Oral Surgery ISSN 1752-2471
LETTER TO THE EDITOR
Tongue-ties: a response to media concerns
Dear editor,
We would like to draw your attention to a recent
newspaper article in The Sunday Times1 which reports
potential concern surrounding tongue-tie release or
frenulotomy procedures in newborns and infants. As
referenced by the article, NICE guidance2 supports the
use of this procedure in infants to facilitate breastfeed-
ing. We are concerned by the claims contained within
the article that there is controversy surrounding this
procedure and limited evidence to support its use. A
systematic review of the literature in 2013 identified
long-term improvement in breastfeeding in more than
50% of cases3. Moreover complications from the pro-
cedure are reported to be uncommon4 and rare in our
experience at Torbay Hospital.
Newborns are initially assessed by the infant feed-
ing specialist midwives who carry out the procedure
where a frenulotomy is indicated for an anterior tie.
If there is uncertainty, the Hazelbaker Assessment
Tool for lingual frenulum function5 is used. This tool
enables assessment of the severity of a tie and has
been shown to have 96% inter-operator agreement6.
If the midwives believe there is a more challenging
posterior tie, or they have undertaken the procedure
but it has failed, there is a well-established rapid
referral pathway to our Oral and Maxillofacial Sur-
gery department.
Following this, infants with parents are seen by an
Oral and Maxillofacial Surgery Consultant or a suit-
ably trained Oral Surgery Registrar, who re-assess
and carry out the procedure if indicated following
parental consent. The Midwifery and Maxillofacial
teams carry out regular audit and this has demon-
strated improvement in breastfeeding from proce-
dures carried out in both departments. On occasion
a repeat procedure may be indicated, however par-
ents have reported high satisfaction levels with the
service we provide.
The Sunday Times’ article highlights how desper-
ate parents may seek private midwifery or nurse-led
treatment but that such practitioners may be ‘inade-
quately qualified and supervised’1. However, it fails
to acknowledge the concern and difficulties that new
mothers face when breastfeeding babies with
88
tongue-ties. We feel that experienced suitably quali-
fied practitioners, such as infant feeding specialist
midwives, play an important role in rapid assessment
and treatment. Integration of multidisciplinary care
within the NHS by coordination of midwifery and
surgical services helps ensure high standards and
good outcomes. From our experience, we believe
such NHS services support mothers with compassion
and help to minimise delays and associated stress for
the families.
C.L. Wilson , M.R. Heming and L.C. Fryer
Oral and Maxillofacial Surgery Department,
Torbay Hospital, UK
References
1. Templeton SK, Gillespie J. Doctors attack ‘needless’
baby tongue surgery. Sunday Times [Online]. 23 Oct
2016. Available from: http://www.thetimes.co.uk/artic
le/doctors-attack-needless-baby-tongue-surgery-sqpbp7g
tg [accessed 29 Nov 2016]
2. National Institute for Health and Care Excellence.
Division of ankyloglossia (tongue-tie) for breastfeed-
ing. NICE interventional procedures guidance IPG149.
London: National Institute for Health and Care Excel-
lence [Online]. 2005. Available from URL: https://
www.nice.org.uk/guidance/ipg149 [accessed 29 Nov
2016]
3. Finigan V, Long T. The effectiveness of frenulotomy
on infant-feeding outcomes: a systematic literature
review. Evid Based Midwifery 2013;11:40–5.
4. Power RF, Murphy JF. Tongue-tie and frenotomy in
infants with breastfeeding difficulties: achieving a bal-
ance [Online]. Arch Dis Child 2014;0:1–6. Available
from: doi:10.1136/archdischild-2014-306211 [Accessed
29 Nov 2016].
5. Hazelbaker AK. Hazelbaker assessment tool for lingual
frenulum function [Online]. Available from URL:
http://www.alisonhazelbaker.com/shop/hatlff-haze
lbaker-assessment-tool-for-lingual-frenulum-function
[accessed 29 November 2016]
6. Amir LH, James JP, Donath SM. Reliability of the
hazelbaker assessment tool for lingual frenulum func-
tion. Int Breastfeed J 2006;1:3.
Oral Surgery 11 (2018) 88.
© 2018 The British Association of Oral Surgeons and John Wiley & Sons Ltd