The Impact of Untreated Ankyloglossia on Feeding, Speech and the Psychosocial Domain: A Systematic Review and Meta-Analysis

Volume 8, Issue 4, August 2023     |     PP. 306-340      |     PDF (1611 K)    |     Pub. Date: August 23, 2023
DOI: 10.54647/cm321144    65 Downloads     3668 Views  

Author(s)

Fariah I Gaba, Dental XL, Private Dental Practise. The Hague. The Netherlands.
Chirag C Sheth, Department of Medicine, Faculty of Health Sciences, Universidad CEU Cardenal Herrera, CEU Universities, Alfara del Patriarca 46115, Valencia, Spain

Abstract
Objectives: (1) To investigate and highlight the impact of untreated AG on feeding, speech and the psychosocial domain in children between 0-15 years. (2) determine surgical outcomes of corrective AG procedures and their influence on feeding, speech and the psychosocial domain (3) highlight AG as an important myofunctional and psychosocial disorder, (4) encourage further collaborative research from healthcare professionals.
Methods: The Central Register of Controlled Trials, EMBASE, EBSCO, NCBI and MEDLINE databases were searched, and a meta‐analysis was conducted. Positive AG treatment outcomes over the past 33 years were also presented.
Results: Feeding Affectations: 49.76% of individuals received corrective AG surgery and 50.24% did not. Calculated risk ratio (RR) was 0.81 with a 95 % CI of 0.45 - 0.90. The GRADE quality assessment of evidence was “LOW”.
Speech Affectations: 60.20%of individuals never had corrective AG surgery whereas 39.80% did. Calculated risk ratio (RR) was 0.92 with a 95 % CI of 0.59 - 0.98 The GRADE quality assessment of evidence was “LOW”.
The Psychosocial Domain Affectations: Data availability was very limited and there was little acknowledgment of this topic from the included articles. Consequently, the quality of presented evidence was “LOW” as per the GRADE system.
Conclusions: Data depicting a significant link between AG and its level of influence over these issues between 0–15 year-olds is scarce, and our results were inconclusive. AG management requires more effective interdisciplinary communication to aid clinical decision making and further investigation is necessary.

Keywords
Meta-analysis; Ankyloglossia, Feeding, Speech, Psychosocial Domain, Surgical Outcomes

Cite this paper
Fariah I Gaba, Chirag C Sheth, The Impact of Untreated Ankyloglossia on Feeding, Speech and the Psychosocial Domain: A Systematic Review and Meta-Analysis , SCIREA Journal of Clinical Medicine. Volume 8, Issue 4, August 2023 | PP. 306-340. 10.54647/cm321144

References

[ 1 ] Ades AE, Higgins JPT. The Interpretation of Random-Effects Meta-Analysis in Decision Models. Medical Decision Making 2005; 25:646-654.
[ 2 ] Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Paediatrics 2002;110: e63.
[ 3 ] Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med 2012; 7:189–93.
[ 4 ] Boyd CM, Singh S, Varadhan R, et al. Methods for Benefit and Harm Assessment in Systematic Reviews [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Nov. Discussion. Available from: https://www.ncbi.nlm.nih.gov/books/NBK115753.
[ 5 ] Buryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Paediatrics 2011; 128:280–8.
[ 6 ] Camargo ZA, Marchesan IQ, Oliveira LR, Svicero MA, Pereira LC, Madureira S. Lingual frenectomy and alveolar tap production: an acoustic and perceptual study. Logoped Phoniatr Vocol. 2013; 38:157-166.
[ 7 ] Chinnadurai S, Francis DO, Epstein RA, Morad A, Kohanim S, McPheeters M. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Paediatrics. 2015;135: e1467-e1474.
[ 8 ] Choi YS, Lim JS, Han KT, Lee WS, Kim MC. Ankyloglossia correction: Z-plasty combined with genioglossus myotomy. J Craniofac Surg. 2011;22(6):2238–2240
[ 9 ] Daggumati S, Cohn JE, Brennan MJ, Evarts M, McKinnon BJ, Terk AR. Speech and language outcomes in patients with ankyloglossia undergoing frenulectomy: a retrospective pilot study. OTO Open. 2019; 3:2473974X19826943.
[ 10 ] DerSimonian R, Laird N. Meta-analysis in Clinical Trials. Controlled Clinical Trials 1986;7:177-188
[ 11 ] Dollberg S, Manor Y, Makai E, Botzer E. Evaluation of speech intelligibility in children with tongue-tie. Acta Paediatr. 2011;100(9): e125–e127
[ 12 ] Downes MJ, Brennan ML, Williams HC, et al. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open 2016;6: e011458. doi:10.1136/bmjopen-2016-011458
[ 13 ] Emond A, Ingram J, Johnson D, et al. Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie. Arch Dis Child Foetal Neonatal Ed 2014;99: F189–F195.
[ 14 ] Eunice Kennedy Shriver National Institute of Child Health and Human Development. National Institutes of Health (NIH), Department of Health and Human Services (DHHS). Preterm labour and birth: condition information.2014. Available at: www.nichd.nih.gov/ Health/topics/preterm/conditioninfo.
[ 15 ] Fleiss JL, Gross AJ. Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: A critique. Journal of Clinical Epidemiology 1991; 44:127-39
[ 16 ] Flinck A, Paludan A, Matsson L, Holm AK, Axelsson I. Oral findings in a group of new-born Swedish children. Int J Paediatr Dent 1994;4: 67-73
[ 17 ] Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. 2015;135: e1458-1466.
[ 18 ] Garcı´a Pola MJ, Gonza´ lez Garcı´a M, Garcı´a Martı´n JM, Gallas M, Seoane Lesto´n J. A study of pathology associated with short lingual frenum. ASDC J Dent Child 2002; 69:59-62.
[ 19 ] Griffiths. D. Do Tongue Ties Affect Breastfeeding? J Hum Lact.20(4), 2004
[ 20 ] A. Hazelbaker AK (1993) The assessment tool for lingual frenulum function: use in a lactation consultant private practice. Pacific Oaks College, Pasadena. B. Hazelbaker, Tongue-tie Morphogenesis, Impact, Assessment and Treatment, Aidan & Eva Press, Columbus, Ohio, 2010.
[ 21 ] Heller J, Gabbay J, O’Hara C, Heller M, Bradley JP. Improved ankyloglossia correction with four-flap Z-frenuloplasty. Ann Plast Surg. 2005;54(6):623–628
[ 22 ] A. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Wiley Online Library, 2008 B. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 2002; 21:1539-1558
[ 23 ] Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005;41: 246-250.
[ 24 ] Hooda A, Rathee M, Yadav S, J Gulia J. Ankyloglossia: A Review of Current Status. The Internet Journal of Otorhinolaryngology. 2009 vol:12; no:2.
[ 25 ] Horton CE, Crawford HH, Adamson JE, Ashbell TS. Tongue-tie. Cleft Palate J 1969; 6:8-23.
[ 26 ] Ingram J et al. Arch. Dis. Child. Foetal Neonatal. 100 (2015)
[ 27 ] Ito Y, Shimizu T, Nakamura T, Takatama C. Effectiveness of tongue-tie division for speech disorder in children [published online ahead of print August 20, 2014].
[ 28 ] Joseph K, Kinniburgh B, Metcalfe A, Razaz N, Sabr Y, Lisonkova S. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004–2013: a population-based study. CMAJ Open 2016; 4: E33.
[ 29 ] Khan U, MacPherson J, Bezuhly M, Hong P. Comparison of frenotomy techniques for the treatment of Ankyloglossia in children: a systematic review. Otolaryngol Head Neck Surg. 2020; 163:428-443.
[ 30 ] Kim TH, Lee YC, Yoo SD, Lee SA, Eun YG. Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: a prospective randomized study. Int J Paediatr Otorhinolaryngol. 2020; 136:110146.
[ 31 ] Klockars T. Short lingual frenulum. Duodecim. 2013; 129:947-949.
[ 32 ] Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999; 30:259-262
[ 33 ] Kummer AW. Ankyloglossia: to clip or not to clip? That’s the Question. ASHA Leader. 2005; 10:6-30.
[ 34 ] A. Lalakea ML, Messner AH. Ankyloglossia: the adolescent and adult perspective. Otolaryngol–Head Neck Surg Off J Am Acad. Otolaryngol-Head Neck Surg. 2003;128(5):746–52.252. B Lalakea ML, Messner AH. Ankyloglossia: does it matter? Pediatr Clin N Am 2003; 50:381-97.
[ 35 ] Marchesan IQ, Martinelli RL, Gusmão RJ. Lingual frenulum: changes after frenectomy. J Soc Bras Fonoaudiol. 2012; 24(4):409–412
[ 36 ] Marmet C, Shell E, Marmet R. Neonatal frenotomy may be necessary to correct breastfeeding problems. J Hum Lact 1990;6(3):117-21.
[ 37 ] Masaitis NS, Kaempf JW. Developing a frenotomy policy at one medical centre: a case study approach. J Human Lact. 1996; 12: 229-32
[ 38 ] A. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg.2002;127(6):539–45. B. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Paediatr Otorhinolaryngol. 2000; 54:123-131. C. Messner AH, Lalakea ML, Aby J, Macmahon J, Bair, E. Ankyloglossia. Incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000; 126:36 –9.
[ 39 ] Miranda BH, Milroy CJ. A quick snip—a study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. J Plast Reconstr Aesthet Surg. 2010;63(9): e683–e685
[ 40 ] Mumcu G, Cimilli H, Sur H, Hayran O, Atalay T. Prevalence and distribution of oral lesions: A cross-sectional study in Turkey. Oral Dis 2005; 11:81-87.
[ 41 ] Notestine G. The importance of the identification of ankyloglossia (short lingual frenulum) as a cause of breastfeeding problems. J Hum Lact 1990;6(3):113-5.
[ 42 ] O'Shea JE, Foster JP, O'Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017;3:CD011065.
[ 43 ] Puthussery FJ, Shekar K, Gulati A, Downie IP. Use of carbon dioxide laser in lingual frenectomy. Br J Oral Maxillofac. Surg. 2011;49(7):580–581
[ 44 ] Puhan, M.A., Singh, S., Weiss, C.O. et al. A framework for organizing and selecting quantitative approaches for benefit-harm assessment. BMC Med Res Methodol 12, 173 (2012).
[ 45 ] Ricke L, Baker N, Madlon-Kay D, DeFor T. Newborn tongue-tie: prevalence and effect on breast-feeding. J Am Board Fam Pract. 2005;18(1):1–7
[ 46 ] Ruffoli R, Giambelluca MA, Scavuzzo MC, et al. Ankyloglossia: A morpho functional investigation in children. Oral Dis 2005; 11:170-174.
[ 47 ] Salt H, Claessen M, Johnston T, Smart S. Speech production in young children with tongue-tie. Int J Pediatr Otorhinolaryngol. 2020; 134:110035.
[ 48 ] Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician. 2007;53(6):1027-1033.
[ 49 ] Shay et. al. Tongue Tie in Infancy. Curr Treat Options Peds (2016) 2:246–255.
[ 50 ] Srinivasan A, Al Khoury A, Puzhko S, et al. Frenotomy in infants with tongue-tie and breastfeeding problems. J Hum Lact. 2019; 35:706-712
[ 51 ] Suter VGA, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment. J Periodontol. 2009;80(8):1204–19.
[ 52 ] Ugar-Cankal D, Denizci S, Hocaoglu T. Prevalence of tongue lesions among Turkish schoolchildren. Saudi Med J 2005; 26:1962-1967.
[ 53 ] Vo¨ro¨s-Balog T, Vincze N, Ba´no´czy J. Prevalence of tongue lesions in Hungarian children. Oral Dis 2003;9: 84-87.
[ 54 ] Walls A, Pierce M, Wang H, Steehler A, Steehler M, Harley EH Jr. Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy. Int J Pediatr Otorhinolaryngol. 2014;78(1):128–131
[ 55 ] Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997–2012. Otolaryngol Head Neck Surg 2017; 156: 735–40
[ 56 ] Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Paediatr Otorhinolaryngol. 2013; 77:635-646.
[ 57 ] World Health Organization (WHO), and UNICEF. Global Strategy for Infant and Young Child Feeding. World Health Organization; 2003
[ 58 ] WHO, UNICEF. Baby-friendly hospital initiative: Revised, updated and expanded for integrated care. Geneva: World Health Organization, 2009,
[ 59 ] Yousefi J, Tabrizian Namini F, Raisolsadat SM, Gillies R, Ashkezari A, Meara JG. Tongue-tie repair: Z-Plasty Vs simple release. Iran J Otorhinolaryngol. 2015; 27:127-135.
[ 60 ] Yeh ML. Outpatient division of tongue-tie without anaesthesia in infants and children. World J Pediatr. 2008;4(2):106–108
[ 61 ] GRADE Tool for the Assessment of the Quality of Evidence presented within Literature. Website: https://www.gradepro.org
[ 62 ] Critical Appraisal Skills Programme (CASP) Tool for quality appraisal of Literature Reviews. Website: https://casp-uk.net [last accessed 14th February 2023]