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Original Research

Open Access

Tongue-tie: incidence and outcomes in breastfeeding after lingual frenotomy in 2333 newborns

  • Francisco Guinot1,*,
  • Natalia Carranza1
  • Elvira Ferrés-Amat1
  • Manuel Carranza2
  • Ana Veloso1

1Department of Pediatric Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), Barcelona, Spain

2Hospital Nostra Senyora de Meritxell, Andorra

DOI: 10.22514/jocpd.2022.023 Vol.46,Issue 6,November 2022 pp.33-39

Published: 01 November 2022

*Corresponding Author(s): Francisco Guinot E-mail:


Aim: To determine the prevalence of ankyloglossia in newborns with breastfeeding problems and to assess the effectiveness of frenotomy in the maintenance of exclusive breastfeeding at 1 month, 3 months and 6 months in newborns at an Andorran Hospital. Study design: A descriptive, cross-sectional, population-based, retrospective study of newborns over a 5-year period (2016–2020) was performed. Nine medical history variables (presence or absence of ankyloglossia and type of frenulum, surgical intervention or not, first degree hereditary component, gender, Rh and blood group, type of breastfeeding, causes of cessation and duration of breastfeeding) related to perinatal and feeding history were collected confidentially and anonymously. The Coryllos classification was used for the diagnosis of ankyloglossia. Descriptive analysis of the data, Chi-square test and prevalence ratios were calculated. Results: A total of 2333 newborns were included in the study (50.02% males and 49.98% females). The prevalence of ankyloglossia was 7.84% (n = 183). Of the infants examined, 136 underwent lingual frenotomy. The number of infants who maintained exclusive breastfeeding, both surgically and non-surgically treated, was no statistically significant differences at 1 month (p = 0.65), 3 months (p = 0.61) and 6 months (p = 0.49). Conclusions: Lingual frenotomy was only performed on patients with ankyloglossia associated with ineffective suction that causes BF difficulties. The realization or not of frenotomy was not a determining factor for the maintenance of breastfeeding at 1 month, 3 months and 6 months. On the contrary, it was a determining factor for the prolongation of mixed feeding. Ankyloglossia related to breastfeeding difficulties should be treated by a multidisciplinary team.


Ankyloglossia; Newborns; Frenotomy; Breastfeeding

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Francisco Guinot,Natalia Carranza,Elvira Ferrés-Amat,Manuel Carranza,Ana Veloso. Tongue-tie: incidence and outcomes in breastfeeding after lingual frenotomy in 2333 newborns. Journal of Clinical Pediatric Dentistry. 2022. 46(6);33-39.


1. Mills N, Pransky SM, Geddes DT, Mirjalili SA. What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clinical Anatomy. 2019; 32: 749–761.

2. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngology—Head and Neck Surgery. 2020; 162: 597–611.

3. Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: incidence and associated feeding difficulties. Archives of Otolaryngology—Head & Surgery. 2000; 126: 36–39.

4. Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis and treatment of ankyloglossia: methodologic review. Can Fam Physician. 2007; 53:1027-1033.

5. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002; 110: e63.

6. O’Shea JE, Foster JP, O’Donnell CP, Breathnach D, Jacobs SE, Todd DA, et al. Frenotomy for tongue-tie in newborn infants. The Cochrane Database of Systematic Reviews. 2017; 3: CD011065.

7. Rowan-Legg A. Ankyloglossia and breastfeeding. Paediatrics & Child Health. 2015; 20: 209–218.

8. Manipon C. Ankyloglossia and the breastfeeding infant: assessment and intervention. Advances in Neonatal Care. 2016; 16: 108–113.

9. Meenakshi S, Jagannathan N. Assessment of lingual frenulum lengths in skeletal malocclusion. Journal of Clinical and Diagnostic Research. 2014; 8: 202–204.

10. Amir LH, James JP, Donath SM. Reliability of the hazelbaker assessment tool for lingual frenulum function. International Breast-feeding Journal. 2006; 1: 3.

11. Edmunds J, Hazelbaker A, Murphy JG, Philipp BL. Tongue-tie. Journal of Human Lactation. 2012; 28: 14–17.

12. Coryllos E, Genna C, Salloum A. Congenital tongue-tie and its impact on breastfeeding. Breastfeeding: Best for Mother and Baby newsletter. American Academy of Pediatrics. 2004; 1–6.

13. Ferrés-Amat E, Pastor-Vera T, Rodriguez-Alessi P, Ferrés-Amat E, Mareque-Bueno J, Ferrés-Padró E. The prevalence of ankyloglossia in 302 newborns with breastfeeding problems and sucking difficulties in Barcelona: a descriptive study. European Journal of Paediatric Dentistry. 2017; 18: 319–325.

14. Kotlow LA. Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence International. 1999; 30: 259–262.

15. Suter VGA, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment. Journal of Periodontology. 2009; 80: 1204–1219.

16. Power RF, Murphy JF. Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Archives of Disease in Childhood. 2015; 100: 489–494.

17. Vörös-Balog T, Vincze N, Bánóczy J. Prevalence of tongue lesions in hungarian children. Oral Diseases. 2003; 9: 84–87.

18. Walsh J, Tunkel D. Diagnosis and treatment of ankyloglossia in newborns and infants: a review. JAMA Otolaryngology—Head & Neck Surgery. 2017; 143: 1032–1039.

19. Griffiths DM. Do tongue ties affect breastfeeding? Journal of Human Lactation. 2004; 20: 409–414.

20. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngology—Head and Neck Surgery. 2002; 127: 539–545.

21. Lalakea ML, Messner AH. Ankyloglossia: the adolescent and adult perspective. Otolaryngology—Head and Neck Surgery. 2003; 128: 746–752.

22. Schafer R, Genna CW. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery & Women’S Health. 2015; 60: 546–553.

23. Haham A, Marom R, Mangel L, Botzer E, Dollberg S. Prevalence of breastfeeding difficulties in newborns with a lingual frenulum: a prospective cohort series. Breastfeeding Medicine. 2014; 9: 438–441.

24. Paisán Grisolía L, Sota Busselo I, Muga Zurriarían O, Imaz Murgiondo M. El recién nacido de bajo peso. Protocolos Diagnóstico Terapticos de la AEP: Neonatología. 2008; 11: 79–84.

25. Puapornpong P, Paritakul P, Suksamarnwong M, Srisuwan S, Ketsuwan S. Nipple pain incidence, the predisposing factors, the recovery period after care management, and the exclusive breastfeeding outcome. Breastfeeding Medicine. 2017; 12: 169–173.

26. Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, et al. Randomised controlled trial of early frenotomy in breast-fed infants with mild-moderate tongue-tie. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2014; 99: F189–F195.

27. Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. Journal of Pediatric Surgery. 2006; 41: 1598–1600.

28. Jakaitis BM, Denning PW. Human Breast Milk and the Gastroin-testinal Innate Immune System. Clinics in Perinatology. 2014; 41: 423–435.

29. Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA, U.S. Preventive Services Task Force. The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Service Task Force. Annals of Family Medicine. 2003; 1: 70–78.

30. Vega López MG, González Pérez GJ. Maternal factors associated with the duration of breast-feeding in peripheral areas of Guadalajara, Mexico. Bol Oficina Sanit Panam. 1993; 115: 118-127. (In Spanish)

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