Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticlePractice

Office-based frenotomy for ankyloglossia and problematic breastfeeding

A. Claire Kenny-Scherber and Jack Newman
Canadian Family Physician July 2016, 62 (7) 570-571;
A. Claire Kenny-Scherber
Family physician practising maternity care with the Partners in Pregnancy Clinic in Peterborough, Ont, and is Adjunct Assistant Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jack Newman
Pediatrician specializing in breastfeeding medicine and is Medical Director of the International Breastfeeding Centre in North York, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

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. Office-based frenotomy is indicated for a newborn with tongue-tie 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.

Materials required

The following materials are needed for the procedure:

  • gloves;

  • a head lamp or pen light;

  • sterile, straight, blunt-tipped scissors;

  • 2-inch by 2-inch gauze pads;

  • silver nitrate and 1:1000 adrenaline (in case of serious bleeding); and

  • sterile saline solution to wet the gauze.

Technique for tongue-tie release

The following is the technique for office-based frenotomy for treatment of ankyloglossia:

  • The assistant hooks his or her index fingers under the infant’s tongue and lifts the tongue superiorly to expose the lingual frenulum (Figure 1).

  • Open scissors to a depth of 2 mm.

  • Place the scissors against the frenulum away from the tongue and submandibular ducts and make a 2-mm cut into the tightest part of the frenulum (Figure 2).

  • Push on the incision with an index finger to extend it fully (Figure 3). Figure 4 shows a fully released frenulum.

  • The LC should help the baby to optimize latching immediately after the procedure.

Figure 1.
  • Download figure
  • Open in new tab
Figure 1.

Position for office-based frenotomy

Figure 2.
  • Download figure
  • Open in new tab
Figure 2.

Initial incision with scissors

Figure 3.
  • Download figure
  • Open in new tab
Figure 3.

Manual push with index finger to achieve full release

Figure 4.
  • Download figure
  • Open in new tab
Figure 4.

Appearance of fully released frenulum

One potential pitfall is injury to the submandibular ducts, lingual artery, or genioglossus muscle. This technique minimizes damage to nearby structures and bleeding. Exercises should be done after the procedure to prevent reattachment of the frenulum. These involve the caregiver using his or her index finger to firmly push into the wound and upward in a J shape. This should be done 5 to 6 times per day for 7 to 10 days. Follow-up within 1 week of the procedure is recommended to check for reattachment of the frenulum. Figure 5 shows a wound healing normally 3 days after frenotomy.

Figure 5.
  • Download figure
  • Open in new tab
Figure 5.

Wound healing normally 3 days after the procedure

Discussion

Learning this technique has allowed Dr Kenny-Scherber to help mothers and babies who are struggling with breastfeeding problems due to tongue-tie. This procedure is safe and effective, requires minimal materials, and can be very beneficial. Dr Newman has not experienced any episodes of substantial bleeding using this technique in his many years of practice. There have been rare cases of prolonged bleeding requiring suturing, but this can be prevented with good technique. Possible alternatives to this procedure are waiting, obtaining help from an LC, or referring the patient to another specialist who performs frenotomy.

This method of office-based frenotomy has not been previously described. A review of articles on PubMed using the search terms frenotomy and technique found a guideline from the National Institute for Health and Care Excellence describing the technique for division of ankyloglossia. It states that if done early in infancy no anesthesia is required. The method consists of the following: an assistant stabilizes the infant’s head; sharp, blunt-ended scissors are used to divide the frenulum; and the infant resumes feeding immediately after the procedure.4 Dr Newman’s technique is an extension of the National Institute for Health and Care Excellence technique, as it adds a manual push to extend the incision for complete release. There is debate in the literature about the need for topical anesthesia for frenotomy in newborns. The American Academy of Pediatric Dentistry states that while frenotomy can be accomplished without local anesthesia, topical anesthetic gel is highly recommended for pain and to alleviate parental concerns.5 Dr Newman has used topical anesthesia for frenotomy in the past but found that infants cried more and were unable to breastfeed immediately after the procedure. He now believes that breastfeeding and skin-to-skin contact immediately after frenotomy, as well as acetaminophen if needed, provide adequate analgesia for the procedure.

Conclusion

This office-based frenotomy technique is unique, easy to learn, and safe, and has been shown to be beneficial.

Notes

We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Praxis articles can be submitted online at http://mc.manuscriptcentral.com/cfp or through the CFP website (www.cfp.ca) under “Authors and Reviewers.”

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Rowan-Legg A
    . Ankyloglossia and breastfeeding. Paediatr Child Health 2015;20(4):209-18.
    OpenUrl
  2. 2.↵
    1. Power RF,
    2. Murphy JF
    . Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Arch Dis Child 2015;100(5):489-94. Epub 2014 Nov 7.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. O’Callahan C,
    2. Macary S,
    3. Clemente S
    . The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding. Int J Pediatr Otorhinolaryngol 2013;77(5):827-32. Epub 2013 Mar 22.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. National Institute for Health and Care Excellence
    . Division of ankyloglossia (tongue-tie) for breastfeeding. Manchester, UK: National Institute for Health and Care Excellence; 2005. Available from: www.nice.org.uk/guidance/ipg149/resources/division-of-ankyloglossia-tonguetie-for-breastfeeding-1899863228061637. Accessed 2015 Nov 14.
  5. 5.↵
    1. Kupietzky A,
    2. Botzer E
    . Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management. Pediatr Dent 2005;27(1):40-6.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 62 (7)
Canadian Family Physician
Vol. 62, Issue 7
1 Jul 2016
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Office-based frenotomy for ankyloglossia and problematic breastfeeding
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Office-based frenotomy for ankyloglossia and problematic breastfeeding
A. Claire Kenny-Scherber, Jack Newman
Canadian Family Physician Jul 2016, 62 (7) 570-571;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Office-based frenotomy for ankyloglossia and problematic breastfeeding
A. Claire Kenny-Scherber, Jack Newman
Canadian Family Physician Jul 2016, 62 (7) 570-571;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Materials required
    • Technique for tongue-tie release
    • Discussion
    • Conclusion
    • Notes
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Practice

  • Approach to diagnosis and management of childhood attention deficit hyperactivity disorder
  • Determining if and how older patients can safely stay at home with additional services
  • Managing type 2 diabetes in primary care during COVID-19
Show more Practice

Praxis

  • Aide décisionnelle simplifiée de PEER : options de traitement des maux de dos chroniques en soins primaires
  • PEER simplified decision aid: chronic back pain treatment options in primary care
  • Managing type 2 diabetes in primary care during COVID-19
Show more Praxis

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2021 by The College of Family Physicians of Canada

Powered by HighWire