Introduction: The past two decades have seen a rapid increase in the diagnosis of ankyloglossia, or “tongue-tie”. Patients are often managed by lingual frenotomy, however, the clinical and socioeconomic factors that determine which patients receive frenotomy are poorly defined.
Methods: A retrospective analysis of 113,995 commercially insured children with ankyloglossia was conducted using Optum Clinformatics database. Trends in frenotomy including provider and setting were described. Records of mothers were linked with children to identify maternal lactation issues in addition to patient-level feeding issues and sociodemographic data. Multiple logistic regression was used to determine predictors of frenotomy.
Results: Diagnosis of ankyloglossia increased during 2003-2019 (from 3,242 in 2003 to 13,204 in 2019). Overall, 52,762 (46.2%) children who were diagnosed with ankyloglossia received frenotomy. The odds of frenotomy increased over time at an annual rate of 1.44% (95% CI 1.20%, 1.69%) representing an over 25% increase over the study period. The proportion of frenotomy procedures that occurred inpatient increased from 0.14% to 16.6% from 2003-2019, with pediatricians having the highest odds of performing inpatient frenotomies (OR 4.61; 95% CI 4.36, 4.88). During 2003-2019, the proportion of frenotomy procedures performed by otolaryngologists decreased from 66.6% to 52.5%, while the proportion performed by pediatricians increased from 17.3% to 36.2%. Children with feeding issues had increased odds while children of mothers with medical complications prohibitive of breastfeeding had lower odds of receiving frenotomy. After adjusting for these clinical factors, frenotomy was significantly associated with male sex, White ethnicity, parental income and education, and number of siblings.
Conclusion: Ankyloglossia has been increasingly diagnosed in the past two decades, and amongst patients with ankyloglossia, frenotomy is increasingly performed. This trend was driven primarily by pediatricians as the proceduralists. After accounting for maternal and patient-level clinical factors, socioeconomic disparities in management of ankyloglossia were observed.