Tools and Criteria Used to Indicate Frenotomy/Frenectomy in Infants With Ankyloglossia: A Scoping Review

Background: The number of surgical interventions in infants to resolve ankyloglossia (tongue-tie) has been increasing. However, there seems to be no consensus on the criteria used to indicate frenotomy or frenectomy. Research Aim: To identify the assessment tools and criteria used to support surgical decision-making in cases of ankyloglossia in infants. Methods: A scoping review was conducted. Studies were retrieved from six electronic databases: PubMed, Embase, Central, LILACS, Scopus, and ProQuest. The articles were assessed in two stages: (1) title/abstract screening and (2) full-text analysis. Clinical trials and observational studies involving infants less than 23 months of age with tongue-tie and submitted to frenotomy or frenectomy were included. Data on the assessment tools and criteria used to diagnose ankyloglossia and indicate surgery were extracted from the studies. Results: A total of 606 documents were identified and 53 were included. Surgical decision-making was based on assessment tools, such as the Coryllos classification ( n = 17), Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF; n = 12), Bristol Tongue Assessment Tool (BTAT; n = 3), and Lingual Frenulum Evaluation Protocol for Infants/Tongue-Tie Test ( n = 4). Other studies adopted a combination of clinical criteria and complaints related to breastfeeding. Conclusion: The findings show that heterogeneity in the choice of assessment tool differences in cut-off points, and in the interpretation of anatomical, functional, and breastfeeding-related findings used to justify surgery. This underscores the need for standardized, evidence-based criteria to guide when frenotomy should be recommended in infants with ankyloglossia.