Main Theme: Head and Neck
Background: Tongue-tie (ankyloglossia) can significantly impair infant feeding, affecting both breastfeeding and bottle-feeding. Frenotomy is commonly performed to address these difficulties, yet its effectiveness remains debated. This study evaluated feeding outcomes following frenotomy in infants and paediatric patients.
Methods: Consecutive patients undergoing frenotomy between October 2023 and November 2025 at Portsmouth University Hospitals Trust were prospectively assessed. Infants under one year received clinic-based division under local anaesthetic, while children aged one year or older underwent division under general anaesthetic in theatre; the surgical technique was otherwise standardised. Feeding outcomes were measured using the Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF), the Pediatric Eating Assessment Tool (PediEAT-10), and additional symptom-based questions. Pre- and post-operative scores were compared using paired t-tests.
Results: Of 121 patients, 94 had complete paired data. The cohort was predominantly infants, with 12 children (13.2%) aged ≥12 months. Mean follow-up was 3.8 months. Significant feeding improvements were observed across feeding modalities. Exclusively breastfed infants demonstrated a 14.6% mean improvement in BSES-SF scores and a 31.6% reduction in breastfeeding symptoms (both p<0.001). Exclusively bottle-fed infants showed a 29.4% reduction in feeding symptoms (p<0.001). Mixed-fed infants under one year showed greater symptom improvement (32.79%) than those aged ≥1 year (20.35%).
Conclusions: Frenotomy was associated with meaningful feeding improvement across all age groups. However, children over one year demonstrated smaller percentage improvements, suggesting that earlier intervention may confer greater benefit.
References
Geddes, D.T., Langton, D.B., Gollow, I., Jacobs, L.A., Hartmann, P.E. & Simmer, K. (2008). Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism. Pediatrics, 122(1), e188–e194.
Ghaheri, B.A., Cole, M., Fausel, S.C., Chuop, M. & Mace, J.C. (2017). Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study. Clinical Lactation, 8(2), 67–74.
Buryk M, Bloom D, Shope T. (2011). Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics, 128(2), 280–288.