Laser Frenotomy among Infants with Significant Ankyloglossia and Maxillary Lip-tie and Its Influence on Breastfeeding: A Retrospective Chart Review

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Abstract

Background: Ankyloglossia, or tongue-tie, is a congenital anomaly that can limit tongue movement and contribute to breastfeeding problems.

Research aim/question(s): This retrospective chart review is aimed at evaluating the prevalence of anterior ankyloglossia and posterior ankyloglossia and its association with maxillary lip-tie among infants with breastfeeding difficulties. It also assesses the impact of office-based soft-tissue laser frenotomy among infants with breastfeeding difficulties and significant ankyloglossia and/or maxillary lip-tie.

Methods: Records of healthy 0–12-month-old infants who received soft tissue laser frenectomy due to significant ankyloglossia and/or maxillary lip-tie, and breastfeeding difficulties and were identified. Any improvement in the latch-on efficiency, decrease in pain during breastfeeding and weight gain per day at the two-week follow-up were documented.

Results: A total of 129 participants were found to meet the inclusion criteria. 106 subjects had ankyloglossia and lip tie, 12 subjects had ankyloglossia only, and 11 subjects had lip-tie only. 120 mothers (93.0%) reported improvement in breastfeeding two weeks after the laser procedure. Participants with anterior ankyloglossia were presented to the office at a significantly younger age (38.2±40.2 days) compared with participants with posterior ankyloglossia (62.71±57.44) (p<0.001). The mean weight on the day of the procedure was significantly higher among those with no ankyloglossia (15.55±5.9) compared with those with anterior ankyloglossia or posterior ankyloglossia (p=0.007); further, the mean weight gain per day after the procedure was significantly higher among those with anterior ankyloglossia (0.13±0.14) compared with participants with posterior ankyloglossia (0.06±0.08) (p=0.033). Participants with lip-tie only presented to the office at a statistically significant older age (p=0.011) and higher weight (p=0.008). The mean weight gain per day after the procedure was statistically significant less in class III maxillary lip-tie participants (0.05±0.1) (p=0.010). Preterm participants were more likely to present with no ankyloglossia or posterior ankyloglossia than anterior ankyloglossia (p<0.001); most of them were diagnosed with lip-tie only (p<0.001).

Conclusion: The majority of the infants with breastfeeding difficulties were diagnosed with posterior ankyloglossia and class III maxillary lip-tie. Parents of infants with anterior ankyloglossia sought treatment when the infants were at a younger age and those infants showed higher mean weight gain per day after the procedure. The majority of the mothers of infants with breastfeeding difficulties reported improvement two weeks after office-based soft-tissue laser frenectomy.