The research on tongue-ties has been steadily increasing year after year. Staying up to date on the latest research is important for both parents and providers. The following articles highlight the impact oral restrictions, like tongue-ties and lip-ties, have on breastfeeding and demonstrate the benefits of Infant Frenectomy. Also included are articles on Laser Frenectomy vs. Traditional Frenectomy (using Scalpel or Scissors), which illustrate the benefits of using a laser for the frenectomy procedure. Articles on Child Frenectomy and the use of Myofunctional Therapy in conjunction with Laser Frenectomy are also shown below.
1. Amir, Lisa Helen et al. “Review of tongue-tie release at a tertiary maternity hospital.” (2005)
OBJECTIVE: To review the first 12 months of assessment and release of lingual frenulum (frenotomy) at a breast-feeding clinic in a tertiary maternity hospital (August 2002 to end of July 2003) and to report on the breast-feeding outcomes and parental satisfaction.
CONCLUSION: Frenotomy is a safe and easy procedure. Infants with a significant tongue-tie that is interfering with breast-feeding have shown an improvement with breast-feeding following frenotomy.
2. Ballard, Jeanne L et al. “Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.” (2002)
OBJECTIVE: Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls.
CONCLUSION: Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.
3. Baxter, Richard, and Lauren Hughes. "Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series." (2018)
ABSTRACT: Ankyloglossia, commonly referred to as tongue-tie has recently seen a surge in cases and awareness with a corresponding increase in diagnosis and treatment. The evidence linking tongue-tie release and breastfeeding improvement has been published previously. However, due to a lack of published evidence for children, many medical professionals still believe that a restricted tongue does not contribute to feeding or speech issues in older children. The condition of tongue-tie exists on a continuum with variable visibility and symptoms. Some restrictions, mainly anterior or classic tongue-tie, are highly visible and easier to detect. However, posterior or submucosal tongue-ties are often more challenging to diagnose. Recently, an increase in awareness and education has led to improved detection of these posterior tongue-ties. The data presented in these case studies will demonstrate that even posterior ties restrict movement and affect oral structures that are required for speech and feeding. In this case series, five patients with posterior tongue restrictions underwent CO2 laser frenectomy without any general anesthesia or sedation.
CONCLUSION: After a quick in-office procedure, all five patients demonstrated increased lingual mobility evidenced by improved speech and feeding skills. Some improvements were observed immediately after the procedure by clinical staff and the child’s family. While these patients required continued intervention from a speech-language pathologist, their improved lingual mobility allowed for more significant and faster improvement in speech and feeding skills. These cases challenge the status quo that speech and feeding are not affected by posterior tongue-tie. Continued research is warranted to determine the impact that all classes of lingual restrictions can have on speech and feeding development.
4. Baxter, Richard et al. “Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study.” (2020)
ABSTRACT: Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.
5. Berry, Janet et al. “A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding.” (2012)
AIM: This study investigated if a maternally reported, immediate improvement in breastfeeding following division of tongue-tie is due to a placebo effect.
CONCLUSION: There is a real, immediate improvement in breastfeeding, detectable by the mother, which is sustained and does not appear to be due to a placebo effect.
6. Carnino, Jonathan M et al. “Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis.” (2024)
OBJECTIVE: Tongue-tie, which is also known as ankyloglossia, is a common condition where the lingual frenulum is unusually tight or short. While most literature investigates the impact of tongue-tie on breastfeeding, recent articles have examined its role in speech production in children. However, these have not previously been reviewed systematically. This study aims to determine the impact of tongue-tie on speech outcomes and assess whether frenectomy can improve speech function.
CONCLUSION: Overall, we conclude that frenectomy is a suitable treatment to correct speech issues in select patients with tongue-tie if caught early in childhood. Despite the limited investigations around speech outcomes post-frenectomy, these results are informative to providers treating tongue-tie.
7. Cordray, Holly et al. “Severity and prevalence of ankyloglossia-associated breastfeeding symptoms: A systematic review and meta-analysis.” (1992)
AIM: To evaluate breastfeeding symptoms associated with ankyloglossia/tongue-tie.
CONCLUSION: Ankyloglossia is adversely associated with breastfeeding success and maternal well-being.
8. Dollberg, Shaul et al. “Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study.” (2006)
PURPOSE: Ankyloglossia ("tongue-tie") occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms.
CONCLUSION: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.
9. Edmunds, Janet et al. “Tongue-tie and breastfeeding: a review of the literature.” (2011)
ABSTRACT: In Australia, initial exclusive breastfeeding rates are 80%, reducing to 14% at 6 months. One factor that contributes to early breastfeeding cessation is infant tongue-tie, a congenital abnormality occurring in 2.8-10.7% of infants, in which a thickened, tightened or shortened frenulum is present. Tongue-tie is linked to breastfeeding difficulties, speech and dental problems. It may prevent the baby from taking enough breast tissue into its mouth to form a teat and the mother may experience painful, bleeding nipples and frequent feeding with poor infant weight gain; these problems may contribute to early breastfeeding cessation. This review of research literature analyses the evidence regarding tongue-tie to determine if appropriate intervention can reduce its impact on breastfeeding cessation, concluding that, for most infants, frenotomy offers the best chance of improved and continued breastfeeding. Furthermore, studies have demonstrated that the procedure does not lead to complications for the infant or mother.
10. Elad, David et al. “Biomechanics of milk extraction during breast-feeding.” (2014)
ABSTRACT: How do infants extract milk during breast-feeding? We have resolved a century-long scientific controversy, whether it is sucking of the milk by sub atmospheric pressure or mouthing of the nipple-areola complex to induce a peristaltic-like extraction mechanism. Breast-feeding is a dynamic process, which requires coupling between periodic motions of the infant's jaws, undulation of the tongue, and the breast milk ejection reflex. The physical mechanisms executed by the infant have been intriguing topics. We used an objective and dynamic analysis of ultrasound (US) movie clips acquired during breast-feeding to explore the tongue dynamic characteristics. Then, we developed a new 3D biophysical model of the breast and lactiferous tubes that enables the mimicking of dynamic characteristics observed in US imaging during breast-feeding, and thereby, exploration of the biomechanical aspects of breast-feeding. We have shown, for the first time to our knowledge, that latch-on to draw the nipple-areola complex into the infant mouth, as well as milk extraction during breast-feeding, require development of time-varying sub atmospheric pressures within the infant's oral cavity. Analysis of the US movies clearly demonstrated that tongue motility during breast-feeding was fairly periodic. The anterior tongue, which is wedged between the nipple-areola complex and the lower lips, moves as a rigid body with the cycling motion of the mandible, while the posterior section of the tongue undulates in a pattern similar to a propagating peristaltic wave, which is essential for swallowing.
11. Garbin, Catherine Peta et al. “Evidence of improved milk intake after frenotomy: a case report.” (2013)
ABSTRACT: Ankyloglossia (tongue tie) is a well-recognized cause of breastfeeding difficulties and, if untreated, can cause maternal nipple pain and trauma, ineffective feeding, and poor infant weight gain. In some cases, this condition will result in a downregulation of the maternal milk supply. Milk-production measurements (24-hour) for a breastfeeding infant with ankyloglossia revealed the ineffective feeding of the infant (78 mL/24 hours), and a low milk supply (350 mL/24 hours) was diagnosed. Appropriate management increased milk supply (1254 mL/24 hours) but not infant milk intake (190 mL/24 hours). Test weighing convincingly revealed the efficacy of frenotomy, increasing breastfeeding milk transfer from 190 to 810 mL/24 hours. Post frenotomy, breastfeeding almost completely replaced bottle-feeding of expressed breast milk. This case study confirms that ankyloglossia may reduce maternal milk supply and that frenotomy can improve milk removal by the infant. Milk-production measurements (24-hour) provided the evidence to confirm these findings.
12. Geddes, Donna T et al. “Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound.” (2008)
OBJECTIVE: There is evidence that infants with ankyloglossia can experience breastfeeding difficulties including poor attachment to the breast, suboptimal weight gain, and maternal nipple pain, which may lead to early weaning of the infant. No studies have investigated the cause of these breastfeeding difficulties. The objective of this study was to determine the effectiveness of frenulotomy in infants experiencing persistent breastfeeding difficulties despite professional assistance by measuring changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy.
CONCLUSION: Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue post frenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause.
13. Ghaheri, Bobak A et al. “Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study.” (2017)
OBJECTIVE: Numerous symptoms may arise that prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue-tie/lip-tie release on breastfeeding impairment.
CONCLUSION: Surgical release of tongue-tie/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.
14. Ghaheri, Bobak A et al. “Objective Improvement After Frenotomy for Posterior Tongue-Tie: A Prospective Randomized Trial.” (2022)
OBJECTIVE: Infants with posterior tongue-tie (PTT) can have substantial difficulty with breastfeeding and bottle-feeding. This study aimed to address the dearth in investigational objective data surrounding PTT release to better quantify the postoperative impacts of frenotomy for ankyloglossia.
CONCLUSION: When measured 10 days after frenotomy for PTT, infants improve feeding parameters using an objective bottle-feeding system. Similar improvements are seen with patient-reported outcomes when PTT is released. Posterior tongue-tie is a valid clinical concern, and surgical release can improve infant and maternal symptoms.
15. Griffiths, D Mervyn. “Do tongue ties affect breastfeeding?.” (2004)
ABSTRACT: This study assessed indications for and safety and outcome of simple division of tongue tie without an anesthetic. There were 215 infants younger than 3 months (mean 0-19 days) who had major problems breastfeeding, despite professional support. Symptoms, tongue tie details, safety of division, and complications were recorded. Feeding was assessed by the mothers immediately, at 24 hours, and 3 months after division. Prior to division, 88% had difficulty latching, 77% of mothers experienced nipple trauma, and 72% had a continuous feeding cycle. During division, 18% slept throughout; 60% cried more after division (mean 0-15 seconds). There were no significant complications. Within 24 hours, 80% were feeding better. Overall, 64% breastfed for at least 3 months (UK national average is 30%). Initial assessment, diagnosis, and help, followed by division and subsequent support by a qualified lactation consultant, might ensure that even more mothers and infants benefit from breastfeeding.
16. Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: a comparison of carbon dioxide laser and scalpel techniques (2006)
BACKGROUND: A frenum that encroaches on the margin of the gingiva may interfere with plaque removal and cause tension. Frenectomy is the complete removal of the frenum that can be made by scalpels or with soft tissue lasers. The aim of this article was to compare the degree of postoperative pain, such as discomfort and functional complications (eating and speech), experienced by patients after two frenectomy operation techniques.
CONCLUSION: This clinical study indicates that CO2 laser treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the CO2 laser offers a safe, effective, acceptable, and impressive alternative for frenectomy operations.
17. Hill, Rebecca R, and Britt F Pados. “Gastrointestinal Symptom Improvement for Infants Following Tongue-Tie Correction.” (2023)
ABSTRACT: Treatment of tongue-tie in infants suggests improvements for breastfeeding mothers, including reduced nipple pain and improved latching onto the breast. The effects of frenotomy on infant feeding and gastrointestinal dysfunction remain controversial, with insufficient evidence on the relationship between tongue-tie and disorders of the gastrointestinal tract. The purpose of this study was to compare symptoms of gastrointestinal (GI) distress and gastroesophageal reflux (GER) prior to and 2 weeks following frenotomy in infants with tongue-tie. Parents were surveyed prior to frenotomy and 2 weeks post procedure, using the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. Eighty-four participants completed surveys at both time points, with significant improvements in GI and GER symptoms 2 weeks after frenotomy. Younger infants and those with more severe tongue-tie had the greatest improvements in GI and GER symptoms. Infants with tongue-tie and symptoms of GI tract distress may experience improvement in symptoms after frenotomy.
18. Hogan, Monica et al. “Randomized, controlled trial of division of tongue-tie in infants with feeding problems.” (2005)
OBJECTIVE: To determine whether, in infants with a tongue-tie and a feeding problem, the current medical treatment (referral to a lactation consultant) or immediate division works best and enables the infants to feed normally.
CONCLUSION: This randomized, controlled trial has clearly shown that tongue-ties can affect feeding and that division is safe, successful and improved feeding for mother and baby significantly better than the intensive skilled support of a lactation consultant.
19. Hong, Soo Jeong et al. “Tongue Growth during Prenatal Development in Korean Fetuses and Embryos.” (2015)
BACKGROUND: Prenatal tongue development may affect oral-craniofacial structures, but this muscular organ has rarely been investigated.
CONCLUSION: The early clockwise growth of the ACB to the maxillary plane became harmonious with the counter-clockwise growth of the PCB to the tongue axis during the early prenatal period. These observations suggest that human embryonic tongue growth affects ACB and PCB angulation, stimulates maxillary growth, and induces mandibular movement to achieve the essential functions of oral and maxillofacial structures.
20.Junqueira, Marina Azevedo et al. “Surgical techniques for the treatment of ankyloglossia in children: a case series.” (2014)
ABSTRACT: This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.
21. Karabulut, R et al. “Ankyloglossia and effects on breast-feeding, speech problems and mechanical/social issues in children.” (2008)
BACKGROUND: This aim of this study was to define the characteristics of the patients who underwent surgery for ankyloglossia.
CONCLUSION: The correction of ankyloglossia at an early age reduces the risk of latent complications. In addition, the early correction will mitigate the feeding- and speech-related concerns of parents and doctors alike.
22.Kumar, Manoj, and Erica Kalke. “Tongue-tie, breastfeeding difficulties and the role of Frenotomy.” (2012)
ABSTRACT: A greater emphasis on exclusive breastfeeding in recent years has re-ignited the historical debate over the role of ankyloglossia (tongue-tie) in infants with breastfeeding difficulties. Several prospective cohort studies and randomized control trials have been published in this area in the last 10-15 years. We critically evaluated recent evidence and attempted to answer two important clinical queries in this area, that is, (i) whether ankyloglossia is associated with breastfeeding difficulties and (ii) whether frenotomy helps mother-baby dyad in such setting?
CONCLUSION: Neonates with tongue-tie are at increased risk for breastfeeding difficulties. An early recognition of this association by primary care provider and prompt referral to a lactation consultant is important. In cases with clearly documented breastfeeding difficulties, frenotomy often results in rapid improvement in symptoms.
23. Marmet, C et al. “Neonatal frenotomy may be necessary to correct breastfeeding problems.” (1990)
ABSTRACT: A review of cases of short frenulum (tongue-tie) seen in a recent year at the Lactation Institute and Breastfeeding Clinic provides data about its relationship to sucking and breastfeeding problems such as insufficient infant weight gain and reduced milk supply, sore nipples and repeat bouts of mastitis in the mother. Frenotomy was recommended for ten of 13 babies who appeared to have a short frenulum. Three mothers chose not to have the frenulum clipped and either gave up breastfeeding or continued to experience problems. Breastfeeding was successfully established by the five healthy babies whose frenulum was clipped. The two babies for whom frenotomy did not completely correct breastfeeding problems had severe birth defects.
24.Martinelli, Roberta Lopes de Castro et al. “The effects of frenotomy on breastfeeding.” (2015)
ABSTRACT: Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals.
OBJECTIVE: To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mother's complaints.
CONCLUSION: After lingual frenotomy, changes were observed in the breastfeeding patterns of the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy.
25. Melissa Buryk, David Bloom, Timothy Shope; Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics (2011)
OBJECTIVE: Our primary objective was to determine whether frenotomy for infants with ankyloglossia improved maternal nipple pain and ability to breastfeed. A secondary objective was to determine whether frenotomy improved the length of breastfeeding.
CONCLUSION: We demonstrated immediate improvement in nipple-pain and breastfeeding scores, despite a placebo effect on nipple pain. This should provide convincing evidence for those seeking a frenotomy for infants with significant ankyloglossia.
26. Messner, A H et al. “Ankyloglossia: incidence and associated feeding difficulties.” (2000)
OBJECTIVE: To determine the incidence of ankyloglossia (tongue-tie) in the well-baby population, and to determine whether patients with ankyloglossia experience breastfeeding difficulties.
CONCLUSION: Ankyloglossia, which is a relatively common finding in the newborn population, adversely affects breastfeeding in selected infants.
27. Miranda, Benjamin H, and Catherine J Milroy. “A quick snip - A study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding.” (2010)
ABSTRACT: A prospective study (62 neonates) of ankyloglossia and breastfeeding difficulty is presented. At 2 weeks post-frenulotomy, there were significant improvements in weight (15+/-1.2 centiles) and breastfeeding, including number of sessions/24h (19%) and bottle top-ups/24h (81%) (p<0.0001).
28. Notestine, G E. “The importance of the identification of ankyloglossia (short lingual frenulum) as a cause of breastfeeding problems.” (1990)
ABSTRACT: The short lingual frenulum can be a cause of breastfeeding problems, including sore and damaged nipples and inadequate feedings. This article describes two cases, discusses the difficulty in recognizing the condition, and describes the role of primary care providers in the recognition, diagnosis, and surgical treatment of the short lingual frenulum.
29. O'Callahan, Cliff et al. “The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding.” (2013)
OBJECTIVES: The objectives of this study were to assess the effect of office-based frenotomy on reversing breastfeeding difficulties among infants with problematic ankyloglossia, and to examine characteristics associated with anterior and posterior ankyloglossia.
CONCLUSION: Breastfeeding difficulties associated with ankyloglossia in infants, particularly posterior, can be improved with a simple office-based procedure in most cases. The diagnosis and treatment of ankyloglossia should be a basic competency for all primary care providers and pediatric otorhinolaryngologists.
30.Post, Erica D M et al. “Problematic breastfeeding due to a short frenulum” (2010)
ABSTRACT: Ankyloglossia (tongue tie) in the neonate can be a cause of breastfeeding problems. Frenotomy (cutting of the frenulum linguae) had fallen into disrepute but has regained its place as a standard medical procedure in Anglo-Saxon countries, though not in the Netherlands. We present two neonates, both boys, presenting with breastfeeding problems caused by ankyloglossia. The first baby described did not drink enough and hence did not gain any weight. The mother of the second patient experienced a great deal of pain and had cracked nipples, caused by an abnormal suckling action. Both boys underwent frenotomy with good result. Recent ultrasound studies reveal that frenotomy immediately normalizes the suckling action in babies with ankyloglossia. Randomized controlled trials show that 95% of breastfeeding problems disappear. There is sufficient evidence to state that frenotomy is a very safe and useful procedure in neonates.
31. Protásio ACR, Galvão EL, Falci SGM. Laser Techniques or Scalpel Incision for Labial Frenectomy: A Meta-analysis. (2019)
INTRODUCTION: Labial frenectomy is a common procedure in the oral surgery specialty. Nowadays, laser surgery seems to provide better post-operative results than scalpel surgery. Thus, the aim of this study was to analyze whether trans-surgical and postoperative variables of labial frenectomy are better when performed with laser than with conventional scalpel.
CONCLUSION: The results of this systematic review have shown better results to laser group in the following variables: pain, discomfort during speech and chewing. However, the evidence is limited due the high risk of bias.
32. Ricke, Lori A et al. “Newborn tongue-tie: prevalence and effect on breast-feeding.” (2005)
ABSTRACT: The purposes of this study were: (1) to determine whether breast-fed infants with tongue-tie have decreased rates of breast-feeding at 1 week and 1 month of age, (2) to determine the prevalence of tongue-tie, and (3) to test the usefulness of the Assessment Tool for Lingual Frenulum Function (ATLFF) in assessing the severity of tongue-tie in breast-feeding newborns.
CONCLUSION: Tongue-tie is a relatively common condition in newborns. Affected infants are significantly more likely to be exclusively bottle-fed by 1 week of age. The ATLFF was not a useful tool to identify which tongue-tied infants are at risk for breast-feeding problems.
33. Riskin, Arieh et al. “Tongue-tie and breastfeeding in newborns-mothers' perspective.” (2014)
OBJECTIVES: This study explored clinical implications of tongue-tie (TT) on breastfeeding from the mothers' perspective and evaluated the assistance provided.
CONCLUSION: TT infants had significantly more breastfeeding problems in the first month, but similar rates and durations of breastfeeding. Early diagnosis and lactation consultation may assist mother-infant dyads substantially. Mothers whose infants underwent frenotomies for breastfeeding more frequently found the procedure alleviated breastfeeding problems.
34.Sahoo, Subhashree et al. “Effect of myofunctional exercise combined with laser-assisted frenectomy in the management of paediatric tongue tie.” (2024)
ABSTRACT: We present three cases for the management of paediatric tongue tie (ankyloglossia) through laser-assisted frenectomy and postoperative oral myofunctional exercises. Ankyloglossia, characterized by a restricted lingual frenulum, poses challenges in tongue movement and is traditionally treated with surgical interventions. Laser technology, particularly diode lasers, has shown promise in paediatric cases due to reduced bleeding, minimal discomfort and faster recovery. The case series presents three instances where patients underwent laser-assisted frenectomy, demonstrating improved tongue function and speech outcomes. The comprehensive approach includes adherence to safety protocols, meticulous surgical techniques and the integration of postoperative exercises. Results indicate significant improvement in speech and tongue mobility, with no reported pain or complications. The study underscores the efficacy, safety and patient-centric nature of the combined laser and exercise strategy in addressing ankyloglossia in paediatric dentistry, emphasising the need for further research and long-term follow-up studies to validate its sustained effectiveness.
35. Sarmadi R, Gabre P, Thor A. Evaluation of upper labial frenectomy: A randomized, controlled comparative study of conventional scalpel technique and Er:YAG laser technique. (2021)
OBJECTIVES: Abnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.
CONCLUSION: Significant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery.Directly after surgery the wound area was significantly larger in the laser group but at the 5-day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.
36. Shang J, Han M, Sun J, Xu D, Qu W. Comparative Study on the Treatment of Ankyloglossia by Using Er:YAG Laser or Traditional Scalpel. (2021)
ABSTRACT: The aim of this study was to compare, respectively, postoperative pain, wound healing, and patient satisfaction following lingual frenum extension treated with the Erbium Yttrium aluminum garnet. (Er:YAG) laser or the conventional scalpel. Twenty-eight patients receiving lingual frenectomy were randomly assigned to the Er:YAG laser group (n = 15) or the traditional scalpel group (n = 13). The surgical parameters were set to 3W or 4W basing on types of the lingual frenum when the Er:YAG laser was working. The same procedure was applied to the traditional scalpel group with transverse incision and longitudinal suture. The postoperative pain, wound healing and patient satisfaction were evaluated at 3 hours, 3, 7, and 30 days after operation. The visual analog scale score of postoperative pain in Er:YAG laser group was lower than that in traditional scalpel group at each time point. The wound healing score of the laser group were significantly lower than that of the traditional scalpel group at 3 and 7 days after surgery. There was no significant difference in mental, diet, and language satisfaction between the 2 groups at different time points after operation. In conclusion, Er:YAG laser was superior to the scalpel regarding minor soft-tissue surgery, and it could relieve the pain and discomfort of patients in the early stage of wound.
37. Siegel, Scott. "Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie)." (2016)
BACKGROUND: Infants with tongue and possible lip tie often have a poor latch in which there is often an inadequate seal around the breast and disorganized swallowing. As a result, many of these infants’ swallow air during breastfeeding. Many of these infants suffer from symptoms of reflux.
CONCLUSION: There appears to be a relationship between maxillary lip tie (ankyloglossia and shortened maxillary labial frenula) and aerophagia induced reflux (AIR). Treatment of these infants with a relatively simple frenotomy procedure may reduce or eliminate reflux. As a result, many of these infants may be spared from invasive testing or medications that have been shown to have potentially significant side effects. This may change diagnostic and treatment algorithms.
38. Sobouti F, Moallem Savasari A, Aryana M, Hakimiha N, Dadgar S. Maxillary labial frenectomy: a randomized, controlled comparative study of two blue (445 nm) and infrared (980 nm) diode lasers versus surgical scalpel. (2024)
BACKGROUND: This study aimed to compare the intra and postoperative complications of frenectomy procedure with a surgical scalpel versus 445 nm and 980 nm diode lasers.
CONCLUSION: In conclusion, diode laser frenectomy resulted in significantly lower intra and postoperative complications compared to the scalpel. Moreover, 445 nm diode laser showed significantly superior effects compared to 980 nm diode laser.
39. Srinivasan, Anjana et al. “Ankyloglossia in breastfeeding infants: the effect of frenotomy on maternal nipple pain and latch.” (2006)
OBJECTIVE: The aim of this study was to measure the effectiveness of frenotomy in ankyloglossic infants, by quantifying the changes in latch and maternal nipple pain using standardized tools.
CONCLUSION: Timely frenotomy and breastfeeding counseling is an effective intervention, improving latch and decreasing nipple pain.
40. Veyssiere, A et al. “Diagnosis and management of ankyloglossia in young children” (2015)
ABSTRACT: Ankyloglossia is a common condition. Its prevalence is between 3.2% and 4.8% depending on the series and is largely underestimated given the fact of non-diagnosis when the symptoms are limited. It is defined as a short lingual frenulum resulting in a limitation of the lingual mobility. It is due to a defect in cellular apoptosis embryogenesis between the floor of the mouth and tongue. The result is a fibrous and short lingual frenulum. Several classifications were used to make the diagnosis. However, these are the clinical implications, particularly on food and primarily breastfeeding in the baby and phonation in older children that will motivate the management. This is surgical and different techniques are available: infants before the age of 6 months and when the lingual frenulum is still a fine cellular membrane, frenotomy is recommended. Frenectomy with or without frenoplasty is indicated for the older child. The surgery is simple, the results are good and rapidly improving grievances. Complications are rare. Finally, speech therapy is important when there are implications for phonation.
41. Wakhanrittee, Junsujee et al. “The outcomes of a frenulotomy on breastfeeding infants followed up for 3 months at Thammasat University Hospital.” (2016)
PURPOSE: To study the effects of frenulotomy on nipple pain, latch and the success in exclusive breastfeeding (EBF) at 3-month follow-up.
CONCLUSION: Frenulotomy could significantly reduce nipple pain and increase LATCH score in tongue-tied infants with breastfeeding difficulty. Several factors are positively associated with the success of EBF. Tongue-tie severity, LATCH score and nipple sensation were the factors that can be modified by frenulotomy.
42. Yoon, A J et al. “Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional - morphological study.” (2017)
OBJECTIVES: To characterize associations between restricted tongue mobility and maxillofacial development.
CONCLUSION: Restricted tongue mobility was associated with narrowing of the maxillary arch and elongation of the soft palate in this study. These findings suggest that variations in tongue mobility may affect maxillofacial development.
Release providers are starting to utilize Serrapeptase and Kenalog to aid in post-frenectomy wound healing. No research is available on the use of Serrapeptase or Kenalog on oral wounds in infants and children following a frenectomy procedure. Until there is scientific basis for its use, Dr. Allie does not support its use in children or infants.
Dr. Allie Lonneman is a tongue-tie and lip-tie specialist, providing Laser Frenectomy services to infants and children in Arlington, VA. She stays up to date with the latest research on Infant Frenectomy and Child Frenectomy in order to provide her patients with the highest quality service possible. Click here to schedule a consultation with Dr. Allie at Arlington Tongue Tie Center.
