Journal Article (Refereed)
The effectiveness of frenulotomy on infant-feeding outcomes: a systematic review
Finigan, V & Long, T 2013, 'The effectiveness of frenulotomy on infant-feeding outcomes: a systematic review', Evidence Based Midwifery, 11(2), pp.40-45.
Background.Tongue-tie is a congenital anomaly in which the short lingual frenulum or highly attached genioglossus muscle restricts tongue movement. NICE (2005) called for robust clinical trials to be conducted on frenulotomy, the surgical procedure in which the lingual frenulum of infants is separated. The available evidence showed that the procedure posed very little, if any, risk for infants, yet NICE also noted that there was little evidence to underpin the conclusions being drawn by experts that frenulotomy improved infant-feeding.
Aim. To assess the effectiveness of frenulotomy on breastfeeding outcomes and maternal satisfaction with infant-feeding.
Method.The search was undertaken through Cochrane Library, Medline, CINAHL and UpToDate. Inclusion and exclusion criteria were set, and the search was restricted to evidence following the release of the 2005 NICE review. MESH search terms were applied: tongue-tie, ankyloglossia, frenotomy, frenulotomy, and breastfeeding. Two independent reviewers appraised all items, referring to the Cochrane Risk of Bias methodology. The Cochrane Library Critical Appraisal Skills Programme (CASP) tools and guidelines were used.
Results.A total of 53 papers were identified, of which 16 met the criteria: nine case studies, five randomised controlled trials, one prospective inter-rater reliability study and one systematic literature review. Frenulotomy appears to offer long-term breastfeeding benefits for more than 50% of cases. No evidence was available relating to the impact of tongue-tie on bottle-feeding infants.
Implications.Development of a robust, objective manual to assess the degree of tongue-tie and impact on feeding is vital. Research is needed to establish the impact on early parent-infant relationships of feeding a tongue-tied infant.
Evidence Based Midwifery