A Protocol for In-Office Management of Infant Ankyloglossia

ObjectiveRecent studies redefine the infant lingual frenulum as a dynamic structure formed by oral mucosa, floor-of-mouth fascia, and genioglossus muscle, rather than a mucosal band. Many existing studies rely on simple sublingual mucosa 'snip' techniques, which have led to high revision rates (8-29%). We review a protocol for infant ankyloglossia management aligned with current expert recommendations to achieve optimum frenulum release.MethodsIn this retrospective case series from a single academic pediatric otolaryngology practice (2002-2023), infants with clinically significant ankyloglossia underwent frenulotomy with complete division of the lingual frenulum to the sublingual fold. If release was functionally incomplete, central dissection continued to include floor of mouth fascia and genioglossus fibers. Demographics, procedural characteristics, mother-infant dyad satisfaction, and complications were recorded.ResultsOf 1,367 infants evaluated, 585 underwent in-office frenulotomy. Mean age was 27.66 days (SD = 31.08), and 62.22% were male. Anterior division was performed in 91.45% of cases, while 8.55% required posterior release. Successful division, defined as improved tongue mobility and/or feeding, was achieved in 98.97% of cases. Five infants (0.85%) required revision surgery. One child required silver nitrate cautery for bleeding.ConclusionsThis microscopically guided approach to infant lingual frenula release demonstrates excellent results with few complications in the office setting.Level of Evidence4 - Case Series.