Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia

Abstract

Objectives There is debate among otolaryngologists and other practitioners about whether upper lip tie contributes to difficulty with breastfeeding and whether upper lip tie and ankyloglossia are linked. Our objectives were to evaluate the anatomy of the upper lip (maxillary) frenulum, to determine if the visual anatomy of the upper lip has an effect on breastfeeding, and to determine whether the occurrence of lip tie and tongue tie are correlated. Methods A prospective cohort study of 100 healthy newborns was examined between day of life 3–7. Surveys were completed by the mother at the time of the initial exam and 2 weeks later. The maxillary frenulum was graded based on the Stanford and Kotlow classifications by two independent reviewers. Inter‐rater reliability and relationships between tongue tie, lip tie, and the infant breastfeeding assessment tool (IBFAT) were calculated. Results Inter‐rater reliability showed fair agreement (κ = 0.302) using the Kotlow scale and better agreement using the Stanford classification (κ = 0.458). There was no correlation between the upper lip tie classification and breastfeeding success score. Lastly, there was a modest inverse correlation in the degree of tethering for the tongue and lip. Conclusions There was no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch. There was also no relationship between tip to frenulum length (tongue tie) and visualized lip anatomy, suggesting that tongue tie and lip tie may not cluster together in infants. Level of Evidence 2 Laryngoscope, 131:E1701–E1706, 2021

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

“…Santa Maria found that the Kotlow classification had poor interrater reliability [ 29 ]. Two studies reported no correlation between the maxillary lip score by the Kotlow classification and breastfeeding outcomes in the newborn nursery [ 30 , 31 ]. Mills’ Cine MR visualization of healthy breastfeeding infants, showed that the majority did not evert their upper lip while breastfeeding [ 32 ].…”

Effect of Frenotomy on Maternal Breastfeeding Symptoms and the Relationship Between Maternal Symptoms and Problematic Infant Feeding

“… 31 , 32 Of note, all the infants being diagnosed and treated for both tongue and lip-tie in this study contradicts prior work where researchers did not find an association between these 2 anomalies occurring concurrently. 33 Future research should be directed at both a larger and more diverse sample, with a variety of tongue-tie classifications and functional assessments, and specific evaluation between infants with and without concomitant lip-tie. It is important to note that the Kotlow criteria has not been assessed for reliability or validity.…”

Re-thinking lactation-related nipple pain and damage

“…The normal spectrum of labial frenula anatomy is not linked with breastfeeding problems, and should not be pathologized as restricted or ‘tied’. 129 – 131 There is no anatomic or functional basis for the diagnosis of posterior tongue-tie. 72 , 94 , 95 , 132 The latter two diagnoses are examples of overmedicalization of breastfeeding problems, resulting in exponential increase in unnecessary infant oral surgery and bodywork exercises.…”