Analysis of the included studies in the discussion section.
| Authors | Type of study | Aim | Materials and methods | Outcomes |
|---|---|---|---|---|
| Zaghi et al. (2019) [73] | Clinical study | To evaluate the safety and efficacy of lingual frenuloplasty combined with myofunctional therapy in a large sample. | Retrospective study on 348 patients (mean age 24.5 years) treated with lingual frenuloplasty and OMT. Evaluations included sleep quality (PSQI), postural assessments, pain (VAS scale), and speech function at 1, 3, and 6 months postoperation. | 96% reported improved breathing; 87% improved resting tongue posture; 68% improved sleep quality. AHI improved > 30% in mild OSAS cases. No major complications were recorded. |
| Lichnowska et al. (2024) [74] | Prospective RCT | To assess the effectiveness of lingual frenuloplasty combined with myofunctional therapy in patients with maxillofacial deformities. | Prospective RCT on 155 patients aged 7 to 50 years with ankyloglossia and class II/III malocclusions. Participants were randomly assigned to receive either myofunctional therapy alone or in combination with lingual frenuloplasty. Clinical evaluations were performed at 6 and 12 months postoperation. | Patients who received both frenuloplasty and myofunctional therapy showed significantly greater improvements in tongue mobility, swallowing function, nasal breathing, and resting tongue posture compared to controls. |
| Carminatti et al. (2022) [75] | RCT | To compare frenectomy with and without myofunctional therapy in children. | The study included 40 children aged 6 to 12 years with ankyloglossia, all of whom underwent a lingual frenectomy. After 15 days, participants were randomized into two groups: one group performed isotonic tongue exercises for 15 days, while the control group received no additional therapy. | Children who received myofunctional exercises showed significantly better results in tongue mobility and mouth opening compared to the control group. |
| Ferrés-Amat et al. (2016) [76] | Descriptive cohort study | To describe a multidisciplinary treatment protocol for children with ankyloglossia and evaluate its clinical effectiveness. | 101 children aged 4 to 14 years were treated with a combined approach that included one week of preoperative myofunctional therapy, surgical frenectomy with lingual plasty, and postoperative rehabilitation. Followups were conducted at 3, 15, and 45 days postoperatively. | Surgery alone led to improvement in 28% of cases, while the full protocol, including myofunctional therapy, resulted in complete resolution in 96% of patients. |
| Zhao et al. (2024) [77] | RCT | To determine the optimal timing and effectiveness of frenotomy (infant tongue-tie release) on speech articulation and intelligibility in young children with ankyloglossia. | The study involved 341 children aged 2 to 5 years with speech difficulties due to tongue-tie. They were randomly assigned to either undergo frenotomy or receive no surgical treatment. Children were further grouped by age (2 to 3, 3 to 4, and 4 to 5 years) and assessed at 2, 6, and 12 months postintervention using clinical and speech-language evaluation tools. | In the youngest group (under 3 years), no significant difference in speech articulation or tongue mobility was observed between those treated and untreated. However, in children aged 3 to 5 years, those who underwent frenotomy showed clear improvements in speech production and intelligibility compared to controls. |
| Fioravanti et al. (2021) [78] | Randomized, double-blind, CCT | To determine if performing a diode laser lingual frenectomy in children with a short tongue-tie can help reduce the severity of OSAS. | The study involved 32 children aged 4 to 13 years, all diagnosed with OSAS and restricted tongue mobility. Participants were randomly assigned to two groups: one received a lingual frenectomy using a diode laser along with myofunctional and speech therapy, while the control group received only the therapy without surgery. Sleep quality was assessed with polysomnography before and three months after treatment. Pain perception was also recorded. | At 3-month followup: in the laser group, 93.8% had mild OSAS and 6.2% moderate; in the control group, only 18.8% had mild OSAS, 62.5% moderate, and 18.8% remained severe. |
| Gouvêa et al. (2025) [79] | RCT | To examine the immediate effect of photobiomodulation on tongue strength. | 30 randomized patients (mean age 16.2 years). Laser group received 810 nm, 100 mW, 60 s photobiomodulation; control group received placebo. Tongue pressure assessed using IOPI before and 10 minutes after intervention. | Laser group had a 21.4% increase in tongue pressure (28.5–34.6 kPa; p = 0.03). No adverse effects. Placebo group showed no significant change. |
| Scarano et al. (2023) [80] | Prospective cohort study | To evaluate the effects of postural myofunctional therapy (Mézières method with postural bench) after lingual frenectomy in children with tongue-tie. | 130 children with severe ankyloglossia underwent frenectomy followed by a structured postural and myofunctional program. Outcomes were assessed at 1 week and 2 months using parent-reported scales. | Tongue mobility improved in 96% at 2 months; speech: 58%→72%; feeding: 58%→75%; sleep: 61% → 74%. PSS score increased from 8.0 to 8.5 (p < 0.0001). Combined therapy led to significant functional improvements over 2 months. |
| Tecco et al. (2015) [81] | Prospective cohort study | To evaluate the effect of lingual frenulectomy and myofunctional exercises on the sEMG activity of masticatory and perioral muscles in children. | 24 children (~7 years old) were enrolled: 13 underwent frenulectomy with rehabilitation, 11 were untreated controls. sEMG recordings were taken at baseline, 1 month, and 6 months during tasks like clenching, swallowing, and protrusion. | After 6 months, treated children showed increased masseter (+ 13.5 µV) and submental (+ 14.2 µV) activity (p < 0.01), with normalized muscle patterns during function. No changes were observed in controls. |
| Scarano et al. (2023) [82] | Case series | To evaluate the effectiveness of atmospheric plasma frenectomy followed by tongue exercises in children with Kotlow class III/IV ankyloglossia. | 30 children (6 to 11 years) with Kotlow class III or IV ankyloglossia underwent frenectomy using atmospheric plasma. Tongue mobility was measured using Kotlow’s free-tongue length, MIO, and MOTTIP at five time points: preoperation, immediately postoperation, and at 1 week, 1 month, and 2 months. | All three measures (Kotlow, MIO, MOTTIP) showed statistically significant improvement immediately after surgery and maintained stable values at followup (p < 0.05). No bleeding, edema, fibrosis, or recurrence was observed during the study period. |
OMT: orofacial myofunctional therapy; PSQI: Pittsburgh Sleep Quality Index; VAS: Visual Analog Scale; AHI: apnea-hypopnea index; OSAS: obstructive sleep apnea syndrome; RCT: randomized controlled trial; CCT: controlled clinical trial; IOPI: Iowa Oral Performance Instrument; PSS: Perceived Stress Scale; sEMG: surface electromyography; MIO: maximal intercisal mouth opening; MOTTIP: mouth opening with tongue tip to incisive papilla.