Dramatic Increase in Tongue Tie-Related Articles: A 67 Years Systematic Review

Background: Tongue tie or ankyloglossia articles are recorded in the Medline since 1949. Objective: To study trends in yearly number of tongue tie or ankyloglossia publications. Methods: Medline search engine was used to determine the yearly number of published consensus statements from 1949 to 2016. Keywords of tongue tie OR ankyloglossia OR frenotomy OR frenulotomy were used for the search. Articles were classified as case reports (or series), reviews, editorials (or opinions), cohort studies, clinical trials (nonrandomized), randomized controlled trials (RCT), and systematic reviews (SR). Linear or polynomial regression was used to determine trends. We also systematically summarized all RCTs published to date. Results: The total number of yearly published articles increased in a cubic fashion (r(2) = 82.6%, p < 0.0001) over time (0-7 per year from 1949 to 1989, and up to 27-44 in the last 5 years). In terms of strength of evidence hierarchy, most articles belonged to low hierarchy categories (case reports 37.9%, reviews 15.4%, and editorials/opinions 13.4%), with only 8 RCTs and 10 SRs (all of them published during the last 10 years of the study period). Conclusion: The yearly number of tongue tie or ankyloglossia-related articles has increased dramatically in past few years. Most articles bring little evidence, but the past few years have witnessed publication of few RCTs and SRs. If this trend continues, much more solid evidence should accumulate about diagnosis and management of tongue tie, as it relates to breastfeeding and other outcomes.