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Tomara E, Dagla M, Antoniou E, Iatrakis G. Ankyloglossia as a Barrier to Breastfeeding: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1902. [PMID: 38136104 PMCID: PMC10741948 DOI: 10.3390/children10121902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
This is a literature review of ankyloglossia and its correlation with lactation problems. Ankyloglossia, commonly referred to as tongue-tie, brings about functional difficulties and, in some cases, may lead to early weaning. It is crucial to use breastfeeding as the exclusive food source for the first six months of an infant's life, and the interference of the tongue contributes substantially to success in this regard. Even though there are many publications about ankyloglossia, there are still many controversies about its definition, diagnosis, classification, and treatment decision determined via frenotomy. Some researchers state that the identification of ankyloglossia should be based on morphological and anatomical evidence, while others claim that a short or tight frenulum should be examined in correlation with the impact on the mother-infant dyad during breastfeeding. By encouraging and supporting mothers in coping with feeding difficulties, their lactation experiences are improved, and they can continue breastfeeding.
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Affiliation(s)
- Eirini Tomara
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.D.); (E.A.); (G.I.)
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Kummer AW. Ankyloglossia: Typical Characteristics, Effects on Function, and Clinical Implications. Semin Speech Lang 2023; 44:217-229. [PMID: 37748489 DOI: 10.1055/s-0043-1772598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The purpose of this article is to (1) define the diagnostic characteristics of ankyloglossia, (2) identify potential problems associated with ankyloglossia, and (3) discuss treatment options, when treatment is appropriate. This article is based on a review of the literature, including recent systematic reviews, and the author's experience as a cleft and orofacial specialist. Ankyloglossia is a common congenital condition characterized by an anterior attachment of the lingual frenulum on the tongue. This causes difficulty elevating and/or protruding the tongue tip. As such, ankyloglossia has been thought to affect neonatal feeding, speech, and other functions. Although systematic reviews have concluded that most infants with ankyloglossia can be fed normally, a small percentage of affected infants will show improved efficiency of feeding post-frenotomy. They also concluded that frenotomy may relieve nipple pain in the breastfeeding mothers of affected infants. Regarding speech, the systematic reviews concluded that there is no evidence that ankyloglossia causes speech disorders. This may be because simple compensations will result in normal acoustics of the sounds. Therefore, frenotomy should be recommended sparingly for newborn infants, and it should rarely, if ever, be recommended for speech disorders.
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Affiliation(s)
- Ann W Kummer
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Yu C, Li QQ, Zhang RZ, Chen SL, Xia FF, Zhou Z. Effects of different surgical treatments on children with ankyloglossia: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e065653. [PMID: 36600360 PMCID: PMC9730349 DOI: 10.1136/bmjopen-2022-065653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Ankyloglossia is a situation where the tongue tip cannot go beyond the mandibular incisor because the frenulum linguae is short. It could affect children's health by interfering with their ability to talk, breast feeding and dental development. The most effective measure to control ankyloglossia is the surgical method. However, which surgical procedure is the best one is still controversial. Thus, this protocol aims to assess the effectiveness of different surgical interventions in children with ankyloglossia. METHODS AND ANALYSIS PubMed, EMBASE, Cochrane Library, Web of Science and OVID will be searched for relevant information from inception to 31 May 2022. Observational studies in English that investigate the association between surgical methods and ankyloglossia will be included in this protocol. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle-Ottawa Quality Assessment Scale for longitudinal studies will be used to assess the included studies. The improvement of breast feeding and nipple pain will be the primary outcome. STATA V.15.1 will do the statistical analysis in the meta-analysis. Subgroup and meta-regression will be carried out based on the characteristics of included studies. ETHICS AND DISSEMINATION This systematic review and meta-analysis will summarise relevant information on the effects of different surgical treatments on patients with ankyloglossia. The results will be disseminated through peer-reviewed publications. The data included in this study will be extracted from the published original studies. Thus, ethical approval and informed consent will not be required. PROSPERO REGISTRATION NUMBER CRD42022323350.
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Affiliation(s)
- Chongqing Yu
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Qi-Qi Li
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Ruo-Zhen Zhang
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | | | - Fei-Fei Xia
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
| | - Zheng Zhou
- Department of Stomatology, Shihezi University, Shihezi, Xinjiang, China
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Cruz PV, Souza-Oliveira AC, Notaro SQ, Occhi-Alexandre IGP, Maia RM, De Luca Canto G, Bendo CB, Martins CC. Prevalence of ankyloglossia according to different assessment tools. J Am Dent Assoc 2022; 153:1026-1040.e31. [DOI: 10.1016/j.adaj.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
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Colombari GC, Mariusso MR, Ercolin LT, Mazzoleni S, Stellini E, Ludovichetti FS. Relationship between Breastfeeding Difficulties, Ankyloglossia, and Frenotomy: A Literature Review. J Contemp Dent Pract 2021; 22:452-461. [PMID: 34267016 DOI: 10.5005/jp-journals-10024-3073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Breastfeeding plays a key role in the development of the baby, in addition to the benefits to the mother and this dyad. Among the possible difficulties in this process, we have ankyloglossia. Some professionals opt for the frenotomy, although the literature is controversial. This paper aims to present how the literature provides subsidies for health professionals' decision and action in the intersection of the themes: breastfeeding, ankyloglossia, and frenotomy. MATERIALS AND METHODS The research on the platforms SciELO and PubMed used the terms: "ankyloglossia," "frenotomy," and "lingual frenulum" and the same ones associated with "breastfeeding." A specific inclusion and exclusion criteria were applied and validated by the American Speech-Language-Hearing Association to reduce any bias in the analysis. In the end, 16 papers were included and, by thematic equivalence, divided into two domains: association between lingual frenulum alteration and breastfeeding and between frenotomy and breastfeeding. RESULTS The literature does not assure that the frenotomy is the "standard conduct" to be adopted in cases of difficulty in breastfeeding and ankyloglossia. CONCLUSION Further studies are needed on the different types of ankyloglossia and their direct influence on the sucking function and lactation difficulties.
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Affiliation(s)
| | | | | | - Sergio Mazzoleni
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
| | - Edoardo Stellini
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
| | - Francesco S Ludovichetti
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy, Phone: +39 3408573561, e-mail:
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Waterman J, Lee T, Etchegary H, Drover A, Twells L. Mothers' experiences of breastfeeding a child with tongue‐tie. MATERNAL & CHILD NUTRITION 2021; 17:e13115. [PMID: 33230939 PMCID: PMC7988863 DOI: 10.1111/mcn.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
Tongue‐tie is characterized by an abnormally tight, short and thick lingual frenulum restricting the tongue's movement. This functional impairment can hinder a child's ability to maintain an effective latch and suckle and may lead to complex breastfeeding difficulties. The primary aim of this study was to explore the experiences of mothers who have breastfed a child with tongue‐tie, including their experiences with the health care system. A qualitative description study design was used. Two semistructured focus groups were conducted in February 2016 with a total of nine participants in the largest metropolitan area of Newfoundland and Labrador, Canada. Content analysis using constant comparison revealed a common incongruity between participants' breastfeeding expectations and their actual experiences of feeding a child with tongue‐tie. Three major themes are discussed: mothers' well‐being, strained interpersonal relationships and frustration with the health care system.
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Affiliation(s)
- Jillian Waterman
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
| | - Tiffany Lee
- School of Pharmacy Memorial University St. John's Newfoundland and Labrador Canada
| | - Holly Etchegary
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
| | - Anne Drover
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
| | - Laurie Twells
- Faculty of Medicine Memorial University St. John's Newfoundland and Labrador Canada
- School of Pharmacy Memorial University St. John's Newfoundland and Labrador Canada
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Khan U, MacPherson J, Bezuhly M, Hong P. Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review. Otolaryngol Head Neck Surg 2020; 163:428-443. [DOI: 10.1177/0194599820917619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
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Affiliation(s)
- Usman Khan
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jake MacPherson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
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Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg 2020; 162:597-611. [PMID: 32283998 DOI: 10.1177/0194599820915457] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements. METHODS An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. CONCLUSION This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
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Affiliation(s)
- Anna H Messner
- Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | | | | | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Scott E Brietzke
- Nemours Specialty Care, Wolfson Children's Hospital, St. Johns, Florida, USA
| | | | | | - Jessica Levi
- Boston University and Boston Medical Center, Boston, Massachusettes, USA
| | - Anna K Meyer
- UCSF School of Medicine, San Francisco, California, USA
| | - Sanjay Parikh
- University of Washington Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey P Simons
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel L Wohl
- Pediatric Otolaryngology Associates, LLC, Jacksonville, Florida, USA
| | - Erin Lambie
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa Satterfield
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Ray S, Hairston TK, Giorgi M, Links AR, Boss EF, Walsh J. Speaking in Tongues: What Parents Really Think About Tongue-Tie Surgery for Their Infants. Clin Pediatr (Phila) 2020; 59:236-244. [PMID: 31875407 DOI: 10.1177/0009922819896583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We evaluate maternal perspectives of frenotomy for ankyloglossia in newborns. We searched highly frequented forums like babycenter.com for comments related to frenotomy posted from 2012 to 2017. We applied modified grounded theory, reviewed posts for thematic synthesis, and calculated frequencies for each theme. High decisional conflict, low discussion of surgical complications, and an overall moderate positive experience were noted. Mothers posted about breastfeeding issues (n = 227, 74.7%) and overall experience (n = 229, 75.3%). Posts related to breastfeeding include discomfort ("I can no longer physically take the pain"; n = 93, 30.6%). Parents posted frequently about a satisfactory outcome ("It was so worth it to improve our nursing relationship"; n = 133, 43.8%), but dissatisfactory outcome ("I'm still having problems latching and am pumping. It's brutal"; n = 31) was present in 10.2%. These results aid in understanding parental thoughts of frenotomy. Physicians can use these self-reported maternal perspectives on frenotomy to guide counseling and improve shared decision making for parents.
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Affiliation(s)
- Shagnik Ray
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Mark Giorgi
- Morehouse School of Medicine, Atlanta, GA, USA
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Fraga MDRBDA, Barreto KA, Lira TCB, Celerino PRRP, Tavares ITDS, Menezes VAD. Ankyloglossia and breastfeeding: what is the evidence of association between them? REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/202022312219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose: to investigate the scientific evidence, in the literature, of the relationship between ankyloglossia and breastfeeding difficulties. Methods: an integrative review of the literature. The MEDLINE and PubMed databases were searched, using the following descriptors in combination: "ankyloglossia", "newborn" and "breastfeeding". The searches included articles published between 2014 and 2019, in Portuguese, English and Spanish. Original articles demonstrating an association between ankyloglossia and breastfeeding issues were selected. Results: a total of 31 articles was fully read in the analysis, 22 of which were excluded and 9 included in the review. There was a diversity of instruments used for the diagnosis of ankyloglossia. In four studies, no standardized evaluation instrument was used for the diagnosis of ankyloglossia, which may limit the analysis of the results. However, most studies have evidenced a possible influence of ankyloglossia on breastfeeding. According to the studies, babies with altered lingual frenulum were more likely to experience difficulties in sucking, showing early weaning, which shows the importance of neonatal screening as a routine protocol in maternity hospitals for the cases of ankyloglossia. Conclusions: ankyloglossia may be related to impaired breastfeeding. The standardization of instruments for the diagnosis of ankyloglossia is necessary to improve the evidence in future research.
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Abstract
OBJECTIVE The purpose of this integrative review was to synthesize the literature on the relationship between infant breastfeeding and ankyloglossia. DATA SOURCES The search terms tongue-tie or ankyloglossia and breastfeeding were used via CINAHL, Ovid MEDLINE, Health Reference Academic, and PsycINFO. Primary research articles and clinical reviews were considered in the search parameters. STUDY SELECTION Searches yielded 201 articles written in English and published between 1999 and 2018. After screening, 50 full-text articles were assessed for eligibility, 43 of which were omitted for irrelevance. Three qualitative and four quantitative studies remained for inclusion in the review. DATA EXTRACTION Studies were reviewed for information on the relationship between ankyloglossia and breastfeeding. Studies examining results of ankyloglossia treatment were omitted. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. DATA SYNTHESIS Analysis revealed a varied degree of difficulties with breastfeeding when the infant has ankyloglossia. Prevalence is uncertain due to lack of universal screening guidelines, and infrequent use of screening tools. No studies were found that examined psychological ramifications of feeding difficulties with ankyloglossia. There are no validated screening tools for ankyloglossia. CONCLUSION More research is necessary on effects of breastfeeding difficulties of infants with ankyloglossia on the mother-infant relationship. A reliable screening tool needs to be developed and validated. Education for nurses to assess infants with ankyloglossia in a systematic fashion should be explored. Investigation of psychological sequelae, including maternal stress, postpartum depression, and mother-infant bonding is an important next step in the research of infants with ankyloglossia.
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Oliveira BH, Brandão CDA, de Marsillac MDWS, Barja-Fidalgo F. Response to Letter to the Editor regarding the article: Is the neonatal tongue screening test a valid and reliable tool for detecting ankyloglossia in newborns? Int J Paediatr Dent 2018; 29:100-104. [PMID: 30580470 DOI: 10.1111/ipd.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Branca Heloisa Oliveira
- Faculty of Dentistry, Department of Community and Preventive Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, RJ, Brazil
| | - Clarissa de Almeida Brandão
- Faculty of Dentistry, Department of Community and Preventive Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, RJ, Brazil
| | | | - Fernanda Barja-Fidalgo
- Faculty of Dentistry, Department of Community and Preventive Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, RJ, Brazil
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Wong K, Patel P, Cohen MB, Levi JR. Breastfeeding Infants with Ankyloglossia: Insight into Mothers' Experiences. Breastfeed Med 2017; 12:86-90. [PMID: 28061033 DOI: 10.1089/bfm.2016.0177] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Breastfeeding difficulty from ankyloglossia can affect both the mother and baby in a breastfeeding dyad. With renewed emphasis in today's culture on breast milk, mothers may feel increasing pressure to breastfeed, and the inability for some to do so may cause significant distress. Recently, online parenting forums have seen exponential growth; these forums allow mothers to connect with peers undergoing similar life transitions. The purpose of this study was to review online discussions regarding ankyloglossia to understand mothers' experiences with breastfeeding. MATERIALS AND METHODS We performed an ethnographic content analysis of 76 online threads and 501 posts regarding ankyloglossia based on six domains: (1) initial expectations, (2) breastfeeding complications, (3) questions, (4) diagnosis, (5) treatment, and (6) outcomes. RESULTS About one-fourth of women who participated in online forum discussions had initial expectations to breastfeed, however, many found it impossible due to poor latch or pain. Concerns were frequently exacerbated by healthcare providers who reportedly missed or overlooked ankyloglossia. Although these complications made breastfeeding a challenging experience, mothers often described both subjective and physical improvements after frenotomy. CONCLUSION Breastfeeding difficulty was a commonly voiced concern in online ankyloglossia forums. Forum analysis is an effective way to gain insight into patients' experiences, which allows providers to anticipate concerns and provides more effective counseling.
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Affiliation(s)
- Kevin Wong
- 1 Boston University School of Medicine , Boston, Massachusetts
| | - Punam Patel
- 1 Boston University School of Medicine , Boston, Massachusetts
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Levkovich R, Sidebotham M, Vaughan K, Dietsch E. Ankyloglossia (Tongue-Tie)—To Snip or Not to Snip: An Integrative Literature Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.3.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE: Ankyloglossia (commonly referred to as tongue-tie), is increasingly being reported as a significant contributory factor to difficulties experienced in establishing the mother–infant breastfeeding relationship. Frenotomy as a management option is contributing to international interest and interdisciplinary controversy. The aim of this article was to identify and examine the evidence in relation to frenotomy to inform practice for newborns diagnosed with symptomatic ankyloglossia.DESIGN: An integrated literature review, informed by Whittemore and Knafl (2005) was used to identify and evaluate contemporary evidence.MAJOR FINDINGS: There is a marked difference in opinion between health disciplines regarding frenotomy as a treatment option for ankyloglossia. There is agreement that support from a trained professional such as a lactation consultant prior to undergoing any invasive procedures to treat ankyloglossia is essential. Controversy persists however as to whether the condition will resolve spontaneously without treatment.CONCLUSION: Although frenotomy does seem to resolve breastfeeding difficulties, little is known regarding long-term consequences for the baby and optimal timing for the procedure. This review indicates a need for education of professionals and standardization of assessment processes along with ongoing research to identify efficacy and optimal timing of frenotomy when used.
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Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics 2015; 135:e1458-66. [PMID: 25941303 PMCID: PMC9923619 DOI: 10.1542/peds.2015-0658] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this study was to systematically review literature on surgical and nonsurgical treatments for infants with ankyloglossia. METHODS Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched up to August 2014. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics and outcomes and assigned quality and strength-of-evidence ratings. RESULTS Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. We included comparative studies published in English. The evidence base is limited, consisting of small studies, short-term outcomes, and little information to characterize participants adequately. No studies addressed nonsurgical interventions, longer-term breastfeeding or growth outcomes, or surgical intervention compared with other approaches to improve breastfeeding, such as lactation consultation. CONCLUSIONS A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient.
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Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | | | - Melissa McPheeters
- Institute for Medicine and Public Health, Evidence-based Practice Center, and Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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Lawrence RA. Urgent issues of breastfeeding management. Breastfeed Med 2014; 9:415-6. [PMID: 25361471 PMCID: PMC4216485 DOI: 10.1089/bfm.2014.9972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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