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How to Treat a Tongue-tie: An Evidence-based Algorithm of Care

Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. METHODS: A meta-analysis...

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Autores principales: Shekher, Rohil, Lin, Lawrence, Zhang, Rosaline, Hoppe, Ian C., Taylor, Jesse A., Bartlett, Scott P., Swanson, Jordan W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859174/
https://www.ncbi.nlm.nih.gov/pubmed/33564576
http://dx.doi.org/10.1097/GOX.0000000000003336
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author Shekher, Rohil
Lin, Lawrence
Zhang, Rosaline
Hoppe, Ian C.
Taylor, Jesse A.
Bartlett, Scott P.
Swanson, Jordan W.
author_facet Shekher, Rohil
Lin, Lawrence
Zhang, Rosaline
Hoppe, Ian C.
Taylor, Jesse A.
Bartlett, Scott P.
Swanson, Jordan W.
author_sort Shekher, Rohil
collection PubMed
description Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. METHODS: A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway. RESULTS: Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy (P < 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48, P < 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire, P < 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division. CONCLUSIONS: Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.
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spelling pubmed-78591742021-02-08 How to Treat a Tongue-tie: An Evidence-based Algorithm of Care Shekher, Rohil Lin, Lawrence Zhang, Rosaline Hoppe, Ian C. Taylor, Jesse A. Bartlett, Scott P. Swanson, Jordan W. Plast Reconstr Surg Glob Open Pediatric/Craniofacial Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. METHODS: A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway. RESULTS: Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy (P < 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48, P < 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire, P < 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division. CONCLUSIONS: Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children. Lippincott Williams & Wilkins 2021-01-25 /pmc/articles/PMC7859174/ /pubmed/33564576 http://dx.doi.org/10.1097/GOX.0000000000003336 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Pediatric/Craniofacial
Shekher, Rohil
Lin, Lawrence
Zhang, Rosaline
Hoppe, Ian C.
Taylor, Jesse A.
Bartlett, Scott P.
Swanson, Jordan W.
How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_full How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_fullStr How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_full_unstemmed How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_short How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
title_sort how to treat a tongue-tie: an evidence-based algorithm of care
topic Pediatric/Craniofacial
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859174/
https://www.ncbi.nlm.nih.gov/pubmed/33564576
http://dx.doi.org/10.1097/GOX.0000000000003336
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