title: Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects.
abstract: OBJECTIVE
  Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility.
  
  
  METHODS
  A prospective cohort study of 1052 consecutive patients was evaluated during a 3-month period. Age, gender, ethnicity, height, weight, BMI, maximal interincisal mouth opening (MIO), mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP), Kotlow's free-tongue measurement, and presence of severe tongue-tie were recorded. Secondary outcome measures include tongue range of motion deficit (TRMD, difference between MIO and MOTTIP) and tongue range of motion ratio (TRMR, ratio of MOTTIP to MIO).
  
  
  RESULTS
  Results indicate that MIO is dependent on age and height; MOTTIP and TRMD are dependent on MIO; Kotlow's free-tongue measurement is an independent measure of free-tongue length and tongue mobility. TRMR is the only independent measurement of tongue mobility that is directly associated with restrictions in tongue function.
  
  
  CONCLUSIONS
  We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. "Functional" ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50-80%, grade 3 < 50%, grade 4 < 25%.
authors.affiliation: Sections of Pediatric Dentistry and Orthodontic, Division of Growth and Development, UCLA School of Dentistry, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA. jungdds@gmail.com.
authors.forename: Audrey
authors.identifier: http://orcid.org/0000-0001-6807-7686
authors.initials: A
authors.lastname: Yoon
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery School of Medicine, Stanford University, Stanford, CA, 94305, USA.|UCLA Health, Santa Monica, CA, 90404, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Weitzman
authors.affiliation: UCLA School of Dentistry, Los Angeles, CA, 90095, USA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Ha
authors.affiliation: Sections of Pediatric Dentistry and Orthodontic, Division of Growth and Development, UCLA School of Dentistry, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
authors.forename: Clarice S
authors.initials: CS
authors.lastname: Law
authors.affiliation: Stanford Outpatient Medical Center, Stanford University Sleep Medicine Division, Redwood City, CA, 94063, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery School of Medicine, Stanford University, Stanford, CA, 94305, USA.
authors.forename: Stanley Y C
authors.initials: SYC
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000072676:Ankyloglossia / Q000175:diagnosis* / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D008035:Lingual Frenum / Q000002:abnormalities*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014059:Tongue / Q000002:abnormalities / Q000503:physiopathology*
keywords: Ankyloglossia; Classification of ankyloglossia; Frenulum; Oromyofacial dysfunction; Tongue tie; Tongue tie grading scale