Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad

Jeanne L. Ballard, Christine E. Auer, Jane C. Khoury

Hazelbaker Assessment Tool for Lingual Frenulum Function*

Appearance ItemsFunction Items
Appearance of tongue when liftedLateralization
 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 frenulumLift 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 liftedExtention 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 tongueSpread 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 ridgeCupping
 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
 2: Complete, anterior to posterior
 1: Partial, originating posterior to tip
 0: None or reverse motion
 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.