Progress towards a functional definition of ankyloglossia!

The tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing/eating, speaking, and much more. Ankyloglossia (tongue tie) is a congenital anomaly that is generally characterized by an abnormally short, thick lingual frenulum which affects movement of tongue. ​

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Until recently, the methods commonly used for screening and defining tethered oral tissues have been limited in their inclusion of "function" as a key variable in assessment.

Conventional definitions of ankyloglossia have been based on assessments of “free tongue length”. In the past decade, research advances have been made that examine mobility using the tongue range of motion ratio (TRMR) while the tongue tip is extended towards the incisive papilla (TIP). This measurement has indeed been helpful in assessing for variations in the mobility of the anterior 1/3 of the tongue (tongue tip to apex), however it can be insufficient to adequately assess the functional mobility of the posterior two-thirds of the body of the tongue. 

A team of researchers from the The Breathe Institute in Los Angeles, CA along with esteemed colleagues and collaborators from The Foundation of Airway Health, the Academy of Applied Myofunctional Sciences, and a host of other organizations (see full article), aware of these limitations, endeavored to refine a new, truly functional approach. Thus began the present study, titled: “Assessment of posterior tongue mobility using lingual‐palatal suction: Progress towards a functional definition of ankyloglossia.” - (Published in the Journal of Oral Rehabilitation, January 2021).

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www.FAIREST.org

This cross-sectional multicenter cohort study examined Six-hundred and eleven (611) subjects ages three (3) and up from the general population. Subjects were surveyed in a standardized fashion by interdisciplinary professionals trained in the evaluation of oro-facial myofunctional disorders at ten (10) different sites including researchers in the United States, Hong Kong, Estonia and Ireland as part of the Functional Airway Evaluation Screening Tool (FAirEST) study.​

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Measurements of tongue mobility using the validated Tongue Range of Motion Ratio (TRMR) were performed during two functional movements:
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a) with the tip of the subject’s Tongue on Incisive Papilla (TIP) - see fig. 1, and
b) while the subjects tongue was held in Lingual Palatal Suction (LPS) - see fig. 2.

fig. 1

fig. 2

Objective TRMR measurements were compared with subjective self-assessments of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate.

The advantage of the LPS (fig. 2) measurement is that it best describes one of the main functional outcome goals of myofunctional therapy: achieving tongue body to palate contact requisite for establishing ideal resting oral posture and swallow mechanics. LPS measurements have been used to track progress with tongue strengthening and rehabilitation in myofunctional, speech and swallow therapy protocols.

Dr. Soroush Zaghi, the principal investigator of this study said: “We can now fully appreciate the potential strength of the LPS measurements in identifying limitations in posterior tongue mobility that may be associated with functional deficits or submucosal restrictions that are not readily identified by other grading scales.”.    ​

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After all the intensive exploration ​(which is now one of the largest case series on the subject in the literature), it was concluded that this study validates TRMR-LPS as a useful, functional metric for assessing posterior tongue mobility. ​

It is research endeavors and studies such as this one that continue to inform and advance medicine and science, and everyone from providers, to patients benefits.

In order to facilitate the ongoing spread of new tools and information, The Breathe Institute makes all of its research publications open-access.   The full length article can be read here --->

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To learn more about The Breathe Institute, visit www.thebreatheinstitute.com