Frenotomy for Ankyloglossia Associated With Feeding Challenges in Infants: Effectiveness, Technique, and Safety-A...

Purpose: To assess the effectiveness, surgical techniques, and safety outcomes of lingual frenum release in infants with feeding difficulties. Methods: The protocol was registered with PROSPERO (CRD42024482618). Ovid MEDLINE, CINAHL, Embase, and Cochrane Library databases were searched from 1946 to May 2025 for studies meeting inclusion criteria. The population included mother-infant dyads with feeding difficulties where infants with restrictive frenum underwent surgical release. The primary outcome measured included feeding difficulties, technique comparison, post-care, and adverse events. Fourteen reviewers screened studies, performed data extraction, and assessed risk of bias (ROB). A Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach determined the quality of evidence. Results: Forty-seven studies qualified for analysis, including 8 randomized controlled trials and 39 observational studies. Maternal nipple pain reduction showed large standardized mean differences sustained from immediate through long-term follow-up. Maternal perception of breastfeeding showed improvement over time. Latch, audible swallowing, type of nipple, comfort, and hold (LATCH) scores showed large improvements in single-arm studies but minimal differences compared to controls in randomized clinical trials. Scissors and lasers appeared comparably effective based on limited evidence. The pooled adverse event frequency was 4%, with bleeding being most common. Conclusion: Very low certainty evidence supports frenotomy for documented functional impairment in carefully selected cases where conservative management has failed, emphasizing multidisciplinary evaluation and individualized decision-making with comprehensive informed consent.