Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study.

Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis.

BACKGROUND: Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial. METHODS: Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores. RESULTS: Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5-10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5-15 days (SMD -1.10 [CI: -1.49, -0.70; P < 0.001]) and 1 month (SMD -1.23 [CI: -1.79, -0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD -0.63 [CI: -0.95, -0.31; P = 0.008]), with continued improvement at 1 month (SMD -0.41 [CI: -0.78, -0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5-7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01). CONCLUSIONS: Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties. PROTOCOL REGISTRATION: PROSPERO identifier CRD42022303838 . IMPACT: This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia. Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.

The buccal frenum: Trends in diagnosis and indications for treatment of buccal-ties among 466 healthcare professionals.

BACKGROUND: The buccal frenum is connective tissue that adheres the mucosa of the cheek to the alveolar process. When restricted, this condition is commonly known as a buccal- or cheek-tie. Restrictive buccal frena are often treated during tongue- and lip-tie procedures, yet widely accepted classification, diagnostic and treatment guidelines are lacking. OBJECTIVE: Provide a scoping review on the evaluation and management of buccal-ties, including diagnosis, classification, symptoms and treatment, by surveying healthcare providers with experience evaluating and managing oral restrictions. METHODS: Literature review and IRB-approved survey to assess practice patterns among healthcare providers identified from online directories of tongue-tie release providers and associated allied health professionals. RESULTS: A multidisciplinary group of 466 providers responded. About 87% indicated that they assess buccal restrictions. Evaluation methods included finger sweep (89.1%), visual inspection (76.4%), tissue blanching (66.5%) and functional assessment (53.4%). Around 94% of providers reported that objective and subjective findings are both needed for diagnosis and that an estimated 5%-10% of infants may be affected. About 70% of providers release buccal-ties (if needed) simultaneously with tongue-ties, and 76.8% recommend post-operative stretches as necessary for optimal healing. Respondents indicated a need for further research, evidence-based assessments, a classification system and treatment protocols. CONCLUSION: Evaluating a buccal frenum to diagnose a symptomatic buccal-tie relies upon visual inspection, palpation and assessment of oral function. Survey data and clinical experience are summarized to review classification systems, diagnostic/evaluation criteria and treatment recommendations as a foundational cornerstone for future works to build upon.

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.

Ranula Formation After Lingual Frenectomy in a Newborn.

Ankyloglossia is a developmental anomaly characterized by a shortened lingual frenulum, which can range from cases with no clinical relevance to severe cases, where frenectomy may be indicated. In newborns, this indication has increased exponentially. The purpose of this report is to discuss obstruction of the sublingual caruncle, with a recurrent ranula, as a post-surgical complication of laser lingual frenectomy performed in a newborn. The treatment provided is also discussed (marsupialization and removal of the affected sublingual glands). Lingual frenectomy should be performed with great care, especially in newborns, because the sublingual caruncles can be affected and complications can occur.

The Impact of Ankyloglossia Beyond Breastfeeding: A Scoping Review of Potential Symptoms.

OBJECTIVE: The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo tongue-tie release (frenotomy) during infancy. DATA SOURCES: This study contains data from PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar (1961-January 2023). REVIEW METHOD: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Experimental and observational studies were eligible if they reported baseline outcomes associated with ankyloglossia in children above a year of age. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded. CONCLUSIONS: Twenty-six of 1,568 screened studies (> 1,228 patients) were included. Six studies were high quality and 20 were medium quality. Studies identified various symptoms that may be partially attributable to ankyloglossia after infancy, including speech/articulation difficulties, eating difficulties, dysphagia, sleep-disordered breathing symptoms, dental malocclusion, and social embarrassment such as oral hygiene issues. Multiple comparative studies found associations between ankyloglossia and risk factors for obstructive sleep apnea; a randomized controlled trial found that frenotomy may attenuate apnea severity. Ankyloglossia may also promote dental crowding. IMPLICATIONS FOR PRACTICE: Ankyloglossia may be associated with myriad effects on children's quality of life that extend beyond breastfeeding, but current data regarding the impact are inconclusive. This review provides a map of symptoms that providers may want to evaluate as we continue to debate the decision to proceed with frenotomy or nonsurgical therapies in children with ankyloglossia. A continuing need exists for controlled efficacy research on frenotomy for symptoms in older children and on possible longitudinal benefits of early frenotomy for maxillofacial development. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23900199.

Surgical and Speech Therapy Evaluation of Lingual Frenulum.

Interdisciplinary evaluation is essential to diagnose and define clinical conduct for children and adults presenting with an altered lingual frenulum; however, there are few reports on the subject in the literature. In this context, the following study exemplifies a proposed protocol for the surgical and SLT treatment of a lingual frenulum based on a review of the literature and the experience of speech and language therapists and maxillofacial surgeons from hospitals in Santiago de Chile. After its application, a history of breastfeeding with difficulties and a maintained preference for soft foods was reported. Upon anatomic examination, the lingual apex was heart-shaped, and the lingual frenulum was fixed in the upper third of the ventral side of the tongue, with a pointed shape, submerged up to the apex, and of adequate thickness. Meanwhile, upon functional examination, the tongue was descended at rest, performed tongue protrusion with restrictions (raising and clicking), did not achieve attachment or vibration, and presented distortion of the sounds / r/ and /rr/. With this information, an altered lingual frenulum was diagnosed, with the indication for surgery and postoperative speech and language therapy. The constructed instrument allowed for the standardization of the evaluation in different teams but should be validated in future research.

Ankyloglossia in Australia: Practices of health professionals.

OBJECTIVES: To investigate the opinions and practices of health professionals involved in ankyloglossia diagnosis and management in Australia. METHOD: Two hundred and thirty-seven health professionals across Australia responded to an online survey including their diagnostic and management practice of ankyloglossia. Descriptive statistics, content analysis and thematic analysis were used to analyse quantitative data and open-ended responses, respectively. RESULTS: Most (91.6%) respondents reported they are responsible for the assessment and diagnosis of ankyloglossia in their clinical practice. A majority (56.7%) reported using more than one assessment tool in clinical practice. Less than half (46.4%) reported providing treatment to manage ankyloglossia. Surgical management was used by 44.5%, and 56.4% used non-surgical management as their primary treatment of ankyloglossia. Of the total sample, 26.6% had completed no further training or professional development in the field. 46% of respondents stated they always educate parents about ankyloglossia diagnoses, whereas 29.5% reported they always educate parents about management of ankyloglossia. Of respondents, a high level of confidence was reported by 62.6% of health professionals in the assessment of infants with ankyloglossia. Of those who perform surgical management, 53.7% reported feeling extremely confident in their skills. Fifty-two percent of respondents reported they were dissatisfied with the current service delivery for infants with ankyloglossia. CONCLUSIONS: The diagnosis, management and education practices varied greatly amongst health professionals in Australia. Clinical guidelines for all relevant health professionals are needed to ensure standardised diagnosis and management processes. In future, this will help guide evidence-based diagnosis and intervention for infants with ankyloglossia.

The effect of frenectomy for tongue-tie, lip-tie, or cheek-tie on breastfeeding outcomes: A systematic review of articles over time and suggestions for management.

OBJECTIVE: Tongue-tie, or ankyloglossia, is a common condition characterized by an abnormally short or tight lingual frenulum and is known to cause breastfeeding difficulties, leading to damage to the nipple, early discontinuation of breastfeeding, and delayed infant growth. In addition to tongue-tie, abnormal frenulums such as the labial frenulum and buccal frenulum can cause lip-tie and cheek-tie, respectively. While both of these conditions have been reported to potentially cause similar issues related to breastfeeding as tongue-tie, limited research has been conducted to understand their effects and how we should treat these conditions. METHODS: In this systematic review, we conducted a comprehensive search of MEDLINE to analyze the trend in publications of all three of these conditions and their impact on breastfeeding for the past 36 years. Keywords included, "tongue-tie", "lip-tie", "cheek-tie", and "breastfeeding outcomes". RESULTS: We found that publications describing the effect of only tongue-ties on breastfeeding have increased exponentially over time while less focus has been on other oral ties. It was also discovered that the majority of studies describing only lip-tie or tongue-tie were editorials, commentary, perspectives, or consensus statements. Finally, we found that articles describing more than one abnormal frenulum were more likely to be cited and articles describing tongue-tie only were published in the highest impact factor journals. CONCLUSION: This study revealed a significant increase in publications discussing tongue-tie and a lack of research on lip-tie and cheek-tie in relation to breastfeeding. The findings highlight the need for more comprehensive research and attention to lip-tie and cheek-tie, as well as standardized diagnostic criteria. Ongoing debate surrounding management of these conditions stem from the lack of investigations on the impact of these abnormal frenulums and outcomes post-frenectomy. Future high-quality studies, specifically prospective cohort studies and randomized controlled trials, are necessary to provide more robust evidence and guide clinical practice.

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).

Ankyloglossia in Central Australia: Prevalence, identification and management in infants.

PURPOSE: To investigate the prevalence and management of ankyloglossia for infants in Central Australia. METHOD: Retrospective chart review consisting of a medical file audit of infants (n = 493) <2 years old diagnosed with ankyloglossia from January 2013 to December 2018 in the primary hospital in Central Australia. Patient characteristics, reason for diagnosis, reason for procedure and outcomes of procedures routinely recorded in the patient clinical files were recorded. RESULTS: The overall prevalence of ankyloglossia in this population was 10.2%. Frenotomy was performed in 97.9% of infants diagnosed with ankyloglossia. Infants with ankyloglossia were more likely to be male (58% vs 42%), diagnosed and managed with a frenotomy on the third day of life. Most ankyloglossia diagnoses were identified by a midwife (>92%). Most frenotomy procedures were completed by lactation consultants who were also midwives (99%) using blunt-ended scissors. More infants were classified with posterior ankyloglossia than anterior ankyloglossia (23% vs 15%). A frenotomy procedure resolved feeding issues in 54% of infants with ankyloglossia. CONCLUSIONS: The prevalence of ankyloglossia and rate of frenotomy procedures were high when compared to previous reports in the general population. Frenotomy for ankyloglossia in infants with breastfeeding difficulties was found to be effective in more than half of the reported sample, improving breastfeeding and decreasing maternal nipple pain. A standardised approach and validated screening or comprehensive assessment tool for the identification of ankyloglossia is indicated. Guidelines and training for relevant health professionals on non-surgical management of the functional limitations of ankyloglossia are also recommended.

Perfil de serviços públicos que realizam avaliação do frênulo lingual em neonatos no Rio Grande do Norte / Profile of health services that assessthelingual frenulum of newborns in public and maternity hospitals of Rio Grande do Norte state / Perfil de servicios que realizanevaluación del frenillo lingual en neonatos en hospitales públicos y maternidades del estado de Rio Grande do Norte

Introdução:A anquiloglossia é caracterizada pela alteração do frênulo lingual resultando na restrição dos movimentos da língua. A avaliação do frênulo lingual em neonatos é importante para diagnosticar precocemente essa alteração. Objetivo:Traçar perfil de serviços que realizam avaliação do frênulo lingual em neonatos nos hospitais e maternidades públicas do estado do Rio Grande do Norte. Metodologia:Trata-se de um estudo observacional, descritivo e transversal, com abordagem quantitativa. Foram incluídos na pesquisa as maternidades públicas e filantrópicas do estadoque realizam procedimentos obstétricos e assistência materno-infantil. As informações acerca da avaliação do frênulo lingual em neonatos e caracterização desses serviços foram coletadas por meio de um questionário eletrônico. Os dados foram armazenados em planilhas no Excel e analisados através do programa estatístico SPSS versão 23.0, em queforam conduzidas análises das variáveis investigadas.Resultados:Participaram do estudo 23 hospitais e maternidades públicas do estado, econstatou-se que apenas 7 (30,44%) ofertam a avaliação do frênulo lingual em neonatos no próprio estabelecimento, enquantoas demais encaminham para outros serviços. O exame foi implantado nas maternidades entre os anos de 2014 e 2018. A quantidade de profissionais que realizam esta avaliação variou entre 1 e 9 por instituição, e os profissionais envolvidos foram os fonoaudiólogos e cirurgiões-dentistas. A prevalência da anquiloglossia variou de 3,7% a 14,5%. A maioria das maternidades realizam a frenotomia e o profissional que executa é o médico ou cirurgião-dentista.Conclusões:Constatou-se uma baixa oferta da avaliação do frênulo lingual em neonatos no próprio estabelecimento de nascimento. Além disso, essa oferta ainda não acontece de forma universal, principalmente no interior do estado (AU).

Introduction:Ankyloglossia is characterized by alterations in the lingual frenulum resulting in restricted tongue movements. Assessing the lingual frenulum in newborns is important for early diagnosis of this disorder. Objective:Describe the profile of health servicesthat assess the lingual frenulum of newborns in public and maternity hospitals of Rio Grande do Norte state. Methodology:This is a cross-sectional descriptive study using a quantitative approach. Included in the research were public and philanthropic maternity hospitals in statethat perform obstetric procedures and provide maternal and child care. The information about lingual frenulum assessment in newborns and characterization of these health services was collected via an electronic questionnaire. The data were stored in Excel spreadsheets and analyzed using the SPSS version 23.0 program, where analyses of the variables investigated were carried out. Results:A total of 23 public and maternity hospitalsparticipated, only 7 of which (30.44%) assessed the lingual frenulum of newborns on site, while the others referred them to other medical facilities. The examination was implemented in maternity hospitals between 2014 and 2018. The number of professionals who performed this assessment varied between 1 and 9 per institution, and included speech therapists, and dentists. The prevalence of ankyloglossia ranged from 3.7 to 14.5%. Most of the maternity hospitals performed frenotomy, where the procedure was conducted by a doctor or dentist. Conclusions:On-site lingual frenulum assessment of newborns was low in the institutions, and does not occur universally, mainly in the rural areas of the state (AU).

Introducción: La anquiloglosia se caracteriza por la alteración del frenillo lingual que resulta en la restricción de los movimientos de la lengua. La evaluación del frenillo lingual en neonatos es importante para un diagnóstico precoz de este trastorno.Objetivo: Delinear un perfil de servicios que realizanevaluación del frenillo lingual en neonatos en hospitales públicos y maternidades del estado de Rio Grande do Norte.Metodología: Se trata de un estudio observacional y transversal con enfoque cuantitativo. Se incluyeron en la investigación las maternidades públicas y filantrópicas del estadoque realizan procedimientos obstétricos y de atención materno-infantil. La información sobre la evaluación del frenillo lingual en neonatos y la caracterización de estos servicios fui recogido por medio de un cuestionario electrónico. Los datos fueron almacenados en hojas Excel y analizados utilizando el programa estadístico SPSSversión 23.0, donde se realizaron análisis de las variables investigadas. Resultados: Un total de 23 hospitales públicos y maternidades participaron del estudio, en el que se constató que solo 7 (30,44%) evalúan el frenillo lingual en neonatos en establecimiento propio, mientras los demás refieren a otros servicios. El examen se implementó en las maternidades entre 2014 y 2018. El número de profesionales que realizan esta evaluación varió entre 1 y 9 por institución, y los profesionales involucrados fueron terapeutas del habla y odontólogos. La prevalencia de anquiloglosia varió entre 3,7 y 14,5 %. La mayoría de las maternidades realizan la frenotomía y el profesional que la realiza es el médico u odontólogo. Conclusiones: Hubo una baja oferta de avaluación del frenillo lingual en neonatos en el propio establecimiento. Además, esta oferta aún no es universal, especialmente en el interior del estado (AU).

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.

Tethered Oral Tissue Release Among Breastfed Infants: Maternal Sources of Information and Treatment.

BACKGROUND: Despite limited clinical consensus regarding surgery for tethered oral tissues ("tongue-tie") for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes. RESEARCH AIM: To explore experiences of breastfeeding mothers with infants having undergone "tongue-tie" surgery. METHOD: This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being ≥ 18 years of age and previously or currently breastfeeding an infant with ≥ 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90. RESULTS: The sample was predominantly white (n = 86; 95%), non-Hispanic (n = 84; 93%), married/cohabitating (n = 85; 94%), and currently providing their own milk (n = 81; 89%).Difficult latch was the primary reason for seeking help. Participants reported lingual (n = 84; 93%), labial (n = 79; 88%), and buccal (n = 16; 17%) tissue-release, with 80% (n = 73) reporting > 1 released. For each tissue released, > 80% (n = 72) of participants felt "very confident" in their ability to correctly identify it and 97% (n = 87) felt "very involved" and "strongly agreed" with surgical release. International Board Certified Lactation Consultants® were the most frequently identified source of information (n = 45; 50%) and referrals (n = 38; 42%), while pediatric dentists most frequently performed interventions (n = 60; 67%). CONCLUSIONS: Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.

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.

Breastfeeding Symptoms with Tongue- and Lip-Tie.

PURPOSE: The aims of this study were to describe maternal and infant symptoms relative to tongue- and lip-tie severity and describe changes in symptoms and feeding efficiency from pre- to post-frenotomy. STUDY DESIGN AND METHODS: A one-group pre- and post-intervention study design was used. Data from a dental practice were collected from medical records of infants less than 1 year old who underwent a frenotomy procedure for tongue- and/or lip-tie. Infant and maternal symptoms were compared with severity of tongue- and lip-tie using binary logistic regression. Wilcoxon Signed Rank test compared pain scores and feeding duration pre- and post-frenotomy. Linear regression compared total number of symptoms reported pre-frenotomy with tongue- and lip-tie severity. RESULTS: N = 121 dyads were included. More severe classifications of tongue- and lip-tie were significantly associated with certain infant and maternal symptoms pre-frenotomy. Improvements were noted in all reported infant symptoms post-frenotomy. Feeding duration times significantly decreased post-frenotomy. CLINICAL IMPLICATIONS: Infants and mothers experience problematic symptoms with feeding associated with tongue- and lip-tie. Nurses are the primary care providers during postpartum and should be alert to signs and symptoms that may suggest oral restrictions. Early evaluation and involvement of feeding experts may improve the breastfeeding experience of the dyad.