Is Public Interest Associated with Real-World Management of Ankyloglossia?

OBJECTIVES: Assess the relationship between public interest in ankyloglossia as determined by internet search volume and real-world medical claims data. STUDY DESIGN: Retrospective Cohort Study. SETTING: This retrospective cohort study was conducted using claims data from the Merative™ Marketscan® Research Databases. The internet search data was collected from Google Trends. METHODS: Annual Google Trends data were compiled using search terms associated with "ankyloglossia" and "frenotomy" for the years 2011 to 2021. We obtained incidence of ankyloglossia diagnoses and frenotomy procedures in children under 12 months from Marketscan relative to all infants enrolled. We compared associations between search and incidence data among US states and over time. RESULTS: Google search correlated with ankyloglossia incidence (r = 0.4104, P = .0031) and with frenotomy incidence (r = 0.4062, P = .0034) per state. Ankyloglossia diagnoses increased with Google search index (coefficient = 0.336, 95% confidence interval [CI] 0.284, 0.388) and year (coefficient = 0.028, 95% CI 0.025, 0.031). Similarly, frenotomy procedures increased with Google search index (coefficient = 0.371, 95% CI 0.313, 0.429) and year (coefficient = 0.027, 95% CI 0.024, 0.030). CONCLUSIONS: Associations between online ankyloglossia search trends and both diagnosis and treatment rates, persist across US regions and timeframes. Internet search trends are pivotal in shaping pediatric health care decisions, driving clinical consensus, and disseminating evidence-based information.

The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia.

INTRODUCTION: Ankyloglossia is a congenital condition that restricts tongue mobility. The aim of this study is to evaluate the relationship between gender and pediatric ankyloglossia and evaluate the planning of ideal timing of surgery. METHODS: The files of pediatric patients in the Turkish population treated surgically for tongue-tie between June 2014 to June 2018 were scanned retrospectively. RESULTS: Three hundred and eighty-two pediatric patients were included in the study. Of these, 115 (30.1%) were female and 267 (69.9%) were male. The prevalence of ankyloglossia was significantly higher in males than in females (P < .001). The age of the patients at time of surgery ranged from 1 day to 114 months. The most common indication was sucking/feeding difficulties (82%) in patients younger than 2 years, and the most common symptom was speech problems (67%) in patients aged 2 years and older. CONCLUSION: In our study, the prevalence of ankyloglossia in Turkish society was significantly higher in males. Frenectomy surgery is a safe procedure that can be performed on the first day of life in newborns.

Prevalencia de anquiloglosia en neonatos y relación con datos auxológicos del recién nacido o con otras malformaciones o enfermedades asociadas / Prevalência de anquiloglossia em recém-nascidos e relação com dados auxológicos do recém-nascido ou com outras malformações ou doenças associadas / Prevalence of ankyloglossia in neonates and relationship with auxological data of the newborn or with other malformations or associated diseases

Objetivo: determinar la prevalencia de anquiloglosia en neonatos del Hospital Nostra Senyora de Meritxell del Principado de Andorra, Europa, así como la relación existente con datos auxológicos u otras malformaciones o enfermedades asociadas. Material y métodos: Se realizó un estudio descriptivo, transversal, retrospectivo poblacional de los recién nacidos durante un período de 8 meses. Se estudiaron once variables: presencia o no de anquiloglosia, tipo de frenillo corto, talla, peso, perímetro craneal, sexo, Rh y grupo sanguíneo, edad gestacional, malformaciones y patologías neonatales asociadas, de forma confidencial y anónima, correlacionándolas para ver si existía alguna asociación entre ellas. Resultados: Un total de 306 recién nacidos fueron incluidos en el estudio (52% varones y 48% mujeres). La prevalencia de anquiloglosia fue del 6,54% (n=20). Del total de varones (159/306), el 8,125% (n=13) presentaban anquiloglosia, mientras que en mujeres (147/306), la prevalencia fue del 4,79% (n=7), sin encontrar diferencias estadísticamente significativas respecto al sexo (p-valor=0,24). Según la clasificación de Coryllos, el tipo II fue el más frecuente (95% de los casos) y el 4,58% de los lactantes con anquiloglosia exhibieron patología/malformación. Conclusiones: La prevalencia de anquiloglosia en recién nacidos en Andorra, Europa, es similar a la observada por otros autores en investigaciones similares. No se observó asociación entre la presencia o no anquiloglosia y las variables estudiadas.

Objetivo: determinar a prevalência de anquiloglossia em recém-nascidos do Hospital Nostra Senyora de Meritxell do Principado de Andorra, Europa, bem como a relação existente com dados auxológicos ou outras malformações ou doenças associadas. Material e métodos: Foi realizado um estudo descritivo, transversal e retrospectivo da população de recém-nascidos durante um período de 8 meses. Onze variáveis foram estudadas: presença ou não de anquiloglossia, tipo de frênulo curto, altura, peso, perímetro craniano, sexo, Rh e grupo sanguíneo, idade gestacional, malformações e patologias neonatais associadas, de forma confidencial e anônima, correlacionando-as para ver se existia alguma associação entre eles. Resultados: Um total de 306 recém-nascidos foram incluídos no estudo (52% masculino e 48% feminino). A prevalência de anquiloglossia foi de 6,54% (n=20). Do total de homens (159/306), 8.125% (n=13) apresentavam anquiloglossia, enquanto nas mulheres (147/306) a prevalência foi de 4,79% (n=7), sem encontrar diferenças estatisticamente significantes em relação ao sexo (valor-p = 0,24). De acordo com a classificação de Coryllos, o tipo II foi o mais frequente (95% dos casos) e 4,58% dos lactente com anquiloglossia apresentaram patologia / malformação. Conclusões: A prevalência de anquiloglossia em recém-nascidos em Andorra, Europa, é semelhante à observada por outros autores em investigações semelhantes. Não foi observada associação entre a presença ou não anquiloglossia e as variáveis estudadas

Aim: to determine the prevalence of ankyloglossia in new-borns of the Nostra Senyora de Meritxell Hospital in the Principado de Andorra, Europe, as well as the existing relationship with auxological data or other malformations or associated diseases. Material and methods: A descriptive, cross-sectional, retrospective population study of 306 newborns was carried out over a period of 8 months. Eleven variables were studied: presence or no of ankyloglossia, type of short frenulum, height, weight, cranial perimeter, sex, Rh and blood group, gestational age, malformations and associated neonatal pathologies, confidentially and anonymously, correlating them to see if there was any association between them. Results: A total of 306 new-borns were included in the study (52% male and 48% female). The prevalence of ankyloglossia was 6,54% (n=20). Of the total of men (159/306), 8,125% (n=13) presented ankyloglossia, while woman (147/306), the prevalence was 4,79% (n=7), without finding statistically significant differences regarding sex (p-value=0,24). According to the Coryllos classification, type II was the most frequent (95% of cases) and 4,58% of infants with ankyloglossia exhibited pathology/malformation. Conclusions: The prevalence of ankyloglossia in new-borns in Andorra, Europe, is similar to that observed by other authors in similar research. No association was observed between the presence or not of ankyloglossia and the variables studied

Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012-2016.

Ankyloglossia, or "tongue-tie," refers to limited tongue mobility caused by a restrictive lingual frenulum. Previous studies have demonstrated rapid increases in diagnosis and treatment of ankyloglossia in the United States up to 2012. We performed an updated retrospective review of data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to evaluate trends in diagnosis of ankyloglossia and use of lingual frenotomy in the hospital setting. From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures. As seen previously, sex, type of insurance, median income ZIP code, and geographic region were associated with diagnosis of ankyloglossia. The observed trends from prior to 2012 have continued to increase, while unanswered questions about diagnostic criteria and about which infants should undergo frenotomy remain.

Implications of Ankyloglossia on Breastfeeding.

OBJECTIVE: The purpose of this integrative review was to synthesize the literature on the relationship between infant breastfeeding and ankyloglossia. DATA SOURCES: The search terms tongue-tie or ankyloglossia and breastfeeding were used via CINAHL, Ovid MEDLINE, Health Reference Academic, and PsycINFO. Primary research articles and clinical reviews were considered in the search parameters. STUDY SELECTION: Searches yielded 201 articles written in English and published between 1999 and 2018. After screening, 50 full-text articles were assessed for eligibility, 43 of which were omitted for irrelevance. Three qualitative and four quantitative studies remained for inclusion in the review. DATA EXTRACTION: Studies were reviewed for information on the relationship between ankyloglossia and breastfeeding. Studies examining results of ankyloglossia treatment were omitted. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. DATA SYNTHESIS: Analysis revealed a varied degree of difficulties with breastfeeding when the infant has ankyloglossia. Prevalence is uncertain due to lack of universal screening guidelines, and infrequent use of screening tools. No studies were found that examined psychological ramifications of feeding difficulties with ankyloglossia. There are no validated screening tools for ankyloglossia. CONCLUSION: More research is necessary on effects of breastfeeding difficulties of infants with ankyloglossia on the mother-infant relationship. A reliable screening tool needs to be developed and validated. Education for nurses to assess infants with ankyloglossia in a systematic fashion should be explored. Investigation of psychological sequelae, including maternal stress, postpartum depression, and mother-infant bonding is an important next step in the research of infants with ankyloglossia.

Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012.

Objectives (1) Describe trends in the diagnosis of ankyloglossia and the use of lingual frenotomy and (2) analyze patient- and hospital-level factors as compared with the total pediatric discharge population. Study Design National database analysis. Methods We reviewed available data from 1997 to 2012 using the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. All weighted pediatric discharges with ankyloglossia, newborn feeding difficulty, or lingual frenotomy were analyzed for variables of sex, payer, zip code median income, hospital ownership, location/teaching status, bed size, region, and children's hospital status. Chi-square analysis with 95% CIs and odds ratio were used to identify differences between the study group and the total database discharge population. Results Diagnosis of ankyloglossia increased each year of publication (every third year)-with 3934, 5430, 7785, 11,397, 19,459, and 32,837 children, respectively, from 1997 to 2012-with the largest increase in the last 6 years. Similarly, frenotomy increased with 1279, 1633, 2538, 3988, 6900, and 12,406 procedures. Compared with the total discharge population, children with ankyloglossia or frenotomy were more often male (63.6% ankyloglossia, 65.3% frenotomy vs 51.2%), privately insured (60.1%, 62.1% vs 43.6%), from a higher median-income zip code (78.1%, 78.2% vs 68.6%), and in Midwest region (29.3%, 32.3% vs 21.7%). Conclusion These pilot data show increases in diagnoses of ankyloglossia and use of frenotomy. There is a preponderance of children who are male, privately insured, or Midwest residents being diagnosed and treated for ankyloglossia. This broad variation may reflect local practice patterns or imply cultural and socioeconomic bias.

The prevalence of ankyloglossia in 302 newborns with breastfeeding problems and sucking difficulties in Barcelona: a descriptive study.

AIM: Oral and maxillofacial development is influenced by the lingual frenulum and also affects breathing, occlusion, sucking, swallowing, speech, among others. Ankyloglossia in the newborn may result in breastfeeding difficulties: maternal nipple pain and/or erosion or mastitis, poor weight gain and excessively long breastfeeds. The main objective of this work is to study the prevalence of ankyloglossia in newborns with breastfeeding difficulties. MATERIALS AND METHODS: This is a transversal descriptive study of 302 patients, between 0 and 6 months, who attended the hospital as a result of breastfeeding difficulties. All patients with sucking problems and ankyloglossia were included in this study and followed the multidisciplinary treatment protocol made up of the services of Breastfeeding, Speech Therapy and Orofacial Rehabilitation and Oral and Maxillofacial Surgery. RESULTS: 1,102 newborns were seen at the paediatric service of Hospital de Nens, Barcelona (Spain) during 2 years; 302 had breastfeeding difficulties and of these, 171 were diagnosed with ankyloglossia (60 girls and 111 boys). Coryllos Grade 3 ankyloglossia was the most prevalent (59.6%) type; 85 infants (49.7%) were exclusively breastfed and 26 (50.35%) were mixed fed (formula and breastfeeding). Only 43 patients had a family history of tongue-tie (25.1%). CONCLUSION: Ankyloglossia linked to breastfeeding difficulties must be treated by a multidisciplinary team. We have found a high prevalence of the condition since the population studied are newborns with sucking problems. If a frenotomy is necessary, we recommend stimulating suction with myofunctional therapy before and after surgery to avoid scar retraction.

Prevalência de anquiloglossia em recém-nascidos e avaliação da confiabilidade e validade do Teste da Linguinha na triagem neonatal / Prevalence of ankyloglossia in newborns and reliability and validity of the Lingual Frenulum Assessment Protocol in Babies (Teste da Linguinha) in neonatal screening

Introdução: O exame de triagem neonatal, conhecido como "Teste da Linguinha" (TL), é realizado através da aplicação do "Protocolo de Avaliação do Frênulo da Língua em Bebês". Este exame é obrigatório em todos os hospitais e maternidades do Brasil desde dezembro de 2014 e tem por objetivo diagnosticar a anquiloglossia que tenha potencial de interferir negativamente no aleitamento materno. Objetivos: 1. Estimar a prevalência de anquiloglossia em recém-nascidos saudáveis de uma maternidade da rede pública de saúde do Rio de Janeiro; 2. Avaliar a confiabilidade e a validade de construto do TL na triagem neonatal. Métodos: O estudo foi realizado em uma maternidade pública do Rio de Janeiro. A amostra de díades mãe/filho incluiu neonatos saudáveis, a termo, de até 48 horas de vida e peso maior ou igual a 2.500 g. Os dados foram coletados por três examinadoras treinadas (duas odontopediatras e uma fonoaudióloga), através de entrevistas com as puérperas, observação da mamada e aplicação do TL. As mães foram entrevistadas um mês após o nascimento da criança, por telefone, por estudantes de odontologia. A confiabilidade do protocolo foi medida através da sua consistência interna e estabilidade. A validade de construto foi analisada através da correlação entre: os escores produzidos com a aplicação do instrumento; indicadores autopercebidos de sucesso e insucesso da amamentação; e a dificuldade na amamentação, medida através do Protocolo de Observação da Mamada ­ UNICEF adaptado. A análise estatística foi feita com o programa Stata 14.0®. Resultados: Entre 25.08.2015 a 30.09.2015 foram examinadas 268 díades mãe/filho. A prevalência da anquiloglossia foi igual a 2,24% (IC 95% = 0,83%; 4,81%). O valor do coeficiente de correlação intraclasse para a confiabilidade entre as três examinadoras foi 0,77 (IC95%:0,64; 0,89) e o valor do coeficiente Alfa de Cronbach para a consistência interna foi 0,28 (limite inferior do IC 95%: 0,14). A correlação entre a pontuação total da escala e a autopercepção: da dificuldade para amamentar, da satisfação com a amamentação, e da dor ao amamentar foram 0,05 (p=0,42), 0,01 (p=0,87) e 0,007 (p=0,92), respectivamente. A correlação entre a pontuação do "TL" e o Protocolo de Observação da Mamada UNICEF- adaptado foi 0,27 (p<0,001). Conclusão: A prevalência da anquiloglossia foi muito baixa O "TL" utilizado na triagem neonatal apresentou estabilidade aceitável e baixa consistência interna. Não foi possível confirmar a sua validade. Esses achados sugerem que o seu uso na identificação de recém-nascidos com anquiloglossia capaz de interferir negativamente na amamentação não deve ser recomendado.

Introduction. The "Lingual Frenulum Assessment Protocol in Babies", popularly known as "Teste da Linguinha" (TL), is a neonatal screening test mandatory in all hospitals and maternity hospitals in Brazil since December 2014. The TL aims to diagnose ankyloglossia that may have a negative impact on breastfeeding. Objectives. 1. To estimate the prevalence of ankyloglossia in healthy newborns from a public maternity in Rio de Janeiro; 2. To evaluate the reliability and validity of the "Lingual Frenulum Assessment Protocol in Babies" when it is used as a screening test. Methods. This study was conducted at a public maternity in the city of Rio de Janeiro, Brazil. The TL was applied to a sample of healthy term newborns, weighing 2.500 g or more, within 48 hours of birth. Data were collected by three trained examiners (two pediatric dentists and one speech therapist), through interviews with the mothers, assessment of breastfeeding and the application of the TL to newborns. One month after the child´s birth, mothers were interviewed by phone by undergraduate dental students in order to collect information about their experiences with breastfeeding after hospital discharge. The assessment of the reliability of the TL included the measurement of its internal consistency and stability. The validity of the protocol was analyzed by the correlation between the scores of the instrument and those of self-perceived indicators of breastfeeding success and failure, and professionally determined breastfeeding difficulty as measured by the Adapted Breastfeeding Observation Aid UNICEF protocol. Statistical analysis was performed with Stata 14.0® software. Results. Total sample comprised 268 dyads mothers/child, recruited between August 25 and September 30, 2015. The prevalence of anklyloglossia was 2.24% (IC 95% = 0.83; 4.81%). The inter-rater reliability among the three examiners as measured by the intraclass correlation coefficient was 0.77 (95% CI: 0.64, 0.89) and the Cronbach's alpha coefficient for internal consistency was 0.28 (95% CI lower limit: 0.14). The correlations between the total TL score and self-perceived difficulty to breastfeed, satisfaction with breastfeeding, and pain while breastfeeding were respectively 0.05 (p = 0.42), 0.01 (p = 0.87) and 0.007 (p = 0.92). The correlation between the TL score and the adapted UNICEF protocol was 0.27 (p <0.001). Conclusion. The prevalence of anklyloglossia was very low. The "Lingual Frenulum Assessment Protocol for Babies" used as a screening test presented acceptable stability and low internal consistency. It was not possible to confirm its validity. These findings suggest that the use of the "Lingual Frenulum Assessment Protocol for Babies" for identifying newborns with ankyloglossia that may negatively interfere with breastfeeding should not be recommended.