Assessment of tongue structure and function in infants for the diagnosis of ankyloglossia: A systematic review

Emma Necus; Mary Claessen; Neville Hennessey; Sharon Smart

doi:10.1016/j.ijporl.2025.112485

Assessment of tongue structure and function in infants for the diagnosis of ankyloglossia: A systematic review

Int J Pediatr Otorhinolaryngol. 2025 Sep:196:112485. doi: 10.1016/j.ijporl.2025.112485. Epub 2025 Jul 11.

Authors

Emma Necus¹, Mary Claessen², Neville Hennessey³, Sharon Smart⁴

Affiliations

¹ Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia. Electronic address: emma.necus@postgrad.curtin.edu.au.
² Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Speech Pathology Australia, Melbourne, Victoria, Australia. Electronic address: mclaessen@speechpathologyaustralia.org.au.
³ Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia. Electronic address: n.hennessey@curtin.edu.au.
⁴ Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia. Electronic address: sharon.smart@curtin.edu.au.

PMID: 40729922
DOI: 10.1016/j.ijporl.2025.112485

Abstract

Background: Ankyloglossia, commonly referred to as tongue tie, has become a topic of increasing interest for health care professionals and families. Global data reports a significant increase in surgical intervention to treat ankyloglossia. It is essential that professionals can identify ankyloglossia in infants accurately and reliably as a basis for providing evidence-based recommendations and intervention, and to understand better its potential impact and outcomes for infants and children.

Aims: The systematic review aimed to (i) identify assessments of tongue structure and function used to diagnose ankyloglossia in infants from birth to 12 months; (ii) evaluate the psychometric properties of these tools, and (iii) identify a comprehensive assessment tool based on the review's findings.

Methods: The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to guide this systematic review. Searches for peer-reviewed articles were conducted on five electronic databases: Nursing and Allied Health Literature (CINAHL), ProQuest, Web of Science (WOS), Medline and Maternal and Infant Care (OVID).

Results: A total of 117 studies met the inclusion criteria and were included in a narrative synthesis of extracted data. Nine assessment tools were identified with varying parameters of appearance and function included, as well as inconsistency in reporting of reliability and validity. Few studies used a measure of feeding as a diagnostic feature when identifying ankyloglossia in study participants.

Conclusion: Based on the findings from this review, the Lingual Frenulum Protocol for Infants (LFPI) had the most reported reliability and validity for the assessment of tongue structure and function and is the most comprehensive tool for ankyloglossia diagnosis. Other tools are useful screeners in clinical practice, but do not provide an in-depth assessment of feeding function. The literature overall supports the notion that a comprehensive assessment of both structure and function, including feeding impact, is required to diagnose ankyloglossia. Based on this evaluation, recommendations for surgical and/or non-surgical intervention pathways can then be considered.

Keywords: Ankyloglossia; Breastfeeding; Feeding; Infants; Oral motor; Psychometrics; Tongue function; Tongue structure; Tongue tie.

Publication types

Systematic Review

MeSH terms

Ankyloglossia* / diagnosis
Ankyloglossia* / physiopathology
Female
Humans
Infant
Infant, Newborn
Male
Psychometrics
Tongue* / abnormalities
Tongue* / physiopathology