Superior Labial Frenulum Attachment Site and Correlation with Breastfeeding Outcomes

Abstract

Objectives Current literature suggests that infant oral anatomy may impact breastfeeding outcomes. Our research seeks to evaluate superior labial frenulum (SLF) attachment site grade utilizing a modified existing system and investigate the correlation with breastfeeding outcomes. Methods Two hundred and eight dyads were recruited from the nursery at Brooke Army Medical Center. The neonate's SLF and lingual frenulum were evaluated and photo‐documented. Photos were assessed by blinded reviewers utilizing a modified Stanford SLF grade. Breastfeeding mothers completed surveys on attitudes and associated pain with feedings 24 h postdelivery, at 2 weeks and at 2 months. Categorical data were analyzed using chi‐squared tests or Fisher's exact tests. Means and standard deviations were analyzed using analysis of variance or Wilcoxon's test. Results At 2 weeks and 2 months, 86.8% and 72.8% were breastfeeding, respectively. At 2 months, SLF grade 1 newborn dyads had a significantly lower breastfeeding rate (50.0%) compared to SLF grade 2 (75.3%) and SLF grade 3 (85.7%) subjects (p = 0.0384). At 2 weeks and 2 months, there was no difference between SLF groups with regard to maternal breastfeeding attitudes or pain scores. There was no significant difference in terms of weight, referrals, or lingual–labial frenulectomy between SLF groups. Conclusions Our study shows no correlation between SLF attachment grade and breastfeeding outcomes to include length of breastfeeding, maternally reported confidence, maternal pain, or infant weight. Our findings do not support labial frenulectomy based on SLF grade alone and highlight the need for a more robust functional grading system. Level of Evidence 2 Oxford Center for Evidence‐Based Medicine. http://www.cebm.net/index.aspx?o=5653 Laryngoscope, 132:2498–2504, 2022

Upper lip tie: A novel classification scale with improved inter‐rater reliability

“…Though length of frenulum on stretch yielded a moderate inter‐rater reliability coefficient of .42, this parameter was included in our final scale as a functional measure of the flexibility and vertical extensibility of the SLF, which have been postulated in prior ULT studies as potentially impactful factors on infant breastfeeding outcomes. 2 , 10 , 17 …”

“…We predict that the HOP‐ROC scale will be more reliable for outcome studies of breastfeeding difficulties and frenotomy impact, especially since the Kotlow and Stanford systems poorly correlate with such functional outcomes. 2 , 10 If our novel HOP‐ROC scale correlates well with functional outcomes, it may be used clinically to guide decision‐making and to counsel families about the potential benefits of releasing the ULT.…”

“…Anatomically, this parameter characterizes how far inferiorly the SLF attaches onto the gingiva, which is also included and is the sole anatomical parameter of the Kotlow and Stanford systems. Though length of frenulum on stretch yielded a moderate inter‐rater reliability coefficient of .42, this parameter was included in our final scale as a functional measure of the flexibility and vertical extensibility of the SLF, which have been postulated in prior ULT studies as potentially impactful factors on infant breastfeeding outcomes 2,10,17 …”

“…This multi‐parameter approach in the BTAT has been validated in prior studies, exhibiting high inter‐rater reliability and correlating strongly with other ankyloglossia assessment tools, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function 8,9 . A similar combined anatomical and functional approach could be applied when classifying the SLF, especially considering the poor inter‐rater reliability and poor correlation with functional breastfeeding outcomes exhibited by both the Kotlow and Stanford classification scales 2,3,6,10 …”

“… 8 , 9 A similar combined anatomical and functional approach could be applied when classifying the SLF, especially considering the poor inter‐rater reliability and poor correlation with functional breastfeeding outcomes exhibited by both the Kotlow and Stanford classification scales. 2 , 3 , 6 , 10 …”