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Symptoms of ankyloglossia after infancy: A review (Cordray et al., 2023)

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posted on 2023-08-22, 13:54 authored by Holly Cordray, Geethanjeli N. Mahendran, Ching Siong Tey, John Nemeth, Nikhila Raol

Objective: The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo tongue-tie release (frenotomy) during infancy.

Data Sources: This study contains data from PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar (1961–January 2023).

Review Method: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Experimental and observational studies were eligible if they reported baseline outcomes associated with ankyloglossia in children above a year of age. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded.

Conclusions: Twenty-six of 1,568 screened studies (> 1,228 patients) were included. Six studies were high quality and 20 were medium quality. Studies identified various symptoms that may be partially attributable to ankyloglossia after infancy, including speech/articulation difficulties, eating difficulties, dysphagia, sleep-disordered breathing symptoms, dental malocclusion, and social embarrassment such as oral hygiene issues. Multiple comparative studies found associations between ankyloglossia and risk factors for obstructive sleep apnea; a randomized controlled trial found that frenotomy may attenuate apnea severity. Ankyloglossia may also promote dental crowding.

Implications for Practice: Ankyloglossia may be associated with myriad effects on children’s quality of life that extend beyond breastfeeding, but current data regarding the impact are inconclusive. This review provides a map of symptoms that providers may want to evaluate as we continue to debate the decision to proceed with frenotomy or nonsurgical therapies in children with ankyloglossia. A continuing need exists for controlled efficacy research on frenotomy for symptoms in older children and on possible longitudinal benefits of early frenotomy for maxillofacial development.

Supplemental Material S1. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

Supplemental Material S2. Search strategy.

Supplemental Material S3. Characteristics of included studies.

Supplemental Material S4. Studies excluded as low quality.

Cordray, H., Mahendran, G. N., Tey, C. S., Nemeth, J., & Raol, N. (2023). The impact of ankyloglossia beyond breastfeeding: A scoping review of potential symptoms. American Journal of Speech-Language Pathology, 32(6), 3048–3063.


This work benefitted from a science infrastructure grant provided by the Marcus Foundation (awarded to Nikhila Raol).