Oromyofunctional Therapy in the Management of Tongue-Tie (Ankyloglossia)

In this article, we address the concept of the cost/benefit ratio of manual and oromyofunctional therapies in the management of tongue-tie (ankyloglossia): What is the cost (financial, emotional, and in terms of time) and what benefit can be expected?

In general, this cost/benefit ratio is studied when a medication or medical device is brought to market, in order to determine its reimbursement rate. If a medication provides significant benefit, this will justify a high cost and substantial reimbursement.

When parents are struggling with their infant, they seek solutions and often turn to alternative therapies: manual therapies, kinesiology, primitive reflexes, Bach flower remedies, homeopathy, etc.

And when we listen to parents, they explain that they turn to these alternatives because conventional medicine does not address their concerns.

Manual therapies are increasingly presented — in prevention, preparation, or post-frenotomy — for cases of tongue-tie, through social media posts with a worrying and alarmist tone. Oromyofunctional care is sometimes recommended as prevention before frenotomy, in preparation for frenotomy, or as a complement to frenotomy. This approach, also described as the "ideal care pathway", involves numerous appointments with various professionals, as well as a home care protocol including facial massage, tongue exercises, and intraoral massages, several times a day. Some authors suggest that oromyofunctional therapy can release the frenulum without frenotomy, or that post-frenotomy care can prevent the frenulum from reattaching.

Cost/Benefit Ratio of Manual Therapies in Tongue-Tie Management

In addition to the financial burden, manual therapies surrounding or in preparation for frenotomy generate a significant physical, mental, and emotional burden.

Cook et al. collected parents' accounts describing the care process as emotionally draining and anxiety-inducing. Bhandarkar et al. noted that parents have difficulty carrying out massage protocols after frenotomy as prescribed, introducing a bias into studies evaluating the efficacy of the method.

Oromyofunctional Therapy: Is It Indispensable?

This therapy is increasingly used in prevention or as a complement to frenotomy, and there may be some improvement in breastfeeding difficulties. A 2022 systematic review by González et al. reported 11 studies, of which only 3 were randomized clinical trials, and only 4 studies concerned infants. The authors reported one observational study of 171 infants, with improvements in maternal pain, infant weight gain, and breastfeeding duration.

The authors concluded: "This systematic review was developed with the aim of evaluating the efficacy of myofunctional therapy in people with ankyloglossia. Based on our results, we can conclude that there is insufficient evidence of the efficacy of this therapy alone, as in the articles evaluated, it was combined with surgical intervention. Furthermore, the studies were not of good methodological quality." They did, however, note improvement on various criteria when combining frenotomy with myofacial therapy compared to frenotomy alone. But this systematic review covers only 11 studies of variable quality, of which only 2 concerned infants in the context of breastfeeding.

Oromyofunctional Therapy for Tongue-Tie: A Controversial Practice

Other experts raise questions:

• If the frenulum can be stretched through oromyofunctional therapy, should the mechanical movement of suckling and time not be sufficient in themselves to improve the situation?

• Could repeated intraoral and facial massages before/after each feeding not risk causing oral aversion in the infant?

A diversity of opinions therefore exists among healthcare professionals on this topic.

The efficacy of these therapies is controversial, and the cost — emotional, in terms of time, financial — is moreover considerable.

Some mothers abandon these care pathways, faced with a crying baby and the lack of time to perform massages multiple times throughout the day and night — and this abandonment is accompanied by feelings of guilt.

Position of Professional Societies

What do professional societies say, following their review of the literature on the value of manual therapy in these indications?

• American Academy of Pediatrics: "Other treatments provided by some healthcare professionals include physical therapy, craniosacral therapy, or myofascial therapies. These treatments are also not well studied and often require costs for families. Post-frenotomy stretching exercises in which parents open the wound several times to prevent reattachment are not recommended and may cause oral aversion. While osteopathic manipulative treatment* has been found helpful for latch issues in breastfeeding newborns, no research specifically examines its role in helping with breastfeeding problems related to ankyloglossia." (*This refers to a review.)

• Academy of Breastfeeding Medicine: "There are no evidence-based data to justify prescribing manual manipulation or post-interventional stretching at or near the incised area following frenotomy."

• Collective of Professional Societies in France: "After frenotomy: no intraoral procedure is necessary in the days following."

• French Academy of Medicine: It notes the lack of scientific evidence, due to insufficient methodological rigor, regarding the value of manipulation or application of substances on or near the incised area post-surgery, and the risk of oral aversion.

It will therefore be important for parents to consider the cost/benefit ratio in these care decisions.

Note: more recently, the French Academy of Medicine and the French Society of Pediatrics have called into question osteopathy in pediatrics and its efficacy.

Conclusion

There are no high-level evidence studies (Cochrane review, meta-analysis, consensus conference) for all of these issues, and it is therefore sometimes difficult to make sense of the available data.

Every parent wants what is best for their child and is prepared to do whatever it takes to provide relief.

It is important that breastfeeding professionals inform parents about the lack of scientific validation for the efficacy of alternative approaches.

And that they invite parents to seek a medical opinion. Tongue-tie diagnoses are medical diagnoses.

Disclaimer: This article is intended to provide general information and is in no way a substitute for medical advice. It is essential to consult a healthcare professional for any questions relating to your individual situation.

For personalised breastfeeding support, you can book an appointment here.

BIBLIOGRAPHY

• Bhandarkar KP, Dar T, Karia L, Upadhyaya M. Post Frenotomy Massage for Ankyloglossia in Infants-Does It Improve Breastfeeding and Reduce Recurrence? Matern Child Health J. 2022 Aug;26(8):1727-1731. doi: 10.1007/s10995-022-03454-x. Epub 2022 Jun 18. PMID: 35716239.

• Cook, T.; Nolan, E.; Tseng, R.J.; Smart, S. Pre- and Post-Operative Care Protocol for Infants with Tongue-Tie: Clinical and Caregiver Perspectives. Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51, 3. https://doi.org/10.3390/ijom51010003

• González Garrido MDP, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of Myofunctional Therapy in Ankyloglossia: A Systematic Review. Int J Environ Res Public Health. 2022 Sep 28;19(19):12347. doi: 10.3390/ijerph191912347. PMID: 36231647; PMCID: PMC9566693.