Infant lingual frenulotomy, the frenulum must be preserved

It is estimated that around 10% of babies are born with a frenulum of the tongue too short or thick, which can sometimes make it difficult to continue breastfeeding. For several months, various experts and scholarly societies have been concerned about an increase in lingual phrenomia in several Western countries. An intervention that should remain exceptional. Explanations.

Tongue brake and lingual frenotomy

After birth, some babies have a very narrow and too short frenum of the tongue. In some situations, this anatomical feature may require a minor surgical procedure, called a lingual frenotomy. Lingual frenotomy consists of cutting the frenulum of the tongue and is performed primarily in infants or young children. The goal of this intervention is to reduce the short, medium or long-term consequences of an abnormal tongue binding:

  • Eating disorders (including difficulty in breastfeeding;
  • Sleep disorders;
  • Digestive disorders;
  • In older children, speech disorders or maxillofacial growth problems.

Lingual frenotomy has been performed in maternity on children for many years. But experts have been observing for some years a sharp increase in this surgical practice in several Western countries, including France. In Australia, for example, the number of interventions has increased by 420% in about ten years. A situation that leads educated companies to position themselves.

Ankyloglossia with significant repercussions, the only indication for lingual frenotomy

However, national and international recommendations already exist on lingual frenotomy, which is only indicatedin case of ankylglossia with significant functional repercussions. Ankyloglossia is a congenital anomaly, which corresponds to a limitation of the movements of the tongue following a restrictive, very anterior and / or too thick brake. The first problem is the lack of a clear and consensual anatomical definition of the lingual frenum and ankyloglossia..

Currently, the diagnosis of ankyloglossia is therefore not based on anatomical criteria, but on functional criteria, such as:

  • Aspiration problems;
  • Nipple pain in the mother;
  • Early termination of breastfeeding.

Furthermore, there is a lack of scientific evidence to demonstrate the link between ankyloglossia and some neonatal pathologies (gastroesophageal reflux disease, sleep apnea, infantile colic, speech disorders, etc.) and to confirm the interest of lingual phrenomies in some clinical situations.

Five recommendations to slow down the pace of interventions

In this context, the National Academy of Medicine has just formulated five recommendations for professionals :

  • In the absence of breastfeeding difficulties, frenotomy is not simply indicated in the presence of a short and / or thick frenulum;
  • In case of breastfeeding difficulties, a diagnosis must be rigorously carried out to evaluate the state of health of the child and anatomically define his tongue ligation;
  • Frenotomy with scissors is reserved only for certain situations, after the failure of other measures aimed at preserving the frenulum of the tongue;
  • Studies aimed at rigorously evaluating the efficacy and tolerance of lingual frenotomy are necessary and must be initiated quickly;
  • The preparation for breastfeeding of expectant mothers and the training of professionals must be optimized in order to avoid the use of lingual frenotomy as much as possible.

Lingual frenotomy must remain an exceptional surgical procedure, the decision of which must be made in consultation between the treating physician and the pediatrician. Parents must be precisely informed of the risks to the newborn, both of the side effects (haemorrhage, tissue damage, obstruction of the airways, refusal to breastfeed, oral aversion, onset of infection) and the risks of relapse and impact on breastfeeding.

Estelle B., Doctor of Pharmacy

Sources

– A brake on lingual frenotomy in newborns and infants! accademia-medicina.fr. Accessed April 26, 2022.
– Brake of the tongue: what to do? Pay attention to unnecessarily practiced sections. THE DOCTOR ARNAULT PFERSDORFF. pediatrician-online.fr. Accessed April 26, 2022.

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