Thorleif Henning Monsen, 2016

 

Background: Breastfeeding is the superior method of infant feeding; clinicians have the important role of supporting measures that promote breastfeeding. Breastfeeding promotes the infant health benefits of ideal nutritional content, better absorption, fewer food-related allergies, improved psychological development, and better immunological defences, as well as substantial economic advantages for the family and society. Ankyloglossia has been identified as a barrier to breastfeeding. Surgical correction of ankyloglossia with frenectomy (also referred to as frenomy, frenotomy, frenulotomy, or simple release) is rapid and low risk, yet experts have not reached a consensus regarding indications for the procedure.

 

Objective: In this study, data from the frenectomy service at Poole Hospital for the past decade was examined to elucidate the profile of infants receiving frenectomy, complications during the procedure, and immediate outcomes reported by mothers. The findings were used to evaluate current clinical evidence regarding the indications for frenectomy in new-borns and infants with ankyloglossia with the aim of further informing this type of practice.

 

Setting: A health services evaluation based on a retrospective quantitative review of medical records using data from the frenectomy service at Poole Hospital for the past decade.

 

Subjects: Infants presenting at the frenectomy service at Poole Hospital since 2005.

 

Method: A health service evaluation reporting form was designed and used to gather data from existing patient records. The collected data were analysed using Excel and SPSS.

 

Results: In total, 1038 forms were randomly selected from over 6000 total, with 952 forms used in the final analysis. 86 forms in total were excluded, 59 (5.8%) forms for the reason “Did not arrive”, and 27 (2.6%) forms due to illegibility. Most patients (69.3%, n=660) were in the 0–3 weeks age group, while 278 (9.2 %) were in the age group 4-6 weeks, and 14 (1.5%) patients were in the age group 7–12 weeks. 570 (59.9%) were male and 382 (40.1 %) female. The mean number of problems for each subject was 3.16, with “problems latching” (69%, n=655) and “sore nipples” (59%, n=557) being the most common reasons for seeking help. The problems of “weight loss” and “colic” were experienced by 166 (17%) and 439 (46%) of subjects, respectively. 108 (1%) of the subjects sought medical attention without stating any symptoms. 709 (74.5%) of the patients had frenectomy performed with 673 (94.9%) of the mothers reporting improvements after the procedure. Out of the 709 (74.5%) who had the procedure, 480 (67.7%) reported minimal blood loss with just a few drops. Another 88 (12.4%) reported no blood loss at all after the procedure while 141 (19.9 %) reported that pressure needed to be applied to the patient to stop the bleeding.

 

Conclusion: The results of the study add the growing evidence base that frenectomy performed by a trained clinician is a safe procedure resulting in high rates of immediate maternal parent-reported improvement. Nevertheless, additional study is needed to further elucidate the significance of this condition as it pertains to breastfeeding, and to clarify the appropriateness and proper timing of the corrective procedure.