This study evaluated the outcomes of frenulotomy in 100 mothers struggling to breastfeed. The procedure involves retracting the tongue and cutting the frenulum. 31% were exclusively breastfeeding after the procedure, and 65% continued breastfeeding for 9-12 months. Mothers reported high satisfaction with the procedure and would recommend it. The study suggests frenulotomy can have a positive impact on breastfeeding outcomes.

1. Is Frenulotomy A Worthwhile Procedure?
Presented by:
Dr. Mai Elhassan
Subtitle goes here

2. Sidra Medicine
Women and Children’s Hospital, Doha, Qatar

3. I have NO financial disclosure or conflicts of interest with the presented
material in this presentation.
Disclosure

4.  Background
 Purpose of the study
 Material and Methods
 Procedure
 Data analysis
 Discussion
 Conclusion
 References
Outlines

5.  The WHO has issued guidelines recommending exclusive breastfeeding for at least 6
months for all infants.
 Frenulotomy may help improve breastfeeding, but evidence on long term effects on
breastfeeding is lacking (Panuwat,2022) [1].
Background

6.  To evaluate the outcome of performing release of tongue tie in mothers
struggling to breastfeed.
 To evaluate the procedure’s long-term effects on continued
breastfeeding.
Purpose of the Study

7.  Retrospective study
 Referrals since 2017
 Over 2000 referrals
 100 patients with breastfeeding issue
were randomly selected.
- 16% referrals from Lactation
consultant
- 84% general referrals
 Below 12 months in clinic
 Above 12 months in the OR under GA
 11 questions questionnaire.
 Descriptive statistical analysis to report the
frequency and percentage.
Material and Methods

8. Procedure
 Verbal consent obtained before the procedure.
 The procedure involves retracting the tongue backwards
with tongue elevator.
 A cut is made in the midline with a sharp blunt ended
scissors.
 Anesthesia is not necessary.
 The only risk is excessive bleeding, however, normally there
is only minimal bleeding

9. Procedure

10. V/S

11. Data analysis as per questionnaire

12. Breast
31%
Bottle
14%
Both
55%
Q2 Patient was exclusively breastfeeding,
bottle-feeding or both ?

13. Q3 Was the patient referred from
lactation consultant or others ?
Lactation
16%
Others
84%
 WWRC
 Sidra Postnatal
 PHCC
 Family their self
 PEC
NO YES
84%
16%
Q6 Did baby receive post procedure
exercises/massages from lactation consultant ?

14. Q4 What was the age of the baby when the tongue tie
was released ?
0%
10%
20%
30%
40%
50%
0-3 month 4-6 month 7-9 month 9-12 month more than 1
year
45%
30%
14%
8%
3%

15. Q9 What’s the mother opinion on the procedure ?
64%
29%
7%
Very worthwhile
Worthwhile
Helpful
Not very helpful
Not at all helpful

16. Q10 Was the family happy and comfortable to be
present during the procedure in clinic ?
0%
20%
40%
60%
80%
100%
Yes No
100%
0%
0%
20%
40%
60%
80%
100%
Yes No
100%
0%
Q11 Would the family recommend the
procedure to other breastfeeding mothers
that are struggling ?

17. - 31% of the babies were on
exclusively breastfeeding
- 65% of our mothers continued to
breastfeed for 9-12months
Mother Satisfaction

18.  WHO guidelines supporting breastfeeding in infants: 50% of all infants receive
EBF for at least the first six months [2]
 Prevalence of infants receiving EBF for the first six months is currently only
38% worldwide [3], only 12%–15% in a study conducted in Thailand [4,5].
 There has been much debate on the long-term benefits of frenulotomy on
breastfeeding outcomes [6].
Discussion

19.  In our study 54% of the patients found to have problems breastfeeding
 All of them underwent release of tongue tie either in clinic /OR using same
technique
 We found 65% continue breastfeeding for at least 6-9 months
 Furthermore mother satisfaction was 100% and all of them would recommend
the procedure to other mothers struggling to breastfeed
Discussion

20.  Positive effect on breastfeeding
 EBF 31% 65%
 Quick, simple solution to breastfeeding issues
 Referrals from a lactation consultant were more likely to have a true tongue tie
issue, and being seen post procedure were more likely to have a longer period of
breastfeeding and satisfaction from their breastfeeding experience
 Limitation of this study, was based on a relatively small number of participants,
therefore, larger studies are required to substantiate these findings
CONCLUSION

21. [1] Panuwat Wongwattana (2022). The effect of frenotomy on long-term breastfeeding in infants with ankyloglossia. International Journal of
Pediatric Otorhinolaryngology,152.
[2] World Health Organization, Global Strategy for Infant and Young Child Feeding: the Optimal Duration of xclusive Breastfeeding,
WHO, Geneva, 2001.
[3] World Health Organization, World Health Statistics 2013, World Health Organisation, Geneva, 2013.
https://apps.who.int/iris/bitstream/handle/10665/ 82058/WHO_HIS_?sequence=1/. (Accessed 16 May 2021).
[4] T. Thepha, D. Marais, J. Bell, S. Muangpin, Perceptions of northeast Thai breastfeeding mothers regarding facilitators and
barriers to six-month exclusive breastfeeding: focus group discussions, Int. Breastfeed. J. 13 (1) (2018) 1–10,
https://doi.org/10.1186/s13006-018-0148-y.
[5] World Health Organization, World Health statistics 2014. Geneva: World Health organisation.
http://www.who.int/gho/publications/world_health_statistics/ 2014/en/, 2014. (Accessed 16 May 2021).
[6] N. Sethi, D. Smith, S. Kortequee, V.M. Ward, S. Clarke, Benefits of frenulotomy in infants with ankyloglossia, Int. J. Pediatr.
Otorhinolaryngol. 77 (5) (2013) 762–765, https://doi.org/10.1016/j.ijporl.2013.02.005.
[7] J.E. O’Shea, J.P. Foster, C.P. O’Donnell, D. Breathnach, S.E. Jacobs, D.A. Todd, P. G. Davi, Frenotomy for tongue-tie in
newborn infants, Cochrane Database Syst. Rev. 3 (2017), https://doi.org/10.1002/14651858.CD011065.pub2
[8] A.N. Webb, W. Hao, P. Hong, The effect of tongue-tie division on breastfeeding and speech articulation: a systematic
review, Int. J. Pediatric. Otorhinolaryngology. 77 (5) (2013) 635–646, https://doi.org/10.1016/j.ijporl.2013.03.008.
References

22.  Senior Consultants: Dr. Patrick Sheehan, Dr. Faisal Abdulkader
 ENT Specialists: Dr Mai Elhasen, Dr. Debora Garcia
 Clinical Nurse Leader: Raydan Sanjad
 Clinical nurses: Sharon Fitzpatrick, Keen Garfil, Philisiwe Gwegwe
Team members