title: The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding.
abstract: OBJECTIVE
  The objectives of this study were to assess the effect of office-based frenotomy on reversing breastfeeding difficulties among infants with problematic ankyloglossia, and to examine characteristics associated with anterior and posterior ankyloglossia.
  
  
  METHODS
  Mother's of infants who underwent a frenotomy for ankyloglossia from December 2006 through March 2011 completed a post-intervention web-based survey about breastfeeding difficulties they experienced before and after the frenotomy. Maternal-infant dyads had been referred from health providers to a primary care practice for assessment of ankyloglossia. Infants were subsequently classified as having no ankyloglossia, anterior (Type I or Type II) or posterior (Type III or Type IV).
  
  
  RESULTS
  There were 311 infants evaluated for ankyloglossia and 299 (95%) underwent a frenotomy. Most infants were classified as having Type III (36%) or IV (49%) ankyloglossia compared to only 16% with anterior (Type I and Type II combined). Differences by classification type were found for gender (P=.016), age (P=.017), and maxillary tie (P=.005). Among survey respondents (n=157), infant latching significantly improved (P<.001) from pre- to post-intervention for infants with posterior ankyloglossia. Both the presence and severity of nipple pain decreased from pre- to post-intervention among all classifications (P<.001). Additionally, 92% of respondents breastfed exclusively post-intervention. The mean breastfeeding duration of 14 months did not differ significantly by classification.
  
  
  CONCLUSIONS
  Breastfeeding difficulties associated with ankyloglossia in infants, particularly posterior, can be improved with a simple office-based procedure in most cases. The diagnosis and treatment of ankyloglossia should be a basic competency for all primary care providers and pediatric otorhinolaryngologists.
authors.affiliation: Family Practice Residency Program, Middlesex Hospital, Middletown, CT, United States. cliff.o'callahan@midhosp.org
authors.forename: Cliff
authors.initials: C
authors.lastname: O'Callahan
authors.forename: Susan
authors.initials: S
authors.lastname: Macary
authors.forename: Stephanie
authors.initials: S
authors.lastname: Clemente
mesh_terms: D000072676:Ankyloglossia; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008035:Lingual Frenum / Q000002:abnormalities*; D008297:Male; D009035:Mothers; D009056:Mouth Abnormalities / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D014059:Tongue / Q000002:abnormalities*; D016896:Treatment Outcome