Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study

Laryngoscope. 2017 May;127(5):1217-1223. doi: 10.1002/lary.26306. Epub 2016 Sep 19.


Objectives/hypothesis: Numerous symptoms may arise that prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue-tie/lip-tie release on breastfeeding impairment.

Study design: Prospective, cohort study from June 2014 to April 2015 in a private practice setting.

Methods: Study participants consisted of breastfeeding mother-infant (0-12 weeks of age) dyads with untreated ankyloglossia and/or tethered maxillary labial frenula who completed preoperative, 1 week, and 1 month postoperative surveys consisting of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), visual analog scale (VAS) for nipple pain severity, and the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). Breastmilk intake was measured preoperatively and 1 week postoperatively.

Results: A total of 237 dyads were enrolled after self-electing laser lingual frenotomy and/or maxillary labial frenectomy. Isolated posterior tongue-tie was identified in 78% of infants. Significant postoperative improvements were reported between mean preoperative scores compared to 1 week and 1 month scores of the BSES-SF (F(2) = 212.3; P < .001), the I-GERQ-R (F(2) = 85.3; P < .001), and VAS pain scale (F(2) = 259.8; P < .001). Average breastmilk intake improved 155% from 3.0 (2.9) to 4.9 (4.5) mL/min (P < .001).

Conclusions: Surgical release of tongue-tie/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.

Level of evidence: 2c Laryngoscope, 127:1217-1223, 2017.

Trial registration: NCT02642133.

Keywords: Breastfeeding; ankyloglossia; gastroesophageal reflux; outcome assessment (healthcare); patient outcome assessment; visual analog scale.

MeSH terms

  • Ankyloglossia / surgery*
  • Breast Feeding*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Lingual Frenum / surgery
  • Lip Diseases / surgery*
  • Pain Measurement
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome

Associated data