Dear Colleagues,

I think that most of you treat many cases of tie tongue. I would like to know what is the criteria you consider for cutting the frenulum, and who does it?

Thank you for your response

Dr. Barak

Hi!

Cutting the frenulum feels, to me, as one of the least evidence-based treatment in neonatology. (also saying that we do a lot of non-evidence based things everyday!)

We do this very infrequently, but sometimes, if the midwifes feels sure about that feeding could be associated with a tight frenulum.

Our ENT people would suggest themselves to do it, since a bad cut can heal with even further tightness. But we do ourselves too sometimes, with a pair of scissors, max 2 cuts, to the tounge muscle.

we do encounter tongue tie regularly but all we do is leave it alone till it causes any speech problems (usually it does not) we leave it to the ENT surgeons for further action

I have never encountered a feeding problem due to tongue tie. We do not cut it ,and leave it as such. Only when there is speech problem later in infancy mostly on insistence of parents ,a cut is given by a surgeon ,which is very infrequent in my practice . If the tonuge can protude upto or beyond lips , there is no cause for conern for speech problem too.

Dear colleagues,

I have read your interesting discussion re tongue tie (ankyloglossia). In our group we used to be rather sceptical about cutting the frenulum. However, some time ago we reviewed the literature again because the issue is often raised by midwives and baby nurses. Following this review, we felt obliged to modify our previous stance. Indeed, there appears to be reasonable evidence suggesting that a very short frenulum may be associated with lactation difficulties. Thus, maternal reports of very sore nipples or frank pain on lactation, combined with evidence of insufficient food intake by the baby, appear to be associated with ankyloglossia. In some such instances, cutting the frenulum appears to resolve or, at least, significantly improve the situation. Currently we will consider cutting the frenulum if the above mentioned signs/symptoms occur in the presence of a frenulum which appears sufficiently short to impede the movement of the tip of the tongue. Some interesting references are listed below.

Thor Willy Ruud Hansen, MD, PhD

Professor

Neonatal Intensive Care Unit

Division of Paediatrics

Rikshospitalet University Hospital

and Faculty of Medicine

University of Oslo

Oslo, Norway

References:

Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Hlth 2005;41:245-50

Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenulotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg 2006;41:1598-600

Srinivasan A, Dobrich C, Mitnick H, Feldman P. Ankyloglossia in breastfeeding infants: the effect of frenulotomy on maternal nippole pain and latch. Breastfeeding Medicine 2006;1:216-24

Hall DMB, Renfrew MJ Tongue tie. Common problem or old wives' tale? Arch Dis Child 2005;90:1211-5