Modest benefit of frenotomy for infants with ankyloglossia and breastfeeding difficulties

With nationwide effort to increase breastfeeding rates in newborns and infants in recent years, there has been a dramatic increase in the diagnosis of ankyloglossia, and the resultant otolaryngology referral for frenotomy. Overall, there is a paucity of data on the expected benefit of frenotomy in this population and the subsequent breastfeeding rate. The objectives of this study were to assess the effect of office-based frenotomy on improving breastfeeding difficulties among infants with ankyloglossia from a patient-centered perspective and examine associated effects of frenotomy and ankyloglossia type on breastfeeding.

Maternal-infant dyads were referred to a tertiary care otolaryngology practice for assessment of ankyloglossia. A prospective cohort study was conducted in this population from January 2017 to September 2018. Mothers completed questionnaires regarding the quality of breastfeeding before the frenotomy procedure in the office and were subsequently contacted by phone to complete the same questionnaires 1 week and 3 months after the initial encounter. Treating physicians reported ankyloglossia type and expected improvement at the time of the procedure. Descriptive statistics and paired analyses were used to analyze post-frenotomy breastfeeding outcomes and ascertain likelihood of improvement.

During the study period, the mothers of 343 infants agreed to participate in the study by completing the initial questionnaire. Of these infants, 314 (91.5%) underwent frenotomy. Most infants were classified as having either type I (35.3%) or type II (45.2%) ankyloglossia with 16.9% having posterior ankyloglossia and 2.6% with no ankyloglossia. At 1-week post-frenotomy the largest group of patients (35%) had mild improvement in breastfeeding abilities compared to baseline with 14% and 7% reporting moderate or marked improvement respectively. At 3 months after the initial consultation, significantly more patients reported moderate (27%) or marked (17%) improvement when compared to baseline although the exclusively breastfeeding rate at 3 months was low at 20.3% for this cohort.

This prospective study demonstrated that frenotomy had a modestly positive effect on breastfeeding ability from the mother's perspective in infants referred for ankyloglossia. It is important to educate patients on the multi-factorial nature of breastfeeding and to set realistic expectations prior to recommending the procedure.