Surgical indications for Ankyloglossia versus an objective and multidisciplinary diagnostic protocol

Aim: Ankyloglossia presents a clinical challenge where anatomical anomalies do not always correlate with functional deficits. This review aims to establish objective diagnostic criteria, moving beyond a purely morphological approach. The research seeks to define a decision making protocol to guide clinicians in patient selection, distinguishing between simple anatomical variations and pathological conditions requiring surgical correction (frenotomy, frenectomy or frenuloplasty) to ensure measurable post-operative benefits. Materials and methods: A systematic literature review was conducted using Pun Ned and Scopus database (updated to March 2025), focusing on surgical indications and objective assessment methods. Clinical studies, anatomical classification, and the efficacy of pre-and post- operative myofunctional therapy were analyzed. Results: Lingual frenulum assessment must be an integral part of a multidisciplinary oral examination involving dentists, speech therapists, and pediatricians. Traditional classifications based solely on appearance are often insufficient: recent studies (Wei Lisonek) demonstrated that many procedures fail to yield expected benefits due to inappropriate patient selection. A protocol proposed in 2023 integrates Coryllos and Tabby anatomical scales with a functional assessment based on four pillars: resting tongue position, lingual kinematics, mandibular movements, and pathological signs (e.g. dental indentations). This system converts clinical signs-such as breastfeeding difficulties, malocclusions, and temporomandibular disorders-into a numerical score. Following CES guidelines, clinicians can assign recommendation classes (“recommended”, “considered”, or “necessary”), reducing subjectivity and medico-legal risks. Conclusions: Ankyglossia surgery must be the results of a shared diagnostic pathway rather than an isolated act. Adopting objective methodologies is essential to avoid inappropriate treatments and prevent secondary complications, such as breastfeeding difficulties or gingival recessions. Further clinical trials are necessary to validate this methods as an international operative standard.