(1029) Frenotomy Outcomes in Anterior Versus Posterior Ankyloglossia

Introduction: Ankyloglossia diagnoses and frenotomy referrals have surged in the last 20 years. This study assessed breastfeeding outcomes post-frenotomy for anterior (AA) versus posterior ankyloglossia (PA), based on maternal-reported breastfeeding success and pain levels.

Methods: We performed a longitudinal study on breastfed infants 0-3 months old undergoing frenotomy from June-Dec 2023 in a pediatric ENT clinic. Data collected included patient age, gender, race, pre-frenotomy feeding issues, and tongue-tie classification using the Coryllos scoring system. Breastfeeding mothers answered 2 Visual Analog Scale (VAS) questions on a scale of 0-10: “How painful is breastfeeding?” and “How well is your baby breastfeeding?.” A score of 0 indicated no pain and successful breastfeeding, respectively. VAS questions were repeated at 1 day, 1 month, and 3 months post-frenotomy.

Results: In total, 41 infants were included (mean age 3.6 weeks at frenotomy, 95% CI 2.6-4.6), with 24 (58.5%) being male and 17 (41.5%) female. Additionally, 27 infants (65.9%) were White, 5 (12.2%) Black, 1 (2.4%) Asian, 1 (2.4%) Native American, and 7 (17.1%) mixed or other races. Physical exam revealed 22 infants (53.7%) with AA (Coryllos score 1 or 2) and 19 (46.3%) with PA (Coryllos score 3 or 4).

There was no difference in frequency of maternal-reported pre-frenotomy feeding issues (breast pain, poor latch, slow feeding, spillage, poor weight gain) between AA and PA groups.

Significant decreases in VAS breastfeeding pain scores occurred from pre-frenotomy (AA mean score 5, 95% CI 3.7-6.3; PA mean score 5, 95% CI 3.8-6.2) to 1 day post-frenotomy (AA mean score 2.6, 95% CI 1.6-3.5; PA mean score 1.9, 95% CI 1-2.8) in both groups (AA p = 0.002; PA p < 0.001). A trend of decreasing mean VAS pain scores and improved breastfeeding success scores was observed across all time points in both groups. There was no difference in either VAS score between the groups at any time point.

Conclusions: Frenotomy for anterior and posterior ankyloglossia yields similar breastfeeding outcomes, providing an immediate reduction in breastfeeding pain that is sustained over time.