Alternative Therapies for Ankyloglossia-Associated Breastfeeding Challenges: A Systematic Review

Background: Ankyloglossia (AG) diagnoses are increasingly common, and management is not standardized. Nonsurgical alternative therapies are frequently recommended in conjunction with or instead of frenotomy, with uncertain evidence. Objective: To evaluate the efficacy of nonsurgical alternative therapies (chiropractic care, myofunctional therapy, and osteopathy) in improving breastfeeding for infants diagnosed with AG. Methods: PubMed, Embase, CINAHL, Scopus, Web of Science, Clinicaltrials.gov, and Google Scholar were searched (September-October 2023). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A librarian-designed search included the terms "Ankyloglossia," "Non-surgical," "myofunctional therapy," "chiropractic," "osteopathy," and related therapies, with no date restrictions. English language studies of infants <24 months with AG and alternative therapy were included. Risk-of-bias evaluation used Newcastle-Ottawa Scale (NOS). Results: Of 1,304 identified articles, four studies (2016-2022) met inclusion criteria (two cross-sectional, one case report, and one case series). All studies reported frenotomy in combination with alternative therapy yielded favorable outcomes for maternal pain, weight gain, feeding duration, and maintenance of latch. The risk of bias was moderate for two studies, low for the case series, and not calculated for the case report, which has an inherent high risk of bias. All studies lacked control or comparator groups preventing definitive conclusions about the role of alternative therapies in AG. Conclusion: Although some studies suggest the potential benefits of combining alternative therapies with surgery for AG-related breastfeeding issues, the lack of control groups renders the evidence inconclusive. Nonsurgical approaches alone currently lack sufficient evidence. As these alternative therapies gain popularity, rigorous research is crucial to determine their cost-effectiveness and role in managing AG.

Tongue and Mandibular Disorders of the Pediatric Patient

Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact on breathing, feeding, speech, dentition, and craniofacial growth. This review discusses the interdependent and coordinated development of both the tongue and mandible, the functional impacts of these disorders, and appropriate management strategies.

Lingual Frenotomy in Pediatric Ankyloglossia: A Diode Laser Approach in Two Case Reports

Ankyloglossia can be related to a number of complications, such as breastfeeding difficulties or alterations in craniofacial development. Treatment can involve surgery to correct the altered lingual frenulum and can be performed by various techniques. The purpose of this paper is to present two case reports of ankyloglossia in pediatric patients of different ages, the diagnostic criteria, and the treatment decision rationale, which led to a lingual frenotomy performed with a diode laser.

Ankyloglossia in Australia: Practices of health professionals

OBJECTIVES

To investigate the opinions and practices of health professionals involved in ankyloglossia diagnosis and management in Australia.

METHOD

Two hundred and thirty-seven health professionals across Australia responded to an online survey including their diagnostic and management practice of ankyloglossia. Descriptive statistics, content analysis and thematic analysis were used to analyse quantitative data and open-ended responses, respectively.

RESULTS

Most (91.6%) respondents reported they are responsible for the assessment and diagnosis of ankyloglossia in their clinical practice. A majority (56.7%) reported using more than one assessment tool in clinical practice. Less than half (46.4%) reported providing treatment to manage ankyloglossia. Surgical management was used by 44.5%, and 56.4% used non-surgical management as their primary treatment of ankyloglossia. Of the total sample, 26.6% had completed no further training or professional development in the field. 46% of respondents stated they always educate parents about ankyloglossia diagnoses, whereas 29.5% reported they always educate parents about management of ankyloglossia. Of respondents, a high level of confidence was reported by 62.6% of health professionals in the assessment of infants with ankyloglossia. Of those who perform surgical management, 53.7% reported feeling extremely confident in their skills. Fifty-two percent of respondents reported they were dissatisfied with the current service delivery for infants with ankyloglossia.

CONCLUSIONS

The diagnosis, management and education practices varied greatly amongst health professionals in Australia. Clinical guidelines for all relevant health professionals are needed to ensure standardised diagnosis and management processes. In future, this will help guide evidence-based diagnosis and intervention for infants with ankyloglossia.

Effects of different surgical treatments on children with ankyloglossia: protocol for a systematic review and meta-analysis

INTRODUCTION

Ankyloglossia is a situation where the tongue tip cannot go beyond the mandibular incisor because the frenulum linguae is short. It could affect children's health by interfering with their ability to talk, breast feeding and dental development. The most effective measure to control ankyloglossia is the surgical method. However, which surgical procedure is the best one is still controversial. Thus, this protocol aims to assess the effectiveness of different surgical interventions in children with ankyloglossia.

METHODS AND ANALYSIS

PubMed, EMBASE, Cochrane Library, Web of Science and OVID will be searched for relevant information from inception to 31 May 2022. Observational studies in English that investigate the association between surgical methods and ankyloglossia will be included in this protocol. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle-Ottawa Quality Assessment Scale for longitudinal studies will be used to assess the included studies. The improvement of breast feeding and nipple pain will be the primary outcome. STATA V.15.1 will do the statistical analysis in the meta-analysis. Subgroup and meta-regression will be carried out based on the characteristics of included studies.

ETHICS AND DISSEMINATION

This systematic review and meta-analysis will summarise relevant information on the effects of different surgical treatments on patients with ankyloglossia. The results will be disseminated through peer-reviewed publications. The data included in this study will be extracted from the published original studies. Thus, ethical approval and informed consent will not be required.

PROSPERO REGISTRATION NUMBER

CRD42022323350.

Grouping of Ankyloglossia According to Coryllos Anatomical Classification and Follow-Up Results for Breastfeeding: Single-Center, Cross-Sectional Study

Ankyloglossia is a condition of limited tongue mobility caused by a short lingual frenulum. The diagnosis and treatment of ankyloglossia are still controversial. The main clinical problems encountered during breastfeeding are difficulty in sucking and its clinical reflections. This study aims to evaluate the infant population born with ankyloglossia and to determine the results of frenotomy. We conducted an observational, cross-sectional study among infants born in a tertiary hospital. We included all infants born between 1 January and 30 June 2022. The neonatal follow-up protocol for ankyloglossia was determined before the defined dates, and data were recorded during the screening period. The recorded data were retrospectively collected from the files. Within six months, 705 infants were born. Due to additional problems and other conditions that prevent breastfeeding, evaluable data of 207 (29.3%) infants could not be provided. Of the remaining 498 infants, 234 (33.2%) had ankyloglossia. While none of the infants without ankyloglossia had a breastfeeding problem after appropriate training, 28.6% of the ankyloglossia group had a breastfeeding problem (p < 0.001). The need for frenotomy differed significantly between Coryllos groups (p < 0.001). Breastfeeding was unsuccessful before frenotomy in 12 Coryllos type-1 patients, and all had difficulty in sucking. Frenotomy was performed within the three-month follow-up period in all patients with complaints of inability to firmly grasp the breast, nipple slipping from the mouth, and nipple biting during the first 24 h. In terms of breastfeeding problems, regardless of the anatomical typology, frenotomy can be performed safely in early life with successful results. If deficiencies or difficulties in breastfeeding are noticed in ankyloglossia patients even at the first control, frenotomy should be recommended in clinical conditions.

Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study

Background

The study aims to describe the lingual laser frenotomy perioperative protocol for newborns with ankyloglossia with or without breastfeeding difficulties developed by Odontostomatology and Neonatology and Neonatal Intensive Care Units of the Aldo Moro University of Bari.

Methods

Authors carried out a prospective observational cohort study. Newborns with ankyloglossia (classified by using both Coryllos’ and Hazelbaker’s criteria) with or without difficult breastfeeding (according to Infant Breastfeeding Assessment Tool) underwent diode laser frenotomy (800 ± 10 nm; 5 W; continuous wave mode; contact technique; under topical anesthesia) and follow-up visits after seven and thirty days postoperatively. The authors analyzed as main outcomes the perioperative pain intensity measured by the C.R.I.E.S. scale, the occurrence of complications and quality of healing, the quality of breastfeeding, newborn’s postoperative weight gain, maternal nipple pain, and the presence of lesions as secondary outcomes.

Results

Fifty-six newborns were included in the current study. Intraoperative mean pain intensity was 5.7 ± 0.5 points, resolved within thirty postoperative minutes. Observed complications were mild punctuating bleeding, carbonization of the irradiated site, and transitory restlessness. All wounds were completely healed within the thirtieth postoperative day. During follow-up, a significant breastfeeding improvement was evident with satisfactory newborns’ weight gain and a significant reduction of nipple pain and lesions (p < .05).

Conclusion

Our lingual laser frenotomy protocol provided significant breastfeeding improvement in the mother-newborn dyads with low intraoperative pain and no significant complications.

Comparison of the Effects of High-Power Diode Laser and Electrocautery for Lingual Frenectomy in Infants: A Blinded Randomized Controlled Clinical Trial

The aim of the study was to evaluate the release of the lingual frenulum through frenectomy in newborns zero to 90 days of age who breastfed and had diagnosis of ankyloglossia with an indication for surgery, comparing two methods: electrocautery and a high-power diode laser. Fifty-seven patients were randomly allocated to two groups (23 submitted to electrocautery and 34 submitted to a high power diode laser). Tongue movements were evaluated based on a clinical assessment and using the Bristol Tongue Assessment Tool (BTAT) before and 15 days after the surgical procedures. The visual analog scale was administered to the mothers on the same occasions for the measurement of pain during breastfeeding. Both groups had an increased BTAT score (favorable outcome) at the post-surgical evaluation, but the anterior third of the tongue was not always free to enable the movements necessary for lingual functions. It is fundamental for surgeons to have skill and in-depth knowledge of the equipment used to avoid accidents and complications in the region of important structures. Both techniques employed in this study were safe and effective, causing little bleeding and few postoperative complications. The group submitted to a high-power diode laser exhibited less post-surgical bleeding compared to the group submitted to electrocautery and no inflammation at the edges of the surgical cut.

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.

Ankyloglossia and Tethered Oral Tissue: An Evidence-Based Review

Tethered oral tissue may represent anatomic variation or true pathology with functional limitations. The most prevalent functional limitation is impaired feeding due to ankyloglossia. Treatment options include conservative management with feeding support versus intervention such as frenotomy or frenuloplasty. The benefits of intervention have yet to be fully elucidated. Many can agree that intervention may improve maternal pain during breastfeeding, but the impact of these procedures on feeding efficiency and intake is debated. Alternate ties such as posterior ankyloglossia and lip tie have been proposed as pathologic oral ties, but their true impact on feeding and speech articulation remains unclear.

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

AIM

Ankyloglossia is a common congenital malformation characterized by a short, thick, or tight tongue frenulum, and its effect on speech articulation remains controversial. This study aimed to evaluate (a) the association between ankyloglossia and speech disorders, and (b) the effectiveness of surgical interventions on the articulation of patients with ankyloglossia.

MATERIAL AND METHODS

A comprehensive search of PubMed was conducted. Randomized control trials (RCTs), cohort studies, case-control studies, and case series with more than five cases were included.

RESULT

Of the 16 included studies, except for one cross-sectional study, all studies were small in sample size. The evidence quality was generally low, with an average of 3.88 in a 7-point system. Three studies investigated the occurrence of speech disorders in the ankyloglossia population and obtained different results. Fifteen studies assessed the effectiveness of surgery, among which eight self-control studies observed significant postoperative improvement, whereas three of four cohort studies with untreated controls reported no significant differences. Three RCTs compared surgical techniques and one pointed out the advantage of frenuloplasty over frenulotomy.

CONCLUSION

There was no clear connection between ankyloglossia and speech disorders. More widely accepted uniform grading systems and well-designed clinical studies are needed.