Materiały źródłowe

• #1 Tongue-tie (ankyloglossia) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tongue-tie/diagnosis-treatment/drc-20378456

  Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach. […] Surgical treatment of tongue-tie may be needed for infants, children or adults if tongue-tie causes problems. Surgical procedures include frenotomy and frenuloplasty. […] If necessary, tongue-tie can be treated with a surgical cut to release the frenulum (frenotomy). […] A simple surgical procedure called a frenotomy can be done with or without anesthesia in the hospital nursery or doctor’s office. […] The doctor examines the lingual frenulum and then uses sterile scissors or cautery to snip the frenulum free. […] Complications of a frenotomy are rare but could include bleeding or infection, or damage to the tongue or salivary glands. […] A more extensive procedure known as a frenuloplasty might be recommended if additional repair is needed or the lingual frenulum is too thick for a frenotomy. […] After a frenuloplasty, tongue exercises might be recommended to enhance tongue movement and reduce the potential for scarring.

• #2 Tongue-tie (ankyloglossia) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tongue-tie/symptoms-causes/syc-20378452

  Tongue-tie (ankyloglossia) is a condition in which an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth. If necessary, tongue-tie can be treated with a surgical cut to release the frenulum (frenotomy). If additional repair is needed or the lingual frenulum is too thick for a frenotomy, a more extensive procedure known as a frenuloplasty might be an option. […] Sometimes tongue-tie may not cause problems. Some cases may require a simple surgical procedure for correction. […] Tongue-tie can interfere with the ability to make certain sounds such as „t,” „d,” „z,” „s,” „th,” „n” and „l.” […] For example, tongue-tie can sometimes lead to: Breastfeeding problems. Breastfeeding requires a baby to keep the tongue over the lower gum while sucking. If unable to move the tongue or keep it in the right position, the baby might chew instead of suck on the nipple. This can cause significant nipple pain and interfere with a baby’s ability to get breast milk. Ultimately, poor breastfeeding can lead to inadequate nutrition and failure to thrive. […] Tongue-tie may affect a baby’s oral development, as well as the way the child eats, speaks and swallows.

• #3 Tongue-tie (ankyloglossia) | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20378437/

  Tongue-tie (ankyloglossia) is a condition present at birth that restricts the tongues range of motion. […] Sometimes tongue-tie may not cause problems. Some cases may require a simple surgical procedure for correction. […] If necessary, tongue-tie can be treated with a surgical cut to release the frenulum (frenotomy). If additional repair is needed or the lingual frenulum is too thick for a frenotomy, a more extensive procedure known as a frenuloplasty might be an option. […] Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach. […] Surgical treatment of tongue-tie may be needed for infants, children or adults if tongue-tie causes problems. Surgical procedures include frenotomy and frenuloplasty.

• #4 Ankyloglossia in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/ankyloglossia.html

  Tongue-tie (ankyloglossia) is a problem with the tongue that is present from birth. It causes speech and eating problems in some children. […] Your child’s healthcare provider might not advise any treatment if your child doesn’t have any symptoms, or if their symptoms are mild. […] If your child is having trouble breastfeeding, the healthcare provider may advise working with a breastfeeding specialist. If that doesn’t work, your child may need to have a surgical procedure. […] A simple surgery called a frenotomy is an effective treatment for many children. […] Some children need a slightly more complex procedure called a frenectomy. […] Talk with your child’s provider about the risks and benefits of a procedure. […] Not all children with tongue-tie need surgery. Your child may need surgery if their tongue-tie is more severe and causes major symptoms.

• #5 Tongue-Tie (Ankyloglossia) in Children

  https://healthlibrary.brighamandwomens.org/library/diseasesconditions/adult/160,101

  Tongue-tie (ankyloglossia) is a problem with the tongue that is present from birth. It causes speech and eating problems in some children. […] Your child’s health care provider might not advise any treatment if your child doesn’t have any symptoms, or if their symptoms are mild. In some children, many or all symptoms go away with time. […] If your child is having trouble breastfeeding, the provider may advise working with a breastfeeding specialist. If that doesn’t work, your child may need to have a surgical procedure. […] A simple surgery called a frenotomy is an effective treatment for many children. […] Some children need a slightly more complex procedure called a frenectomy. This completely removes the lingual frenulum. […] Not all children with tongue-tie need surgery. Your child may need surgery if their tongue-tie is more severe and causes major symptoms.

• #6 CoxHealth | Tongue-Tie (Ankyloglossia) in Children

  https://www.coxhealth.com/condition/ankyloglossia-in-children/

  Tongue-tie (ankyloglossia) is a problem with the tongue that is present from birth. It causes speech and eating problems in some children. […] Your child’s health care provider might not advise any treatment if your child doesn’t have any symptoms, or if their symptoms are mild. In some children, many or all symptoms go away with time. […] If your child is having trouble breastfeeding, the provider may advise working with a breastfeeding specialist. If that doesn’t work, your child may need to have a surgical procedure. […] A simple surgery called a frenotomy is an effective treatment for many children. […] Some children need a slightly more complex procedure called a frenectomy. This completely removes the lingual frenulum. Another choice is frenuloplasty. […] Not all children with tongue-tie need surgery. Your child may need surgery if their tongue-tie is more severe and causes major symptoms.

• #7 Ankyloglossia (Tongue-Tie) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482295/

  The treatment of ankyloglossia has many controversies, which can be very confusing for parents who seek different opinions. The best approach for any healthcare worker encountering this issue is to weigh the benefits for the patient. Observation is the best treatment option if the condition is not causing any problems during the neonatal period. Once other potential causes of feeding difficulties have been excluded, a frenotomy can be presented as a possible treatment option. […] Overall, most patients benefit from observation. However, frenotomy is generally considered a low-risk procedure that can be performed in an outpatient clinic without anesthesia. It has the potential to improve breastfeeding difficulties and provide relief to the typically frustrated mother.

• #8

  https://link.springer.com/article/10.1007/s40746-016-0052-x

  Comparing frenotomy to Z-plasty frenuloplasty among infants and children ranging from 5 days to 8 years of age, Yousefi et al. (2015) found that frenuloplasty had significantly greater improvements in speech articulation, reduced maternal breast pain, increased lingual mobility, and parent satisfaction. […] A multidisciplinary approach may be beneficial in the management of ankyloglossia. Involvement of lactation consultants should be undertaken to help mothers find optimal latch positioning while breastfeeding. […] Tongue exercises have been proposed for infants that do not undergo surgical intervention and for postoperative patients to prevent scarring. […] In the postoperative period following frenotomy or frenuloplasty, tongue exercises are also often utilized to help prevent scarring and recurrence of ankyloglossia. […] Surgical intervention should be recommended with caution only in infants for whom ankyloglossia is clearly evident on physical examination and who have documented difficulties with breastfeeding.

• #9 Tongue-Tie (Ankyloglossia) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17931-tongue-tie-ankyloglossia

  Tongue-tie can sometimes pose challenges for breastfeeding. Babies with tongue-tie may have trouble latching on or removing milk. This can prevent them from getting enough nutrition. Latching difficulties can also cause pain or discomfort for you as you breastfeed, and you may feel you need to stop breastfeeding. […] If these methods arent enough, your baby may need a safe and quick procedure called a frenotomy. This involves clipping the lingual frenulum so your babys tongue can move freely. […] Healthcare providers manage tongue-tie by: Helping you with breastfeeding position and latch. This can help many tongue-tied babies breastfeed comfortably and successfully. Your lactation consultant will support you each step of the way and follow up with you to assess your progress. […] Doing a quick, in-office procedure (in some cases). This involves clipping the lingual frenulum under your babys tongue to help their tongue move more freely.

• #10 Has Your Baby Been Diagnosed With Tongue-Tie? | Children’s Hospital Los Angeles

  https://www.chla.org/blog/advice-experts/has-your-baby-been-diagnosed-tongue-tie

  If you and your infant are struggling with breastfeeding, its natural to feel concerned. A tongue-tie is one possible cause of these difficulties. A tongue-tie (ankyloglossia) may affect your babys ability to feed efficiently. To treat this condition, doctors may discuss a tongue-tie release procedure with you, which can help the tongue move more functionally. Other treatments options include feeding therapy and working with a lactation consultant. […] Danto and Lee recommend exploring the following treatment options for a tongue-tie: […] Working with a lactation consultant: It is always a good idea to meet with an international Board-certified lactation consultant (IBCLC) if you are having any issues with breastfeeding. […] Meeting with an occupational therapist or speech-language pathologist: Occupational therapists and speech-language pathologists who are specialized in feeding therapy are skilled at evaluating and treating your babys ability to suck and swallow.

• #11 Tongue Tie (Ankyloglossia) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/tongue-tie.html

  Kids who dont have problems from tongue tie dont need treatment. The frenulum stretches as a child grows, and this usually gives the tongue enough freedom to move normally. […] If surgery is needed, the ENT, dentist, or oral surgeon can do a: frenotomy (freh-NOT-uh-mee) or frenulectomy (fren-yuh-LEK-tuh-mee): The doctor makes a small cut in the frenulum with a scalpel, laser, or scissors. This helps lengthen the frenulum. The procedure is quick but may hurt a little. It can be done at a doctor’s office if the baby is young enough to be swaddled and safely held still for the procedure. Older infants and children may need anesthesia if they can’t stay still. […] frenuloplasty (FREN-yuh-lo-plass-tee): For older kids, or if the frenulum is too thick for a simple frenotomy, the doctor will do surgery to divide and lengthen the frenulum to free the tongue. Kids get anesthesia to sleep through the surgery so they don’t feel any pain.

• #12 Tongue-tie (ankyloglossia) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/tongue-tie-ankyloglossia

  Sometimes tongue-tie may not cause problems. Some cases may require a simple surgical procedure for correction. […] Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach. […] In some cases, consultation with a lactation consultant can assist with breastfeeding, and speech therapy with a speech-language pathologist may help improve speech sounds. […] Surgical treatment of tongue-tie may be needed for infants, children or adults if tongue-tie causes problems. Surgical procedures include frenotomy and frenuloplasty. […] A simple surgical procedure called a frenotomy can be done with or without anesthesia in the hospital nursery or doctor’s office.

• #13 How Can Physical Therapy Help With Tongue Tie? | District Speech and Language Therapy | Speech Therapy Clinic in Washington DC

  https://districtspeech.com/how-can-physical-therapy-help-with-tongue-tie/

  Tongue tie is a type of orofacial myofunctional disorder. […] However, kids as young as newborn babies with tongue tie can benefit from physical therapy. […] This is important, since kids with an orofacial myofunctional disorder like tongue tie will often benefit from both pediatric speech therapy and physical therapy. […] Surgery for tongue tie is often recommended, especially in babies to help improve breastfeeding problems. […] However, surgery is not the only option if your child has a tongue tie. […] Over the course of this study, the 72 babies who were not recommended for surgery were able to improve their feeding and put on weight with the help of physical therapy. […] The good news is, your child’s physical therapist can help. […] They can diagnose tongue tie and make treatment recommendations, including evaluating whether surgery is the correct option for your child.

• #14 How Can Physical Therapy Help With Tongue Tie? | District Speech and Language Therapy | Speech Therapy Clinic in Washington DC

  https://districtspeech.com/how-can-physical-therapy-help-with-tongue-tie/

  To improve the success of the surgery, it’s recommended to work with a physical therapist. […] Physical therapy can help mitigate some of these issues. […] A physical therapist can work with you and your infant in a fun, gentle, and engaging way. […] A physical therapist can also assess for any co occurring conditions, like torticollis or plagiocephaly, that may impact feeding. […] If your child is getting surgery for their tongue tie, a physical therapist can help improve outcomes. […] Before and after surgery, physical therapy can help your infant’s tongue function and ability to suck.

• #15 Treatment of Ankyloglossia: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10670877/

  In the literature, various traditional surgical techniques are described for releasing the tongue from the low attachment of the frenulum, but none of these techniques are widely accepted as a treatment guideline. […] Currently, there are still few published articles regarding the treatment of pathological lingual frenulum. There are no guidelines available, and there is no universally accepted classification. […] For the treatment of lingual frenulum, it can be concluded that clinicians prefer the use of a diode laser due to its numerous advantages over the use of a scalpel blade. […] Many studies agree on the usefulness of incorporating myofunctional rehabilitation for patients to improve lingual mobility, both before and after surgical therapy.

• #16 Treatment of Ankyloglossia: A Review

  https://www.mdpi.com/2227-9067/10/11/1808

  Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period. […] The study by Tancredi et al. highlights the operative and postoperative advantages of treating hypertrophic lingual frenulum using diode laser therapy, evaluating the extent of postoperative healing and differences in pain perception compared with traditional surgical methods. […] Unlike a scalpel blade, the laser does not cut through the structures that make up the lingual frenulum (collagen and elastic fibers) but rather causes denaturation and coagulation. Therefore, it can be concluded that laser-assisted intervention offers numerous advantages over conventional surgical techniques. […] In addition to this aspect, the laser offers numerous benefits, including adequate hemostasis, reduced operating time, easier access, surgical site disinfection, precise incision, minimal tissue damage, more effective tissue healing, reduced inflammation, better control of postoperative pain, and greater acceptance and compliance, especially in pediatric patients.

• #17 Tongue-Tie (Ankyloglossia) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17931-tongue-tie-ankyloglossia

  Many babies with tongue-tie dont need surgery. And if your baby does need treatment, you can rest assured its not major surgery. In fact, healthcare providers can often clip a babys lingual frenulum in a quick in-office procedure called a frenotomy. […] Often, babies with tongue-tie dont need this procedure at all. Providers only suggest a frenotomy if changes to your breastfeeding position and your babys latch dont resolve the symptoms. […] This safe procedure is the gold standard for treating infants with tongue-tie. Before doing a frenotomy, healthcare providers rule out or treat other causes of breastfeeding difficulty. When a frenotomy is necessary, its typically best when done within the first month of a babys life. This allows your baby to establish effective breastfeeding habits early on.

• #18 Ankyloglossia (Tongue Tie) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/ankyloglossia-tongue-tie

  Tongue tie can be corrected in one of two simple ways: […] This can often be done in the ENTs office if tongue tie is discovered in a newborn. The physician examines the frenulum and then snips it free with sterile scissors. The procedure is quick and usually bloodless. Most of the time, local anesthesia isnt used because discomfort is minimal due to few nerve endings and blood vessels in the frenulum. After the procedure, the baby will breast feed while in the office. The breast milk acts as pain relief and an antiseptic. […] If the frenulum is too thick for a frenotomy, a slightly more extensive procedure, called a frenuloplasty, may be recommended. This procedure uses general anesthesia and surgical tools to free the tongue from the thick band or several bands tied to it. The wound is closed with stiches that absorb on their own within a couple of weeks. Your child will go home the same day as the operation and will most likely not need to stay in the hospital overnight.

• #18 Ankyloglossia (Tongue Tie) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/ankyloglossia-tongue-tie

  In the vast majority of cases, treatment for tongue tie permanently corrects the condition and prevents the eating, speech, and dental problems that frequently go along with tongue tie. Occasionally, the simple frenotomy procedure fails to eliminate tongue tie and the problem recurs. Follow-up treatment with a frenuloplasty is then recommended. […] Your child may be required to do tongue movement exercises to encourage proper movement and reduce the risk of scarring. Depending on your childs speech, your childs primary care provider may recommend working with a speech therapist, to correct enunciation problems.

• #19 Tongue-tie symptoms and treatment – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/the-truth-about-tongue-tie

  If treatment is recommended, a frenotomy is a quick, low-risk procedure to correct tongue-tie. In an office setting, a laser or sterile scissors is used to snip the frenulum free. The healing time is quick, with minimal pain and blood loss. […] The risks for the procedure are low. However, your health care team must carefully avoid the glands, ducts and nerves located under the tongue to prevent injury, especially if treating a posterior tongue-tie.

• #20 Ankyloglossia (Tongue-Tie) | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17608

  Relative contraindications to frenotomy in infants include neuromuscular disorder, hypotonia, retrognathia, and micrognathia, as a lingual frenotomy may aggravate glossoptosis, obstruct the airways, and complicate swallowing. […] It is essential to distinguish between 'frenotomy,’ 'frenuloplasty,’ and 'frenectomy,’ as these terms are sometimes used interchangeably. Frenotomy, also known as frenulotomy, is the incision of the lingual frenulum and is the procedure performed in infants. Frenuloplasty involves cutting the lingual frenulum and repositioning the tissue; frenectomy refers to removing the lingual frenulum. […] Frenotomy involves holding the tongue up to tighten the frenulum, then cutting through the fascia-like tissue along a line parallel and close to the tongue. The cut is made in a single motion in less than a second. The infant is restrained by swaddling or in a Papoose board, with an assistant holding the child’s head for better support. In a study of 200 infants undergoing frenotomy without analgesia, researchers found that 18% cried during and 60% after the procedure. In a study by Griffiths et al, the mean crying time for frenotomy was 15 seconds. Some physicians choose to give sucrose before the procedure to minimize and help with the pain. Placing topical anesthesia is not beneficial, and local anesthesia is contraindicated in infants.

• #21 Tongue-tie (ankyloglossia) | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20378437/

  A simple surgical procedure called a frenotomy can be done with or without anesthesia in the hospital nursery or doctors office. […] A more extensive procedure known as a frenuloplasty might be recommended if additional repair is needed or the lingual frenulum is too thick for a frenotomy. […] After a frenuloplasty, tongue exercises might be recommended to enhance tongue movement and reduce the potential for scarring.

• #22 TONGUE TIED? UNDERSTANDING TONGUE TIE SURGERY FOR CHILDREN AND ADULTS | Mya Care

  https://myacare.com/blog/tongue-tied-understanding-tongue-tie-surgery-for-children-and-adults

  Frenuloplasty is an extensive surgical procedure used for complex or severe cases. It involves altering the frenulum, possibly using techniques like Z-plasty, to improve the lingual frenulum’s length and flexibility. It is usually performed under general anesthesia. […] The decision on which surgical procedure to opt for is influenced by the severity of the tongue tie, the patient’s age, potential bleeding risks, and the extent of functional impairment. Healthcare providers should collaborate closely with patients or parents to choose the most appropriate and effective treatment method. […] Post-procedure, some children may experience minimal bleeding and discomfort. Adjusting to the newfound range of tongue movement can be challenging, especially for those who have developed compensatory feeding habits. Appointments for follow-up are essential to guarantee appropriate healing and evaluate the functional results of the surgery.

• #23 Treatment of Ankyloglossia: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10670877/

  Speech therapy, in conjunction with frenulectomy, frenulotomy, or frenuloplasty, can be a therapeutic option to improve tongue mobility and consonant pronunciation. […] The study by Tancredi et al. highlights the operative and postoperative advantages of treating hypertrophic lingual frenulum using diode laser therapy, evaluating the extent of postoperative healing and differences in pain perception compared with traditional surgical methods. […] Unlike a scalpel blade, the laser does not cut through the structures that make up the lingual frenulum (collagen and elastic fibers) but rather causes denaturation and coagulation. Therefore, it can be concluded that laser-assisted intervention offers numerous advantages over conventional surgical techniques. […] Fioravanti et al. evaluated the effectiveness of lingual frenulectomy using a diode laser to improve both the length of the frenulum and the obstructive-sleep-apnea-syndrome (OSAS) index in pediatric patients.

• #24 Comparative Analysis of Methods for Surgical Treatment of Ankyloglossia: A Review Article

  https://opendentistryjournal.com/VOLUME/17/ELOCATOR/e187421062211040/FULLTEXT/

  The utilization of CO2 laser has several advantages, which include the decrease in postoperative pain, swelling, and intraoperative bleeding, provision of a dry surgical field, minimal scarring, and no need for sutures. Laser frenectomy of the tongue is a simple and safe surgical operation, which is less traumatic than a scalpel surgery. […] In comparison with the conventional method of a frenectomy, the correction of the lingual frenulum with a diode laser results in the reduced duration of the operation; the complete absence of intraoperative bleeding; an apparent bactericidal effect, which is preferable in patients with a high risk of postoperative wound infection; better tissue regeneration; less apparent postoperative pain. […] Excision of the lingual frenulum using an Er:YAG laser radiation is quite effective, safe, and minimally invasive for the patient. The duration of the surgery can be significantly reduced, it is better tolerated than the conventional operation, and relapses are minimal.

• #25 Comparative Analysis of Methods for Surgical Treatment of Ankyloglossia: A Review Article

  https://opendentistryjournal.com/VOLUME/17/ELOCATOR/e187421062211040/FULLTEXT/

  Surgery with an Nd:YAG laser has significant advantages over the conventional technique, one of which is minimal intraoperative bleeding or its absence. This, in its turn, also reduces the risk of postoperative bleeding to a minimum. Additionally, the laser beam ensures that the cut tissue is already decontaminated during the exposure itself. […] Given the above elements, it can be stated that laser lingual frenectomy has several undeniable advantages over conventional surgery. There are many benefits to using a laser for a lingual frenectomy. Key advances reported in the literature include reduced inflammation and pain in the postoperative period, bloodless surgery that generates positive psychological feedback from the patients, reduced duration of surgery, and technical simplicity. The treatment of ankyloglossia in children should be carried out with a multidisciplinary medical approach, consisting of surgery, speech therapy and phoniatrics.

• #26 Comparative Analysis of Methods for Surgical Treatment of Ankyloglossia: A Review Article

  https://opendentistryjournal.com/VOLUME/17/ELOCATOR/e187421062211040/FULLTEXT/

  The laser technique is an alternative to traditional surgery due to a simple and quick operation, requiring a minimum amount of anesthesia, with no need for suturing. Moreover, depending on the wavelength of the laser radiation used, a good hemostatic and disinfecting effect is provided, while access, visualization, and accuracy of the intervention are improved.

• #27 CG-SURG-122 Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties

  https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_e003198.html

  In this short-term, RCT cross-over study, frenotomy to treat ankyloglossia-related feeding difficulties in infants resulted in immediately improved and sustained feeding in 54/57 (95%) of infants. […] Given the premature cross-over, further investigation is warranted to determine if frenotomy provides sustained benefit compared to lactation consultation in infants with ankyloglossia experiencing feeding difficulties. […] The study authors concluded, A small body of evidence suggests that frenotomy may be associated with lactating parent-reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient. […] 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.

• #28 CG-SURG-122 Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties

  https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_e003198.html

  Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia. […] Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. […] This study demonstrates the importance of expert assessment and lactation support as part of a comprehensive evaluation when determining the appropriateness of surgical intervention for ankyloglossia. […] The authors concluded, The statistical power of the analysis was extremely limited due to not achieving the target sample size and the high proportion of infants in the breastfeeding support arm who underwent frenotomy. […] This trial does not provide sufficient information to assess whether frenotomy in addition to breastfeeding support improves breastfeeding rates in infants diagnosed with tongue-tie. […] The small number of trials along with methodological shortcomings limits the certainty of these findings. Further randomised controlled trials of high methodological quality are necessary to determine the effects of frenotomy.

• #29 Frenectomy or Frenotomy for Ankyloglossia – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/100_199/0116.html

  The authors concluded that based on maternal observations, when frenotomy is performed on neonates with ankyloglossia and feeding difficulties in the first week of life, there is more benefit than when it is performed after the first week of life. […] The authors concluded that frenotomy for ankyloglossia demonstrated a high degree of maternal satisfaction; is well-tolerated and has been shown to improve breast-feeding and decrease pain and difficulty associated with breast-feeding. […] The authors concluded that breast-feeding difficulties associated with ankyloglossia in infants, particularly posterior, can be improved with a simple office-based procedure in most cases. […] The authors concluded that performing the frenotomy in the office on their 25 patients resulted in a cost savings of more than $240,000 and the avoidance of general anesthesia in the first few weeks of life.

• #30 Ankyloglossia – Conditions We Treat – Breastfeeding & Lactation Medicine – Golisano Children’s Hospital – Rochester, NY – University of Rochester Medical Center

  https://www.urmc.rochester.edu/breastfeeding/conditions-we-treat/tongue-tie

  We have seen good outcomes with clipping these ties, and there is evidence to support this. However, these children often also need accompanying suck therapy or craniosacral therapy. […] The frenotomy procedure is a low-risk, but not no-risk procedure in which the tongue-tie is cut. It may be recommended to treat certain kinds of tongue-tie that are impacting feeding. […] Frenotomy has shown benefits in breastfed infants including: improved latch, decreased pain for breastfeeding parents/mothers. […] Risks of frenotomy include bleeding, infection, cutting of surrounding structures such as muscle or salivary ducts. These are all rare outcomes. […] Keeping the frenotomy area open and scar-free: Some practitioners advise exercises to prevent the cut edges of the frenulum from re-attaching and forming a scar that makes an even worse „tongue tie.” […] We encourage you to try and slowly normalize breastfeeding over the next 1-2 weeks, transitioning as you see fit from the things you might have been using, like a nipple shield or bottles with expressed breast milk or formula.

• #31 Tongue Tie (Ankyloglossia): Diagnosis, Symptoms, Surgery, and More

  https://askthedentist.com/tongue-tie/

  After the frenectomy, caring for the wound is also critical. The mouth and tongue are great at healing, so its possible that the tongue will reattach, meaning it will literally heal back down the way it was. […] So, I meet with my patients immediately following the release to guide them through caring for the wound and to teach them new gentle exercises. This allows the tissues to heal without reattaching and affecting the end result. […] Its often covered by insurance, but the cost of a frenectomy (tongue tie surgery) is somewhere between $795-2729. […] Myofunctional Therapy for Tongue Tie and Why It Matters […] Theres more to treating a tongue tie than just releasing it, and this is where myofunctional therapy comes in. […] Its very important to do myofunctional therapy exercises for at least 4-6 weeks before the frenectomy. This helps prepare for the procedure by strengthening the muscles of the tongue.

• #32 Tongue Tie (Ankyloglossia): Diagnosis, Symptoms, Surgery, and More

  https://askthedentist.com/tongue-tie/

  Once the tongue tie has been released, its time to train the tongue to move properly. Just because the tongue is now capable of a normal range of motion doesnt mean it will be able to move the way it should. […] Without these exercises, its entirely possible that the tongue will never regain its full range of motion.

• #33 Ankyloglossia (Tongue-Tie) | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17608

  Risks and complications of frenotomy are uncommon but have been described. Rare complications include bleeding, airway obstruction, damage to surrounding structures, scarring, and oral aversion. Bleeding is the most common and is usually resolved with local pressure. A family history of bleeding disorders should be assessed before the procedure, and in older patients, a history of bleeding should be elicited. […] The management of ankyloglossia concerns multiple specialties within medicine and dentistry. Ankyloglossia may be encountered by primary care clinicians, pediatricians, otolaryngologists, nurse practitioners, lactation nurses, speech consultants, and dentists. […] The treatment of ankyloglossia has many controversies, which can be very confusing for parents who seek different opinions. The best approach for any healthcare worker encountering this issue is to weigh the benefits for the patient. Observation is the best treatment option if the condition is not causing any problems during the neonatal period. Once other potential causes of feeding difficulties have been excluded, a frenotomy can be presented as a possible treatment option. Frenotomy should only be performed by a trained and qualified healthcare provider. […] Overall, most patients benefit from observation. However, frenotomy is generally considered a low-risk procedure that can be performed in an outpatient clinic without anesthesia. It has the potential to improve breastfeeding difficulties and provide relief to the typically frustrated mother.

• #34 Tongue Tie Treatment

  https://nurturenourishservices.com/learn/tongue-tie-surgery

  Within the healthcare team, different specialists play vital roles, ranging from lactation consultants and speech therapists to release providers. […] By prioritizing a tongue tie functional evaluation and treatment, a family can make a decision on if a release is needed. […] A thorough functional evaluation lays the foundation for informed treatment decisions, emphasizing the significance of a well-informed beginning on the path to improved oral health, motor development, comfort, and overall well-being.

• #35 Ankyloglossia (Tongue-Tie) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482295/

  Ankyloglossia, also known as tongue-tie, is a condition that impairs tongue movement due to a restrictive lingual frenulum. Multiple specialties within medicine and dentistry are involved in the evaluation and treatment of this condition. Management of ankyloglossia remains controversial. If surgical treatment is decided, frenotomy is the most common procedure. […] This activity reviews the available data regarding the etiology, epidemiology, and common clinical findings of ankyloglossia. It also describes the current evaluation and management strategies for patients with ankyloglossia; identifies the differential diagnoses, prognosis, and complications; and highlights the role of the interprofessional team in the management of ankyloglossia. […] Frenotomy is usually recommended in infants diagnosed with ankyloglossia experiencing breastfeeding difficulties after other conservative treatments have failed. Early release of the lingual frenulum will decrease the possibility that the mother abandons breastfeeding. Notably, there is limited evidence to support that frenotomy is associated with positive outcomes in other issues besides breastfeeding. […] Risks and complications of frenotomy are uncommon but have been described. Rare complications include bleeding, airway obstruction, damage to surrounding structures, scarring, and oral aversion.

• #36 Frenotomy Procedure To Treat Tongue-Tie

  https://my.clevelandclinic.org/health/procedures/frenotomy

  Healthcare providers recommend feeding your baby right after the procedure ends. Doing so helps comfort your baby and stop any bleeding. […] Possible benefits of a frenotomy (frenectomy) include helping your baby breastfeed more effectively and reducing pain or discomfort you feel from breastfeeding. […] Its hard to predict whether your baby will have improved breastfeeding after this procedure. […] A frenotomy is generally very safe. Rarely, it can cause a baby to have bleeding, infection, scarring, feeding aversion, or injury to the saliva ducts or nerves in their mouth. […] Your provider will tell you when you should bring your baby back for a follow-up. At this follow-up, your provider will check for any complications, ask how breastfeeding is going and discuss any difficulties, and offer help with breastfeeding, as needed. […] Just the thought of something being cut in your babys mouth might make you nervous or scared. […] But a frenotomy is typically a simple, safe and quick procedure. Healthcare providers exhaust all other methods of helping your baby breastfeed before doing a frenotomy.

• #37 Ankyloglossia (Tongue-tie) | ENT Doctor In Tuscaloosa, AL | Allergy & Asthma Center of Tuscaloosa, P.C.

  https://www.allergytuscaloosa.com/articles/aohns_patient_education/516475-ankyloglossia-tongue-tie/

  Ankyloglossia, which is also referred to as tongue-tie, is a condition where the tongue cannot move normally because it is attached to the floor of the mouth by the frenulum, which is too tight. […] The typical treatment of symptomatic ankyloglossia is a frenotomy, a surgery that involves cutting the band of tissue between the tongue and floor of the mouth to release the tongue and help it move more freely. […] For example, an infant who has a frenulum that attaches farther out on the tongue but is feeding well does not necessarily require surgery. […] If nonsurgical interventions do not resolve the problem or ankyloglossia is moderate to severe, a lingual frenotomy may be recommended. […] The procedure involves cutting the restricted frenulum with scissors, laser, or cautery device depending on the preference of the treating physician. […] While many infants benefit from frenotomy, not all infants with ankyloglossia experience symptoms or require any intervention. […] A few rare risks of frenotomy may include bleeding, infection, scarring, salivary duct injury, and airway obstruction.

• #38 Ankyloglossia | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ankyloglossia/research-protocol

  Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts mobility of the tongue. […] The significance of this anomaly and the best method of management have been controversial for more than 50 years. […] Recognition of potential benefits of breastfeeding in recent years has resulted in a renewed interest in the functional sequelae of ankyloglossia. […] Of infants with anterior or posterior ankyloglossia, there is a 25 to 80 percent incidence of breastfeeding difficulties including failure to thrive, maternal nipple damage, maternal breast pain, poor milk supply, maternal breast engorgement, and refusing the breast. […] Mechanistically, infants with restrictive ankyloglossia cannot extend their tongues over the lower gum line to form a proper seal and therefore use their jaws to keep the breast in the mouth.

• #39 Ankyloglossia | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ankyloglossia/research-protocol

  In a review focused solely on frenotomy and breastfeeding, Segal and colleagues (2007) assessed diagnostic criteria, prevalence, and effectiveness of the procedure. […] The authors rated most of the seven studies evaluating frenotomy as poor quality (mean score of 24.4, range 9-40 on a 47-point scale). […] In a 2009 review addressing diagnosis and treatment, Suter and colleagues similarly noted multiple diagnostic criteria for ankyloglossia, and prevalence rates for the condition ranged from 0.1 to 10.7 percent. […] The most recent systematic review, published in 2013, assessed outcomes related to breastfeeding and speech. […] Clarity is needed to help guide clinical and family decision-making about whether, when and how to intervene to address ankyloglossia, in particular in light of controversies about the topic and the limitations of the existing systematic reviews.

• #40 Frenectomy or Frenotomy for Ankyloglossia – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/100_199/0116.html

  The authors concluded that ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breast-feeding; however, there was a limited number of studies available with quality evidence. […] The authors concluded that the lack of an accepted definition and classification of ankyloglossia makes comparisons between studies almost impossible. […] The authors concluded that the findings of this study aided clinicians in decision-making not to advise massage as it is unlikely to benefit infants with ankyloglossia. […] The authors concluded that this study demonstrated a significant increase in publications discussing tongue-tie and a lack of research on lip-tie and cheek-tie in relation to breast-feeding. […] The authors concluded that further investigations with a greater number of patients should be conducted to compare lingual frenectomy surgery with other methods including minimally invasive ones.

• #41 Tongue Tie: What Is It and How Is It Treated? | Cedars-Sinai

  https://www.cedars-sinai.org/blog/treating-ankyloglossia.html

  Tongue tie (ankyloglossia) is when the tissue connecting the tongue to the floor of the mouth is too short or thick and keeps the tongue from lifting up from the bottom of the mouth. This can make it hard for a baby to breastfeed and can later interfere with the child’s speech. […] In infants, tongue tie is treated by making a small cut to the tissue connecting the tongue to the floor of the mouth (lingual frenulum). The procedure, called a frenotomy, allows the tongue to move more freely. This can be done in a healthcare provider’s office without anesthesia. […] Dr. Rieber notes that there has been a dramatic increase in frenotomy procedures in recent years, and many of the procedures are unnecessary. She emphasizes that parents who are considering a frenotomy for their child need to go to a pediatric ENT specialist who’s trained in how to cut the frenulum the right way. […] Some tongue-tied children may need a more complex procedure called a frenuloplasty, which uses sutures to help prevent the tie from reforming. Young patients also may need to see a speech therapist after having any procedure to correct a tongue tie.

• #42 Correct treatment for tongue-tie in infants | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2021/10/opinions/correct-treatment-tongue-tie-infants

  The frenotomy of a tongue-tie on the basis of an appropriate indication is associated with improved breastfeeding. […] Follow-up with breastfeeding counselling and support should be offered irrespective of whether a frenotomy is performed or the tongue tie is treated conservatively, with the aim of enabling all mothers who wish to breastfeed to do so successfully. […] The new Norwegian guidelines for the diagnosis and treatment of tongue-tie in infants have been prepared by a nationwide working group, consisting of neonatologists, paediatricians, otorhinolaryngologists, a dentist, a speech therapist, midwives, school nurse practitioners, general practitioners and doctors specialising in community medicine, as part of an initiative from the Norwegian National Advisory Unit on Breastfeeding.

• #43

  https://www.handyhandouts.com/viewHandout.aspx?hh_number=505

  Tongue-tie (ankyloglossia) occurs when the band of skin connecting the tongue to the floor of the mouth (lingual frenulum) is shorter, thicker, and/or tighter than usual. […] Treatment Options Some doctors and lactation experts recommend immediate treatment of tongue-tie, while others recommend waiting to see if the condition will resolve on its own. […] Treatment can occur immediately after birth, when a child is older, or when a child reaches adulthood. […] Doctors may recommend a frenotomy, a simple procedure consisting of clipping the lingual frenulum. […] If the lingual frenulum is too thick, doctors may recommend a more extensive procedure called a frenuloplasty. […] When deciding the best approach for addressing tongue-tie, parents would benefit from consulting with doctors, feeding specialists, and speech-language pathologists. A team approach can help parents make the best decision for their family.

• #44 Tongue Tie Treatment: Does Your Child Need Surgery?

  https://www.sitarambhartia.org/blog/pediatrics/tongue-tie-treatment/

  Yes, it can be corrected. […] Tongue-tie treatment is a simple surgical procedure that involves cutting the thin tissue that binds the tongue to the floor of the mouth together. […] The procedure, known as frenotomy or frenuloplasty, is quick, almost painless, and can be carried out with or without local anaesthetic for infants. […] Lakshay was advised surgery. […] They were, however, reassured that it is a painless surgery that requires only a few hours of hospital stay. […] To their relief, the child safely underwent excision of the fraenulum under anesthesia and was sent home after recovery within a few hours.

• #45 Has Your Baby Been Diagnosed With Tongue-Tie? | Children’s Hospital Los Angeles

  https://www.chla.org/blog/advice-experts/has-your-baby-been-diagnosed-tongue-tie

  The care team may recommend follow-up visits to make sure the tongue is healing well. They may also recommend seeing a lactation consultant or a feeding therapist after the procedure, to assure your baby is feeding effectively. […] Not all babies with tongue-tie will need a tongue-release procedure, say Danto. […] You may decide that a tongue-tie procedure is the best option if you have significant breast or nipple pain or if feeding is especially difficult. […] Many babies and parents have benefitted from tongue-tie surgery. These procedures are generally safe and may help with: […] Alleviating nipple pain and discomfort in the breastfeeding parent […] Helping babies gain weight […] Improving a babys feeding efficiency […] Facilitating bonding between the baby and the parent […] Reducing fussiness and irritability that can result from feeding issues.

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