Tag Archive for: Ankyloglossia

Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial

Buryk M, Bloom D, Shope T.
Pediatrics. 2011 Aug;128(2):280-288.


BACKGROUND: Ankyloglossia has been associated with a variety of infant-feeding problems. Frenotomy commonly is performed for relief of ankyloglossia, but there has been a lack of convincing data to support this practice.

OBJECTIVES: 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.

METHODS: Over a 12-month period, neonates who had difficulty breastfeeding and significant ankyloglossia were enrolled in this randomized, single-blinded, controlled trial and assigned to either a frenotomy (30 infants) or a sham procedure (28 infants).
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Tongue Tie and Frenotomy in the Breastfeeding Newborn

Isabella Knox
NeoReviews (2010) 11, 513-519


Tongue tie or ankyloglossia has been the subject of much controversy. As defined in this review, tongue tie occurs when a common minor embryologic tissue remnant—persistence of midline sublingual tissue that usually undergoes apoptosis during embryonic development—causes restriction of normal tongue movement. Effective breastfeeding requires newborns to fine-tune their tongue movements to adapt to their mothers’ particular nipple and breast anatomy and physiology.

In the presence of tongue tie, two categories of signs/symptoms arise: those related to nipple trauma and those related to ineffective breast emptying and low infant intake. Untreated tongue tie can lead to untimely weaning and its attendant health risks.
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Defining ankyloglossia: A case series of anterior and posterior tongue ties.

Hong P, Lago D, Seargeant J, Pellman L, Magit AE, Pransky SM.
Int J Pediatr Otorhinolaryngol. 2010 Jun 15. [Epub ahead of print]


Introduction Ankyloglossia is a congenital condition in which tongue mobility is limited due to an abnormality of the lingual frenulum. The impact of ankyloglossia on breastfeeding is poorly understood but there is a recent trend toward more recognition of this condition and early intervention when needed. Currently, there lacks clear definition of ankyloglossia and different subtypes have been proposed with no clinical correlation.

Objective To determine the prevalence of anterior versus posterior ankyloglossia in a large series of consecutive patients and to assess clinical outcomes after frenotomy.
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Posterior ankyloglossia: A case report

Michael W. Chua and David C. Bloom

Int J Pediatr Otorhinolaryngol. 2009 Jun;73(6):881-3.


Ankyloglossia, or tongue-tie, refers to an abnormally short lingual frenulum. Ankyloglossia is a recognized but poorly defined condition and has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. In infants, the most concerning symptoms are feeding difficulties and inability to breastfeed.

While a recent trend toward breastfeeding has brought frenulectomy back into favor, the literature regarding treatment remains inconclusive. We report a case of posterior ankyloglossia with anterior mucosal hooding and a simple, safe, and effective way to treat it to improve breastfeeding.
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Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound

Donna T. Geddes, Diana B. Langton, Ian Gollow, Lorili A. Jacobs, Peter E. Hartmann and Karen Simmer

PEDIATRICS Vol. 122 No. 1 July 2008, pp. e188-e194


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.
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Ankyloglossia in Breastfeeding Infants: The Effect of Frenotomy on Maternal Nipple Pain and Latch

Anjana Srinivasan, Carole Dobrich, Howard Mitnick, Perle Feldman
Breastfeeding Medicine. 2006, 1(4): 216-224.


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.

Methodology: Infants below 12 weeks of age were recruited from the Goldfarb Breastfeeding Program between August 2004 and February 2005. Infants were selected based on the Frenotomy Decision Rule for Breastfeeding Infants (FDRBI), a new clinical tool for future validation. Latch was assessed using the Latch Tool. Maternal nipple pain was assessed using R. Melzack’s Short Form McGill Pain Questionnaire, consisting of the Pain Rating Index (PRI) and Present Pain Intensity (PPI).
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Reliability of the Hazelbaker Assessment Tool for Lingual Frenulum Function

Lisa H Amir, Jennifer P James and Susan M Donath

International Breastfeeding Journal 2006, 1:3



About 3% of infants are born with a tongue-tie which may lead to breastfeeding problems such as ineffective latch, painful attachment or poor weight gain. The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) has been developed to give a quantitative assessment of the tongue-tie and recommendation about frenotomy (release of the frenulum). The aim of this study was to assess the inter-rater reliability of the HATLFF.


Fifty-eight infants referred to the Breastfeeding Education and Support Services (BESS) at The Royal Women’s Hospital for assessment of tongue-tie and 25 control infants were assessed by two clinicians independently.
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Review of tongue-tie release at a tertiary maternity hospital

Lisa Helen Amir, Jennifer Patricia James and Joanne Beatty

Journal of Paediatrics and Child Health 41 (5-6), 243–245. – May 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.

Methods: A structured telephone interview was conducted with the mother at least 3 months after the assessment. Data were collected about the presenting problem and the effect of release of the tongue-tie (if performed). Parents were also asked about their satisfaction with the procedure and of problems following the release.
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Randomized, controlled trial of division of tongue-tie in infants with feeding problems

Monica Hogan, Carolyn Westcott and Mervyn Griffiths

Journal of Paediatrics and Child Health 41 (5-6), 246–250. – May 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.

Methods: Between March and July 2002, all the babies in the district of Southampton with tongue-ties were followed in order to see if they had any feeding problems. If they developed problems, the mothers gave written consent and were enrolled in an ethics committee approved, randomized, controlled trial, comparing 48 h of intensive lactation consultant support (control) with immediate division.
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