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Chapter 57 ■ Lingual Frenotomy 397

(2) A range of methods to describe and quantify

tongue tie have been proposed, including methods of measuring the anatomic differences and

quantifying observations (2,14–17).

b. Clinical significance (1,2,8,18,19)

(1) Prior to the introduction and widespread use of

breast milk substitutes in the early 20th century,

breast-feeding was necessary for survival.

(a) Release of tongue tie was commonly performed by the midwife at delivery (18,20).

(b) Tongue tie does not generally pose a problem for the more passive process of bottle

feeding.

(c) With a decrease in breast-feeding rates,

frenotomy became unnecessary for infant

feeding.

(2) With the current resurgence in breast-feeding and

increasing knowledge of the risks of breast milk

substitutes, tongue tie is again emerging as an

entity that interferes with successful breast-feeding.

(3) A recent article surveying >1,500 pediatricians,

otolaryngologists, lactation consultants, and

speech pathologists concluded that there is little

consensus among and within these groups

regarding the significance or management of

ankyloglossia (21).

c. Need for surgical intervention (2)

(1) Some babies with tongue tie can breast-feed

successfully with no surgical intervention (1,22).

(2) Each breast-feeding dyad is a unique combination of many factors, including the infant’s intraoral structures, adequacy of suckling, and the

size, shape, and elasticity of maternal nipples.

(3) An emerging body of literature suggests that, for

those mother–baby dyads who are experiencing

difficulty breast-feeding associated with the presence of tongue tie, frenotomy is a safe, effective,

and immediate means of providing relief of

symptoms and supporting breast-feeding (4,5,

18,19,22–28).

d. Timing of surgical intervention: To facilitate breastfeeding, it can be performed in the first days of life,