tongue limiting its movement. The aim of this study was to evaluate the relationship between ankyloglossia classification and tongue mobility. In addition, the prevalence of ankyloglossia among males and females was assessed.

METHODS

300 subjects (150 boys and 150 girls) with an age range of 7-12 years were randomly selected from different schools. The distance between the uppermost point of lingual fraenulum and its insertion into the oral floor was measured in the subjects. The subjects were categorised from having no ankyloglossia to severe tongue-tie based on the measurements.

RESULTS AND CONCLUSION

This study showed that ankyloglossia was more common in males. It also showed that only subjects with a lingual fraenulum of <1.5 cm suffered from inadequate tongue movement.

Benefits of frenulotomy in infants with ankyloglossia

OBJECTIVES

Ankyloglossia is a common, congenital abnormality often causing feeding difficulties in infants. This study aimed to evaluate indications and outcomes of frenulotomy performed in infants with ankyloglossia for breast-feeding difficulties.

METHODS

85 patients were prospectively identified as they underwent frenulotomy in Pinderfields Hospital ENT outpatient department between February 2008 and February 2011. 52 patients were successfully followed up with a telephone questionnaire about effects on breast-feeding and any complications.

RESULTS

All mothers had experienced problems breast-feeding prior to frenulotomy. Following frenulotomy 40/52 (77%) of mothers reported an improvement in breast-feeding within 2 weeks of the procedure. No complications were reported.

CONCLUSION

This study supports the view that ankyloglossia is a common cause of breast-feeding difficulties. However the lack of universal improvement in breast-feeding following frenulotomy suggests that it is not the only cause of problems and supports the clinician approaching these situations holistically and exploring other causes.

A retrospective review of frenotomy in neonates and infants with feeding difficulties

OBJECTIVES

To measure maternal breast feeding benefit after infant frenotomy. To investigate if timing of neonatal/infant frenotomy affects outcome.

STUDY DESIGN

Cohort survey and retrospective review.

METHODS

Medical records of neonates and infants suspected to have ankyloglossia between April 2006 and February 2011 were reviewed. Patient demographic data was compiled. A telephone survey was conducted to gather data on this cohort of patients.

RESULTS

Neonatal and infant consultations (N=367) were performed for feeding difficulties due to suspected ankyloglossia, 302 of these infants underwent frenotomy for ankyloglossia. A total of 91 mothers agreed to participate in a follow-up telephone survey regarding the intervention. Results showed that 80.4% of mothers strongly believed the procedure benefited their child's ability to breastfeed, and 82.9% of mothers were able to initiate/resume breastfeeding after the procedure was performed. The belief that frenotomy significantly benefitted an infant's ability to feed significantly differed in patients that had the procedure performed in the first week of life (86%) as compared to infants that had the procedure performed after the first week of life (74%) (p<0.003).

CONCLUSIONS

Based on maternal observations, when frenotomy is performed on neonates with ankyloglossia and feeding difficulties in the first week of life, there is more benefit than when it is performed after the first week of life. The population of patients with ankyloglossia is predominantly male with a high familial/genetic correlation associated with the phenotypic trait. Frenotomy for ankyloglossia demonstrates a high degree of maternal satisfaction, is well tolerated and has been shown to improve breastfeeding and decrease pain and difficulty associated with breastfeeding.

A study on the genetic inheritance of ankyloglossia based on pedigree analysis

Background

Ankyloglossia or tongue-tie is a congenital anomaly characterized by an abnormally short lingual frenum. Its prevalence in the newborn population is approximately 4%. Its mode of inheritance has been studied in some articles, but no conclusion has been established. Also, no relevant report has been published in Korea. This study was conducted to elucidate the genetic inheritance of ankyloglossia via pedigree analysis.

Methods

In this study, 149 patients with no other congenital anomaly who underwent frenuloplasty between March 2001 and March 2010 were studied. Pedigrees were made via pre- or post-operative history taking, and patients with uncertain histories were excluded. In the patient group that showed a hereditary nature, the male-to-female ratio, inheritance rate, and pattern of inheritance were investigated.

Results

One hundred (67.11%) of the patients were male and 49 (32.89%) were female (male-female ratio=2.04:1). Ninety-one (61.07%) patients reported no other relative with ankyloglossia, and 58 (38.93%) patients had a relative with this disease. The inheritance rate was 20.69% in the 58 cases with a hereditary nature. In the group with no family history of ankyloglossia, the male-female ratio was 3.79:1, which significantly differed from that of the group with a family history of ankyloglossia. X-chromosome mediated inheritance and variation in the gene expression was revealed in the pedigree drawn for the groups with hereditary ankyloglossia.

Conclusions

Ankyloglossia has a significant hereditary nature. Our data suggest X-linked inheritance. This study with 149 patients, the first in Korea, showed X-linked inheritance in patients with a sole anomaly.

Autosomal-dominant ankyloglossia and tooth number anomalies

Ankyloglossia is a congenital oral anomaly characterized by the presence of a hypertrophic lingual frenulum. It frequently accompanies X-linked cleft palate and is sometimes seen alone due to mutations in the gene encoding the transcription factor TBX22, while knockout of Lgr5 in the mouse results in ankyloglossia. The aim of the present study was to characterize the phenotype and to verify sequence variations in the LGR5 gene in a Brazilian family with ankyloglossia associated with tooth number anomalies. Twelve individuals of three generations were submitted to physical, oral, and radiographic examinations and molecular analysis. Eight had ankyloglossia with various degrees of severity. Six also had hypodontia in the lower incisor region; one had a supernumerary tooth in this region, and another had a supernumerary tooth in the lower premolar region. The characterization of this family determined an autosomal-dominant inheritance and excluded the LGR5 gene mutations as being involved in the pathogenesis of this condition.