Capturing a Moment in an Evolving Landscape: Contemporary Management of Ankyloglossia

Abstract

This special issue on ‘Contemporary Approaches to Collaborative Management in Ankyloglossia’ contains a collection of scholarly papers that address the assessment, diagnosis, treatment, and follow-up care of tethered oral tissues (TOTs). In this column, the editors summarize the content of the issue and reflect upon its relevance at the current time in the evolution of research and clinical care of TOTs.

As guest editors, we are pleased to present this special issue on Contemporary Approaches to Collaborative Management in Ankyloglossia. This collection of scholarly papers delves into the assessment, diagnosis, treatment, and follow-up care of tethered oral tissues (TOTs) reflecting the global reach, collaborative care and continually evolving field of ankyloglossia research and treatment. This issue is published at a pivotal time, as clinicians, researchers, and families navigate the complexities of tongue-tie and its many impacts on oral function and development across the lifespan. The increasing awareness of the complex nature of ankyloglossia has driven a surge in research over the past decade, focusing on its diverse impacts on breastfeeding, speech, swallowing, craniofacial development, sleep- disordered breathing, and various other functions, many of which are still being explored. Despite this progress, much is still unknown. This special issue emphasizes the key themes of "contemporary approaches" and "collaborative management."

We humbly acknowledge that this issue captures a moment in a rapidly advancing field. Over the last decade, we have witnessed significant progress in diagnostic criteria, assessment tools, and treatment methodologies. However, with progress comes the recognition of ongoing challenges. How do we ensure that diagnostic and therapeutic approaches are standardized without oversimplifying the nuances of individual cases? How can we better quantify the long-term outcomes of interventions for infants, children, and even adults? And how do we convince the naysayers?

This issue seeks to explore innovative techniques from our global community, engage in thoughtful exploration of questions still unanswered, and pursue a forward-thinking multidisciplinary perspective on ankyloglossia management. Our journal opens with ‘Global Perspectiveson Tongue-tie Assessment, a review paper by Smart, Whitfield, and Claessen examining the variations in clinical approaches to diagnosis of ankyloglossia in children aged one to 10 years, emphasizing the need for standardization among assessment tools while acknowledging the global diversity of clinical practices. Clinical Perspectives on Post-operative Care for TetheredOral Tissues (TOTs), by Merkel-Walsh and Overland, reminds us that the contemporary view of management focuses not only on diagnosis and surgical treatment, and the prehab and aftercare should be tailored to each patient to ultimately provide the best outcomes for our patients.

As editors, we are particularly inspired by the collaborative spirit, which is essential, and defines this field. The paper International Consortium of oral AnkylofrenulaProfessionals (ICAP): Practice Guidelines for Ankylofrenula Management by Smart, Kittrell, Merkel- Walsh, and Tseng reiterates that no single discipline or perspective can fully address the multifaceted nature of ankyloglossia and its management. Collaboration remains essential in advancing both our understanding and treatment of ankyloglossia and reflects a shared commitment to improving outcomes for children and families.

The Conference Proceedings of the 2024 International Consortium of oral Ankylofrenula Professionals (ICAP) Convention showcases presentation abstracts from an international community of ankyloglossia professionals and highlights the efforts by clinicians and researchers to collaborate to answer these difficult questions as a global community.

We hope this issue serves as both a snapshot of the current state of research, and as a catalyst for future inquiry. The articles herein invite readers to think critically about the existing evidence and to engage in a concerted effort to foster open, evidence-based dialogue, acknowledging that there is always room for improvement. Papers like Hill’s ‘Feeding and Gastrointestinal Symptomatology’ and Khatri, Musani, Udavant, and Parikh’s systematic review ‘Gastrointestinal Symptom Improvement in Infants after Restrictive Tethered Oral Tissue Release’ remind us to confirm the current base of knowledge under different lenses to make sure that future, iterative advances are built on a solid foundation. By embracing well-designed studies to comprehensively understand the complexities of ankyloglossia and its potential sequelae, we can innovate, while addressing skepticism with the same scientific integrity that drives all meaningful progress. More importantly, it enables us to move forward, together.

We are profoundly grateful to the authors, reviewers, and researchers who contributed to this special issue. This collection of work showcases the breadth and depth of current research in the field. Contributions range from investigations into the effectiveness of frenotomy and other surgical interventions, to studies examining the complex and nuanced role of myofunctional therapy in addressing the effects of restricted lingual mobility. These works reflect the interdisciplinary nature of ankyloglossia management, highlighting the critical roles of pediatricians, dentists, lactation consultants, speech- language pathologists, manual therapists, and other allied health professionals in delivering comprehensive care. To our readers, we encourage you to engage with this issue with curiosity and an open mind. May the insights shared here re-inspire you to refine your craft to continually enhance the lives of the patients and families we serve.

Warmly,

Dr. Raymond Tseng and Dr. Sharon Smart