Ankyloglossia: controversies in management

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Abstract

Purpose: To determine current beliefs regarding ankyloglossia and its treatment. Design: Anonymous written survey. Participants: Otolaryngologists (OTO, n=423), pediatricians (PD, n=425), speech pathologists (SP, n=400), and lactation consultants (LC, n=350) were randomly selected from professional membership lists, with a response rate of 209 (49%), 235 (55%), 150 (37.5%), and 203 (58%), respectively. Clinical findings: Sixty-nine percent of LCs, but a minority of physician respondents, believe tongue-tie is frequently associated with feeding problems. Sixty percent of OTOs, 50% of SPs, but only 23% of PDs believe tongue-tie is at least sometimes associated with speech difficulties. Sixty-seven percent of OTOs versus 21% of PDs believe tongue-tie is at least sometimes associated with social/mechanical issues. Surgery is recommended at least sometimes for feeding, speech, and social/mechanical issues by 53, 74, and 69% of OTOs, respectively, but by only 21%, 29%, and 19% of PDs. Conclusion: The significance of ankyloglossia in children remains controversial, both within, and between, specialty groups.

Introduction

The diagnosis and management of ankyloglossia has long been and continues to be a controversial topic. Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by an abnormally short lingual frenulum, which may result in a varying degree of decreased tongue tip mobility. Opinions range widely regarding the significance of this anomaly; some feel that ankyloglossia is only rarely symptomatic [1], [2], [3], while others feel that it may lead to a host of problems. Possible consequences of ankyloglossia include infant breast-feeding difficulties, speech disorders, and various mechanical and social issues such as an inability to lick the lips, play a wind instrument, and ‘french kiss’ [4], [5], [6], [7], [8], [9], [10].

The current study was conducted to determine the prevailing opinion and practice regarding ankyloglossia among four groups of medical professionals, including otolaryngologists (OTOs) pediatricians (PDs) lactation consultants (LCs) and speech pathologists (SPs). Information was sought relating to (1) incidence of ankyloglossia; (2) associated feeding, speech, and mechanical disorders; (3) recommendations for surgical intervention; and (4) surgical outcomes.

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Materials and methods

Four groups of medical professionals were chosen to participate in the current study. These included US and Canadian members of the American Academy of Otolaryngology/Head and Neck Surgery (AAO-HNS), American Academy of Pediatrics (AAP), International Lactation Consultant Association (ILCA), and speech pathologist members of the American Speech-Language Hearing Association (ASHA). A representative sample of OTOs, PDs, LCs, and SPs from these groups was obtained in the following manner. Names of

Participants

Of the 1598 questionnaires mailed, 831 were returned from all groups combined. Thirty-four of the returned surveys were eliminated, either because the respondent indicated that he/she was not currently in practice, or because the survey was grossly incomplete, or, in the case of SPs, when the respondent indicated that children made up less than 10% of their practice. This resulted in an overall response rate of 50%. LCs had the highest response rate (203/350 or 58%), followed by PDs (235/425 or

Comment

A survey format has obvious limitations for determining the importance and effects of ankyloglossia. Sampling error and bias are risks of any survey in which not all members of a group respond, and in which practitioners are asked to recall information and offer personal opinion. Nonetheless, the present study does provide useful information regarding prevailing opinion and management practices for ankyloglossia among those providers who encounter it most frequently.

Ankyloglossia is uncommon,

Conclusion

This study highlights the controversial nature of ankyloglossia both within and between specialty groups. There is currently no consensus among otolaryngologists, pediatricians, speech pathologists, and lactation consultants regarding the significance of ankyloglossia and indications for its treatment.

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Presented at the American Academy of Pediatrics, San Franciso, CA, October 18, 1998.

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