Appearance Items Function Items Appearance of tongue when lifted Lateralization  2: Round or square  2: Complete  1: Slight cleft in tip apparent  1: Body of tongue but not tongue tip  0: Heart- or V-shaped  0: None Elasticity of frenulum Lift of tongue  2: Very elastic  2: Tip to mid-mouth  1: Moderately elastic  1: Only edges to mid-mouth  0: Little or no elasticity  0: Tip stays at lower alveolar ridge or rises to mid-mouth only with jaw closure Length of lingual frenulum when tongue lifted Extention of tongue  2: >1 cm  2: Tip over lower lip  1: 1 cm  1: Tip over lower gum only  0: <1 cm  0: Neither of the above, or anterior or mid-tongue humps Attachment of lingual frenulum to tongue Spread of anterior tongue  2: Posterior to tip  2: Complete  1: At tip  1: Moderate or partial  0: Notched tip  0: Little or none Attachment of lingual frenulum to inferior alveolar ridge Cupping  2: Attached to floor of mouth or  well below ridge  2: Entire edge, firm cup  1: Attached just below ridge  1: Side edges only, moderate cup  0: Attached at ridge  0: Poor or no cup Peristalsis  2: Complete, anterior to posterior  1: Partial, originating posterior to tip  0: None or reverse motion Snapback  2: None  1: Periodic  0: Frequent or with each suck

Adapted with permission from Hazelbaker.²⁶

^* The infant’s tongue was assessed using the 5 appearance items and the 7 function items. Significant ankyloglossia was diagnosed when appearance score total was 8 or less and/or function score total was 11 or less.

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