Shekher Rohil, Lin Lawrence, Zhang Rosaline, Hoppe Ian C, Taylor Jesse A, Bartlett Scott P, Swanson Jordan W
Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2021 Jan 25;9(1):e3336. doi: 10.1097/GOX.0000000000003336. eCollection 2021 Jan.
Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear.
A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway.
Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy ( < 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48, < 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire, < 0.00001); however, Breastfeeding Self-Efficacy-Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division.
Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.
舌系带过短，即舌粘连，其特征为舌系带短或增厚；这可能与母乳喂养、言语及牙颌面生长受损有关。进行舌系带切开术、舌系带成形术或其他手术干预的指征尚不清楚。
进行一项荟萃分析，以确定在随机对照试验中，舌系带切开术在母乳喂养措施、舌系带过短程度及喂养期间母亲疼痛方面的获益程度。一项结构化文献综述分析了修复的最佳类型和时机。开发了一种算法，将这些证据纳入管理路径。
在审查的424项研究中，5项随机对照试验符合荟萃分析的纳入标准。舌系带切开术显著改善了舌系带过短的程度，与未接受舌系带切开术者（下降0分）相比，使用舌系带功能的Hazelbaker评估工具评分下降了4.5分（P<0.00001）。这与自我报告的母乳喂养改善（相对危险度[RR]=3.48，P<0.00001）及疼痛减轻（简短麦吉尔疼痛问卷，P<0.00001）相关；然而，母乳喂养自我效能量表简表及含接、吞咽声音、乳头类型、舒适度、抱姿评分并未显著改善。多项研究表明，与舌系带切开术相比，舌系带成形术后有显著改善，但关于舌系带切开时机的影响结果不一。
舌系带切开术与母乳喂养的改善相关，个体改善情况各异，但在婴儿发育的关键时期总体呈显著趋势。对于舌系带功能的Hazelbaker评估工具评分严重或母乳喂养困难的患者，我们得出结论，婴儿期一般建议行无麻醉的简单舌系带切开术，大龄儿童则建议在全身麻醉下行舌系带成形术。
