The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding

Int J Pediatr Otorhinolaryngol. 2013 May;77(5):827-32. doi: 10.1016/j.ijporl.2013.02.022. Epub 2013 Mar 22.


Objectives: The objectives of this study were to assess the effect of office-based frenotomy on reversing breastfeeding difficulties among infants with problematic ankyloglossia, and to examine characteristics associated with anterior and posterior ankyloglossia.

Methods: Mother's of infants who underwent a frenotomy for ankyloglossia from December 2006 through March 2011 completed a post-intervention web-based survey about breastfeeding difficulties they experienced before and after the frenotomy. Maternal-infant dyads had been referred from health providers to a primary care practice for assessment of ankyloglossia. Infants were subsequently classified as having no ankyloglossia, anterior (Type I or Type II) or posterior (Type III or Type IV).

Results: There were 311 infants evaluated for ankyloglossia and 299 (95%) underwent a frenotomy. Most infants were classified as having Type III (36%) or IV (49%) ankyloglossia compared to only 16% with anterior (Type I and Type II combined). Differences by classification type were found for gender (P=.016), age (P=.017), and maxillary tie (P=.005). Among survey respondents (n=157), infant latching significantly improved (P<.001) from pre- to post-intervention for infants with posterior ankyloglossia. Both the presence and severity of nipple pain decreased from pre- to post-intervention among all classifications (P<.001). Additionally, 92% of respondents breastfed exclusively post-intervention. The mean breastfeeding duration of 14 months did not differ significantly by classification.

Conclusions: Breastfeeding difficulties associated with ankyloglossia in infants, particularly posterior, can be improved with a simple office-based procedure in most cases. The diagnosis and treatment of ankyloglossia should be a basic competency for all primary care providers and pediatric otorhinolaryngologists.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ankyloglossia
  • Breast Feeding*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Lingual Frenum / abnormalities*
  • Male
  • Mothers
  • Mouth Abnormalities / complications
  • Mouth Abnormalities / surgery*
  • Surveys and Questionnaires
  • Tongue / abnormalities*
  • Treatment Outcome