#391 Trying Tongue-Tie Treatment: Does Frenotomy Fix Feeding Frustrations?
CLINICAL QUESTION
Does surgical frenotomy in infants with ankyloglossia (tongue-tie) improve mother or infant breastfeeding outcomes?
BOTTOM LINE
Surgical frenotomy likely reduces maternal nipple pain ~2 points on a 10-point scale, and “improves breastfeeding” in 78-96% versus 3-47% in control groups. Effects on infant weight gain and rates of breastfeeding are unknown, due to large crossover in control groups. Most common adverse events are bleeding (up to 5%) and repeat frenotomy (up to 4%).
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EVIDENCE
- Results are statistically significant unless otherwise reported.
- 6 randomized control trials (RCTs), infants 1 day to 10 weeks of age, with ankyloglossia and breastfeeding difficulties (25-169 patients).1-6
- Nipple pain, comparing pre-frenotomy to post-frenotomy (immediately after procedure and up to 2 weeks):
- ~2 point improvement on 10-point visual analogue scale.1-4
- Statistically different in 1 RCT,4 others1-3 statistics not reported.
- 1 RCT: No statistical difference versus sham.2
- ~12-point improvement versus 6 (sham) on 50-point scale.5
- Changes likely clinically relevant.
- ~2 point improvement on 10-point visual analogue scale.1-4
- Self-reported breastfeeding improvement, frenotomy versus none,2 sham procedure,5 or “intensive lactation consultation support”.6 At 0-48 hours:
- 78-96% versus 3-47% (control),2,6 numbers needed to treat (NNT)=1-3.
- Overall breastfeeding assessment score (15-point scale): Improved 2.3 (frenotomy) versus decreased 0.41 points (sham procedure).5
- Any breastfeeding, at 3 months of age, as-treated analysis:
- 90% (frenotomy) versus 69% (breastfeeding support only).1
- Intention-to-treat analysis uninterpretable (73-85% patients underwent frenotomy in control groups).1,3
- Adverse events, not statistically different:
- Minor bleeding: ~1 to 5%.1,2
- Repeat frenotomy: 4%.3
- Salivary duct damage: ~1%.1
- Small white patch at frenulum base: ~64%, healed ~7 days.3
- Nipple pain, comparing pre-frenotomy to post-frenotomy (immediately after procedure and up to 2 weeks):
- Limitations: Long-term outcomes (examples: Infant weight gain, continued breastfeeding) uninterpretable due large numbers of controls undergoing procedure (73% to 100%).1,3 Breastfeeding scores do not always include nipple pain. Largest RCT stopped early due to COVID-19.1 Systematic review unable to pool most results.7
CONTEXT
- Ankyloglossia is a functional diagnosis. Evaluate by observing latch and breastfeeding; appearance of tongue tie alone does not necessitate intervention.8,9
- Frenotomy only indicated to improve nipple pain and latch difficulties.8,9
- Surgical frenotomy is considered standard of care over laser.9
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Pas d’étude à haute puissance mettant en évidence une amélioration de la santé des enfants.
There is no comment on effect on speech. Are there any research to show speech can be affected or is this a myth?
I remember during residency, paeds used to have a difference of opinion in the outcome and relevance. It’s heartwarming to see evidence.
informative
Interesting,what about early speech development
Supports frenotomy for breast feeding difficulties- large proportion of mothers reported breastfeeding improvements.
Large proportion of women report an improvement in breastfeeding after frenotomy- this research is supportive of frenotomy for tongue tie
Interesting summary.
Surgical frenotomy modestly reduces maternal nipple pain and improves breastfeeding success, though benefits on infant weight gain and breastfeeding rates remain unclear. Minor adverse events are uncommon.
This summary reflects my limited personal experience
Ankyloglossia needs to be assessed on an individual basis. Surgery is NOT indicated in all cases!
These studies avoid a massive problem that I am noticing in my city of practice. Sham diagnosis of tongue tie and having RPNs and RNs uncorrectly state to the new family that their infant has a tongue tie when they effectively do not. Parents now have this in their mind that something is wrong with their infant and then usually feel compelled to spend 600+ bucks to a dentist willing to take their money no matter whether the laser treatment offered is even required. This is happening so much in my area it almost feels like there is an underground deal between send dental office and our labour and delivery unit.