Surface Electromyographic Analysis of the Suprahyoid Muscles in Infants Based on Lingual Frenulum Attachment during Breastfeeding

Effects of lingual frenotomy on breastfeeding and electrical activity of the masseter and suprahyoid muscles

PURPOSE

To analyze the effects of lingual frenotomy on the breastfeeding of infants, based on the electrical activity of the masseter and suprahyoid muscles and assessment of the breastfeeding.

METHODS

Observational study developed between October 2017 and June 2018 with a sample of 20 newborns and infants who attended a dental clinic and were diagnosed with ankyloglossia. Another 20 were excluded for meeting some of the following exclusion criteria: babies more than 6 months old, who were not on exclusive or mixed breastfeeding, who had other clinical impairments that interfered with breastfeeding, who had other foods introduced into their diet, who had neurological changes and/or craniofacial deformities, and/or who did not finish all the stages of the study. Breastfeeding was assessed with the UNICEF Breastfeeding Assessment and Observation Protocol, while the muscle electrical activity was assessed with the Electrical Activity Assessment Protocol for the Masseter and Suprahyoid Muscles in Newborns During Breastfeeding. The same speech-language-hearing therapist conducted the two assessments both before the conventional frenotomy and 7 days after it.

RESULTS

The signs suggestive of breastfeeding difficulties changed 7 days after the surgery, with a p-value ≤ 0.002 for general observation of the mother, position of the infant, latch, and sucking. The maximum voluntary contraction of the masseter was the only integral parameter with a difference, as the electrical activity had decreased.

CONCLUSION

Behaviors favorable to breastfeeding increased 7 days after the frenotomy in all the breastfeeding assessment categories, whereas the electrical activity of the masseter decreased.

Tongue-tie and breastfeeding

OBJECTIVE

To evaluate the efficiency of maternal breastfeeding and maternal pain pre- and post-lingual frenulum release procedures in infants with ankyloglossia.

METHODS

Infants under 4 months of age with tongue-tie who were actively breastfeeding, and their mothers (mother-infant dyads) were recruited. Infants' ankyloglossia severity was evaluated using the Coryllos® ankyloglossia tongue-tie grading scale. Each mother completed a pre-procedure questionnaire where breastfeeding efficiency was evaluated using the LATCH® criteria. Each mother also reported a numeric score of pain with feeding, breastfeeding time, and a perceived feeding efficiency score. After the tongue-tie release procedure, each mother completed a post-procedure questionnaire within a 1-week to 1-month window to assess the change in breastfeeding efficiency using the LATCH® criteria, breastfeeding pain, breastfeeding time, and perceived breastfeeding efficiency.

RESULTS

41 mother-infant dyads participated in the study. No surgical complications occurred during or post-procedure. All dyads reported improved (40) or equal (1) LATCH® scores: with a mean improved LATCH® score of 3.2 points (p < 4^10^-15, 95% CI 2.6, 3.7.). The mean improved maternal perception of feeding was 3.3 points (p < 6^10^-10,95% CI 2.6, 4.0.), the mean decreased maternal pain was 4.0 points (p < 1^10^-14, 95% CI 3.3, 4.8), and the mean decreased maternal feeding time was 0.80 points (p = 0.002, 95% CI 0.5, 1.1.).

CONCLUSION

Lingual frenulum release procedures appear to consistently improve breastfeeding efficiency and decrease maternal pain.

Efficacy of Infants Release of Ankyloglossia on Speech Articulation: A Randomized Trial

PURPOSE

The relationship between ankyloglossia and speech is controversial. Our objective in the present study was to determine the most appropriate intervention and optimal timing for infants with speech articulation caused by ankyloglossia.

PATIENTS AND METHODS

A total of 341 pediatric patients (aged 2 to 5 years) being referred for speech concerns due to ankyloglossia were enrolled in a randomized trial and assigned to either a surgical intervention (N = 166) or a no surgical intervention (N = 175) group. Subsequently, patients were further categorized into 3 groups according to age: 2 to < 3 years, 3 to < 4 years, and 4 to < 5 years. Measures of tongue appearance, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected at preintervention (T0), 2-month postintervention (T1), 6-month postintervention (T2), and 12-month postintervention (T3).

RESULTS

No statistically significant difference was found between surgical intervention and no surgical intervention groups for tongue appearance, tongue mobility, speech production, and intelligibility in the 2 to < 3 years age. However, there was significantly improved speech production and intelligibility in the surgical intervention group when compared to the no surgical intervention group in the 3 to < 4 and 4 to < 5 years old age.

CONCLUSION

Surgical intervention should not be performed too early for infants aged 2 to < 3 years with speech articulation caused by ankyloglossia, but rather watch and wait for the physiological growth of the lingual frenulum. The optimal timing range for surgical intervention is 4 to 5 years. This should provide certain significant guidance for infants with speech articulation caused by ankyloglossia.