Subscribe to RSS
DOI: 10.1055/s-0043-1772598
Ankyloglossia: Typical Characteristics, Effects on Function, and Clinical Implications
Funding Source None.![](https://www.thieme-connect.de/media/ssl/202304/lookinside/thumbnails/10-1055-s-0043-1772598_230013clinp-1.jpg)
Abstract
The purpose of this article is to (1) define the diagnostic characteristics of ankyloglossia, (2) identify potential problems associated with ankyloglossia, and (3) discuss treatment options, when treatment is appropriate. This article is based on a review of the literature, including recent systematic reviews, and the author's experience as a cleft and orofacial specialist. Ankyloglossia is a common congenital condition characterized by an anterior attachment of the lingual frenulum on the tongue. This causes difficulty elevating and/or protruding the tongue tip. As such, ankyloglossia has been thought to affect neonatal feeding, speech, and other functions. Although systematic reviews have concluded that most infants with ankyloglossia can be fed normally, a small percentage of affected infants will show improved efficiency of feeding post-frenotomy. They also concluded that frenotomy may relieve nipple pain in the breastfeeding mothers of affected infants. Regarding speech, the systematic reviews concluded that there is no evidence that ankyloglossia causes speech disorders. This may be because simple compensations will result in normal acoustics of the sounds. Therefore, frenotomy should be recommended sparingly for newborn infants, and it should rarely, if ever, be recommended for speech disorders.
Financial Disclose
The author has no relevant financial interests to disclose.
Publication History
Article published online:
25 September 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- Ballard JL, Auer CE. , & Khoury JC. (2002). Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics, 110 (05) e63
- Bargale S, Deshpande A, Macwan C. , & Sikligar S. (2014). Ankyloglossia in the infant and young child: a review. Journal of Advanced Medical and Dental Sciences, 2 (01) 64-67
- Bin-Nun A, Kasirer YM. , & Mimouni FB. (2017). A dramatic increase in tongue tie-related articles: a 67 years systematic review. Breastfeeding Medicine, 12 (07) 410-414
- Black LI, Vahratian A. , & Hoffman HJ. (2015). Communication disorders and use of intervention services among children aged 3–17 years: United States, 2012. NCHS Data Brief, No 205. Hyattsville, MD: National Center for Health Statistics;
- Block JR. (1968). The role of the speech clinician in determining indications for frenulotomy in cases of ankyloglossia. The New York State Dental Journal, 34 (08) 479-481
- Brinkmann S, Reilly S. , & Meara JG. (2004). Management of tongue-tie in children: a survey of paediatric surgeons in Australia. Journal of Paediatrics and Child Health, 40: 600-605
- Brookes A. , & Bowley DM. (2014). Tongue tie: the evidence for frenotomy. Early Human Development, 90 (11) 765-768
- Brzęcka D, Garbacz M, Micał M, Zych B. , & Lewandowski B. (2019). Diagnosis, classification and management of ankyloglossia including its influence on breastfeeding. Developmental Period Medicine, 23 (01) 79-87
- Buryk M, Bloom D. , & Shope T. (2011). Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics, 128: 280-288
- Catlin FI. , & De Haan V. (1971). Tongue-tie. Archives of Otolaryngology (Chicago, Ill.), 94 (06) 548-557
- Caloway C, Hersh CJ, Baars R, Sally S, Diercks G. , & Hartnick CJ. (2019). Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology-Head & Neck Surgery, 145: 817-822
- Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S. , & McPheeters M. (2015). Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics, 135 (06) e1467-e1474
- Dixon B, Gray J, Elliot N, Shand B. , & Lynn A. (2018). A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: observational study. International Journal of Pediatric Otorhinolaryngology, 113: 156-163
- Dollberg S, Botzer E, Grunis E. , & Mimouni FB. (2006). Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. Journal of Pediatric Surgery, 41 (09) 1598-1600
- Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M. , & Sutcliffe A. (2014). Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Archives of Disease in Childhood. Fetal and Neonatal Edition, 99 (03) F189-F195
- Ewart NP. (1990). A lingual mucogingival problem associated with ankyloglossia: a case report. The New Zealand Dental Journal, 86 (383) 16-17
- Fitz-Desorgher R. (2003). All tied up. Tongue tie and its implications for breastfeeding. The Practising Midwife, 6 (01) 20-22
- Fleiss PM, Burger M, Ramkumar H. , & Carrington P. (1990). Ankyloglossia: a cause of breastfeeding problems?. Journal of Human Lactation, 6 (03) 128-129
- Flinck A, Paludan A, Matsson L, Holm AK. , & Axelsson I. (1994). Oral findings in a group of newborn Swedish children. International Journal of Paediatric Dentistry, 4 (02) 67-73
- Francis DO, Chinnadurai S, Morad A, Epstein RA, Kohanim S, Krishnaswami S, Sathe NA. , & McPheeters ML. (2015). Treatments for ankyloglossia and ankyloglossia with concomitant lip-tie. AHRQ Comparative Effectiveness Reviews
- Francis DO, Krishnaswami S. , & McPheeters M. (2015). Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics, 135: e1458-e1466
- Fraser L, Benzie S. , & Montgomery J. (2020). Posterior tongue tie and lip tie: a lucrative private industry where the evidence is uncertain. BMJ (Clinical Research Ed.), 371: m3928
- Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE. , & Simmer K. (2008). Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics, 122: e188-e194
- Genther DJ, Skinner ML, Bailey PJ, Capone RB. , & Byrne PJ. (2015). Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin sequence. International Journal of Pediatric Otorhinolaryngology, 79 (09) 1592-1594
- Griffiths DM. (2004). Do tongue ties affect breastfeeding?. Journal of Human Lactation, 20 (04) 409-414
- Ghaheri BA, Lincoln D, Mai TN. T. , & Mace JC. (2022). Objective improvement after frenotomy for posterior tongue-tie: a prospective randomized trial. Otolaryngology - Head and Neck Surgery, 166 (05) 976-984
- Hill R. (2019). Implications of ankyloglossia on breastfeeding. The American Journal of Maternal/Child Nursing, 44 (02) 73-79
- Hong P, Lago D, Seargeant J, Pellman L, Magit AE. , & Pransky SM. (2010). Defining ankyloglossia: a case series of anterior and posterior tongue ties. International Journal of Pediatric Otorhinolaryngology, 74 (09) 1003-1006
- Kotlow LA. (1999). Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence International, 30 (04) 259-262
- Kummer AW. (2005). Ankyloglossia: to clip or not to clip? That is the question. ASHA Leader, 10 (17) 6-30
- Kummer AW. (2010). Ankyloglossia: to clip or not to clip … What is the answer?. In: S. Chabon & E. Cohn (Eds.), Communication Disorders: A Case-Approach for SLPs, . Boston: Allyn & Bacon/Pearson;
- Kummer AW. (2020). Facial, oral, and pharyngeal anomalies. In: Kummer AW. Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management, 4th Edition . Burlington, MA: Jones & Bartlett Learning;
- Lalakea ML. , & Messner AH. (2003). Ankyloglossia: Does it matter?. Pediatric Clinics of North America, 50 (02) 381-397
- Lisonek M, Liu S, Dzakpasu S, Moore AM, Joseph KS. , & the Canadian Perinatal Surveillance System (Public Health Agency of Canada). (2017). Changes in the incidence and surgical treatment of ankyloglossia in Canada. Paediatrics & Child Health, 22 (07) 382-386
- Melong J, Bezuhly M. , & Hong P. (2021). The effect of tongue-tie release on speech articulation and intelligibility. Ear, Nose, and Throat Journal, 15: 1455613211064045
- Messner AH. , & Lalakea ML. (2000). Ankyloglossia: controversies in management. International Journal of Pediatric Otorhinolaryngology, 54 (2-3), 123-131
- Messner AH, Lalakea ML, Aby J, Macmahon J. , & Bair E. (2000). Ankyloglossia: Incidence and associated feeding difficulties. Archives of Otolaryngology–Head & Neck Surgery, 126 (01) 36-39
- Messner AH. , & Lalakea ML. (2002). The effect of ankyloglossia on speech in children. Otolaryngology - Head and Neck Surgery, 127: 539-545
- Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E. , & Satterfield L. (2020). Clinical consensus statement: ankyloglossia in children. Otolaryngology - Head and Neck Surgery, 162 (05) 597-611
- O’Callahan C, Macary S. , & Clemente S. (2013). The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding. International Journal of Pediatric Otorhinolaryngology, 77 (05) 827-832
- O'Shea JE, Foster JP, O'Donnell CP. F, Breathnach D, Jacobs SE, Todd DA. , & Davis PG. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews, 3 (03) CD011065
- Power RF. , & Murphy JF. (2015). Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Archives of Disease in Childhood, 100 (05) 489-494
- Pransky SM, Lago D. , & Hong P. (2015). Breastfeeding difficulties and oral cavity anomalies: the influence of posterior ankyloglossia and upper-lip ties. International Journal of Pediatric Otorhinolaryngology, 79 (10) 1714-1717
- Ranly DM. (1998). Early orofacial development. The Journal of Clinical Pediatric Dentistry, 22 (04) 267-275
- Riskin A, Mansovsky M, Coler-Botzer T, Kugelman A, Shaoul R, Hemo M, Wolff L, Harpaz S, Olchov Z. , & Bader D. (2014). Tongue-tie and breastfeeding in newborns-mothers' perspective. Breastfeeding Medicine, 9: 430-437
- Ricke LA, Baker NJ, Madlon-Kay DJ. , & DeFor TA. (2005). Newborn tongue-tie: prevalence and effect on breast-feeding. The Journal of the American Board of Family Practice, 18 (01) 1-7
- Rowan-Legg A. (2011). Ankyloglossia and breastfeeding. Paediatrics & Child Health, 16 (04) 222
- Ruffoli R, Giambelluca MA, Scavuzzo MC, Bonfigli D, Cristofani R, Gabriele M, Giuca MR. , & Giannessi F. (2005). Ankyloglossia: a morphofunctional investigation in children. Oral Diseases, 11: 170-174
- Salah KB. (2013). Localized severe chronic periodontitis with frenal pull and ankyloglossia: a case report. Clinical Dentistry, 7 (03) 44-51
- Segal LM, Stephenson R, Dawes M. , & Feldman P. (2007). Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Canadian Family Physician Medecin de Famille Canadien, 53 (06) 1027-1033
- Shekher R, Lin L, Zhang R, Hoppe IC, Taylor JA, Bartlett SP. , & Swanson JW. (2021). How to treat a tongue-tie: an evidence-based algorithm of care. Plastic and Reconstructive Surgery. Global Open, 9 (01) e3336
- Suter VG. , & Bornstein MM. (2009). Ankyloglossia: facts and myths in diagnosis and treatment. Journal of Periodontology, 80 (08) 1204-1219
- Talmor G. , & Caloway CL. (2022). Ankyloglossia and tethered oral tissue: an evidence-based review. Pediatric Clinics of North America, 69 (02) 235-245
- Wallace AF. (1963). Tongue tie. Lancet, 2 (7304) 377-378
- Walls A, Pierce M, Wang H, Steehler A, Steehler M. , & Harley Jr EH. (2014). Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. International Journal of Pediatric Otorhinolaryngology, 78 (01) 128-131
- Walsh J. , & McKenna Benoit M. (2019). Ankyloglossia and other oral ties. Otolaryngologic Clinics of North America, 52 (05) 795-811
- Walsh F. , & Kelly D. (1995). Partial airway obstruction after lingual frenotomy. Anesthesia and Analgesia, 80 (05) 1066-1067
- Walsh J, Links A, Boss E. , & Tunkel D. (2017). Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngology - Head and Neck Surgery, 156 (04) 735-740
- Walsh J. , & Tunkel D. (2017). Diagnosis and treatment of ankyloglossia in newborns and infants: a review. JAMA Otolaryngology-Head & Neck Surgery, 143 (10) 1032-1039
- Wang J, Yang X, Hao S. , & Wang Y. (2022). The effect of ankyloglossia and tongue-tie division on speech articulation: a systematic review. International Journal of Paediatric Dentistry, 32 (02) 144-156
- Webb AN, Hao W. , & Hong P. (2013). The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. International Journal of Pediatric Otorhinolaryngology, 77 (05) 635-646
- Wright JE. (1995). Tongue-tie. Journal of Paediatrics and Child Health, 31 (04) 276-278