Tongue-and lip-tie beyond breastfeeding difficulties

Abstract

The diagnosis and treatment of tethered oral tie tissues, such as ankyloglossia (tongue-tie) and lip-tie, have grown substantially. Although robust evidence indicates that these abnormal anatomic variations are associated with breastfeeding difficulties, impaired craniofacial growth, sleep, speech and posture in children, both diagnosis and treatment of oral ties remain controversial. The oral cavity displays considerable morphological variation across individuals. One of these variations includes tight, restrictive connective tissue between oral structures known as tethered oral tie tissues (TOTs). The clinical view regarding these anomalies has evolved with increasing interest not only in tongue-tie (ankyloglossia) but also in lip-tie [1-3]. Ankyloglossia has been considered a risk factor for breastfeeding difficulties [4-16]. Recent evidence indicates that TOTs can be also associated with whole-body consequences, such as reflux, dental malocclusion, and respiratory disorders, ultimately increasing the risk of sleep and speech disorders, and detrimental changes in posture and eating patterns [13, 17-25]. The prevalence of TOTs is highly variable across populations and is still a matter of ample debate. Currently, there is a lack of consensus on diagnosis criteria, best surgical treatment techniques, and pre- and post-surgery care [19, 26, 27]. Yet, the diagnosis and surgical treatment of TOTs have substantially increased in recent years [28-31]. This mini-review will summarize evidence-based data regarding the cascade of consequences of tongue-tie and lip-tie in children and the main signs and symptoms of these anomalies in newborns. It will also discuss the available evidence on treatment options for TOTs, including pre- and post-surgical care that may enable better outcomes and prevention of possible complications. For a better understanding, tongue-tie and lip-tie will be addressed separately.