Ankyloglossia is a congenital anomaly defined as having a short tongue frenulum which limits the tongue’s mobility. An article published in JAMA Otolaryngology – Head and Neck Surgery this 2017 provided a review on ankyloglossia treatment modalities, clinical presentation, diagnosis, and prognosis.
Ankyloglossia is a congenital anomaly defined as having a short tongue frenulum which limits the tongue’s mobility. However, the basis for the diagnosis of this condition and the need for surgical intervention in ankyloglossia treatment are still a subject of debate in the medical community.
In an article published in JAMA Otolaryngology — Head and Neck Surgery this 2017, Jonathan Walsh, M.D., and David Tunkel, M.D. presented a review on the diagnosis and treatment of ankyloglossia in newborns and infants. Newborns and infants with this condition often present with the following symptoms: poor latching, frequent loss of latch, prolonged feeding, irritability with feeding, poor weight gain, or inability to breastfeed. Upon physical examination, tongue mobility restriction, heart-shaped tongue deformity, dimpling, or restriction of the tongue on protrusion may be found. The mother of an infant with ankyloglossia may also experience the following symptoms: pain with breastfeeding, nipple ulceration, nipple bleeding, poor milk letdown due to inadequate suck, and breast infection.
Several classification and grading systems on ankyloglossia have been published, depending on point of frenulum attachment, tongue length from the tip of the frenulum attachment, and length of the frenulum. However, none of these published classification systems have been used consistently due to a difficulty of measurement and impracticality in clinical practice.
The primary treatment for ankyloglossia is frenotomy, wherein the frenulum is cut. Non-surgical treatment modalities include physical therapy, speech therapy, nipple shields, changes in positioning during breastfeeding, or tongue stretching. Complication rates reported for frenotomy are low. However, studies done to strengthen the evidence on the benefits of surgical and non-surgical procedures for ankyloglossia have been limited. As for prognosis, mothers of patients post-frenectomy reported an improvement in breastfeeding and reduction in nipple pain. However, the overall strength and quality of evidence in support of frenectomy are still low. As for untreated ankyloglossia, prognosis remains unknown.
Overall, the authors have provided an overview of the clinical presentation, diagnosis, treatment, and prognosis of ankyloglossia on newborns and infants. As stated in the study, a uniform grading system such as the Hazelbaker Assessment Tool for Lingual Frenulum Function and Coryllos grading, and consistent terminology are needed to improve the quality of future research. The ability to make definitive treatment recommendations is limited at this time by an urgent need for further research.
Written by Karla Sevilla
Resource: Walsh, J. &Tunkel, D. (2017). Diagnosis and treatment of ankyloglossia in newborns and infants: A review. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2017.0948