Mothers’ Perceptions and Experiences on Tongue-tie and Frenotomy: A Qualitative Study

@#Introduction: Tongue-tie is a congenital condition of a thickened, tightened or shortened frenulum. This condition may cause breastfeeding difficulties to both mother and infant, such as ineffective suckling and painful nipple. In older children, it can cause speech difficulties. Although many studies have investigated the problems associated with tongue-tie and its treatments, there are limited studies on the mother’s experiences of tongue-tie and post frenotomy. This study aimed to explore the mother’s experiences of tongue-tie associated problems, frenotomy and the outcome. Methods: In-depth interviews were conducted in a one-on-one setting with fifteen mothers whose infant and children underwent frenotomy. Data were collected, transcripted, translated and analysed according to themes. Results: The analysis revealed a common story of stressful challenges and difficulties of breastfeeding. The mothers described that tongue-tie caused poor latching, nipple pain and bleeding, prolong feeding and lack of sleep. Their infant had poor weight gain, sleeping problems, insufficient milk transfer, fatigue and constant crying. For the older children, mothers complained of restricted tongue movement, difficulty in licking ice cream and speech problems. All of them agreed that the frenotomy procedure was easy, simple and less invasive and the outcome was positive. Furthermore, mothers continued breastfeeding without any difficulties and complications. Conclusion: Mothers in this study had difficulties with breastfeeding. However, all of the reported symptoms improved after frenotomy. They considered frenotomy was a simple and safe procedure that was highly recommended for symptomatic tongue-tie.

Prevalence of ankyloglossia in newborns and impact of frenotomy in a Baby-Friendly Hospital / Prevalencia de la anquiloglosia en el recién nacido e impacto de la frenotomía en un hospital de la Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia

Abstract Background: Ankyloglossia is a condition present in some newborns and can be associated with breastfeeding difficulties, leading to symptoms in the child and the mother. This study aimed to analyze the characteristics of newborns with tongue-tie and the symptoms reported by their mothers, and the short and long-term outcomes of frenotomy. Methods: We conducted a prospective and observational 7-month study in a Baby-Friendly Hospital (BFH). We included all the breastfed newborns without comorbidities that underwent a frenotomy. Results: A total of 33 frenotomies were performed. The most common findings before the procedure were maternal breastfeeding pain (29/33), ineffective latch (18/33), and maternal nipple lesions (18/33). We observed that newborns surgically intervened later showed a high incidence of jaundice (p = 0.03), weight loss greater than 10% at hospital discharge (p = 0.004), and their mothers experienced pain more often (p = 0.004). At one month of age, there was an improvement in breastfeeding-related pain (p = 0.012) and its intensity (p = 0.016), the presence of maternal cracked nipples (p < 0.01), and latching on (p < 0.01). Conclusions: Ankyloglossia can prevent the correct establishment of breastfeeding. Frenotomy is associated with few complications, and when appropriately indicated, may have a positive impact on breastfeeding, reducing maternal pain, the presence of nipple lesions, and latching problems.

Resumen Introducción: La anquiloglosia está presente en algunos recién nacidos y puede interferir en el amamantamiento, produciendo sintomatología en el niño y en la madre. El objetivo de este estudio fue analizar las características de los recién nacidos con anquiloglosia, así como la sintomatología referida por sus madres, y la evolución tras la frenotomía. Métodos: Estudio observacional analítico prospectivo de las frenotomías realizadas en la planta de maternidad de un hospital IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia) durante 7 meses. Se incluyeron todos los recién nacidos alimentados inicialmente con lactancia materna a quienes se realizó una frenotomía. Resultados: Se realizaron 33 frenotomías. Los hallazgos más frecuentes previos a la frenotomía fueron dolor con las tomas (29/33), dificultad en el agarre (18/33) y presencia de grietas (18/33). Asimismo, se vio que los pacientes intervenidos más tarde presentaban con mayor frecuencia ictericia (p = 0.03) y pérdida de peso superior al 10% previa al alta (p = 0.004), y sus madres presentaron dolor con mayor frecuencia (p = 0.004). Al mes de vida se observó la mejoría del dolor con las tomas (p = 0.012) y su intensidad (p = 0.016), la presencia de grietas (p < 0.01) y el agarre al pecho (p < 0.01). Conclusiones: La anquiloglosia puede impedir el correcto establecimiento de la lactancia materna. La frenotomía presenta escasas complicaciones y, cuando está bien indicada, puede mejorar el amamantamiento, reduciendo el dolor, la presencia de grietas y las dificultades en el agarre.

Diagnosis and treatment of ankyloglossia in newborns and infants / 华西口腔医学杂志

Ankyloglossia is a congenital condition characterized by a short lingual frenulum, which may result in the restriction of tongue movement and function. Considerable controversy regarding the diagnosis, clinical significance, and management of the condition remains, and great variations in practice have been recorded. Indeed, attitudes toward ankyloglossia differ among professional groups, and opinions may vary remarkably even among those within the same specialty. This article reviews the embryology, genetics, diagnosis, clinical presentation, and treatment of ankyloglossia to help physicians better understand and treat the condition.

Repercussão da anquiloglossia em neonatos: diagnóstico, classificação, consequências clÍnicas e tratamento / Repercussion of ankyloglossia in neonates: diagnosis, classification, clinical consequences and treatment

Introdução: A anquiloglossia é uma anomalia congênita que envolve alterações morfofuncionais no frênulo lingual e que pode estar atrelada às condições genéticas; apresentando-se em maior frequência no sexo masculino; e caracteriza-se por limitar os movimentos linguais. Com isso, pode contribuir na disfunção do sistema estomatognático, desencadear prejuízos na amamentação e comprometer o desenvolvimento craniofacial do neonato. Objetivo: As divergentes opiniões encontradas promovem um quadro de incerteza na escolha do protocolo de avaliação ou na intervenção, impulsionando assim a realização deste artigo. O presente artigo objetivou revisar a literatura de modo a desenvolver o conhecimento nos protocolos de avaliação para o diagnóstico da anquiloglossia, analogamente verificar as interferências condicionadas por esta anomalia no sistema estomatognático e observar as formas de tratamento para liberação do frênulo lingual. Materiais e Métodos: Foi realizada uma revisão de literatura de estudos anteriores com acesso possibilitado pelo PubMED/Medline, Lilacs, Scielo, Scopus; estabelecido o critério de artigos recém-publicados, no intervalo de 2015-2019. Conclusão: Assim, a ausência de um método de identificação que se enquadre em um padrão ouro revela a necessidade de realização de mais estudos sobre um protocolo mais eficaz para diagnóstico e classificação dessa anomalia, pois um método com maior nível de exatidão evitará intervenções inoportunas, e promoverá o conhecimento básico para realização do tratamento adequado para cada quadro de anquiloglossia.

Introduction: Ankyloglossia is a congenital anomaly involving morphofunctional changes in the lingual frenulum and which may be linked to genetic conditions; presenting more frequently in males; it is characterized by limiting lingual movements, which can contribute to the dysfunction of the stomatognathic system, triggering losses in breastfeeding and compromising the craniofacial development of the newborn. Objective: The divergent opinions found promote a picture of uncertainty in the choice of the evaluation protocol or intervention, thus driving the realization of this article. This article aimed to review the literature in order to develop knowledge in the assessment protocols for the diagnosis of ankyloglossia, similarly to verify the interferences conditioned by this anomaly in the stomatognathic system and to observe the forms of treatment for release of the lingual frenulum. Materials and Methods: A literature review of previous studies with access made possible by PubMED / Medline, Lilacs, Scielo, Scopus; the criterion for newly published articles in the 2015-2019 range was established. Conclusion: Thus, the absence of a gold-standard identification method reveals the need for further studies on a more effective protocol for diagnosing and classifying this anomaly, as a more accurate method will avoid inappropriate interventions, and will promote the basic knowledge for carrying out the appropriate treatment for each ankyloglossia picture.

Free gingival graft: An effective technique to create healthy keratinised gingiva

The high labial frenal attachment in mandibular anterior segment is most commonly associated with inadequate width of attached gingiva. Insufficient attached gingiva contributed to the difficulty in oral hygiene maintenance and ultimately poor gingival health. Frenectomy, vestibular extension and gingival augmentation procedures either alone or in combination are often required to maintain adequate health of the gingiva. Clinical relevance Inadequate width of keratinised gingiva contributed to the difficulty in oral hygiene maintenance and ultimately poor gingival health. Frenotomy with free gingival graft (FGG) technique is most predictable in these situations. Objective To highlight the importance of keratinised gingiva and overview of the FGG technique.

Surgical techniques for the treatment of ankyloglossia in children: a case series

This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.