Dinh Lisa A, El-Rabbany Mohamed, Aslam Sadaf, Ricalde Pat
Private practice, Lakeland, FL.
Assistant Clinical Professor, Division of Oral and Maxillofacial Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
J Oral Maxillofac Surg. 2025 Jul;83(7):806-812. doi: 10.1016/j.joms.2025.04.006. Epub 2025 Apr 16.
The management of ankyloglossia and its impact on breastfeeding remains a controversial issue with limited scientific evidence, particularly regarding the utility of frenotomies.
The study purpose was to determine the effects of lingual frenotomy on improving breastfeeding effectiveness and pain in newborns with ankyloglossia.
STUDY DESIGN, SETTING, AND SAMPLE: We conducted a double-blind randomized controlled trial at Tampa General Hospital from April 2015 to October 2017. Eligible mother-newborn couplets with breastfeeding difficulties and ankyloglossia were randomized to frenotomy or sham procedure. Exclusion criteria included prematurity, older than 2 weeks, craniofacial anomalies, neurological compromise, or maternal conditions affecting milk supply.
The predictor variable was lingual frenum management, and newborns were randomly assigned in a 1:1 allocation to frenotomy or sham procedure.
The outcome variables were the changes in LATCH scores (a breastfeeding assessment tool) and maternal pain scores (using the Wong-Baker Pain Scale), assessed by a blinded lactation consultant before and immediately after the intervention.
The covariates were newborn age, gestational age, sex, race, severity of ankyloglossia, as well as maternal comorbidities.
Descriptive and multivariate linear regression analyses were conducted, with significance set at P < .05.
A total of 112 couplets were enrolled (55 [49%] frenotomy, 57 [1%] sham). No significant differences were observed in LATCH or pain scores between groups (LATCH: 0.02; 95% CI, 0.64 to 0.69; P = .9; and pain: 0.32; 95% CI, 0.56 to 1.19; P = .5). Similarly, the results of the multivariate linear regression analyses showed no significant differences between the 2 groups for improvements in both LATCH and pain scores (-0.11; 95% CI, -0.89 to 0.68; P = .8 and .38; 95% CI, -1.20 to 1.96; P = .6, respectively).
The study findings did not demonstrate significant differences between lingual frenotomy and sham procedures on immediate improvements in pain or LATCH scores. Therefore, this study does not support the recommendation of a lingual frenotomy to improve breastfeeding difficulties in the immediate newborn setting.
舌系带过短的处理及其对母乳喂养的影响仍是一个存在争议的问题，科学证据有限，尤其是关于舌系带切开术的效用。
本研究的目的是确定舌系带切开术对改善舌系带过短新生儿母乳喂养效果和疼痛的影响。
研究设计、地点和样本：我们于2015年4月至2017年10月在坦帕综合医院进行了一项双盲随机对照试验。有母乳喂养困难且舌系带过短的合格母婴对被随机分配接受舌系带切开术或假手术。排除标准包括早产、年龄超过2周、颅面畸形、神经功能损害或影响乳汁供应的母体状况。
预测变量是舌系带处理，新生儿以1:1的比例随机分配接受舌系带切开术或假手术。
结果变量是干预前和干预后立即由一名盲法泌乳顾问评估的LATCH评分（一种母乳喂养评估工具）和母体疼痛评分（使用面部表情疼痛量表）的变化。
协变量包括新生儿年龄、胎龄、性别、种族、舌系带过短的严重程度以及母体合并症。
进行描述性和多变量线性回归分析，显著性设定为P < .05。
共纳入112对母婴（55对[49%]接受舌系带切开术，57对[51%]接受假手术）。两组之间在LATCH评分或疼痛评分上未观察到显著差异（LATCH评分：0.02；95%CI，-0.64至0.69；P = .9；疼痛评分：0.32；95%CI，-0.56至1.19；P = .5）。同样，多变量线性回归分析结果显示，两组在LATCH评分和疼痛评分改善方面无显著差异（-0.11；95%CI，-0.89至0.68；P = .8；以及.38；95%CI，-1.20至1.96；P = .6）。
研究结果未显示舌系带切开术与假手术在即刻改善疼痛或LATCH评分方面存在显著差异。因此，本研究不支持在新生儿期推荐舌系带切开术来改善母乳喂养困难。
