Evaluation of parental perceptions of lingual and labial frenectomy on their child: a comparison of CO2 laser and conventional scalpel.

To evaluate parental reports of postoperative pain, improvement and satisfaction following frenectomy with scalpel versus carbon dioxide (CO2) laser treatment. Forty-nine patients aged 2-6 years with a short labial or lingual frenulum who required frenectomy were randomly assigned to undergo CO2 laser or scalpel treatment. They were divided into a labial and a lingual frenulum group based on the severity of attachment. Frenectomy was performed using a scalpel or Pixel CO2 10,600 nm laser (Alma Lasers Company, Caesarea, Israel). Postoperative follow-up was conducted via a mobile application where pain was evaluated daily using the visual analog scale (VAS) in the first 72 hours, and painkiller use was recorded. Improvement and satisfaction were evaluated at 1-month post-surgery and compared among the groups. Our results showed significant differences between the degree of clinical attachment of the frenulum, one-month postoperative improvement and satisfaction based on VAS scores (p < 0.001). Although the use of scalpel was associated with lower postoperative pain scores than the CO2 groups, VAS scores of improvement and satisfaction after 1 month were higher in the CO2 groups (p < 0.05). This study showed that although laser was associated with more postoperative pain, it showed greater improvement and higher satisfaction among patients' parents at 1 month post-surgery compared with scalpel.

Prevalence of breastfeeding difficulties in newborns with a lingual frenulum: a prospective cohort series.

OBJECTIVE: The prevalence of a lingual frenulum in newborn infants is reportedly 0.3-12%. The purpose of this study was to describe the prevalence of a lingual frenulum based on the Coryllos classification in nonselected newborn infants after delivery, hypothesizing that it is higher than the values reported in the literature. STUDY DESIGN: The lingual frenula of 200 healthy infants were evaluated by visual examination and palpation within the first 3 days after delivery. The frenulum was categorized according to the four Coryllos classifications. Each infant's mother responded, immediately after the examination, to a structured questionnaire on the quality and type of feeding. An additional structured telephone interview with the 179 breastfeeding mothers was conducted 2 weeks later. RESULTS: All but one infant (n=199) had an observable or palpable lingual frenulum that was Coryllos type 1 (n=5), type 2 or 3 (n=147), or type 4 (n=47). Although our study was not powered enough to test for any correlation between the cessation of breastfeeding and the type of frenulum, we found no statistical correlation between the Coryllos type of lingual frenulum and the presence of breastfeeding difficulties. CONCLUSIONS: A lingual frenulum is a normal anatomical finding whose insertion point and Coryllos classification are not correlated with breastfeeding difficulties. We suggest that the term "lingual frenulum" should be used for anatomical description and that the term "tongue-tie" be reserved for a lingual frenulum associated with breastfeeding difficulties in newborns.

Lingual frenotomy for breastfeeding difficulties: a prospective follow-up study.

INTRODUCTION: Breastfeeding difficulties are sometimes attributable to tongue-tie with short-term relief after frenotomy. Limited follow-up is available, and predictors for nonsuccessful frenotomy have not yet been found. PATIENTS AND METHODS: We recruited 264 mother-infant dyads who underwent lingual frenotomy for breastfeeding difficulties. Data regarding the indications, anatomy of the tongue, and the response of the infant were noted by the physician. Mothers were contacted by telephone at 2 weeks, 3 months, and 6 months after frenotomy to answer a questionnaire. RESULTS: Two weeks after frenotomy, 89% of mothers were still breastfeeding. An improvement in breastfeeding was reported by three-quarters of the mothers, but, unexpectedly, 3% reported worsening. At 3 and 6 months after the procedure, 68% and 56% of mothers were still breastfeeding, respectively. We could not find any predictor to indicate those infants in whom breastfeeding would not improve. CONCLUSIONS: There are favorable long-term effects of frenotomy on breastfeeding. Lingual frenotomy does not always alleviate breastfeeding difficulties, and rarely worsening ensues. We could not find any predictor for successful breastfeeding after frenotomy. We speculate that because the procedure is minor, in the event of breastfeeding difficulties, lingual frenotomy should be considered as an effective tool to assist in long-term breastfeeding.

Biomechanics of milk extraction during breast-feeding.

How do infants extract milk during breast-feeding? We have resolved a century-long scientific controversy, whether it is sucking of the milk by subatmospheric pressure or mouthing of the nipple-areola complex to induce a peristaltic-like extraction mechanism. Breast-feeding is a dynamic process, which requires coupling between periodic motions of the infant's jaws, undulation of the tongue, and the breast milk ejection reflex. The physical mechanisms executed by the infant have been intriguing topics. We used an objective and dynamic analysis of ultrasound (US) movie clips acquired during breast-feeding to explore the tongue dynamic characteristics. Then, we developed a new 3D biophysical model of the breast and lactiferous tubes that enables the mimicking of dynamic characteristics observed in US imaging during breast-feeding, and thereby, exploration of the biomechanical aspects of breast-feeding. We have shown, for the first time to our knowledge, that latch-on to draw the nipple-areola complex into the infant mouth, as well as milk extraction during breast-feeding, require development of time-varying subatmospheric pressures within the infant's oral cavity. Analysis of the US movies clearly demonstrated that tongue motility during breast-feeding was fairly periodic. The anterior tongue, which is wedged between the nipple-areola complex and the lower lips, moves as a rigid body with the cycling motion of the mandible, while the posterior section of the tongue undulates in a pattern similar to a propagating peristaltic wave, which is essential for swallowing.

[Neonatal tongue-tie: myths and science].

Anatomical restraining of tongue movement (tongue-tie, ankyloglossia) has been known for centuries and the subject of dozens of articles. The heated debate persists on its clinical significance and indications for treatment. Most authorities in the field of infant feeding and Lactation agree that breastfeeding problems, such as nipple pain and latching difficulties, are common signs of clinicaLly significant tongue-tie and indications for performing a frenotomy, while the sole presence of a visible lingual frenulum is not. In contrast, the lack of a visible frenulum does not rule out the diagnosis of clinically significant tongue-tie since submucosal ties, also called "posterior tongue-tie", may interfere with efficient breastfeeding. Whether tongue-tie interferes with speech articulation to a significant extent is currently unknown. Theoretically, articulation of some consonants (e.g., /s/, /th/, /r/) would be affected by impeded tongue movement. These articulation problems are, however, Less common than tongue-tie itself, and children and adults characteristically use various compensatory techniques of mouth opening and tongue movements. When it is indicated, frenotomy is performed by lifting the tongue and snipping the frenulum with scissors. Complications of frenotomy are rare and consist mainly of self-limited minor bleeding. The significance of posterior tongue tie and the long-term effects of frenotomy performed during early infancy are unresolved issues.

Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study.

PURPOSE: Ankyloglossia ("tongue-tie") occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms. METHODS: Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breast-feeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother. RESULTS: There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06). CONCLUSION: Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.

Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management.

Since the recommended time for a child's first dental visit is early, it is essential that pediatric dentists be familiar with all possible pathologies occurring during this early period of life. The parents of infants and toddlers who notice in their child a "tongue-tie" (ankyloglossia) are likely to turn first to their pediatric dentist for advice and help. Treatment options such as observation, speech therapy, frenotomy without anesthesia, and frenectomy under general anesthesia have all been suggested in the literature. The purposes of this report are to describe ankyloglossia, its clinical significance, and the timing of treatment. The frenotomy procedure is presented for the pediatric dentist with clinical suggestions for the diagnosis and management of ankyloglossia.

Nitrous oxide-oxygen inhalation for outpatient otologic examination and minor procedures performed on the uncooperative child.

OBJECTIVE: Otomicroscopic examination with suctioning of ears or other procedures is frequently uncomfortable especially for children. Anxiety and pain with lack of cooperation may result in trauma to the ear, incompletion of the examination, delayed diagnosis and treatment and need for completion of the examination under general anesthesia. The purpose of this study was to evaluate the efficacy and safety of utilizing nitrous oxide-oxygen inhalation for sedation and analgesia in otologic examination and minor surgical procedures performed on the uncooperative child at the outpatient clinic. METHODS: In a prospective pilot case series study conducted at the Pediatric Otolaryngology outpatient clinic of a tertiary medical center, nitrous oxide-oxygen inhalation was administered by the examining otolaryngologist and the assisting nurse. The study group included children over 2 years old, for which an accurate diagnosis of ear pathology could not be made or a minor surgical procedure could not be tolerated because of anxiety and lack of cooperation. RESULTS: Completion of the indicated procedure was successful in 21 of 24 patients (88%). Full cooperation, where no restraint was necessary was achieved in 20 of 24 patients (83%). The mean rank pain scores, evaluated separately by the patient, parent and staff, were in the mild pain range using a 0-10 coding for Faces Pain Rating Scale. The mean procedure time was 8.9 min. An adverse reaction, vomiting, occurred in one patient. Twenty-one of 24 parents stated that they would repeat the procedure if necessary. CONCLUSION: This pilot study shows the potential usefulness of nitrous oxide-oxygen inhalation administered by an otolaryngologist in the outpatient clinic. Alleviation of pain and anxiety and avoiding the need for physical restraint is an important goal that can be achieved with this form of sedation.