Tongue-Tie: Does Frenotomy Improve Breastfeeding?

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Tongue-Tie and Breastfeeding: Regarding a Clinical Trial on Frenotomy

This study presents a randomised double-blind clinical trial in neonates presenting with tongue-tie (ankyloglossia): frenotomy (performed with scissors) versus a sham procedure, with evaluation of the LATCH score and pain immediately following the procedure.

112 dyads with infants older than 2 weeks without other comorbidities, and ankyloglossia assessed using the Hazelbaker scale: 57 in the sham procedure group / 55 in the frenotomy group. 3 infants in the frenotomy group could not be assessed post-intervention: 2 due to fatigue, 1 due to significant bleeding requiring suturing.

Results of This Randomised Controlled Trial:

Frenotomy and the sham procedure both led to an improvement in LATCH score and pain reduction, with no significant difference between the groups.

The authors conclude that the perceived improvement in breastfeeding pain and latch following frenotomy is attributable to a placebo effect.

They align with the position statement of the Academy of Breastfeeding Medicine, which states that the presence of tongue-tie alone is not an indication for frenotomy.

This study distinguishes itself from the observational studies typically found on this subject, in that it is a randomised double-blind trial. It highlights the lack of high-quality studies and the lack of international consensus on the management of tongue-tie.

It underscores the uncertainty surrounding the effectiveness of frenotomy in improving breastfeeding difficulties. It would have been valuable to include an evaluation several days after the intervention (although at that point parents would have been able to identify whether they were in the frenotomy or sham procedure group).

Conclusion

In France, the breastfeeding field witnessed a wave of tongue-tie diagnoses and frenotomies between 2019 and 2022, discussed in various articles: here and here. Since alerts were issued by various breastfeeding support organisations and by the Académie de Médecine, practices have evolved. Healthcare professionals in perinatal care who previously referred parents towards frenotomy are now directing them towards myofascial therapies as a preventive measure (or as an adjunct) to frenotomy. However, in this regard, there is no greater evidence of efficacy, for a significant financial cost and substantial cognitive burden for families.

Dinh LA, El-Rabbany M, Aslam S, Ricalde P, Does Lingual Frenotomy

Improve Breastfeeding in Newborns with ankyloglossia? A randomized controlled trial, Journal of Oral and Maxillofacial Surgery (2025), doi:https://doi.org/10.1016/j.joms.2025.04.006.