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International Breastfeeding Journal May 2022In the past 10-15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased...
BACKGROUND
In the past 10-15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased performance of frenotomy. Physicians and other healthcare professionals with expertise in breastfeeding have voiced concerns about complications related to the performance of infant frenotomy. Reviews of this topic have reported no significant complications after frenotomy. Other data on complications consist of case reports.
METHODS
An online survey was developed by physicians with expertise in breastfeeding and e-mailed to physician and dentist members of Academy of Breastfeeding Medicine (ABM) between 11 November and 31 December 2019. It requested information from the respondents who cared for the mother/infant breastfeeding couple about their experiences personally caring for infants with complications or misdiagnoses related to referral for frenotomy or the performance of a frenotomy. Data were analyzed using chi square, Cramer's V correlation, and binomial logistic regression.
RESULTS
Of 211 eligible respondents, 129 (61%) had cared for an infant with a complication or misdiagnosis. Two hundred and nine (209) infants were reported to have a complication and 237 had a misdiagnosis. The most common misdiagnoses reported were 101 of 237 infants (43%) with neuromuscular dysfunction and 65 of 237 (27%) with inadequate breastfeeding support. The most common complications reported were a repeat procedure considered/requested/performed 65 of 203 (32%) and oral aversion 57 of 203 (28%). Parental report of infant pain was associated with performance of a posterior frenotomy (Chi Square p < .003). Bleeding was associated with using scissors/scalpel vs laser/bovie/electrosurgery (Chi Square p = .001). Oral aversion was associated with performance of frenotomy by laser/bovie/electrosurgery vs scissors/scalpel (adjusted Odds Ratio of 4.05; 95% CI 2.07, 7.93).
CONCLUSIONS
Complications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to provide skilled breastfeeding support and to evaluate for other confounding problems that might impact infant breastfeeding before referral for frenotomy. Randomized controlled trials of optimized lactation support vs. frenotomy and of scissors vs laser in performance of frenotomy are needed.
Topics: Ankyloglossia; Breast Feeding; Delivery of Health Care; Diagnostic Errors; Female; Humans; Infant; Lingual Frenum; Mothers; Nervous System Diseases; Oral Surgical Procedures; Parenting; Surveys and Questionnaires; Treatment Outcome
PubMed: 35597985
DOI: 10.1186/s13006-022-00481-w -
Danish Medical Journal Apr 2022A tightening of the lingual frenulum may cause breastfeeding difficulties. Surgical release of the restricted frenulum is accomplished by a frenotomy. Between 2015 and...
INTRODUCTION
A tightening of the lingual frenulum may cause breastfeeding difficulties. Surgical release of the restricted frenulum is accomplished by a frenotomy. Between 2015 and 2019, frenotomy procedures in Danish primary healthcare doubled. Causality has not previously been established. The primary aim of this study was to investigate infant/maternal symptom relief and parent satisfaction following frenotomy and discuss potential causes for the increasing frenotomy frequency in Danish infants.
METHODS
Between April 2019 and April 2020, 230 breastfed infants less-than 12 months had a frenotomy performed in three private ENT clinics. Parents of 163 infants participated in a phone interview.
RESULTS
A moderate to high degree of symptom relief was reported in 138 (85%) infants and 127 (78%) mothers. If more than one preoperative symptom was reported, post-operative infant/maternal symptom relief increased significantly, and maternal symptom alleviation occurred more quickly. Also, infant and maternal symptom relief increased significantly when "infant breastfeeding difficulty" or "maternal nibble/breast pain during breastfeeding" was reported preoperatively. Most parents (95%) would have a frenotomy performed on their child again under similar circumstances.
CONCLUSIONS
Most parents reported a moderate to high degree of infant and maternal symptom relief following frenotomy. Parent satisfaction was compelling. A uniform assessment tool may sharpen diagnostic criteria and eventually stabilise the frenotomy frequency in Danish infants.
FUNDING
none.
TRIAL REGISTRATION
not relevant.
Topics: Ankyloglossia; Breast Feeding; Denmark; Female; Humans; Infant; Lingual Frenum; Mothers; Parents; Personal Satisfaction
PubMed: 35485787
DOI: No ID Found -
Life (Basel, Switzerland) Apr 2022Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study... (Review)
Review
Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.
PubMed: 35455049
DOI: 10.3390/life12040558 -
Journal of Oral and Maxillofacial... Feb 2022Binder's syndrome, a rare congenital malformation of nasomaxillary complex, first described in 1962, has a hexad of characteristic clinical and radiographic features...
Binder's syndrome, a rare congenital malformation of nasomaxillary complex, first described in 1962, has a hexad of characteristic clinical and radiographic features consisting of arhinoid face, intermaxillary hypoplasia with malocclusion, abnormal position of nasal bones, atrophy of nasal mucosa, reduced or absent anterior nasal spine and hypoplastic/absent frontal sinus. The typical facies due to mid-face hypoplasia may also be accompanied by other midline malformations such as cleft palate, spinal, skeletal and cardiac abnormalities. It is usually sporadic, of unknown etiology although various environmental and genetic mechanisms are implicated due to few familial cases predominantly in the Swedish population. A case of inherited Binder's syndrome is presented in an Indian female patient with an unusual finding of ankyloglossia (AG). The development of the anterior nasal spine and AG are chronologically related as they both occur during the 5-6 weeks of gestation. The possible etiopathogenetic mechanisms for this rare association are reviewed.
PubMed: 35450230
DOI: 10.4103/jomfp.jomfp_143_21 -
Cureus Mar 2022The objective of this is to report a newer novel technique of harmonic scalpel frenotomy, a day care procedure under local infiltration anesthesia that could achieve...
The objective of this is to report a newer novel technique of harmonic scalpel frenotomy, a day care procedure under local infiltration anesthesia that could achieve quick bloodless adequate ankyloglossia release and excellent healing with subsequent improved articulation and speech. The procedure was performed, patient followed up for six months and excellent results noted. A 37-year-old male patient presented with type II ankyloglossia on Coryllos ankyloglossia grading scale and class III on Kotlow's assessment. A quick bloodless frenotomy with adequate release of ankyloglossia was achieved using harmonic scissors. Patient experienced no discomfort. Patient was observed for two hours and discharged the same day with chlorhexidine mouth gargles and analgesics. Postoperative healing was excellent with adequate tongue protrusion and improvement in articulation and speech. We report this newer novel technique of harmonic scissors frenotomy, a day care procedure under local infiltration anesthesia, that achieved quick bloodless adequate ankyloglossia release, excellent healing and evident improvement in articulation and speech.
PubMed: 35449686
DOI: 10.7759/cureus.23223 -
Cureus Mar 2022Ankyloglossia, commonly known as tongue-tie, is a developmental abnormality that may interfere in speech and articulation of lingual and sibilant sounds, due to the...
Ankyloglossia, commonly known as tongue-tie, is a developmental abnormality that may interfere in speech and articulation of lingual and sibilant sounds, due to the abnormal lingual frenal attachment. Lingual frenectomy severs the tie, however in adolescents and young adults, kinesthetic awareness, that is, the senses of position and movement of the tongue, needs to be increased. In such a scenario, tongue exercises lend a helping hand. Here, we discuss the benefits of this combined treatment modality in two cases diagnosed with ankyloglossia.
PubMed: 35449662
DOI: 10.7759/cureus.23274 -
Cureus Mar 2022We present the case of a newborn with 17q23.1q23.2 microdeletion and additional homozygosity of 11p11.2q13.4. In the literature, 17q23.1q23.2 microdeletion syndrome is a...
We present the case of a newborn with 17q23.1q23.2 microdeletion and additional homozygosity of 11p11.2q13.4. In the literature, 17q23.1q23.2 microdeletion syndrome is a novel syndrome reported in nine patients. Our patient is a full-term baby boy admitted to a neonatal intensive care unit for hypoglycemia, respiratory distress, presumed sepsis, and thrombocytopenia. General appearance revealed microcephaly, micrognathia, ankyloglossia, small mouth, and high arch palate. The patient also presented with hypotonia, poor feeding, and poor weight gain in the first week of life followed by hypertonia and tremors from the second week of life. The phenotypic and clinical presentation lead to the genetic investigation of microarray which revealed 17q23.1q23.2 microdeletion and additional homozygosity of 11p11.2q13.4.
PubMed: 35449653
DOI: 10.7759/cureus.23290 -
World Journal of Pediatrics : WJP Jun 2022Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates.
METHODS
We conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the "experimental group" and "control group". In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate's nose for two minutes prior to and during the frenotomy.
RESULTS
We enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups.
CONCLUSIONS
We observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies.
Topics: Analgesics; Ankyloglossia; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Lavandula; Lingual Frenum; Oils, Volatile; Pain
PubMed: 35377106
DOI: 10.1007/s12519-022-00531-7 -
Ear, Nose, & Throat Journal Mar 2022The relationship between ankyloglossia and speech is controversial. Our objective in the present study was to determine the most appropriate intervention and optimal...
PURPOSE
The relationship between ankyloglossia and speech is controversial. Our objective in the present study was to determine the most appropriate intervention and optimal timing for infants with speech articulation caused by ankyloglossia.
PATIENTS AND METHODS
A total of 341 pediatric patients (aged 2 to 5 years) being referred for speech concerns due to ankyloglossia were enrolled in a randomized trial and assigned to either a surgical intervention (N = 166) or a no surgical intervention (N = 175) group. Subsequently, patients were further categorized into 3 groups according to age: 2 to < 3 years, 3 to < 4 years, and 4 to < 5 years. Measures of tongue appearance, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected at preintervention (T0), 2-month postintervention (T1), 6-month postintervention (T2), and 12-month postintervention (T3).
RESULTS
No statistically significant difference was found between surgical intervention and no surgical intervention groups for tongue appearance, tongue mobility, speech production, and intelligibility in the 2 to < 3 years age. However, there was significantly improved speech production and intelligibility in the surgical intervention group when compared to the no surgical intervention group in the 3 to < 4 and 4 to < 5 years old age.
CONCLUSION
Surgical intervention should not be performed too early for infants aged 2 to < 3 years with speech articulation caused by ankyloglossia, but rather watch and wait for the physiological growth of the lingual frenulum. The optimal timing range for surgical intervention is 4 to 5 years. This should provide certain significant guidance for infants with speech articulation caused by ankyloglossia.
PubMed: 35324342
DOI: 10.1177/01455613221087946 -
CMAJ : Canadian Medical Association... Feb 2022Recent data suggest an increased risk of congenital anomalies with prenatal exposure to opioid analgesics. We sought to further quantify the risk of anomalies after...
BACKGROUND
Recent data suggest an increased risk of congenital anomalies with prenatal exposure to opioid analgesics. We sought to further quantify the risk of anomalies after opioid analgesic exposure during the first trimester in a population-based cohort study.
METHODS
Using administrative health data from Ontario, we followed 599 579 gestational parent-infant pairs from singleton pregnancies without opioid use disorder. We identified opioid analgesics dispensed in the first trimester and congenital anomalies diagnosed during the first year of life. We estimated propensity score-adjusted risk ratios (RRs) between first trimester exposure (any opioid analgesic and specific agents) and congenital anomalies (any anomaly, organ system anomalies, major or minor anomalies and specific anomalies).
RESULTS
The prevalence of congenital anomalies was 2.8% in exposed infants and 2.0% in unexposed infants. Relative to unexposed infants, we observed elevated risks among those who were exposed for some anomaly groups, including gastrointestinal anomalies (any opioid analgesic: adjusted RR 1.46, 95% confidence interval [CI] 1.15-1.85; codeine: adjusted RR 1.53, 95% CI 1.12-2.09; tramadol: adjusted RR 2.69, 95% CI 1.34-5.38) and several specific anomalies, including ankyloglossia (any opioid: adjusted RR 1.88, 95% CI 1.30-2.72; codeine: adjusted RR 2.14, 95% CI 1.35-3.40). These findings persisted in sensitivity analyses.
INTERPRETATION
Although the absolute risk of congenital anomalies was low, our findings add to accumulating data that suggest a small increased risk of some organ system anomalies and specific anomalies with first trimester exposure to opioid analgesics. These findings further quantify the potential risks associated with prenatal exposure to opioid analgesics to inform treatment choices for pain in pregnancy.
Topics: Abnormalities, Drug-Induced; Analgesics, Opioid; Cohort Studies; Databases, Factual; Female; Humans; Infant; Infant, Newborn; Insurance Claim Review; Male; Ontario; Practice Patterns, Physicians'; Pregnancy; Pregnancy Trimester, First; Prenatal Care; Prenatal Exposure Delayed Effects; Prevalence; Propensity Score
PubMed: 35131753
DOI: 10.1503/cmaj.211215