#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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There is no comment on effect on speech. Are there any research to show speech can be affected or is this a myth?
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