Dr. Truong, who conducted a case study review of major complications following tongue tie release (Int J Pediatr Otorhinolarngol. 2020;138:110356) was surprised by the findings. “I wasn’t expecting to find such severe complications,” she said.
Explore This Issue
April 2023The general consensus among clinicians has been that the risks of performing frenotomy are minimal, Dr. Truong said. “Our research really opened my eyes to how aggressive this procedure can be. Some of the children in the report were quite harmed.” Indeed, of the 47 major complications in the study, four involved hypovolemic shock, and there were four cases of apnea, four cases of acute airway obstruction, and two cases of Ludwig angina. Dr. Truong acknowledged possible selection bias in the study, but it does provide an honest look at complications and their effects on neonates.
Exploring Other Causes
Dr. Messner noted that, before performing a frenotomy, “it’s appropriate to evaluate the infant for other potential sources of breastfeeding problems.” These might include nasal obstruction, airway obstruction, laryngopharyngeal reflux, and craniofacial anomalies. Parents should also be cautioned about the risks and benefits of the procedure. “Frenotomy isn’t always effective in relieving maternal pain and breastfeeding difficulties,” she said.
“This procedure isn’t without complications,” Dr. Truong said. “We all feel pressured to make sure we cut as much [of the frenulum] as possible [to free the tie], but this may also increase the risk of complications. So, we have to watch that pendulum—if it seems like the pendulum has swung to one extreme, we should all look for the place in the middle. However, at the end of the day, supporting a breastfeeding mother and her infant needs to be our top priority.”
Nikki Kean is a freelance medical writer based in New Jersey.
Have Otolaryngologists Dropped the Ball?
Parents experiencing difficulties with breastfeeding often turn to social media for advice. This has opened the door for other practitioners besides otolaryngologists to advertise their services for tongue ties. According to Bobak A. Ghaheri, MD, an otolaryngologist at the Oregon Clinic in Portland, Ore., parents are turning to dentists because otolaryngologists have “dropped the ball as a specialty.”
Dr. Ghaheri has an active social media presence and posts videos describing the benefits and risks of frenotomy for women having issues with breastfeeding. He also trains clinicians at his clinic. “I try to explain that this is something that’s easy to do. It’s all about understanding what the tongue is supposed to do. I’m not trying to reinvent the wheel; I’m just saying, let’s do a better procedure.” The people who come to shadow Dr. Ghaheri are mostly lactation consultants and dentists, he noted; fewer than 1% are otolaryngologists.
“I don’t think we’ve dropped the ball,” said Anna H. Messner, MD, a professor at Baylor College of Medicine and division chief of otolaryngology–head and neck surgery at Texas Children’s Hospital in Houston. “As otolaryngologists, we’ve always performed frenotomies for selected infants.” She acknowledged, however, that “we have allowed other specialties to take over the narrative on this, especially within online forums.”
“When parents seek information about tongue tie on social media, there are forums with people who are outspoken. There’s a culture on social media right now of preferred providers,” explained Mai Thy Truong, MD, a clinical associate professor in the department of otolaryngology–head and neck surgery at Stanford University in California. Parents are giving advice on which doctors and dentists will perform the procedure. “From the medical professional side, it puts pressure on providers who want to be able to provide this service for mothers. This should be in my wheelhouse.”