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.
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
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
Editor's Notes
We are going to show THE VIEWS OF THE MOTHERS AND THE EVIDENCE ON THEIR
BREASTFEEDING HABITS AFTER THE PROCEDURE
- Therefore this study was conducted to evaluate the effect of Frenotomy on breastfeeding, the view of the mothers and the evidence on their breastfeeding habits after the procedure.
1 minor complication
digital pressure with adrenaline 1:80.000 on a gauze
Stopped after 5-10 minutes
- Has a critical role in guiding parents towards breastfeeding methods which are comfier and healthier for both mom and baby
- Assess the baby’s latching and positioning to make sure they are feeding properly and meeting demands
- Identify issues on breastfeeding
- Assigns preliminary intra-oral exercises to help the baby adapt to the change after tongue tie release
- Monitoring after release for adjustments to compensate for the issues the procedure has caused – both mom and bay need to re-learn feeding from the beginning
- When a proper position and latch has been achieved, feeding should be painless for both mother and baby
Follow–up in OPC for at least for 6-9 months after the procedure
Our percentage of EBF in our study was 31%
Reasons why??
This study supports the hypothesis that Frenulotomy has a positive effect on breastfeeding in infants with ankyloglossia
Among infants with tongue tie who received Frenulotomy 31% continued to be exclusively breastfed for six months and the percentage became 65% after .
Mothers were very satisfied with the quick simple solution to the breastfeeding issues
Mothers, occasionally grandparents, were happy to participate in the procedure
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