Office-based frenotomy for ankyloglossia and problematic breastfeeding.

The Canadian Paediatric Society position statement “Ankyloglossia and Breastfeeding” describes the common congenital anomaly of a tight lingual frenulum, which can restrict tongue mobility and lead to breastfeeding problems. When ankyloglossia (“tongue-tie”) contributes to substantial breastfeeding difficulties, frenotomy should be performed by an experienced clinician.1 A review article on tongue-tie found the prevalence to be 2% to 5%, with 50% of infants with tongue-tie experiencing breastfeeding problems. Frenotomy is effective for improving breastfeeding and complications are rare.2 Posterior tongue-tie is an emerging topic and a condition that can have a devastating effect on breastfeeding.3 Given the prevalence of tongue-tie, most family physicians will encounter this problem. Dr Jack Newman pioneered a technique for office-based frenotomy and Dr Claire Kenny-Scherber learned this technique when she spent 2 weeks training with him. This procedure is not technically difficult and can be learned by hands-on practice with an experienced physician. Officebased frenotomy is indicated for a newborn with tonguetie and breastfeeding problems such as maternal pain, poor latch, damaged maternal nipples, nonlatching, and poor weight gain. The mother and baby should first be seen by a lactation consultant (LC) to attempt to achieve a pain-free latch. When breastfeeding problems persist, frenotomy is indicated. Contraindications are bleeding disorders and failure to receive vitamin K at birth. Adverse outcomes include risk of bleeding, pain, infection, damage to adjacent structures, failure to improve breastfeeding, and reattachment of the frenulum.