A few thoughts re ankyloglossia and frenotomy. The condition of "tight
frenulum" affecting breast-feeding seems to only exist in first-born
infants. It seems to me that if this were a "real" condition, the
incidence in second and third babies would equal the incidence in first
babies, but the condition seems to vanish if the mother has successfully
breast-fed previously.
Also, here in Richmond, VA, about 15 years ago, the local speech
pathologist organization officially requested that pediatricians stop
performing frenotomies. According to the speech pathologists, at least
back then, speech worsened if the frenulum was cut. One of my former
associates, now retired, stopped doing his occasional frenotomies, and
noticed no difference in outcome over the years. It might be
interesting to find out the current position, if any, of the speech
pathologists.
With regard to dealing with your family of dentists, all clamoring to
cut your patient's frenulum, you might gently suggest that you are glad
they're not hematologist/oncologists--then they'd be asking you to
perform a bone marrow biopsy on an asymptomatic patient.
Good luck,
David Arkin, MD
Richmond, VA
Eve Switzer wrote:
I had some parents ask about frenotomy (frenulectomy?
frenuloplasty?) yesterday even though the child is
completely asymptomatic that I can tell. She is 4
months old and breastfeeding without difficulty,
gaining weight very well, no nipple soreness, etc. I
had advised the mom early on that I would not advise
this procedure without a good reason. The MGF and 2
uncles are all dentists and were very adamant about
having the frenulum clipped because it is transparent
with very little risk, etc. The parents are confused
and, frankly, so am I now.
I went back to the Pedtalk archives and looked through
the previous discussions about this topic and the
general consensus seemed to be proceed only if there
are problems - and revolved mostly around
breastfeeding issues. There was mention back then
that maybe the AAP ought to have a policy statement on
this - there still isn't one that I can find. I'm
going to pass on some of the studies that were
discussed previously on this list to the parents but a
couple questions that I could not/still can't answer:
1. Once a problem has set in (speech difficulties,
oral hygiene issues, etc) what is the likelihood that
the procedure is "too late"? The corollary question
being - isn't it "better" to do when younger wrt pain,
anesthesia, etc?
2. The parents are concerned that if it's not done
NOW, the transparent frenulum will "become
vascularized". I have no idea if that is, indeed,
true.
3. How common is scarring following frenulectomy?
Anyone seen it?
4. ENT or oral-maxillo-facial surgeon?
Eve H. Switzer, MD, FAAP
rural peds
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