Doctors Notes:

Tongue Tie (Ankyloglossia)

Daniela Egelmeer

“Frenotomy, frenulotomy, frenulectomy…what a tongue twister!”

Anterior Tongue-Tie

Frenotomy, frenulotomy, frenulectomy…what a tongue twister! Many names for one procedure…but can this tongue twisting tongue-tie fixing procedure help with breast feeding?  Interestingly, there is no general consensus amongst experts about its effectiveness, and according to current reviews- 10% of pediatricians, 30% of otolaryngologists (Ear Nose and Throat doctors or ENT), 69% of lactation consultants believe it can be helpful.  So what is a parent to choose? Most frenotomies are performed before a baby goes home from the newborn nursery, so think fast! Or better yet- be prepared! Know what current studies have shown about the safety and efficacy of resecting a tongue tie.

After the birth of a baby, lack of maternal sleep, lack of milk production, or difficulty latching can often make breast feeding quite difficult.  A good latch is key to promote milk production and prevent maternal pain during nursing…let’s see what researchers tell us about how a frenotomy can help.  The way science objectively assesses medical treatments is through “Randomized Controlled Trials (RCT)-” studies where people are assigned at random to receive different interventions, one being the treatment we want to test (ie. Frenotomy) vs. other interventions, or no intervention at all. “Systemic Reviews” summarize the results of RCT’s which are considered well designed- to show us what makes most sense for doctors to recommend to our patients and families:

  • 2013 and 2015 systemic and comparative reviews demonstrated that frenotomies are well tolerated by babies and improved efficacy of breast feeding- “yay” for fixing tongue ties!
  • 2017 systemic review showed short term improvement in maternal pain and was inconclusive on observed infant feeding- maybe “yay” for fixing tongue ties?!

Taking into account most RCT’s up to date, the experts from the American Academy of Pediatrics (AAP) let us know that it makes sense to recommend frenotomies for babies with breast feeding problems AND anterior ankyloglossia (tongue-tie)…It can be helpful, it’s safe, but we need more studies to truly know.

Posterior Tongue-tie

Now, if you have done any internet search for tongue tie, you’ll quickly notice that sticking out your tongue is not as easy as it seems! This little muscle can be attached at places you can’t even imagine :P. When the frenulum (the small fold of tissue that extends from the floor of the mouth to the midline of the underside of the tongue) is attached to the middle to posterior aspect, it is referred to as posterior ankyloglossia (posterior tongue-tie).  Posterior tongue-ties can be short, thickened, or at times below the visible tongue surface (submucosal).  At times, posterior tongue-ties can restrict the movement of the tongue, so it would make sense that they may interfere with breast feeding- but wait! Remember those Randomized Controlled Trials (RCT’s) aforementioned? None have been conducted that may lead us to believe releasing posterior tongue-ties is effective (or even safe) in regards to breast feeding. Furthermore, frenuloplasty (the plastic procedure that would be needed to release a posterior tongue tie) usually requires general anesthesia. Some providers feel comfortable performing this procedure with a diode laser, yet one of its possible complications is ulceration which is painful and difficult to heal. But as with every medical procedure, if you would like to understand it better- it’s always a good option to discuss it with a specialist such as an ENT.

Upper Lip-Tie

 Wait! There is more- what about lip ties? Some believe that an upper lip tie can also affect breast feeding- yet, again, there are no RCT’s to show the efficacy or safety of its resection.  The studies that are available treated both upper lip tie and tongue tie at the same time, so it’s difficult to say if fixing the lip tie contributed to any more improvement on breast feeding than fixing the tongue tie alone.

In summary…

  • Medical research supports resecting anterior tongue-ties if affecting breast feeding
  • Current medical research is not enough to support the resection of posterior tongue-ties or upper lip-ties
  • Also, a tongue tie can cause articulation problems in some children, but it does not prevent vocalization, so children should attain language at the normal rate.

So in the spirit of the season- next time you feel inclined to say “Crazy kids clamor candy canes and Christmas cookies..” be thankful for the unrestricted movement of your tongue 😊.

Merry Christmas, Happy New Year and enjoy your beautiful babies.