Tongue-tie division. Is it worth it? A retrospective cohort study
Breastfeeding is a complex process, influenced by various factors. Tongue tie may be an impediment to breastfeeding, so division of tongue tie (frenotomy) is routinely recommended to improve breastfeeding.
This study aimed to assess the value of frenotomy based on its impact on breastfeeding-related problems.
A 1-year retrospective cohort study was undertaken of all the patients referred to a London-based tongue-tie service with breastfeeding difficulties. A telephone survey was performed using a standardised questionnaire.
The rate of exclusively breastfed babies increased from 36.7% before frenotomy to 53.8% at 48 hours post-procedure. All the breastfeeding-related problems significantly reduced by 48 hours post-procedure. There was no major bleeding, infection or ulceration reported. Of babies that had frenotomy, 3.2% underwent a second procedure.
Frenotomy is a well-tolerated surgical procedure accompanied by very low complication rates. It significantly increases the exclusive breastfeeding rate in the short-term period and reduces breastfeeding-related problems.
Ankyloglossia, or tongue tie, is a congenital abnormality characterised by a short frenulum, which may restrict tongue motility. It is usually asymptomatic, but in some cases may cause problems during breastfeeding. These problems can be severe enough to make some women give up breastfeeding.
National Institute for Health and Care Excellence (NICE, 2005) guidelines considered frenotomy a safe procedure but highlighted a dearth of evidence of its efficacy in improving breastfeeding practice. Recommendations were made to monitor the outcome of the procedure in terms of successful long-term breastfeeding.
Since these recommendations, several studies have reported varying degrees of effectiveness of frenotomy. Some have shown that frenotomy brings subjective and objective improvements in breastfeeding and reduction in problems related to breastfeeding itself (Buahin et al, 2013; Brookes and Bowley, 2014). A recent retrospective 1-year study on the immediate outcome of frenotomy saw an 80% improvement in the breastfeeding rate immediately after the procedure (Gruber et al, 2013). In a randomised single-blinded controlled trial from 2014, although at 5 days post-frenotomy there was no significant objective improvement in breastfeeding, fewer mothers in the intervention group switched to bottle-feeding (Sutcliffe et al, 2014). A 2012 Dutch observational study saw a breastfeeding improvement of 89% at 1-week follow-up (Post et al, 2012). Timing of frenotomy seems to be important in its effectiveness as perceived by mothers: according to a 2012 cohort survey, frenotomy performed in the first week of life is more effective than if performed subsequently (Steehler et al, 2012). Two systematic literature reviews have found that frenotomy is a safe procedure that improves breastfeeding both objectively and subjectively, but most studies in the literature are not randomised (Constantine et al, 2011; Webb et al, 2013). It is often difficult to determine predictive factors of successful tongue-tie division (Dollberg et al, 2014).
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