Ankyloglossia: Evaluation of Anatomic Features by Practitioners When Determining Surgical Treatment of Ankyloglossia

Background: Ankyloglossia refers to a short, thickened, or tight frenulum located on the ventral surface of the tongue that limits its motion and can cause sucking, latching, and swallowing dysfunctions in infants. Ankyloglossia can present as three general types: cord, strand, and webbed. There is significant variance in the prevalence of ankyloglossia which is likely a result of a lack of standardization and variation in diagnostic criteria. While there are several standardized assessment tools, not all practitioners use these tools and instead base ankyloglossia criteria off of anatomical features. The purpose of this study is to evaluate the variation in frenotomy assessment tools amongst pediatric dentists and otolaryngologists and to ascertain which anatomical features were most important in determining if a frenotomy is necessary.

Methods: This study included a 9-question survey utilizing Google Forms. The survey was sent by email to pediatric dentists through the American Academy of Pediatric Dentistry and otolaryngologists through the American Medical Association. The survey questions consisted of demographics, use of a standardized assessment tool, and assessment of anatomical features indicative of a frenotomy. The final three questions were presented to responders who previously indicated that they did not utilize a standardized assessment tool. These questions displayed a cord, strand, and webbed type of frenulum, and responders were tasked with selecting which anatomical features they used to determine the necessity for a frenotomy.

Results: A total of 404 practitioners responded to the survey, a majority (66.1%) did not use a standardized frenotomy assessment tool. Of those who did utilize one of these tools, the HATLFF was the most commonly used tool, followed by the LATCH, and then the BTAT. For those who relied on anatomical features in place of a standardized tool, the most valued anatomical feature amongst all 3 frenulum types was the appearance of the tongue when lifted (79.8% in cord, 41.2% in strand, and 42.3% in webbed). In all 3 cases, tongue protrusion and frenulum length were also important anatomical features. For the anatomical features of appearance and elasticity, there was statistical significance distinguishing the group who used these features and the group who did not when evaluating the need for a frenotomy. Additionally, anatomical features were valued the most when assessing the cord frenulum image in comparison to the other two frenulum types.

Conclusion: There is a lack of consistency on how to manage and assess lingual frenulums amongst health professionals. Anatomical features, along with presence of functional impairments, should be used to determine the necessity of a frenotomy.