Lingual Frenotomy Research Articles

Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012-2016.

Ankyloglossia, or "tongue-tie," refers to limited tongue mobility caused by a restrictive lingual frenulum. Previous studies have demonstrated rapid increases in diagnosis and treatment of ankyloglossia in the United States up to 2012. We performed an updated retrospective review of data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to evaluate trends in diagnosis of ankyloglossia and use of lingual frenotomy in the hospital setting. From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures. As seen previously, sex, type of insurance, median income ZIP code, and geographic region were associated with diagnosis of ankyloglossia. The observed trends from prior to 2012 have continued to increase, while unanswered questions about diagnostic criteria and about which infants should undergo frenotomy remain.

Oral health of neonates: mothers’ perception of lingual frenotomy performed in a university hospital

ABSTRACT Objective: The study sought to know mothers’ perception of neonates on lingual frenotomy performed by a dental care program of a university hospital in Paraná Methods: It is a descriptive research with a qualitative approach, developed with mothers of newborns and whose children were submitted to a lingual frenzy procedure during maternal hospitalization (n = 09). Data were collected through a focus group interview and analyzed according to the content analysis technique Results: It was identified five thematic nuclei linked to lingual frenotomy in infants: ‘maternal impressions agaisnt the professional indication’; ‘Family trial’; ‘Need to perform frenotomy’; ‘Feelings after the completion of the frenotomy’; ‘Changes in baby behavior’. The main maternal impressions were linked to fear and suffering related to the babies reaction. Regarding to the need to perform the lingual frenotomy, the intrinsic opinions were initially divergent, however, all evidenced that the procedure was indispensable for the baby, mainly for speech. After the frenotomy completion, the mothers reported well-being for the improvement in the lingual physiology and babies’ quality of life, with emphasis on breastfeeding and improvement in the baby’s behavior Conclusion: The results obtained are encouraging for the hospital managers to consider, in their clinical protocols, the technique of lingual frenotomy in newborns, with a view to facilitating mothers’ access to the procedure, qualifying breastfeeding and consequently expanding the maternal and child bond.

Randomized, Controlled Trial Evaluating Lingual Frenotomy in Newborns with Simultaneous Lip Tie for the Relief of Breastfeeding Pain

Randomized, Controlled Trial Evaluating Lingual Frenotomy in Newborns with Simultaneous Lip Tie for the Relief of Breastfeeding Pain

Association of Feeding Evaluation With Frenotomy Rates in Infants With Breastfeeding Difficulties

Inpatient surgical release of lingual frenulums rose 10-fold between 1997 and 2012 despite insufficient evidence that frenotomy for ankyloglossia is associated with improvements in breastfeeding. Clear indications for surgical release remain murky, and best practice guidelines have yet to be developed. To determine whether infants referred for frenotomy to treat breastfeeding difficulties should undergo procedures after comprehensive feeding examination, during which the primary cause of feeding issues was identified, and targeted intervention was provided. This observational quality improvement study followed mother-infant dyads between March and December of 2018 who were referred to our tertiary care center for difficulty with breastfeeding. All infants underwent a comprehensive feeding evaluation by speech and language pathologists who examined the infants' ability to breastfeed prior to a surgical consultation for initial frenotomy. Data analysis was performed between January 2019 and May 2019. A multidisciplinary feeding evaluation that examined infants' oral structure and function and their ability to breastfeed and that offered techniques for mothers to address any feeding difficulties prior to surgical intervention was developed. Infants either found success in feeding and weight gain through this program or underwent procedures. The primary outcome was the percentage of frenotomy procedures following implementation of a multidisciplinary feeding team evaluation. The secondary outcome was the percentage of infants referred for lingual frenotomy who later had either combined lingual and labial frenotomy or labial frenotomy alone. Included in the study were 115 patients (median age, 34 days [interquartile range, 19-56 days], 68 (59%) were male) referred for surgical division of the lingual frenum. Following the development of a program with feeding examination with a pediatric speech and language pathologist, 72 (62.6%) patients subsequently did not undergo surgical procedures. Although all of the referrals were for lingual frenotomy, 10 (8.7%) underwent labial frenotomy alone and 32 (27.8%) underwent both labial and lingual frenotomy. The majority of patients referred for ankyloglossia may benefit from alternative intervention strategies following comprehensive feeding evaluation. Close collaboration and formation of multidisciplinary teams are imperative for treating these children.

Lingual frenotomy of a patient with Juvenile Idiopathic Arthritis and Attention Deficit Hyperactivity Disorder

Lingual frenotomy of a patient with Juvenile Idiopathic Arthritis and Attention Deficit Hyperactivity Disorder

Revision Lingual Frenotomy Improves Patient-Reported Breastfeeding Outcomes: A Prospective Cohort Study.

Lingual frenotomy improves patient-reported outcome measures, including infant reflux and maternal nipple pain, and prolongs the nursing relationship; however, many mother-infant dyads continue to experience breastfeeding difficulty despite having had a frenotomy. Research aim: The aim of this study was to determine how incomplete release of the tethered lingual frenulum may result in persistent breastfeeding difficulties. A one-group, observational, prospective cohort study was conducted. The sample consisted of breastfeeding mother-infant (0-9 months of age) dyads ( N = 54) after the mothers self-elected completion lingual frenotomy and/or maxillary labial frenectomy following prior lingual frenotomy performed elsewhere. Participants completed surveys preoperatively, 1-week postoperatively, and 1-month postoperatively consisting of the Breastfeeding Self-Efficacy Scale-Short-Form (BSES-SF), Visual Analog Scale (VAS) for nipple pain severity, and the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). Significant postoperative improvements were reported between mean preoperative scores compared with 1-week and 1-month scores of the BSES-SF, F(2) = 41.2, p < .001; the I-GERQ-R, F(2) = 22.7, p < .001; and VAS pain scale, F(2) = 46.1, p < .001. We demonstrated that besides nipple pain, measures of infant reflux symptoms and maternal breastfeeding self-confidence can improve following full release of the lingual frenulum. Additionally, a patient population was identified that could benefit from increased scrutiny of infant tongue function when initial frenotomy fails to improve breastfeeding symptoms.

Lingual frenotomy in a newborn, from diagnosis to surgery: a case report

ABSTRACT This report describes the diagnostic approach and frenotomy in a newborn with breastfeeding difficulty, and the observation and analysis during the following 6 months. The patient was delivered normally and without complications, but showed breastfeeding difficulty during her first 5 days of life. The protocol proposed by Martinelli in 2013 was used to evaluate the lingual frenulum. After applying the protocol, the newborn was determined to require a frenotomy and the urgery was performed. The patient was reassessed using the protocol immediately after surgery and again 24 hours latter. There were improvements in the protocol scores at both reassessments. The newborn was observed and analyzed during the next six months by collecting monthly data from the vaccination card and by asking the mother for information. She was given no food supplements, pacifiers, nor sucked the thumbs, and was fed only breast milk and presented an age-appropriate weight gain. We conclude that the diagnosis using the Martinelli protocol is of fundamental importance to recognizing the need for early intervention and that the frenotomy helped improve the patient’s breastfeeding and swallowing capacity.

Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012.

Objectives (1) Describe trends in the diagnosis of ankyloglossia and the use of lingual frenotomy and (2) analyze patient- and hospital-level factors as compared with the total pediatric discharge population. Study Design National database analysis. Methods We reviewed available data from 1997 to 2012 using the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. All weighted pediatric discharges with ankyloglossia, newborn feeding difficulty, or lingual frenotomy were analyzed for variables of sex, payer, zip code median income, hospital ownership, location/teaching status, bed size, region, and children's hospital status. Chi-square analysis with 95% CIs and odds ratio were used to identify differences between the study group and the total database discharge population. Results Diagnosis of ankyloglossia increased each year of publication (every third year)-with 3934, 5430, 7785, 11,397, 19,459, and 32,837 children, respectively, from 1997 to 2012-with the largest increase in the last 6 years. Similarly, frenotomy increased with 1279, 1633, 2538, 3988, 6900, and 12,406 procedures. Compared with the total discharge population, children with ankyloglossia or frenotomy were more often male (63.6% ankyloglossia, 65.3% frenotomy vs 51.2%), privately insured (60.1%, 62.1% vs 43.6%), from a higher median-income zip code (78.1%, 78.2% vs 68.6%), and in Midwest region (29.3%, 32.3% vs 21.7%). Conclusion These pilot data show increases in diagnoses of ankyloglossia and use of frenotomy. There is a preponderance of children who are male, privately insured, or Midwest residents being diagnosed and treated for ankyloglossia. This broad variation may reflect local practice patterns or imply cultural and socioeconomic bias.

Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study.

Objectives/HypothesisNumerous symptoms may arise that prevent mother‐infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue‐tie/lip‐tie release on breastfeeding impairment.Study DesignProspective, cohort study from June 2014 to April 2015 in a private practice setting.MethodsStudy participants consisted of breastfeeding mother–infant (0–12 weeks of age) dyads with untreated ankyloglossia and/or tethered maxillary labial frenula who completed preoperative, 1 week, and 1 month postoperative surveys consisting of the Breastfeeding Self‐Efficacy Scale‐Short Form (BSES‐SF), visual analog scale (VAS) for nipple pain severity, and the revised Infant Gastroesophageal Reflux Questionnaire (I‐GERQ‐R). Breastmilk intake was measured preoperatively and 1 week postoperatively.ResultsA total of 237 dyads were enrolled after self‐electing laser lingual frenotomy and/or maxillary labial frenectomy. Isolated posterior tongue‐tie was identified in 78% of infants. Significant postoperative improvements were reported between mean preoperative scores compared to 1 week and 1 month scores of the BSES‐SF (F (2) = 212.3; P < .001), the I‐GERQ‐R (F (2) = 85.3; P < .001), and VAS pain scale (F (2) = 259.8; P < .001). Average breastmilk intake improved 155% from 3.0 (2.9) to 4.9 (4.5) mL/min (P < .001).ConclusionsSurgical release of tongue‐tie/lip‐tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue‐tie and less obvious posterior tongue‐tie. This study identifies a previously under‐recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.Level of Evidence2c Laryngoscope, 127:1217–1223, 2017

Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy.

The problems of suction in newborns give rise to multiple consequences for both the mother and the newborn. The objective of this paper is to present a case of ankyloglossia (“tongue-tie”) and the suction problems that were treated by a multidisciplinary team. The subject is a 17-day-old male patient, with ankyloglossia and suction problems during breastfeeding (pain in the breastfeeding mother, poor weight gain, and long breastfeeds). The patient followed the circuit established in our centre between the services of Oral and Maxillofacial Surgery and Breastfeeding and Speech Therapy and Orofacial Rehabilitation (CELERE). The evolution following the breastfeeding sessions, the myofunctional stimulation, and the lingual frenotomy was very favourable, thereby solving the suction problems that the newborn presented. All our patients receive breastfeeding sessions and myofunctional therapy as treatment. We know that a frenotomy is not always necessary and we believe that the stimulation of sucking before and after the surgical intervention is important in order to improve the final result.

The effects of frenotomy on breastfeeding.

Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals. Objective: To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mother's complaints.Material and Methods : Oral yes/no questions about breastfeeding symptoms and sucking/swallowing/breathing coordination were answered by the mothers of 109, 30 day old infants. On the same day the infants had their lingual frenulum assessed by administering a lingual frenulum protocol. After the assessment, all tongue-tied infants were referred for frenotomy; nevertheless, only 14 underwent the surgery. Of the 109 infants, 14 infants who did not have frenulum alterations were included as controls. Birth order and gender were the criteria for recruiting the control group. The tongue-tied infants underwent lingual frenotomy at 45 days of age. At the conclusion of the frenotomy, the infants were breastfed. At 75 days old, both groups – control and post-frenotomy – were reassessed. Before the reassessment the same oral yes/no questions were answered by the mothers of the 14 infants who underwent frenotomy. The mothers of the control group answered the questionnaire only at the time of the first assessment. Data were subjected to statistical analysis.Results : After frenotomy, the number of sucks increased and the pause length between sucking decreased during breastfeeding. The controls maintained the same patterns observed in the first assessment. From the questionnaire answered by the mothers of the 14 tongue-tied infants, at 30 days and 75 days, we observed that the symptoms concerning breastfeeding and sucking/swallowing/breathing coordination were improved after lingual frenotomyConclusions : after lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy.

Lingual Frenotomy for Breastfeeding Difficulties: A Prospective Follow-Up Study

Breastfeeding difficulties are sometimes attributable to tongue-tie with short-term relief after frenotomy. Limited follow-up is available, and predictors for nonsuccessful frenotomy have not yet been found. We recruited 264 mother-infant dyads who underwent lingual frenotomy for breastfeeding difficulties. Data regarding the indications, anatomy of the tongue, and the response of the infant were noted by the physician. Mothers were contacted by telephone at 2 weeks, 3 months, and 6 months after frenotomy to answer a questionnaire. Two weeks after frenotomy, 89% of mothers were still breastfeeding. An improvement in breastfeeding was reported by three-quarters of the mothers, but, unexpectedly, 3% reported worsening. At 3 and 6 months after the procedure, 68% and 56% of mothers were still breastfeeding, respectively. We could not find any predictor to indicate those infants in whom breastfeeding would not improve. There are favorable long-term effects of frenotomy on breastfeeding. Lingual frenotomy does not always alleviate breastfeeding difficulties, and rarely worsening ensues. We could not find any predictor for successful breastfeeding after frenotomy. We speculate that because the procedure is minor, in the event of breastfeeding difficulties, lingual frenotomy should be considered as an effective tool to assist in long-term breastfeeding.

Using topical benzocaine before lingual frenotomy did not reduce crying and should be discouraged.

The US Food and Drug Administration has said that oral preparations containing benzocaine should only be used in infants under strict medical supervision, due to the rare, but potentially fatal, risk of methemoglobinemia. This study aimed to determine the analgesic effect of topical application of benzocaine prior to lingual frenotomy in infants with symptomatic tongue-tie. We hypothesised that the duration of crying immediately following frenotomy with topical benzocaine would be shorter than with no benzocaine. This randomised controlled study compared the length of crying after lingual frenotomy in term infants who did, or did not, receive topical application of benzocaine to the lingual frenulum prior to the procedure. We recruited 21 infants to this study. Crying time was less than one minute in all of the subjects. The average length of crying in the benzocaine group (21.6 ± 13.6 sec) was longer than the length of crying in the control group (13.1 ± 4.0 sec), p = 0.103. Contrary to our hypothesis, infants who were treated with topical benzocaine did not benefit from topical analgesia in terms of crying time. The use of benzocaine for analgesia prior to lingual frenotomy in term infants should therefore be discouraged.

Treating Tongue-Tie: Assessing the Relationship Between Frenotomy and Breastfeeding Symptoms

Objective: Ankyloglossia (or “tongue-tie”) may increase the risk for newborn breastfeeding symptoms. Lingual frenotomy is the standard treatment for ankyloglossia, but its efficacy at improving the quality of infant breastfeeding has received little formal study. We developed an original 10-question survey of mother and newborn breastfeeding symptoms that are typically observed with ankyloglossia. Possible survey scores ranged from 10 (minimal breastfeeding symptoms) to a maximum of 50 (extreme symptoms). We predicted that survey scores should decrease after lingual frenotomy.Method: The survey was administered to mothers of 20 newborns with ankyloglossia, before lingual frenotomy, and about 2 weeks after. The control group consisted of 15 breastfeeding dyads recruited from a breastfeeding support group who filled out the survey twice at 2-week intervals. A 2 × 2 mixed-methods ANOVA was conducted to test for an interaction between group and time.Results: Post hoc analysis of simple effects provided evidence that (a) the frenotomy group had higher survey scores than the control group before intervention and (b) the frenotomy-group survey scores decreased after the intervention. No significant score differences were observed between the frenotomy and control groups after the intervention, and the control group scores did not show a statistically significant decrease over time.Conclusions: The study provides preliminary evidence for the effectiveness of lingual frenotomy for reducing breastfeeding symptoms associated with ankyloglossia. Furthermore, the study suggests that the use of surveys, such as the one in this study, may help with assessment for ankyloglossia.

Partial Airway Obstruction After Lingual Frenotomy

Partial Airway Obstruction After Lingual Frenotomy