Do all infants with tongue and lip ties (Ankyloglossia) needs frenotomy ?
An article published online on 11/07/2019 (PMID 31294774), examining infants referred to frenotomy in cases of tongue and lip ties (tongue tie is also called Ankyloglossia), who were managed without the procedure, after an intervention by a multidisciplinary team.
The rational for this research is that the rate of this condition is 10 times higher in 2012 than in 1997 (and probably even more in the past years). Having said that – there are still no clear indications when or who to operate, and if this procedure improves breastfeeding in the long term.
The purpose of this study was to see if infants referred to this procedure because of breastfeeding difficulties, really did needed this surgical intervention, or that another intervention could have prevented the frenotomy.
Methods – Infants, who were referred to a tertiary center preforming this procedure, were evaluated to see if reports on breastfeeding difficulties were in fact associated with tongue and lip ties. A multidisciplinary team examined and diagnosed these infants, giving the parents additional guidance and tips for breastfeeding improvement.
Results – 115 infants were referred to the clinic, in the average age of 33 days. After examination and intervention by the multidisciplinary team, 62.6% did not require surgery. (It’s worth to mention, that in the time previous to this study, 95% of infants went through this procedure when referred to this tertiary center).
Conclusions – Most of the infants referred to this procedure, improved under intervention by a multidisciplinary team, and not by surgery.
What do I learn from this?
It is clear to most pediatricians, that this procedure has become very common all over the world (even too common), and it is used way too often. In my opinion we must choose infants for this procedure more carefully and after thorough examination. Many of the cases can be resolved using conservative measures.
I recommend not to hurry and go through this procedure, but to reach for experts in diagnosing breastfeeding problems, and only choose the surgical way in conclusive cases, where other conservative attempts have failed. If you want to read more of my personal opinion on the topic of tongue-tie. read the full article here.
And if you want to learn more of the advantages (as well as disadvantages), of breastfeeding, read here.
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