- Treatments for Ankyloglossia and Ankyloglossia with Concomitant Lip-tie
- Objectives. We systematically the reviewed the literature on surgical and nonsurgical treatments for infants and children with ankyloglossia and ankyloglossia and concomitant lip-tie.
Data Sources. We searched MEDLINE (PubMed), PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL®) and EMBASE (Excerpta Medica Database) as well as the reference lists of included studies and recent systematic reviews. We conducted the searches between September 2013 and May 2014.
Review Methods. We included studies of interventions for ankyloglossia published in English. Two investigators independently screened studies against predetermined inclusion criteria and independently rated the quality of included studies. We extracted data into evidence tables and summarized them qualitatively.
Results. We included 52 unique studies comprising six RCTs (three good, one fair, two poor quality), three cohort studies (all poor quality), 28 case series, 14 case reports, and one unpublished thesis. Most studies assessed the effects of frenotomy on breastfeeding-related outcomes. Four RCTs reported improvements in breastfeeding efficacy using either maternally reported or observer ratings, while two RCTs found no improvement with observer ratings. Although mothers consistently reported improved breastfeeding effectiveness after frenotomy, outcome measures were heterogeneous and short term. Future studies could provide additional data to confirm or change the measure of effectiveness; thus we consider the strength of the evidence (SOE; confidence in the estimate of effect) to be low at this time. Pain outcomes improved for mothers of frenotomized infants compared with control in one study of 6-day old infants but not in studies of infants a few weeks older. Given these inconsistencies and the small number of comparative studies and participants, the SOE is low for an immediate reduction in nipple pain. Three studies with significant limitations reported improvements in other feeding outcomes with frenotomy, and three poor quality studies reported some improvements in articulation but mixed results related to fluent speech. Three poor quality comparative studies noted some improvements in social concerns and gains in tongue mobility in treated participants. SOE for all of these outcomes is insufficient. SOE is moderate for minor and short-term bleeding following surgery and insufficient for other harms (reoperation, pain).
Conclusions. A small body of evidence suggests that frenotomy may be associated with improvements in breastfeeding as reported by mothers, and potentially in nipple pain, but with small, short-term studies, inconsistently conducted, SOE is generally low to insufficient. Research is lacking on nonsurgical interventions as well as on outcomes other than breastfeeding.
- Authors of Report
- Methodology description
- Funding Source
- Agency for Healthcare Research and Quality Contract No. 290-2012-00009-I