ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

The Dramatic Rise in Tongue Tie and Lip Tie Treatment

by Nikki Kean • September 6, 2019

  • Tweet
  • Email
Print-Friendly Version

Anna Messner, MDThe incidence of AG is a subject of debate because of different definitions for tongue tie. —Anna Messner, MD

You Might Also Like

  • Treating OSA? Don’t Forget the Tongue
  • Oral Tongue Squamous Cancer in Never Smokers
  • Diagnosis, Treatment of Swallowing Disorders Require Focused Evaluation by Otolaryngologists
  • TORS Base of Tongue Surgery Reduces Sleepiness, AHI in OSA
Explore This Issue
September 2019

How Common Is AG?

“The incidence of AG is a subject of debate because of different definitions for tongue tie,” said Dr. Messner. The definition is generally divided into two classifications: anterior (Type 1 and Type 2) and posterior (Type 3 and Type 4). “With the recent inclusion of posterior tongue tie, there has been an overdiagnosis of ties in some areas of the country, leading to babies having procedures that are not really necessary,” she said.

Among newborn infants in a hospital setting, the incidence of AG has been reported to range between 4% and 11%, she noted (Cochrane Database Syst Rev. 2017;3:CD011065). In children older than 6 years of age, the incidence is much lower—between 2% and 3%.

The rates of diagnosis in hospital births increased three-fold in Canada from 2008 to 2013 and 10-fold in the United States from 1997 to 2012, Dr. Balakrishnan said (Paediatr Child Health. 2017;22:382–386). “There is no public heath reason to explain the increase, only an increase in awareness and diagnosis.”

The data on the benefits of treating tongue tie are very weak. … There are no large, well-controlled studies; we need more standardization on the definitions and how to measure outcomes. —Karthik Balakrishnan, MD, MPH

Diagnosis and Treatment

Many issues can contribute to feeding issues in an infant. Therefore, a careful exam of the newborn or infant is needed to diagnose tongue or lip tie, as well as to rule out more serious issues that might affect feeding, including airway issues, neurologic issues, and hypotonia, among others, said Dr. Balakrishnan.

Dr. Carter’s operative set up for frenotomy.

Dr. Carter’s operative set up for frenotomy.
© Courtesy Dr. Carter

“It is normal for everyone to have a ‘tie,’ or frenulum. However, not all clinicians know what a tongue or lip tie looks like. Doctors may not check under the tongue and therefore miss even the most obvious tongue ties,” Dr. Wei said. To evaluate for tongue tie, “I use my clean finger to “sweep” under the tongue. If I palpate a ridge or I can clearly see the excessive frenulum limiting tongue movement [anterior tongue tie classification 1 and 2], I am more willing to recommend release,” Dr. Wei said.

To look for lip tie, Dr. Wei everts the upper lip to see if the natural upper frenulum comes down and “wraps around” the alveolar ridge. “If it’s too thick, broad, and, specifically in children who have teeth, if the thick band is between the gap of both central incisors, it may be reasonable to consider releasing it only if it interferes with brushing teeth or causes pain. If not, especially in babies without teeth, there is not enough evidence to support release to ‘improve’ nursing,” Dr. Wei said.

The research on whether or not frenectomy is an effective treatment has yielded mixed results. One report found that there is a “small body of evidence that frenotomy may be associated with improvements in breastfeeding as reported by mothers, and potentially in nipple pain” (Pediatrics. 2015;135:e1458–1466). However, “with small, short term studies with inconsistent methodology, strength of the evidence is low to insufficient,” the authors concluded.

Pages: 1 2 3 4 5 | Single Page

Filed Under: Features, Home Slider Tagged With: ankyloglossia, diagnosis, lip tie, tongue tie, treatmentIssue: September 2019

You Might Also Like:

  • Treating OSA? Don’t Forget the Tongue
  • Oral Tongue Squamous Cancer in Never Smokers
  • Diagnosis, Treatment of Swallowing Disorders Require Focused Evaluation by Otolaryngologists
  • TORS Base of Tongue Surgery Reduces Sleepiness, AHI in OSA

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.