Comparing Non-Surgical and Surgical Management of Ankyloglossia in Infants: A Descriptive Literature Review
DOI:
https://doi.org/10.36002/js.v5i1.5825Keywords:
Ankyloglossia, tongue-tie, frenotomy, conservative management, breastfeedingAbstract
Ankyloglossia or tongue-tie is a congenital condition characterized by a short or tight lingual frenulum that restricts tongue movement. This condition is frequently associated with breastfeeding challenges, which often leads to an increase in surgical procedures such as frenotomy and frenectomy. Nevertheless, the indication and effectiveness of surgery for all cases remain debatable. This descriptive literature review aims to compare the outcomes of non-surgical and surgical interventions in infants with ankyloglossia. A literature search was performed on PubMed, Cochrane Library, and Google Scholar for articles published from 2010 to 2024. The review included systematic reviews, meta-analyses, RCTs, and observational studies comparing both management approaches. Evidence shows that frenotomy provides rapid improvement in breastfeeding for infants with severe ankyloglossia. However, a substantial number of cases can be successfully managed conservatively through lactation support, feeding technique modification, and oral motor exercises. Tools such as the HATLFF and BTAT are essential to differentiate anatomical from functional restrictions. The findings advocate for a selective approach to ankyloglossia management. Surgical release should be reserved for infants with severe functional impairment, while conservative therapy remains the first-line option for mild to moderate cases.
References
Buryk, M., Bloom, D., & Shope, T. (2011). Efficacy of neonatal release of ankyloglossia: A randomized trial. Pediatrics, 128(2), 280–288.
Caloway, C., Hersh, C. J., Baars, R., Sally, S., Diercks, G., & Hartnick, C. J. (2019). Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology-Head & Neck Surgery, 145(9), 817-822.
Cordray, H., Mahendran, G. N., Tey, C. S., Nemeth, J., Sutcliffe, A., Ingram, J., & Raol, N. (2023). Quantitative impact of frenotomy on breastfeeding: A systematic review and meta-analysis. Pediatric Research, 95.
Cruz, P. V., Brizuela, M., & Miguez-Contreras, M. (2022). Prevalence of ankyloglossia according to different assessment tools. Journal of the American Dental Association, 153(11), 1026-1034.
Dixon, B., Gray, J., Elliot, N., Shand, B., & Lynn, A. M. (2018). A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study. International Journal of Pediatric Otorhinolaryngology, 113, 156–163.
Emond, A., Ingram, J., Johnson, D., Blair, P., Whitelaw, A., Copeland, M., & Sutcliffe, A. (2014). Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Archives of Disease in Childhood-Fetal and Neonatal Edition, 99(3), F189–F195.
Fraga, M. do R. B. de A., Barreto, K. A., Lira, T. C. B., Celerino, P. R. R. P., Tavares, I. T. da S., & Menezes, V. A. de. (2020). Ankyloglossia and breastfeeding: What is the evidence of association between them? Revista CEFAC, 22(3).
Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. Pediatrics, 135(6), e1458-1466.
Ghaheri, B. A., Lincoln, D., Mai, T. N. T., & Mace, J. C. (2022). Objective improvement after frenotomy for posterior tongue-tie: A prospective randomized trial. Otolaryngology-Head and Neck Surgery, 166(5), 976–984.
Hill, R. R., Lee, C. S., & Pados, B. F. (2021). The prevalence of ankyloglossia in children aged <1 year: A systematic review and meta-analysis. Pediatric Research, 90(2), 259-266.
Ingram, J., Johnson, D., Copeland, M., Churchill, C., Taylor, H., & Emond, A. (2015). The development of a tongue assessment tool to assist with tongue-tie identification. Archives of Disease in Childhood-Fetal and Neonatal Edition, 100(4), F344-F348.
Knight, M., Ramakrishnan, R., Ratushnyak, S., Rivero-Arias, O., Bell, J., Bowler, U., Buchanan, P., Carter, C., Cole, C., Hewer, O., Hurd, M., King, A., Juszczak, E., Linsell, L., Long, A-M., Mottram, L., Murray, D., Oddie, S., Quigley, M., …
Hardy, P. (2023). Frenotomy with breastfeeding support versus breastfeeding support alone for infants with tongue-tie and breastfeeding difficulties: The FROSTTIE RCT. Health Technology Assessment, 27(11), 1–73.
Messner, A. H., Lalakea, M. L., Aby, J., Macmahon, J., & Bair, E. (2000). Ankyloglossia: Incidence and associated feeding difficulties. Archives of Otolaryngology-Head & Neck Surgery, 126(1), 36–39.
O'Shea, J. E., Foster, J. P., O'Donnell, C. P., Breathnach, D., Jacobs, S. E., Todd, D. A., & Davis, P. G. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews, (3).
Sabharwal, K. A., & Simon, M. W. (2025). Evaluating the efficacy of frenotomy in breastfeeding success: A review of current guidelines and outcomes. Frontiers in Pediatrics, 13, 1702138.
Thomas, J., Bunik, M., Holmes, A., Keels, M. A., Poindexter, B., & Meyer, A. (2024). Identification and management of ankyloglossia and its effect on breastfeeding in infants: Clinical report. Pediatrics, 154(2), e2024067605.
Walsh, J., Links, A., Boss, E., & Tunkel, D. (2017). Ankyloglossia and lingual frenotomy: National trends in inpatient diagnosis and management in the United States, 1997–2012. Otolaryngology-Head and Neck Surgery, 156(4), 735–740.
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