In the breastfeeding period, this can lead to difficulties in establishing feeding, manifested by maternal nipple soreness and infant growth retardation.
The National Institute for Health and Care Excellence (NICE) has issued guidance for clinicians in the UK, applicable to breastfed babies with ankyloglossia (www.nice.org.uk/guidance/ipg149). This guidance states that:
* A) there are no major safety concerns about sublingual frenectomy and limited evidence suggests that this procedure may improve breastfeeding. This evidence is adequate to support the use of the procedure.
* B) 95% of infants who underwent sublingual frenectomy accompanied by 48 hours of intensive support from a lactation specialist had improved breastfeeding 48 hours after frenectomy, compared to 5% of infants in the control group.
* C) 80% of mothers reported improved breastfeeding 24 hours after the procedure. In another series, 100% of mothers reported improved latching after the procedure, and mothers with nipple pain noted significant improvement immediately after the procedure. In a third case series, 100% of infants were reported to have normal tongue movement at 3 months.
* D) few adverse effects were reported. One case series reported that, after the procedure, 2% of infants had an ulcer under the tongue for more than 48 hours. Two other studies indicated that there were no complications.
Recently in 2024, the American Academy of Pediatrics published a scientific article clarifying certain points:
* Symptomatic ankyloglossia is defined as a restrictive tongue-tie that causes problems with breastfeeding that do not improve with breastfeeding support.
* Babies with ankyloglossia and normal feeding patterns do not need intervention.
* Frenotomy for other problems or to prevent problems such as speech articulation or obstructive sleep apnea in the future is not based on scientific evidence.
* Posterior ankyloglossia is an ill-defined term, on which there is no consensus among experts and should not be used as a reason to perform surgical intervention on an infant.
* Sucking calluses are a normal finding in newborns and as such do not suggest pathology.
* Suboptimal breastfeeding is a complex problem and every breastfeeding with painful or ineffective feeding should undergo a full evaluation before any treatment is offered. In this case, multidisciplinary communication and management between lactation specialists, feeding therapists, surgeons, and pediatricians are essential to obtain the best outcome for the family.
* Surgical intervention for symptomatic ankyloglossia may be offered after other causes of breastfeeding problems have been evaluated and treated.
* Frenotomy may decrease maternal nipple pain.
The recommended time to perform frenectomy is in the neonatal age. After 12 months, it is usually waited until approximately 5 years and the pronunciation of the “R” to perform the intervention under anesthesia.
Children with ankyloglossia and speech difficulties should be evaluated first by a speech therapist.
time to perform frenectomy is at neonatal age. After 12 months of age, it is usually necessary to wait until about 5 years of age and the pronunciation of "R" before performing the procedure under anesthesia.
