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Upper lip tie: A novel classification scale with improved inter-rater reliability.

Raymond J So1, Carolyn Jenks1, Marisa A Ryan1

  • 1Department of Otolaryngology Johns Hopkins University School of Medicine Baltimore Maryland USA.

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|October 19, 2022
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Summary

A new 3-point classification system for upper lip tie (ULT) offers improved reliability over existing methods. This novel scale, incorporating three oral parameters, provides a more comprehensive assessment of restrictive superior labial frenulum (SLF) attachments in newborns.

Keywords:
Kotlow classificationnovel scalesuperior labial frenulumupper lip tie

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Area of Science:

  • Oral surgery
  • Pediatric dentistry
  • Neonatal care

Background:

  • Upper lip tie (ULT) involves restrictive superior labial frenulum (SLF) attachment, potentially affecting lip function.
  • Current classification systems for ULT lack reliability due to reliance on single parameters.
  • Objective outcome studies are limited by the inadequacy of existing diagnostic tools.

Purpose of the Study:

  • To introduce a novel 3-point classification system for upper lip tie (ULT).
  • To compare the inter-rater reliability of this new system against the Kotlow and Stanford classification systems.
  • To enhance the characterization of restrictive superior labial frenulum (SLF) conditions.

Main Methods:

  • Five raters evaluated images of the superior labial frenulum (SLF) from 20 newborns.
  • The Kotlow, Stanford, and a novel 3-point classification systems were used for scoring.
  • Inter-rater reliability was calculated using Fleiss's kappa.

Main Results:

  • The novel 3-point scale demonstrated the highest inter-rater reliability at 0.41.
  • The Kotlow and Stanford systems showed lower inter-rater reliability, with kappa values of 0.24 and 0.25, respectively.
  • The new system incorporates attachment length, frenulum stretch length, and lip length ratio.

Conclusions:

  • The novel 3-point classification system for upper lip tie (ULT) offers superior inter-rater reliability.
  • This system utilizes three oral parameters, including a functional assessment, for a more complete characterization of the superior labial frenulum (SLF).
  • The proposed classification scheme addresses limitations of previous single-parameter systems.