Tools and Criteria Used to Indicate Frenotomy/Frenectomy in Infants With Ankyloglossia: A Scoping Review

The number of surgical interventions in infants to resolve ankyloglossia (tongue-tie) has been increasing. However, there seems to be no consensus on the criteria used to indicate frenotomy or frenectomy.

To identify the assessment tools and criteria used to support surgical decision-making in cases of ankyloglossia in infants.

A scoping review was conducted. Studies were retrieved from six electronic databases: PubMed, Embase, Central, LILACS, Scopus, and ProQuest. The articles were assessed in two stages: (1) title/abstract screening and (2) full-text analysis. Clinical trials and observational studies involving infants less than 23 months of age with tongue-tie and submitted to frenotomy or frenectomy were included. Data on the assessment tools and criteria used to diagnose ankyloglossia and indicate surgery were extracted from the studies.

A total of 606 documents were identified and 53 were included. Surgical decision-making was based on assessment tools, such as the Coryllos classification (n = 17), Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF; n = 12), Bristol Tongue Assessment Tool (BTAT; n = 3), and Lingual Frenulum Evaluation Protocol for Infants/Tongue-Tie Test (n = 4). Other studies adopted a combination of clinical criteria and complaints related to breastfeeding.

The findings show that heterogeneity in the choice of assessment tool differences in cut-off points, and in the interpretation of anatomical, functional, and breastfeeding-related findings used to justify surgery. This underscores the need for standardized, evidence-based criteria to guide when frenotomy should be recommended in infants with ankyloglossia.