Low strength of evidence for ankyloglossia treatment outcomes

1. Some evidence suggests maternally reported improvement and decreased pain with breastfeeding after frenotomy for ankyloglossia.

2. However, only a small body of evidence currently exists for ankyloglossia treatment and that evidence varies in consistency and methodology, suggesting the need for further literature in order to establish a recommendation for frenotomy.

Evidence Rating Level: 3 (Average)  

Study Rundown: Ankyloglossia is described as a congenital condition in newborns where the lingual frenulum is tight, thickened, or short leading to restrictive tongue movement especially in the context of breastfeeding. It additionally may have further orthodontic limitations. While ankyloglossia treatment – usually surgical frenotomy – is often considered to help with breastfeeding difficulties, there are only small studies to support the evidence behind this practice. This systematic review compiled studies on ankyloglossia surgical treatment, and analyzed its effectiveness on breastfeeding outcomes. Some increase in maternal satisfaction with breastfeeding and minimal decreases in pain with breastfeeding were found. However, this review was significantly limited by its paucity of included trials, inconsistent definitions and methodology, and no data analyzing long-term outcomes. Given some potential benefits alongside concerns with current literature, this review suggests addressing these limitations and other research gaps including natural progression of ankyloglossia without treatment prior to continued recommendation of frenotomy as standard of care.

Click to read the study published today in Pediatrics

Relevant Reading: Ankyloglossia: controversies in management

In-Depth [systematic review]: This systematic review included 29 studies analyzing breastfeeding outcomes with relation to ankyloglossia; studies were compiled using Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase. The included studies were divided into 23 case series reports, 5 randomized control trials (rated as 3 good, 1 fair, 1 poor), and 1 retrospective cohort (rated as poor). No set definition was used for ankyloglossia, and heterogenous methodology existed amongst trials. Randomized control trials compared frenotomy to sham surgery, usual care, or close lactation support. In non-blinded trials, mothers reported improvement in breastfeeding after frenotomy (96% treatment vs 3% controls, 78% treatment vs 47% controls). When a blinded observer was used to evaluate breastfeeding effectiveness, 1 of 3 trials reported improvement with frenotomy compared to sham surgery.

Image: PD

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