Hazelbaker Assessment Tool for Lingual Frenulum Function

The following is an exerpt from Ankyloglossia: Assessment,Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad
Jeanne L. Ballard, Christine E. Auer and Jane C. Khoury

The Hazelbaker score was calculated after scoring the appearance and function items using the following method: The appearance of the tongue when lifted is determined by inspecting the anterior edge of the tongue as the infant cries or tries to lift or extend the tongue. The elasticity of the frenulum is determined by palpating the frenulum for elasticity while lifting the infant?s tongue. The length of the lingual frenulum is determined by noting its approximate length in centimeters as the tongue is lifted. Attachment of the frenulum to the tongue is determined by noting its origin on the inferior aspect of the tongue. It should be approximately 1 cm posterior to the tip. The attachment of the lingual frenulum to the inferior alveolar ridge is determined by noting the location of the anterior attachment of the frenulum. It should insert proximal to or into the genioglossus muscle on the floor of the mouth.

Assessment and Interpretation of Lingual Characteristics

Lateralization is measured by eliciting the transverse tongue reflex by tracing the lower gum ridge and brushing the lateral edge of the tongue with the examiner's finger. Lift of the tongue is noted when the finger is removed from the infant's mouth. If the infant cries, then the tongue tip should lift to mid-mouth without jaw closure. Extension of the tongue is measured by eliciting the tongue extrusion reflex by brushing the lower lip downward toward the chin. Spread of anterior tongue is determined by first eliciting a rooting reflex, just before cupping, by tickling the upper and lower lips and looking for even thinning of the anterior tongue. Cupping is a measure of the degree to which the tongue hugs the finger as the infant sucks on it. Peristalsis is a backward, wave-like motion of the tongue during sucking that should originate at the tip of the tongue and is felt with the back of the examiner?s finger. Snapback is heard as a clucking sound when the tethered tongue loses it grasp on the finger or breast when the infant tries to generate negative pressure. Values are assigned as indicated on the score sheet.

Interpretation of the Hazelbaker Score

• Perfect item score - 2 points
• Perfect Appearance - 10 points
• Perfect Function - 14 points
• Function outweighs appearance
  • Function < 11 suggests impaired tongue function
  • Appearance < 8 in the presence of impaired function suggests need for frenotomy

Score Sheet for the Hazelbaker Score

Lingual Appearance

Lingual Function