Major complications after tongue-tie release: A case report and systematic review

Solís-Pazmiño, Paola; Kim, Grace S.; Lincango-Naranjo, Eddy; Prokop, Larry J.; Ponce, Oscar J.; Truong, Mai Thy

doi:10.1016/j.ijporl.2020.110356

Cited by 23 publications

(24 citation statements)

References 36 publications

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“…Solis reported an infant with mucocele after a laser frenotomy and reviewed eight prior reported cases of complications after frenotomy including: two infants with Pierre Robin sequence with airway obstruction after frenotomy, four infants with infections at the frenotomy site, and two with bleeding and hypovolemia [ 38 ]. Another report describes an infant with Staphylococcus aureus infection at the frenotomy site [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey

O’Connor

Gilliland

LeFort³

2022

Int Breastfeed J

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Background In the past 10–15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased performance of frenotomy. Physicians and other healthcare professionals with expertise in breastfeeding have voiced concerns about complications related to the performance of infant frenotomy. Reviews of this topic have reported no significant complications after frenotomy. Other data on complications consist of case reports. Methods An online survey was developed by physicians with expertise in breastfeeding and e-mailed to physician and dentist members of Academy of Breastfeeding Medicine (ABM) between 11 November and 31 December 2019. It requested information from the respondents who cared for the mother/infant breastfeeding couple about their experiences personally caring for infants with complications or misdiagnoses related to referral for frenotomy or the performance of a frenotomy. Data were analyzed using chi square, Cramer’s V correlation, and binomial logistic regression. Results Of 211 eligible respondents, 129 (61%) had cared for an infant with a complication or misdiagnosis. Two hundred and nine (209) infants were reported to have a complication and 237 had a misdiagnosis. The most common misdiagnoses reported were 101 of 237 infants (43%) with neuromuscular dysfunction and 65 of 237 (27%) with inadequate breastfeeding support. The most common complications reported were a repeat procedure considered/requested/performed 65 of 203 (32%) and oral aversion 57 of 203 (28%). Parental report of infant pain was associated with performance of a posterior frenotomy (Chi Square p < .003). Bleeding was associated with using scissors/scalpel vs laser/bovie/electrosurgery (Chi Square p = .001). Oral aversion was associated with performance of frenotomy by laser/bovie/electrosurgery vs scissors/scalpel (adjusted Odds Ratio of 4.05; 95% CI 2.07, 7.93). Conclusions Complications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to provide skilled breastfeeding support and to evaluate for other confounding problems that might impact infant breastfeeding before referral for frenotomy. Randomized controlled trials of optimized lactation support vs. frenotomy and of scissors vs laser in performance of frenotomy are needed.

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Section: Discussionmentioning

confidence: 99%

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey

O’Connor

Gilliland

LeFort³

2022

Int Breastfeed J

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“…According to the systematic review by O’Shea et al, the optimal age to perform lingual frenotomy is still unclear [ 7 ] but it is suggested to intervene before the development of atypical deglutition [ 16 ]. Neonatal lingual frenotomy is performed in neonatology or otolaryngology wards [ 7 ] as well as in outpatient settings [ 4 , 16 ] (especially for thin lingual frenula [ 2 ]) and, according to a recent systematic review [ 15 ], is performed by surgeons, neonatologists, pediatricians, otorhinolaryngologists, obstetricians, lactation consultants, or pediatric dentists [ 16 ]. Many techniques for lingual frenotomy are currently used in newborns.…”

Section: Discussionmentioning

confidence: 99%

“…During laser lingual frenotomy in newborns, the mucosa can be cooled by using wet gauze tamponing [ 17 ] other than ice tips, to prevent thermal damage [ 14 ]. Advantages of laser frenotomy comprehend brief-lasting surgery [ 2 , 14 – 16 , 18 , 23 ], immediate hemostasis [ 2 , 15 , 18 ], low risk of bleeding [ 14 ], clear vision [ 15 , 16 ], no need of suturing [ 2 , 14 , 16 , 18 , 23 ], less need of local anesthetics (in children) [ 2 , 15 ], low postoperative edema and pain [ 14 ], less healing time [ 2 , 14 , 18 ], tissues sterilization – thus reducing the need of antibiotics and analgesics − [ 2 , 14 , 15 ], likely null risk of intraoperative bacteremia [ 14 ]. Furthermore, several reports show that the laser technique allows better wound healing than cold-blade surgery by exerting anti-inflammatory, bio-stimulant effects and reducing the colonization by myofibroblasts [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of hyaluronic-acid-based medical devices is safe and beneficial for alleviating oral symptoms in infants [ 25 ]. The real incidence of complications is biased by the lack of univocal diagnostic criteria and different classifications of ankyloglossia [ 15 ]. Posterior tongue-tie and cold blade-based techniques are reported to have more complications [ 5 , 15 ] with possible damage around the lingual frenulum [ 18 ] due to the hypermobility of both the tongue and floor of the mouth [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study

et al. 2022

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Background The study aims to describe the lingual laser frenotomy perioperative protocol for newborns with ankyloglossia with or without breastfeeding difficulties developed by Odontostomatology and Neonatology and Neonatal Intensive Care Units of the Aldo Moro University of Bari. Methods Authors carried out a prospective observational cohort study. Newborns with ankyloglossia (classified by using both Coryllos’ and Hazelbaker’s criteria) with or without difficult breastfeeding (according to Infant Breastfeeding Assessment Tool) underwent diode laser frenotomy (800 ± 10 nm; 5 W; continuous wave mode; contact technique; under topical anesthesia) and follow-up visits after seven and thirty days postoperatively. The authors analyzed as main outcomes the perioperative pain intensity measured by the C.R.I.E.S. scale, the occurrence of complications and quality of healing, the quality of breastfeeding, newborn’s postoperative weight gain, maternal nipple pain, and the presence of lesions as secondary outcomes. Results Fifty-six newborns were included in the current study. Intraoperative mean pain intensity was 5.7 ± 0.5 points, resolved within thirty postoperative minutes. Observed complications were mild punctuating bleeding, carbonization of the irradiated site, and transitory restlessness. All wounds were completely healed within the thirtieth postoperative day. During follow-up, a significant breastfeeding improvement was evident with satisfactory newborns’ weight gain and a significant reduction of nipple pain and lesions (p < .05). Conclusion Our lingual laser frenotomy protocol provided significant breastfeeding improvement in the mother-newborn dyads with low intraoperative pain and no significant complications.

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“…Of note, the Cochrane review of O'Shea et al [4] and the study of Francis et al [5] did not mention serious complications after performing a frenotomy. The observations in the case studies regarding complications [6][7][8][9], as mentioned in the letter to the editor by Paul and Heaton [1], have to be taken into mind by the surgeons who perform frenectomies, but are not representative for frenectomies performed by experienced surgeons. In the case series cited, the treatment protocol applied, whether a complete oral and physical investigation is performed, and whether a non-interventional professional support by a multi-disciplinary team was in place are not mentioned, all of which could have prevented these complications.…”

Section: Dear Editormentioning

confidence: 99%

Reply to the editor concerning: Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study

et al. 2021

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Major complications after tongue-tie release: A case report and systematic review

Cited by 23 publications

References 36 publications

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey

Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study

Reply to the editor concerning: Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study

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