Feeding, Speech, and Sleep-Related Breathing Outcomes in Ankyloglossia With and Without Lingual Frenotomy

Introduction: Tongue tie diagnoses and surgeries are increasing at a booming rate, with some ankyloglossia stakeholders suggesting non-feeding roles for frenotomy in children such as in preventing obstructive sleep apnea (OSA) and speech problems, though the data on these topics are limited. This study aims to evaluate feeding, speech, and OSA-related outcomes in children with ankyloglossia who undergo and do not undergo lingual frenotomy.

Methods: The TriNetX EMR research database was queried in January 2024 for patients ages 18 years and under with ankyloglossia. Patients were assigned to one of two cohorts based on whether they underwent lingual frenotomy. Cohorts were matched based on age at ankyloglossia diagnosis, prior feeding difficulties, and prior sleep-related breathing diagnoses (OSA, snoring, mouth breathing) prior to frenotomy/ankyloglossia diagnosis. Outcomes compared between cohorts included feeding difficulties, speech problems, OSA, snoring, and mouth breathing diagnosed after frenotomy/ankyloglossia diagnosis. Results are reported as risk percentages and risk differences with analysis conducted using chi-square testing.

Results: After 1:1 propensity score matching, a total of 55,724 patients were included in the study sample: 27,862 patients within each cohort. Mean age at ankyloglossia diagnosis was roughly 1.5 years old in both cohorts. Ankyloglossia patients who underwent frenotomy had 1.52% lower risk of feeding problems than those who did not undergo frenotomy (12.09% vs 13.6%, p < 0.0001). Frenotomy patients had 1.10% higher risk of snoring that non-frenotomy patients (9.26% vs 8.17%, p < 0.0001). Frenotomy and non-frenotomy patients did not have statistically different risk of speech problems (13.74% vs 13.54%, p = 0.48), OSA (8.51% vs 8.56%, p = 0.84), or mouth breathing (1.78% vs 1.67%, p = 0.28).

Conclusions: This study affirms the feeding-facilitating role of lingual frenotomy in ankyloglossia patients with feeding difficulties. These data support that lingual frenotomy and ankyloglossia do not affect speech, OSA, or mouth breathing, and that lingual frenotomy may worsen snoring.