Frenotomy improves breastfeeding immediately in neonates with ankyloglossia

Both groups demonstrated statistically significantly decreased pain scores after the intervention. The frenotomy group improved significantly more than the sham group (P<.001). Breastfeeding scores significantly improved in the frenotomy group (P = .029) without a significant change in the control group. All but one parent in the sham group elected to have the procedure performed when their infant reached 2 weeks of age, which prevented additional comparisons between the 2 groups.

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Conclusions

Frenotomy resulted in immediate improvement in nipple pain and breastfeeding scores, despite a placebo effect on nipple pain.

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Commentary

There is still no evidence about the need and exact timing of frenotomy for ankyloglossia. Evidence about the benefit of frenotomy in newborns of breastfeeding women is missing because there is a lack of randomized controlled trials (RCTs). Therefore, the present RCT is of much interest. The use of parameters for the pain scores (Short-Form McGill Pain Questionnaire) and the breastfeeding capacity of the newborns (Infant Breastfeeding Assessment Tool) have added value over a previous RCT.¹ The screening tool (Hazelbaker Assessment Tool for Lingual Frenulum Function) used to grade ankyloglossia is known to have some limitations and moderate inter-rater reliability, because of its subjectivity due to the fact that “functional scores” are of more importance than “appearance scores.”² Because significant differences in improvement were found immediately after the frenotomy, longer-term controlled data would have been of interest. However, the two weeks of data from the “sham group” are confusing, because all but one newborn already had frenotomy. Another limitation was that the trial was supposed to be blinded (with the mothers not looking in the mouth after the procedure), which seems nearly impossible after the first post-procedure breastfeeding, and mothers likely could have detected themselves whether frenotomy was done. This trial showed the effect of immediate improvement after frenotomy, but did not compare it with other methods of possible improvement, like training. Nevertheless, for breastfeeding mothers whose infants are struggling with it, a simple frenotomy can be indicated, and is a quick and painless treatment. Late consequences of ankyloglossia on speech development, possible malocclusion, and gingival recession remain controversial.³

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References

Hogan M, Westcott C, Griffiths MJ. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. Paediatr Child Health. 2005;41:246–250
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Madlon-Kay DJ, Ricke LA, Baker NJ, DeFor TA. Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function. Midwifery. 2008;24:353–357

Suter VG, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment. J Periodontol. 2009;80:1204–1219
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