Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic
Introduction
Ankyloglossia or tongue-tie is a congenital condition characterized by a lingual frenulum that can limit tongue movement [1], [2]. Contemporary studies have shown a link between ankyloglossia and breastfeeding difficulties, with an improvement in breastfeeding outcomes following tongue-tie release procedures [3], [4], [5], [6], [7], [8]. Ankyloglossia can be classified as the more obvious anterior ankyloglossia, with a thin web-like lingual frenulum inserting at or just behind the tongue tip. or the less obvious posterior ankyloglossia, which is thicker and further back from the tongue tip [9], [10]. Upper lip ties are characterized by a thickened labial frenulum which restricts lip splay [4], [11]. Recent studies have shown improved breastfeeding outcomes following posterior ankyloglossia and upper lip tie frenotomies [4], [9], [12], [13]. Unfortunately there is currently limited literature of this condition and its management.
The aim of our study was to assess the outcomes of office-based frenotomy for the management of posterior ankyloglossia and lip ties as managed by our multidisciplinary service.
Section snippets
Study design
A prospective audit was performed of patient outcomes following frenotomy for ankyloglossia and/or upper lip tie in an outpatient setting between May 2014–September 2015. Data including patient demographics, breastfeeding concerns and post-frenotomy outcomes were collected prospectively on a dedicated database. Where incomplete, patient records were reviewed for further detail.
Referral process
Outpatient frenotomy for posterior ankyloglossia and upper lip tie is performed by a paediatric Otolaryngologist. This
Results
43 patients were seen at our outpatient clinic and 34 had a procedure carried out between May 2014–August 2015 (Fig. 2). Most of them were males (n = 21, 62%) and of New Zealand European ethnicity. The median age was 6.6 weeks with a wide range of 2–20 weeks. The most commonly reported breastfeeding issues included poor latching (n = 29, 85%), mothers' painful nipples (n = 22, 65%) and poor weight gain (n = 14, 41%) (Table 1).
14 of these patients had a previous anterior frenotomy carried out
Discussion
There has been increased awareness that breastfeeding confers improved infant and maternal health outcomes. Breast milk offers unique nutritional and non-nutritional benefits that optimise infant growth and development [15]. Ankyloglossia is associated with difficulties in breastfeeding including failure to thrive, maternal nipple pain and risk of cessation of breastfeeding [10]. This is possibly related to an ineffective latch caused by ankyloglossia [10]. Previous studies have shown
Conclusion
Breastfeeding problems are typically multifactorial and largely managed by midwives and lactation consultants. However, for infants with ongoing breastfeeding difficulties with posterior ankyloglossia and upper lip ties, an office based frenotomy is an easy and effective procedure. Prior assessment and post-procedural support by lactation consultants is imperative in the management of these infants.
Conflict of interest
The authors do not have any personal or financial conflicts of interest in this study.
Acknowledgements
We had significant assistance in data collection from the lactation consultants within our region.
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Cited by (22)
Relationship between short lingual frenulum and malocclusion. A multicentre study
2022, Acta Otorrinolaringologica EspanolaCitation Excerpt :The size of the jaw has also a sex relationship.19 The examination of the lingual frenulum should be systematic among professionals dealing with pediatric patients, including the posterior tongue tie, which is often neglected.20 There are several published methods which aim to diagnose short lingual frenulum.
Ankyloglossia and Tight Maxillary Frenula
2021, Cummings Pediatric OtolaryngologyAnkyloglossia and Other Oral Ties
2019, Otolaryngologic Clinics of North AmericaCitation Excerpt :Of those with isolated ULT, 100% reported improvement in breastfeeding after release. Benoiton and colleagues99 also reported on a mixed group of subjects with tongue-tie and ULT and found that, for isolated ULT, 2 out of 3 subjects reported improvement, and, for combined posterior tongue-tie and ULT, 9 out of 10 subjects eventually reported improvement in breastfeeding. Finally, in 2017, Ghaheri and colleagues44 reported a statistically significant improvement on the BSES following release of both tongue-tie and ULT in a cohort of 178 infants.
Upper lip frenotomy for neonatal breastfeeding problems
2019, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Whereas most newborns have a significant labial frenum, this rarely restricts breastfeeding and does not require intervention [4]. Ankyloglossia is much more common cause of breastfeeding difficulties, with isolated upper lip tie rarely considered significant or performed concurrent with ankyloglossia correction [2,4,5]. A few authors have reported their outcomes on methods to treat ankyloglossia with a concurrent upper lip tie and its effect on breastfeeding, but to our knowledge, there is no reported study in the literature that describes isolated upper lip ties and its effect on breastfeeding and hence, we felt it important to publish our methods and case series [2,4,5].
The Effect of Tongue-Tie and Lip-Tie on Breastfeeding
2019, Journal for Nurse PractitionersCitation Excerpt :No studies were available that reported whether frenotomy led to long-term successful breastfeeding. More recent studies have shown an association between tongue-tie and upper lip-ties and breastfeeding difficulties.17,25 A group of researchers monitored a cohort of 237 mother/infant dyads who underwent surgical release of tongue-tie and lip-tie.26
Pediatric Dysphagia: Evaluation and Management for Otolaryngologists
2023, Current Otorhinolaryngology Reports