# Brazilian Academy of Paediatric Otorhinolaryngology Task Force – lingual frenulum disorders in childhood – evidence-based recommendations

## TL;DR

This paper provides evidence-based recommendations on diagnosing and managing lingual frenulum disorders in children, emphasizing lack of validated methods and surgical outcomes.

## Contribution

The paper offers the first evidence-based clinical recommendations for managing lingual frenulum disorders in children by a Brazilian task force.

## Key findings

- Most evaluation methods for lingual frenulum lack validation.
- Lingual frenotomy may reduce maternal pain during breastfeeding.
- No surgical technique is proven superior for frenectomy.

## Abstract

•Most of methods to evaluate lingual frenulum lack internal or external validation.•The diagnosis of submucosal lingual frenulum is controversial.•Ankyloglossia does not cause speech delay, dysphagia, sleep apnoea or reflux.•Lingual frenotomy may reduce maternal pain during breastfeeding.•No surgical technique or instrument in frenectomy is superior to another.

Most of methods to evaluate lingual frenulum lack internal or external validation.

The diagnosis of submucosal lingual frenulum is controversial.

Ankyloglossia does not cause speech delay, dysphagia, sleep apnoea or reflux.

Lingual frenotomy may reduce maternal pain during breastfeeding.

No surgical technique or instrument in frenectomy is superior to another.

To provide evidence-based recommendations for the diagnosis, assessment of functional impact, and management of altered lingual frenulum in children.

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on ankyloglossia, or lingual frenotomy were eligible for inclusion. The American College of Physicians’ guideline grading system was used for critical appraisal of evidence and recommendations for therapeutic interventions.

There are several methods described in the literature for the evaluation of the lingual frenulum, and most of them lack internal or external validation. There are no data supporting a relationship between altered lingual frenulum and dysphagia, orofacial alterations, malocclusion, social limitations, obstructive sleep apnoea, or gastroesophageal reflux. According to the studies, an altered lingual frenulum does not cause speech delay; however, some studies with very low levels of evidence show that an altered lingual frenulum may make the pronunciation of some phonemes more difficult. In children with an altered lingual frenulum, lingual frenotomy may reduce maternal pain during breastfeeding. Therefore, in children with an altered lingual frenulum, lingual frenotomy may be a good therapeutic option when there is a complaint of pain during breastfeeding. There are several surgical techniques described in the literature for the release of the lingual frenulum, as well as different instruments that can be used for this purpose. There is no scientific evidence that one method is superior to another.

Lingual frenectomy may improve maternal pain during breastfeeding and may be an option in selected cases of phonetic alterations.