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.

Influence of frenotomy on breastfeeding in newborns with ankyloglossia

“…The study provides important evidence regarding the influence of frenotomy on breastfeeding in newborns with ankyloglossia. The results demonstrate that frenotomy has a positive effect on breastfeeding symptoms, corroborating the conclusion of recent studies (16,17) and reinforcing the importance of the current Ministry of Health recommendation, which guides the identification of severe cases of ankyloglossia in maternity wards due to its potential interference in breastfeeding (18) .…”

“…The treatment of ankyloglossia is also controversial, but several studies report the benefits of frenotomy for breastfeeding (4,6,15,17,28,29,30) , which was also observed here, where all the variables related to breastfeeding symptoms improved statistically after surgery. Of the ten questions related to breastfeeding symptoms, those involving resting between feedings and the baby's tiredness while breastfeeding exhibited the greatest decline.…”

“…Studies have found that the newborns' grasp of the nipple improved after frenotomy, resulting in less trauma and pain reported by mothers (17,29) . These findings were also obtained here.…”

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

“…The benefits observed after the frenotomy involve improvement in the movement and lingual position of the neonate, besides a better lip position, relieving the discomforts at the time of breastfeeding and favoring a correct handgrip within the mother [25,26]. This improvement in mothers' perceptions of ankyloglycosis on breastfeeding can be observed even during hospital admission in their midterm, with evolution at 24 and 72 hours after the frenotomy [7].…”

“…In neonates, this condition has reported rates varying from 4% to 11% [5], and may have significant impacts on the anatomical, physiological and cognitive balance of the baby [6], with interferences in breastfeeding [7]. In this bias, the challenge of breastfeeding is exposed to neonates with strongly inserted lingual frenulum, with unfolding in the maturation of their perioral musculature and, consequently, in the development of correct breathing, swallowing and, subsequently, occlusion [8].…”