1040 Is Difficulty Feeding An Indication for Frenulotomy in Patients with Ankyloglossia?

Abstract

Background:Ankyloglossia or “tongue-tie” is a common congenital anomaly that can restrict movement of the tongue and thus cause feeding difficulties. The immediate sequalae of this include distress to both mother and baby, and in the long term may result in sub-optimal weight gain. Thus ascertaining the value of frenulotomy in such patients is necessary.

Aims: To analyse the experimental literature relating to frenulotomy in ankyloglossia patients with feeding difficulties.

Methods: PubMed and Cochrane Library search of combinations of MeSH terms: “ankyloglossia”, “tongue-tie”, “feeding”, “frenulotomy”, “frenulectomy”, “frenotomy”, “frenuloplasty”, “frenectomy”, “tonguetie division” yielded 104 results; 22 relevant and accessible.

Results: Few studies exist to date, and these have concluded in favour of frenulotomy over breastfeeding advice alone. However, the quality of evidence is somewhat questionable. In many cases, the supposed improvement in feeding is subjective, with no data on growth of the baby, which would be a more accurate long-term measure of outcome. Additionally, sample sizes are too small to provide a conclusion of strength. The only randomized control trial to date is hampered by significant bias, as mothers were given the option of frenulotomy if breastfeeding did not improve with counselling.

Conclusion: Issues with diagnosing and assessing the severity of ankyloglossia contribute to the sparsity of evidence available. Additionally, lactation consultants are often in favour of frenulotomy, thus introducing bias into studies. While the evidence is controversial, the minimal adverse effects associated with the procedure lead the author to conclude that it should be offered when feeding difficulties arise.

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