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

Abstract

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

Clinical Consensus Statement: Ankyloglossia in Children

“…37,43,[55][56][57][58] The panel agreed that informed consent for lingual frenotomy should include mention of the possibility of failure to experience improvement in breastfeeding ( Table 4). While much evidence in the literature supports the idea that lingual frenotomy can lead to improvement in breastfeeding, 43,44,46,50,51,54,[59][60][61][62][63][64][65][66][67][68][69][70][71][72] it is also important to recognize that not all infant-mother dyads experience breastfeeding improvement after the procedure. 5,45,51,62 The panel also reached consensus that patients and caregivers of patients with ankyloglossia should be counseled about nonsurgical options, including observation, lactation consultation, and/or speech-language pathology consultation ( Table 4).…”

What is a tongue tie? Defining the anatomy of the in‐situ lingual frenulum

“…Individual variability in the location or height of attachment of the lingual frenulum on the ventral surface of the tongue is observed, with this feature forming the basis of grading systems for tongue ties developed by Kotlow () and adapted later by Coryllos et al (). The premise of these grading systems is based on using this single feature of the visual appearance of the lingual frenulum to categorize a frenulum into a grade of ‘“tongue tie.” An attachment of the lingual frenulum closer to the tip of the tongue, the more classically recognized appearance, is now commonly referred to as an “anterior tongue tie.” The term “posterior tongue tie” has been coined more recently to describe a frenulum with a lower ventral tongue attachment, or a frenulum that is “submucosal” and not at all visible, with “tension” or “restriction” in the floor of mouth needing to be palpated for diagnosis (Chu and Bloom, ; Hong et al, ; O'Callahan et al, ; Pransky et al, ; Ghaheri et al, ). As the categories of these grading systems encompass the full range of possible variation in frenulum appearance, they allow any frenulum to be categorized as a “tongue tie” and to therefore be labeled as “abnormal.” This creates a dilemma regarding when a lingual frenulum's appearance can be considered normal, and potentially drives an international trend for an increasing rate of diagnosis of ankyloglossia, reported in Canada, Unites States of America and Australia (Joseph et al, ; Walsh et al, ; Kapoor et al, ).…”

“…Some practitioners believe that there are deep attachments of the frenulum, warranting a deeper incision (Fabbie et al, ). Heated debates take place in social media bringing into question the “completeness” of a frenotomy procedure, particularly when improvement does not occur after a procedure (Ghaheri, ) and in these circumstances it is not uncommon for babies to be considered for a second or multiple frenotomies (Ghaheri et al, ).…”

Avaliação da anquiloglossia em neonatos por meio do teste da linguinha: um estudo de prevalência

“…Alterações anatômi-cas nesse órgão interferem diretamente na capacidade de movimentação, gerando dificuldades para alimentação, desmame precoce e/ou ganho de peso abaixo do esperado 2,3 . Tais situações interferem negativamente no desenvolvimento do bebê 4 .…”