Neonatological aspects of frenotomy in children with ankyloglossia

Abstract

Ankyloglossia or tongue-tie is a congenital anomaly characterized by a short lingual frenulum, which can lead to short- and longterm restrictions of tongue movements. In newborns it can cause feeding diffi culty. The aim of the study was to identify ankyloglossia by clinical and functional presentation in otherwise healthy newborns, to establish the degree of breastfeeding diffi culties in infants with ankyloglossia, and to evaluate the eff ectiveness of frenotomy. This retrospective analysis included 2872 healthy newborns. Ankyloglossia was estimated clinically, diffi culties in breastfeeding were identifi ed, and effi cacy of frenotomy in newborns with severe ankyloglossia was assessed. The frequency of ankyloglossia was 3.76%, with the male to female ratio 3.1:1. Mild ankyloglossia was found in 27 (25%), moderate in 32 (29.63%) and severe in 49 (45.37%) infants. Transient diffi culties in breastfeeding in infants with mild and moderate ankyloglossia were resolved through timely professional help during breastfeeding, without the need of frenotomy. In 37.04% of the total number of children with ankyloglossia, only infants with severe ankyloglossia and associated diffi culties in breastfeeding (40 of 49 cases) underwent frenotomy. The most common diffi culty was nipple pain during breastfeeding (75%), attachment to the breast (22.5%), and nipple damage (2.5%). Pain intensity before frenotomy was 7.38±1.53 and after frenotomy 1.75±1.11 (p<0.0001). In conclusion, proper assessment of the degree of ankyloglossia and the need of frenotomy in newborns can resolve most diffi culties with breastfeeding. Frenotomy in newborns is a mild, rapid and safe procedure that can be performed in the fi rst days of life, and its long-term eff ectiveness should be confi rmed by randomized controlled trials.