Age-dependent trends in pediatric maxillary frenum classification

Objective

To describe maxillary frenum Kotlow scores in a pediatric population.

Methods

A retrospective chart review was performed for children ages 0–19 years old seen at a pediatric otolaryngology clinic by one surgeon from March–December 2022. Inclusion criteria required a recorded maxillary frenum Kotlow score. Data collected included age, gender, race/ethnicity, Kotlow score, and history of maxillary frenotomy.

Results

570 children were included, comprising 267 (46.8%) females, 302 (53.0%) males, and 1 (0.2%) transgender male. Mean age was 5.0 years (95% CI 4.6–5.4). 24 patients (4.2%) had a history of maxillary frenotomy, while 546 (95.8%) did not. Among those with no maxillary frenotomy history, 21 (3.8%) had a Kotlow 1, 127 (23.3%) Kotlow 2, 261 (47.8%) Kotlow 3, and 137 (25.1%) Kotlow 4. Kotlow scores decreased with age. For children with prior maxillary frenotomy, class 1 frenum mean age was 6.9 years, and class 4 was 0.6 years (P=.008). For those without a maxillary frenotomy history, class 1 frenum mean age was 8.7 years, and class 4 was 1.3 years (P<.001). No association was found between maxillary frenotomy history and lower Kotlow scores.

Conclusion

Nearly half of children have a Kotlow 3 maxillary frenum. Kotlow scores decrease as children age, reflecting elevated frenum insertion as the alveolar ridge develops. Otolaryngologists may find this data valuable when considering maxillary frenotomy in children.