Lingual Frenotomy in Pediatric Ankyloglossia: A Diode Laser Approach in Two Case Reports.

Ankyloglossia can be related to a number of complications, such as breastfeeding difficulties or alterations in craniofacial development. Treatment can involve surgery to correct the altered lingual frenulum and can be performed by various techniques. The purpose of this paper is to present two case reports of ankyloglossia in pediatric patients of different ages, the diagnostic criteria, and the treatment decision rationale, which led to a lingual frenotomy performed with a diode laser.

Frenotomy Provides Improved Direct Laryngoscopy Exposure in Select Adult Patients With Ankyloglossia.

Objective: To analyze the effects of lingual frenotomy on adults with restrictive ankyloglossia and difficult direct laryngoscopy exposure. Methods: A case series study was conducted. Restriction of tongue protrusion due to ankyloglossia was identified in 2 patients who had a history of suboptimal true vocal fold (TVF) exposure on direct laryngoscopy for phonomicrosurgery. Inadequate exposure of the vocal folds was achieved on direct laryngoscopy attempts with manual tongue protrusion. Mandibular tori were not present in these patients. An intraoperative lingual frenotomy was performed in both patients. Results: After frenotomy and with manual tongue protrusion, direct laryngoscopy exposure was substantially improved allowing for considerably more visualization of the anterior TVFs. Conclusion: Lingual frenulum procedures with manual tongue protrusion should be considered in select adult patients with restrictive ankyloglossia affecting optimal direct laryngoscopy exposure.

Is Public Interest Associated with Real-World Management of Ankyloglossia?

OBJECTIVES: Assess the relationship between public interest in ankyloglossia as determined by internet search volume and real-world medical claims data. STUDY DESIGN: Retrospective Cohort Study. SETTING: This retrospective cohort study was conducted using claims data from the Merative™ Marketscan® Research Databases. The internet search data was collected from Google Trends. METHODS: Annual Google Trends data were compiled using search terms associated with "ankyloglossia" and "frenotomy" for the years 2011 to 2021. We obtained incidence of ankyloglossia diagnoses and frenotomy procedures in children under 12 months from Marketscan relative to all infants enrolled. We compared associations between search and incidence data among US states and over time. RESULTS: Google search correlated with ankyloglossia incidence (r = 0.4104, P = .0031) and with frenotomy incidence (r = 0.4062, P = .0034) per state. Ankyloglossia diagnoses increased with Google search index (coefficient = 0.336, 95% confidence interval [CI] 0.284, 0.388) and year (coefficient = 0.028, 95% CI 0.025, 0.031). Similarly, frenotomy procedures increased with Google search index (coefficient = 0.371, 95% CI 0.313, 0.429) and year (coefficient = 0.027, 95% CI 0.024, 0.030). CONCLUSIONS: Associations between online ankyloglossia search trends and both diagnosis and treatment rates, persist across US regions and timeframes. Internet search trends are pivotal in shaping pediatric health care decisions, driving clinical consensus, and disseminating evidence-based information.

The development of a specialist tongue tie assessment clinic for neonates.

OBJECTIVES: Ankyloglossia or tongue tie is a condition where the lingual frenulum restricts tongue movement, negatively impacting breastfeeding. An increasing number of infants diagnosed with ankyloglossia may lead to unnecessary procedures. To limit the overtreatment of this problem, we established a specialist clinic to provide the best available evidence-based care to the mother-infant dyad. METHODS: We discuss the development of a specialist tongue tie assessment clinic in our unit. RESULTS: From January to October 2023, there were 162 visits to the clinic by 157 patients. During this time, there were 96 frenotomies performed. CONCLUSIONS: The mother-infant dyad is a vulnerable patient group. Establishing a specialist tongue tie assessment clinic with otolaryngology and lactation expertise provides the best available evidence-based care.

Ankyloglossia as a Barrier to Breastfeeding: A Literature Review.

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.

Frenotomy with breastfeeding support versus breastfeeding support alone for infants with tongue-tie and breastfeeding difficulties: the FROSTTIE RCT.

Background: Tongue-tie can be diagnosed in 3-11% of babies, with some studies reporting almost universal breastfeeding difficulties, and others reporting very few feeding difficulties that relate to the tongue-tie itself, instead noting that incorrect positioning and attachment are the primary reasons behind the observed breastfeeding difficulties and not the tongue-tie itself. The only existing trials of frenotomy are small and underpowered and/or include only very short-term or subjective outcomes. Objective: To investigate whether frenotomy is clinically and cost-effective to promote continuation of breastfeeding at 3 months in infants with breastfeeding difficulties diagnosed with tongue-tie. Design: A multicentre, unblinded, randomised, parallel group controlled trial. Setting: Twelve infant feeding services in the UK. Participants: Infants aged up to 10 weeks referred to an infant feeding service (by a parent, midwife or other breastfeeding support service) with breastfeeding difficulties and judged to have tongue-tie. Interventions: Infants were randomly allocated to frenotomy with standard breastfeeding support or standard breastfeeding support without frenotomy. Main outcome measures: Primary outcome was any breastmilk feeding at 3 months according to maternal self-report. Secondary outcomes included mother's pain, exclusive breastmilk feeding, exclusive direct breastfeeding, frenotomy, adverse events, maternal anxiety and depression, maternal and infant NHS health-care resource use, cost-effectiveness, and any breastmilk feeding at 6 months of age. Results: Between March 2019 and November 2020, 169 infants were randomised, 80 to the frenotomy with breastfeeding support arm and 89 to the breastfeeding support arm from a planned sample size of 870 infants. The trial was stopped in the context of the COVID-19 pandemic due to withdrawal of breastfeeding support services, slow recruitment and crossover between arms. In the frenotomy with breastfeeding support arm 74/80 infants (93%) received their allocated intervention, compared to 23/89 (26%) in the breastfeeding support arm. Primary outcome data were available for 163/169 infants (96%). There was no evidence of a difference between the arms in the rate of breastmilk feeding at 3 months, which was high in both groups (67/76, 88% vs. 75/87, 86%; adjusted risk ratio 1.02, 95% confidence interval 0.90 to 1.16). Adverse events were reported for three infants after surgery [bleeding (n = 1), salivary duct damage (n = 1), accidental cut to the tongue and salivary duct damage (n = 1)]. Cost-effectiveness could not be determined with the information available. Limitations: The statistical power of the analysis was extremely limited due to not achieving the target sample size and the high proportion of infants in the breastfeeding support arm who underwent frenotomy. Conclusions: This trial does not provide sufficient information to assess whether frenotomy in addition to breastfeeding support improves breastfeeding rates in infants diagnosed with tongue-tie. Future work: There is a clear lack of equipoise in the UK concerning the use of frenotomy, however, the effectiveness and cost-effectiveness of the procedure still need to be established. Other study designs will need to be considered to address this objective. Trial registration: This trial is registered as ISRCTN 10268851. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme (project number 16/143/01) and will be published in full in Health Technology Assessment; Vol. 27, No. 11. See the NIHR Journals Library website for further project information. The funder had no role in study design or data collection, analysis and interpretation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Many mothers and babies experience difficulties in establishing breastfeeding. In some babies it is thought that their difficulties may be linked to a condition called tongue-tie, in which a piece of skin tightly joins the middle part of the underside of the tongue to the base of the baby's mouth. This can be treated by an operation to divide the tight part/skin in the middle of the underneath of the tongue. We planned to carry out a trial of 870 babies to find out whether an operation together with breastfeeding support helps more mothers and babies with tongue-tie to continue breastfeeding until the baby is 3 months old compared to breastfeeding support on its own and whether the costs were different between the two groups of mothers and babies. We were only able to recruit 169 babies as the trial was stopped because of slow recruitment, changes to services in the COVID-19 pandemic and a high proportion of the babies in the breastfeeding support group going on to have an operation. There were no differences in the rate of breastfeeding at 3 months between the babies in the group who had an operation straightaway and those in the group that had breastfeeding support alone, or had an operation later. More than four in every five babies in both groups were still breastmilk feeding at 3 months. Three babies who had an operation, around 1 in 50 babies, had a complication of the operation (bleeding, scarring or a cut to the tube that makes saliva). Because of the small size of the study, we cannot say whether an operation to divide a tongue-tie along with breastfeeding support helps babies with tongue-tie and breastfeeding difficulties or has different costs. We will need to try different types of research to answer the question.

Maxillary Frenulum and "Lip Tie": What Parents Understand.

Objective: To determine the proportion of parents that have some knowledge of abnormal maxillary frenulum, or "lip tie," and their sources of this information. Study Design: Cross-sectional study. Setting: Otolaryngology clinic. Methods: Consecutive parents of children ≤12 years of age presenting at a pediatric otolaryngology clinic were surveyed to discover their understanding of "lip tie" in children. The survey included questions on the effects of "lip tie," where they learned about "lip tie," whether they thought their child had "lip tie," whether they had a child undergo "lip tie" division, and how concerned they would be if they thought their child had "lip tie." Information on participant demographics and social media was collected. Results: Overall, 59.8% (193) of the 323 parents surveyed had heard of "lip tie"; of those, 17.1% (33) had a child that had undergone "lip tie" surgery. Most parents (91.2%, 176) thought "lip tie" caused breastfeeding problems. Roughly one-quarter of parents (51 of 197 responses) rated their concern about "lip tie" as >8 of 10 on a Likert scale (mean, 5.7). The reported sources of "lip tie" information included lactation consultants (36.8%, 71), nurses (22.8%, 44), and pediatricians (31.6%, 61) as well as nonmedical sources, such as social media, family, and friends (68.4%, 132). Overall, 87% (282) of the 323 participants reported daily use of social media. Conclusion: Although many parents are concerned about "lip tie," much of their information on this condition comes from nonmedical sources. Social media would be a valuable platform to provide accurate information on "lip tie."

Frenillo lingual corto: resultados de una intervención para mejorar la continuidad asistencial / Short lingual frenulum: results of an intervention to improve continuity of care

Introducción: la discrepancia entre los criterios de derivación de pacientes con diagnóstico de frenillo lingual corto/anquiloglosia (FLC/A) a la consulta de cirugía plástica infantil desde Atención Primaria (AP) y los criterios propuestos por parte de los profesionales de la unidad para la realización de frenotomía lingual motivó la creación de un tríptico informativo sobre la patología para intentar homogeneizar la actuación entre niveles asistenciales. El objetivo principal del trabajo consiste en analizar el impacto de la intervención en las derivaciones de estos pacientes a atención especializada (AE). Material y métodos: redacción y divulgación de la información entre los profesionales de AP adscritos al área de salud de nuestro hospital. Análisis retrospectivo de las derivaciones a AE y de la actuación llevada a cabo en consulta en los 2 años previos al envío de la información. Análisis prospectivo de las consultas atendidas en el año posterior a la difusión del tríptico. Comparación de ambos periodos. Resultados: se analizaron 874 consultas; de ellas, el 59,6% se realizó previa difusión del tríptico. Las derivaciones se ajustaron a los criterios propuestos por la UCPI (Unidad de Cirugía Plástica Infantil) en un 61,9% de los casos, observándose una reducción significativa en los pacientes mal derivados entre ambos periodos de tiempo (41,8% vs. 32,6%). Se comprobó una disminución estadísticamente significativa en el número de pacientes derivados sin un problema funcional claro asociado al FLC (34,4% vs. 23,3%). Conclusiones: la difusión de un tríptico informativo sobre FLC/A ha demostrado ajustar las derivaciones hechas desde AP a los criterios propuestos para frenotomía lingual en la UCPI de nuestro hospital (AU)

Introduction: we created an informative triptych about short lingual frenulum/ ankyloglossia (SLF/A) to avoid discrepancy in the referral criteria of patients to the pediatric plastic surgery consultation from primary care (PC). The main objective is to analyze the impact of this intervention on the referrals to specialized care (SC).Material and methods: the information was sent to the primary care professionals attached to the health area of our hospital. We performed a retrospective analysis of the referrals to SC in the 2 years prior sending the information. We compared these results with the prospective analysis of the consultations attended in the year after sending the triptych.Results: we analyzed 874 consultations. 59.6% of them were attended prior sending the information. 61.9% of the referrals adjusted to the proposed criteria for lingual frenotomy, observing a significant reduction in the wrongly referred patients between the compared periods of time (41.8% vs 32.6%). We also found a significant reduction in the number of patients with no functional problem associated to the SLF (34.4% vs 23.3%).Conclusions: our informative triptych about SLF/ ankyloglossia has adjusted referrals from PC to the proposed criteria for lingual frenotomy in our hospital. (AU)

[On the reasons for ankyloglossia relapse. Part 1. Frenotomy in newborns]. / O prichinakh povtornoi plastiki uzdechki yazyka. Chast' 1. Frenulotomiya v grudnom vozraste.

The article presents modern data on the structure of the lingual frenulum in newborns and factors associated with restricted tongue mobility besides the length of the mucosal part of the frenulum. The diversity of these factors dictates to limit the indications for frenectomy in newborns to cases with breastfeeding negative events evaluated and documented by a pediatrician. The assessment protocol should include weight gain but also child and mother position, duration, and comfort of the breastfeeding sessions, as well as breast condition in mother. The cases of long-term complications of frenotomy performed in newborns are described, as well as a case illustrating indications for frenotomy associated with chronic injury (Riga-Fede disease).

What is tongue-tie and does it interfere with breast-feeding? - a brief review.

The most common symptom attributed to ankyloglossia is difficulty breast feeding due to poor latch, inefficient milk extraction and/or maternal nipple pain. During the past two decades, despite a declining birth rate, there has been a dramatic increase in the number of infants diagnosed with and treated for ankyloglossia in the United States, Canada and Australia. Despite a dramatic increase in the diagnosis and treatment of ankyloglossia in these countries, there remains no universally agreed upon definition of ankyloglossia and none of the published scoring systems have been rigorously validated. However ankyloglossia is defined, the majority of infants with ankyloglossia are asymptomatic. Perhaps, infants with ankyloglossia have a greater incidence of difficulty breast feeding. Lingual frenulotomy may decrease maternal pain and at least transiently improve the quality of breast feeding in some infants however no published studies take into account the fact that sucking and feeding are soothing to infants and the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself. While there are almost certainly some infants in whom tongue-tie interferes with breast-feeding, there is currently no good evidence lingual frenulotomy leads to longer duration of breast-feeding. Frenulotomy appears to be a generally safe procedure however there are reports of serious complications. Finally, there are no studies of long-term outcomes following frenulotomy during infancy and given traditional thinking that the lingual frenulum is a cord of connective tissue tethering the tongue to the floor of the mouth may be incorrect and the frenulum contains motor and sensory branches of the lingual nerve, the procedure may be less benign than previously thought.

Bottle-feeding and gastroesophageal reflux disease improvement after restrictive tethered oral tissues release.

Aim: This study aimed to determine the impact of laser surgical tongue-tie, lip-tie, buccal-tie release on bottle-feeding and gastroesophageal reflux disease (GERD) after functional assessment of tongue and lip movement in a prospective cohort study conducted from June 2019 to June 2020 in a private general dental practice. Methods: Preoperative, one-week and one-month postoperative surveys were completed, using the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). All study participants were bottle-feeding dyads (0-12 weeks of age) with untreated ankyloglossia and/or tethered maxillary/buccal frena. Results: The study had 40 bottle feeding infants enrolled. Posterior :tongue-tie was noted in 67.5% of this cohort. Statistically significant improvement in I-GERQ-R scores was reported between preoperative (16.6, SD: 6.1; min-max: 8-28), 1 week (14.1, SD: 4.2; min-max: 6-24) and 1 month I-GERQ-R total scores (9.1, SD: 4.5; min-max:3-27) (ANOVA test - P <.001). Conclusion: This study confirms the need for functional assessment of tongue and lip movement for this significantly affected cohort when surgical release is proposed. Laser surgical release (frenotomy) of tongue-tie, lip-tie, buccal-tie resulted in significant improvement in I-GERQ-R outcomes were found for cohorts of the classically recognised anterior tongue-tie and the less obvious (without functional assessment) and less diagnosed posterior tongue tie were found.

Ankyloglossia, Syndactyly and Polydactyly in the Pediatric Patient.

Ankyloglossia is a congenital alteration in the development of the tongue characterized by the presence of a short or thick lingual frenulum, which leads to a limitation in its movements. There is an associative inconsistency between ankyloglossia and complications with breastfeeding, speech, swallowing, breathing, and the development of orofacial structures, and it is urgent to make more scientific research in this area. In the presence of polydactyly and syndactyly may be also present ankyloglossia. The purpose of this paper is to present two ankyloglossia cases with finger alterations, without a syndromic disease, and lead the medical team to research this topic and make an improved treatment plan for these cases.

Ankyloglossia: Clinical and Sociodemographic Predictors of Diagnosis and Management in the United States, 2004 to 2019.

OBJECTIVE: The past 2 decades have seen a rapid increase in the diagnosis of ankyloglossia. Patients are often managed by lingual frenotomy. The objective is to define the clinical and socioeconomic factors that determine which patients receive frenotomy. STUDY DESIGN: A retrospective analysis of commercially insured children. SETTING: Optum Data Mart database. METHODS: Trends in frenotomy including provider and setting were described. Multiple logistic regression was used to determine predictors of frenotomy. RESULTS: Diagnosis of ankyloglossia increased from 2004 to 2019 (from 3377 in 2004 to 13,200 in 2019), while lingual frenotomy similarly increased from 1483 in 2004 to 6213 in 2019. The proportion of inpatient frenotomy procedures increased from 6.2% to 16.6% from 2004 to 2019, with pediatricians having the highest odds of performing inpatient frenotomies (odds ratio: 4.32, 95% confidence interval: 4.08, 4.57). Additionally, during the study period, the proportion of frenotomies performed by pediatricians increased from 13.01% in 2004 to 28.38% in 2019. In multivariate regression analyses, frenotomy was significantly associated with the male sex, white non-Hispanic ethnicity, higher parental income and education, and a greater number of siblings. CONCLUSION: Ankyloglossia has been increasingly diagnosed in the past 2 decades, and among patients with ankyloglossia, frenotomy is increasingly performed. This trend was driven at least in part due to increasing rates of pediatricians as proceduralists. After accounting for maternal and patient-level clinical factors, socioeconomic differences in the management of ankyloglossia were observed.

Impacte de la frenotomia neonatal en la taxa de lactància materna a l’alta de la maternitat / Impact of neonatal frenotomy on the breastfeeding rate at discharge from the maternity ward / Impacto de la frenotomía neonatal en la tasa de lactancia materna al alta de la maternidad

Fonament: L’anquiloglòssia pot provocar el deslletamentprecoç. La realització d’una frenotomia podria augmentarla taxa de lactància materna exclusiva a l’alta de la maternitat. Objectiu: Descriure les diferències en el tipus d’alimentacióa l’alta de la maternitat entre els nounats amb anquiloglòssia i els que no en tenen, i entre els nounats amb anquiloglòssia tractada i els no tractats. Mètode: Estudi de cohorts prospectiu de tots els nadonsnascuts a la unitat neonatal l’any 2018 (n=1.392). Es vanexcloure 7 pacients que es van traslladar abans de l’alta.Es va oferir una frenotomia a tots els pacients amb anquiloglòssia (451). Es va determinar quantes frenotomies esvan fer (422/451), si la lactància materna va millorar acurt termini, i es van comparar les taxes de lactància materna entre els nounats amb anquiloglòssia i sense. Resultats: La taxa de lactància materna a l’alta va ser mésalta en els nounats amb anquiloglòssia tractada que en elsno tractats (393/422 vs 22/29, 93,1% vs 75,9%, respectivament, p <0,001). Conclusions: La frenotomia podria ajudar a augmentar lataxa de lactància materna a l’alta dels nounats amb anquiloglòssia.(AU)

Fundamento: La anquiloglosia puede provocar el destete precoz. Larealización de una frenotomía podría aumentar la tasa de lactanciamaterna al alta de la maternidad. Objetivo: Describir las diferencias en el tipo de alimentación al altade la maternidad entre los neonatos con anquiloglosia frente a losque no la sufren y entre los neonatos con anquiloglosia tratada ylos no tratados. Método. Estudio de cohorte prospectivo de todos los neonatos nacidos en la unidad neonatal el año 2018 (n=1.392). Se excluyeron7 pacientes que se trasladaron antes del alta. Se ofreció una frenotomía a todos los pacientes con anquiloglosia (451). Se determinó cuántas frenotomías se realizaron (422/451) y si la lactanciamaterna mejoró a corto plazo, y se compararon las tasas de lactancia materna entre los neonatos con y sin anquiloglosia. Resultados: La tasa de lactancia materna al alta fue mayor en losneonatos con anquiloglosia tratada que en los no tratados(393/422 frente a 22/29, 93,1% frente a 75,9%, respectivamente, p <0,001).Conclusiones. La frenotomía podría ayudar a aumentar la tasa delactancia materna al alta de los neonatos con anquiloglosia.(AU)

Background: Ankyloglossia may lead to an early abandonment ofbreastfeeding. Performing a frenotomy could increase the breastfeeding rate at discharge from the maternity ward. Objective: The aim of our study was to describe differences in thetype of feeding at discharge from the maternity ward, betweentongue-tied and non tongue-tied neonates, and between treatedand untreated tongue-tied neonates. Method: This prospective cohort study included all the neonatesborn at a neonatal unit in 2018 (n=1392). We excluded 7 patientswho were transferred before discharge. We offered a frenotomy toall tongue-tied patients (451). We determined how many frenotomies we performed (422/451), whether breastfeeding improved inthe short term, and compared the breastfeeding rates betweentreated and untreated tongue-tied and non-tongue-tied neonates. Results: The breastfeeding rate at discharge was higher amongtreated tongue-tied infants than in untreated neonates (393/422vs. 22/29, 93.1% vs. 75.9%, respectively, p <0.001).Conclusions: Frenotomy could help increase the breastfeeding rateat discharge among tongue-tied neonates.(AU)

Atmospheric Plasma Lingual Frenectomy Followed by Post Operative Tongue Exercises: A Case Series.

The lingual frenulum is a submucosal component significantly involved in the mobility of the tongue. In the case of short lingual frenulum, different surgical approaches have been proposed. Atmospheric plasma is a thermal technique of vaporization or sublimation of the superficial tissues, without going deep, and the resulting fine carbonized layer avoids bleeding. The aim of the present investigation was to evaluate the effectiveness of atmospheric plasma (voltaic arc dermabrasion) for the frenectomy of a short lingual frenulum. A total of 30 patients with an age range between 6−11 years old and a class III/IV Kotlow's ankyloglossia classification were included in the study. The Kotlow's free-tongue, maximal interincisal mouth opening (MIO, mm) and interincisal mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP, mm) were calculated at the baseline, immediately postoperatively (T0), at one week (T1), one month (T2) and two months (T3). A significant increase of Kotlow's measurements, MOTTIP and MIO were detected when comparing the baseline and the T0 (p < 0.05). No significant difference was detected between the T0, T1 and T2 (p > 0.05). The atmospheric plasma demonstrated a very minimal invasive approach for frenectomy, without important or fibrotic complications and with very low recurrence rates.

What is a superior labial frenulum? An anatomical and histological study.

Anatomy of the superior labial frenulum (SLF), at first glance, seems to be well established. However, existing studies on the SLF lack description of the incisivus labii superioris (ILS), which cannot be ignored when discussing the SLF. We believe that thorough understanding of the SLF necessitates the anatomical knowledge of the ILS. This study aimed to elucidate the anatomical relationship between the orbicularis oris (OO), ILS, and SLF. A total of 20 formalin fixed human cadaveric specimens were used for gross anatomical and/or histological observation. For histological observation, all specimens were stained with Masson-trichrome. The SLF was a mucosal fold between the gingival mucosa and alveolar mucosa with connective tissue deep to it. The connective tissue attached to the alveolar bone in the junction between the right and left ILS. Skeletal muscle fibers other than orbicularis oris was found in one specimen, which were considered the ILS. During a frenulectomy, removal of the connective tissue bundle is required to prevent recurrence of the high SLF insertion.

Grouping of Ankyloglossia According to Coryllos Anatomical Classification and Follow-Up Results for Breastfeeding: Single-Center, Cross-Sectional Study.

Ankyloglossia is a condition of limited tongue mobility caused by a short lingual frenulum. The diagnosis and treatment of ankyloglossia are still controversial. The main clinical problems encountered during breastfeeding are difficulty in sucking and its clinical reflections. This study aims to evaluate the infant population born with ankyloglossia and to determine the results of frenotomy. We conducted an observational, cross-sectional study among infants born in a tertiary hospital. We included all infants born between 1 January and 30 June 2022. The neonatal follow-up protocol for ankyloglossia was determined before the defined dates, and data were recorded during the screening period. The recorded data were retrospectively collected from the files. Within six months, 705 infants were born. Due to additional problems and other conditions that prevent breastfeeding, evaluable data of 207 (29.3%) infants could not be provided. Of the remaining 498 infants, 234 (33.2%) had ankyloglossia. While none of the infants without ankyloglossia had a breastfeeding problem after appropriate training, 28.6% of the ankyloglossia group had a breastfeeding problem (p < 0.001). The need for frenotomy differed significantly between Coryllos groups (p < 0.001). Breastfeeding was unsuccessful before frenotomy in 12 Coryllos type-1 patients, and all had difficulty in sucking. Frenotomy was performed within the three-month follow-up period in all patients with complaints of inability to firmly grasp the breast, nipple slipping from the mouth, and nipple biting during the first 24 h. In terms of breastfeeding problems, regardless of the anatomical typology, frenotomy can be performed safely in early life with successful results. If deficiencies or difficulties in breastfeeding are noticed in ankyloglossia patients even at the first control, frenotomy should be recommended in clinical conditions.

Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study.

BACKGROUND: The study aims to describe the lingual laser frenotomy perioperative protocol for newborns with ankyloglossia with or without breastfeeding difficulties developed by Odontostomatology and Neonatology and Neonatal Intensive Care Units of the Aldo Moro University of Bari. METHODS: Authors carried out a prospective observational cohort study. Newborns with ankyloglossia (classified by using both Coryllos' and Hazelbaker's criteria) with or without difficult breastfeeding (according to Infant Breastfeeding Assessment Tool) underwent diode laser frenotomy (800 ± 10 nm; 5 W; continuous wave mode; contact technique; under topical anesthesia) and follow-up visits after seven and thirty days postoperatively. The authors analyzed as main outcomes the perioperative pain intensity measured by the C.R.I.E.S. scale, the occurrence of complications and quality of healing, the quality of breastfeeding, newborn's postoperative weight gain, maternal nipple pain, and the presence of lesions as secondary outcomes. RESULTS: Fifty-six newborns were included in the current study. Intraoperative mean pain intensity was 5.7 ± 0.5 points, resolved within thirty postoperative minutes. Observed complications were mild punctuating bleeding, carbonization of the irradiated site, and transitory restlessness. All wounds were completely healed within the thirtieth postoperative day. During follow-up, a significant breastfeeding improvement was evident with satisfactory newborns' weight gain and a significant reduction of nipple pain and lesions (p < .05). CONCLUSION: Our lingual laser frenotomy protocol provided significant breastfeeding improvement in the mother-newborn dyads with low intraoperative pain and no significant complications.

Comparison of the analgesic effect of inhaled lavender vs vanilla essential oil for neonatal frenotomy: a randomized clinical trial (NCT04867824).

It is necessary to treat neonatal pain because it may have short- and long-term adverse effects. Frenotomy is a painful procedure where sucking, a common strategy to relieve pain, cannot be used because the technique is performed on the tongue. In a previous randomized clinical trial, we demonstrated that inhaled lavender essential oil (LEO) reduced the signs of pain during neonatal frenotomy. We aimed to find out whether inhaled vanilla essential oil (VEO) is more effective in reducing pain during frenotomy than LEO. Randomized clinical trial with neonates who underwent a frenotomy for type 3 tongue-ties between May and October 2021. Pain was assessed using pre and post-procedure heart rate (HR) and oxygen saturation (SatO2), crying time, and NIPS score. Neonates were randomized into "experimental" and "control" group. In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for 2 min. We placed a gauze pad with one drop of LEO (control group) or of VEO (experimental group) under the neonate's nose for 2 min prior to and during the frenotomy. We enrolled 142 neonates (71 per group). Both groups showed similar NIPS scores (2.02 vs 2.38) and crying times (15.3 vs 18.7 s). We observed no differences in HR increase or in SatO2 decrease between both groups. We observed no side effects in either of the groups. CONCLUSIONS: We observed no appreciable difference between LEO and VEO; therefore, we cannot conclude which of them was more effective in treating pain in neonates who underwent a frenotomy. TRIAL REGISTRATION:  This clinical trial is registered with www. CLINICALTRIALS: gov with NCT04867824. WHAT IS KNOWN: • Pain management is one of the most important goals of neonatal care as it can have long-term neurodevelopmental effects. • Lavender essential oil can help relieve pain due to its sedative, antispasmodic, and anticolic properties. WHAT IS NEW: • Lavender and vanilla essential oils are safe, beneficial, easy to use, and cheap in relieving pain in neonates who undergo a frenotomy for type 3 tongue-ties.