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Nurse Taking Notes


The Science

Tongue tie has been around forever. Evidence-based medicine has not. The large body of evidence support to use of frenotomy to help resolve feeding issue and for non-feeding related issues is growing every day.

As with any pioneering research, it can invoke strong, polarised opinion. The main thing is we are talking about it. Tongue Tie Galway has compiled a page of important research articles from the past and emerging articles for your interest. This page will be updated regularly.

Geddes' study that used ultrasound images of breastfeeding dyads to show the tongue's role in milk extraction:

CONCLUSIONS: Ultrasound imaging demonstrated that milk flow from the nipple into the infant's oral cavity coincided with both the lowering of the infants tongue and peak vacuum. Therefore vacuum is likely to play a major role in milk removal from the breast.

Another study by Geddes that shows the effect of frenotomy on milk removal at the breast:

CONCLUSIONS: Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue postfrenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause.

Randomized, controlled trial of division of tongue-tie in infants with feeding problems.

CONCLUSIONS: We demonstrated immediate improvement in nipple-pain and breastfeeding scores, despite a placebo effect on nipple pain. This should provide convincing evidence for those seeking a frenotomy for infants with signficant ankyloglossia.

Efficacy of neonatal release of ankyloglossia: a randomized trial:

CONCLUSIONS: This randomized, controlled trial has clearly shown that tongue-ties can affect feeding and that division is safe, successful and improved feeding for mother and baby significantly better than the intensive skilled support of a lactation consultant.

Does frenotomy improve breast-feeding difficulties in infants with ankyloglossia?

CONCLUSIONS: every outcome consistently showed a favorable effect of frenotomy on breast-feeding. The literature review supported an overall moderate quality of evidence for the effectiveness of frenotomy for the treatment of breast-feeding difficulties in infants with ankyloglossia. No major complications from frenotomy were reported.

Lingual frenotomy for breastfeeding difficulties: a prospective follow-up study

CONCLUSIONS: There are favorable long-term effects of frenotomy on breastfeeding. Lingual frenotomy does not always alleviate breastfeeding difficulties, and rarely worsening ensues. We could not find any predictor for successful breastfeeding after frenotomy. We speculate that because the procedure is minor, in the event of breastfeeding difficulties, lingual frenotomy should be considered as an effective tool to assist in long-term breastfeeding.

Do tongue ties affect breastfeeding?

CONCLUSIONS: Prior to division, 88% had difficulty latching, 77% of mothers experienced nipple trauma, and 72% had a continuous feeding cycle. During division, 18% slept throughout; 60% cried more after division (mean 0-15 seconds). There were no significant complications. Within 24 hours, 80% were feeding better. Overall, 64% breastfed for at least 3 months (UK national average is 30%). Initial assessment, diagnosis, and help, followed by division and subsequent support by a qualified lactation consultant, might ensure that even more mothers and infants benefit from breastfeeding.

The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review.

CONCLUSIONS: Ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breastfeeding; however, there was a limited number of studies available with quality evidence. There are no significant data to suggest a causative association between ankyloglossia and speech articulation problems. Aspects of ankyloglossia that would benefit from further research are described, and recommendations for tongue-tie release candidacy criteria are provided.

Tongue-Tie Assessment and Division: A Time-Critical Intervention to Optimise Breastfeeding. 

CONCLUSIONS: Demonstrated a time-critical dimension for frenulotomy: delay beyond 4-weeks from referral to assessment of neonatal tongue-tie is more likely to be associated with abandonment of breastfeeding. Timely assessment and division of tongue-tie in selected infants can therefore play an important role in a birthing unit’s breastfeeding strategy.

Frenotomy for tongue-tie (frenulum linguae breve) showed improved symptoms in the short- and long-term follow-up

Results: Of the 295 infants (median age six weeks), 199 (=60%) showed inadequate breastfeeding. Symptoms were painful or sore maternal nipples, poor weight gain, dribbling milk from the corner of the mouth, reduced milk supply, inadequate latch during bottle-feeding and maternal mastitis. In the 34 children, predominant symptoms were articulation disorders, misaligned teeth and problems with swallowing solid food. Of the 141 patients with short-term feedback, 86% reported improvement, 13% an unchanged situation. In a former premature, the reported worsening of symptoms ('breath spells') are likely related to prematurity. Of the 164 patients where the questionnaire for long-term outcome was provided, 82% reported improvement, 16% an unchanged situation. For two infants worsening was reported, referring to refusal to drink from breast or bottle for two hours after the procedure and fever for one day, respectively.
Conclusions: Frenulum breve is a potential cause of breastfeeding difficulties and can be treated safely and efficiently by frenotomy.

American Academy of Breastfeeding Medicine (AABM). (2016). Protocol # 11:

Guidelines for the evaluation and management of neonatal ankyloglossia and its

complications in the breastfeeding dyad. 

Coryllos, E., Genna, C.W. & Salloum, A.C. (2004). Congenital tongue-tie and its impact

on breastfeeding. American Academy of Pediatrics.

Short lingual frenulum as a risk factor for sleep-disordered breathing in school-age children,  Sleep Medicine, Volume 66, February 2020, Pages 119-122

Conclusions: Recent evidence has emphasized the role of a short lingual frenulum in the pathogenesis of sleep-disordered breathing (SDB) in childhood. The oral dysfunction induced by a short frenulum may promote oral−facial dysmorphism, decreasing the size of upper airway lumen and increasing the risk of upper airway collapsibility during sleep. The aim of this study was to evaluate the presence of a short lingual frenulum as risk factor for SDB in children of school age, with and without snoring, who were recruited from the community.

Efficacy of an Osteopathic Treatment Coupled With Lactation Consultations for Infants' Biomechanical Sucking Difficulties.

CONCLUSIONS: This study is one of the first to bring together lactation consultants and osteopaths to address infants with biomechanical sucking difficulties. Findings support the hypothesis that the addition of osteopathy to regular lactation consultations is beneficial and safe.

Lingual frenuloplasty with myofunctional therapy: Exploring Safety and efficacy in 348 cases, Soroush Zaghi & Sanda Valcu-Pinkerton, et Al.


Lingual frenuloplasty with myofunctional therapy protocol

as described in this manuscript is a safe and potentially

effective treatment for mouth breathing, snoring,

clenching, and myofascial tension in appropriately selected

patient candidates. Further research will help to better

identify the most optimal candidates for this treatment.

Level 2

Borrie  FRP, Bearn  DR, Innes  NPT, Iheozor‐Ejiofor  Z. Interventions for the cessation of non‐nutritive sucking habits in children. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD008694. DOI: 10.1002/14651858.CD008694.pub2.

Level 1

Camacho M, Guillleminault C, Wei JM, Song SA, Noller MW, Reckley LKm Fernandez- Salvador C, Zaghi S (2018). Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. European Archives of Otorhinolaryngology, Apr;275(4):849-855. doi: 10.1007/s00405-017-4848-5. Epub 2017 Dec 23.

Level 1

Campanha SM, Fontes MJ, Camrgos PA, Freire LM (2010). The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents. Jornal de Pediatria, May-Jun;86(3):202-8.doi:10.2223/JPED.1995. Epub 2010 May 6

Level 1

Ferreira TS, Mangilli LD, Sassi FC, Fortunato-Tavares T, Limongi SC, Andrade CR (2011). Speech and myofunctional exercise physiology: a critical review of the literature. Jornal da Sociedade Brasileira de Fonoaudiologia, Sep;23(3):288-96.

Level 2

Fucile S, Gisel EG (2010). Sensorimotor interventions improve growth and motor function in preterm infants. Neonatal Network, Nov-Dec;29(6):359-66. Level 1

Fucile S, McFarland DH, Gisel EG, Lau C (2012). Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants. Early Human Development, Jun;88(6):345-50. doi: 10.1016/j.earlhumdev.2011.09.007. Epub 2011 Sep 29.

Level 1

Greene Z, O’Donnell CP, Walshe M (2016). Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database of Systematic Reviews, Sep 20;9:CD009720.

Level 1

Haewon B (2016). Effect of orofacial myofunctional exercise on the improvement of dysphagia patients’ orofacial muscle strength and diadochokinetic rate. Journal of Physical Therapy Science, Sep; 28(9): 2611–2614. doi: 10.1589/jpts.28.2611.

Level 3

Ieto V, Kayamori F, Montes MI, Hirata RP, Gregorio MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G (2015). Effects of oropharyngeal exercises on snoring: a randomized trial. Chest, Sep;148(3):683-691. doi: 10.1378/chest.14-2953.

Level 1

Khaleghipour S, Masjedi M, Kelishadi R (2013). The effect of breathing exercises on the nocturnal enuresis in the children with the sleep-disordered breathing. Iranian Red Cresent Medical Journal, Nov;15(11):e8986. doi: 10.5812/ircmj.8986. Epub 2013 Nov 5.

Level 1

Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS (2017). Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal of Oral Rehabilitation, Jan;44(1):59- 64. doi: 10.1111/joor.12461.

Level 1

Lee AS, Gibbon FE (2015). Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systematic Reviews, Mar 25;(3):CD009383. doi: 10.1002/14651858.CD009383.pub2.

Level 1

Lee SY, Guilleminault C, Chiu HY, Sullivan SS (2015). Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing. Sleep and Breathing, Dec;19(4):1257-64. doi: 10.1007/s11325-015-1154-6. Epub 2015

Level 1

Van Dyck C, Dekeyser A, Vantricht E, Manders E, Goeleven A, Fieuws S, Willems G

(2016). The effect of orofacial myofunctional treatment in children with anterior open

bite and tongue dysfunction: a pilot study. The European Journal of Orthodontics.

June;38(3):227-234. doi:10.1093/ejo/cjv044

Van Lierde KM, Luyten A, D’haeseller E, Van Maele G, Becue L, Fonteyne E, Corthals P, DePauw G (2015). Articulation and oromyofunctional behavior in children seeking orthodontic treatment. Oral Diseases, May;21(4):483-92. doi: 10.1111/odi.12307. Epub 2015 Feb 2.

Level 1

Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M (2017). Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep and Breathing, Dec;21(4):1025-1032. doi: 10.1007/s11325-017-1489-2. Epub 2017 Mar 18.

Bin‐Nun A, Kasirer YM and Mimouni FB. A dramatic increase in tongue‐tie related articles: a 67 years

systematic review. Breastfeeding Medicine. 2017; 12(7): 410‐414

Hale D, Mills N, Edmonds L et al Complications following Frenotomy for Ankyloglossia: A 24‐ month

prospective New Zealand Paediatric Surveillance Unit Study. J Paeds and Child Health. 2019 doi:


Jin RR, Sutcliffe A, Vento M et al. What does the world think of tongue tie? Acta Paed 2018: 107 (10):


Joseph et al. Temporal trends in Ankyloglossia and frenotomy in British Columbia Canada 2004‐2014:

a population‐based study. CMAJ Open 2016 Jan‐Mar; 4(1): E33–E40.

Kapoor V et al. Frenotomy for tongue ‐tie in Australian Children, 2006‐2016, an increasing problem.

O’Shea JE, Foster JP, O’Donnell CPF, Breathnach D, Jacobs SE, Todd DA, David PG. Frenotomy for

tongue‐tie in newborn Infants. Cochrane Database of Systematic Reviews. 2017, Issue 3. Art.

No.:CD011065 DOI: 10.1002/14651858.CD011065.pub2

Walker R, Messing S, Rosen‐Carole C and McKenna Benoit M. Defining tip to frenulum length for

Ankyloglossia and its impact on Breastfeeding: A Prospective Cohort Study. Breastfeeding Medicine.

Vol 13(3) 2018

Walsh J et al. Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and

Management in the United States, 1997‐2012. Oto Head & Neck Surg 2017; 156:735 ‐40

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