Indian Journal of Otology

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 28  |  Issue : 2  |  Page : 116--118

The frenotomy efficacy in gaining weight of exclusively breastfed infant with ankyloglossia


Trimartani Koento1, Susyana Tamin1, Syahrial Marsinta Hutahuruk1, Asti Praborini2, Ervin Amouzegar1,  
1 Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
2 Department of Pediatric, Brawijaya Hospital, Jakarta, Indonesia

Correspondence Address:
Dr. Trimartani Koento
Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jl, Diponegoro No. 71, Jakarta
Indonesia

Abstract

Background: Ankyloglossia, or tongue-tie, is a condition in which the tongue is attached to the floor of the mouth through the frenulum, causing limited tongue movement. Short frenulum variations cause reduced anterior tongue movement resulting in breastfeeding, swallowing, articulation, and orthodontics problems. These abnormalities in infants cause breastfeeding problems that affect infants' weight gain, malocclusion, and speech disorders. Frenotomy in infant ankyloglossia is performed if there are problems with breastfeeding, poor sucking, slow weight gain, and recurrent mastitis. With this indication, we need to observed the efficacy of frenotomy done before the age of 1 month, and the frenotomy done at 1-3 months old in gaining weight of exclusively breastfed infants with ankyloglossia. Materials and Methods: A observational retrospective cohort method from patient medical records in a private hospital in Jakarta, Indonesia. The research subject is a total sampling patient medical records secondary data and collected 68 subjects. The Subjects are divided into two groups, the first group was patients whose frenotomy was done before the age of 1 month, and the second group was patients whose frenotomy was done at 1-3 months old. We assessed the weight gain between the two groups. The data were analyzed and compared the percentage of weight gain before and after frenotomy. Results: The percentage of weight gain before and after frenotomy shows that in the first group, there was a percentage gain of 11.4% in body weight of the subjects and during post-frenotomy control, the percentage of weight gain in this group increased to 111, 4%. In the second group, the percentage of weight gain before the frenotomy was 70.6%, while the post-frenotomy control was only 57.7%. Conclusion: The study demonstrated the efficacy of frenotomy in gaining weight of exclusively breastfed infants with ankyloglossia. There was a significant difference in the weight gain of infants with ankyloglossia who underwent frenotomy at the age of exclusive breastfeeding, before the age of 1 month and between the ages of 1 to 3 months.



How to cite this article:
Koento T, Tamin S, Hutahuruk SM, Praborini A, Amouzegar E. The frenotomy efficacy in gaining weight of exclusively breastfed infant with ankyloglossia.Indian J Otol 2022;28:116-118


How to cite this URL:
Koento T, Tamin S, Hutahuruk SM, Praborini A, Amouzegar E. The frenotomy efficacy in gaining weight of exclusively breastfed infant with ankyloglossia. Indian J Otol [serial online] 2022 [cited 2022 Sep 28 ];28:116-118
Available from: https://www.indianjotol.org/text.asp?2022/28/2/116/356458


Full Text



 Background



Ankyloglossia or tongue-tie is a condition in which the tongue is attached to the floor of the mouth through the frenulum, causing limited tongue movement. Ankyloglossia is a congenital condition characterized by an abnormal, short, thickened, and tight lingual frenulum. Short frenulum variations cause reduced anterior tongue movement resulting in breastfeeding, swallowing, articulation, and orthodontics problems. Orthodontic problems include malocclusion, open bite, separation of the lower incisors, and mechanical problems related to oral and psychological stress.[1]

A study in Indonesia found that from 505 samples of infants, there were 62 infants with ankyloglossia (prevalence rate 12.3%). This study also shows that early performed frenotomy performed (before the infant is 8 days old) has a greater impact on the weight gain than frenotomy done after the infant is 8 days old.[2]

The World Health Organization recommends exclusive breastfeeding for the first 6 months of life.[3] Ankyloglossia abnormalities in infants cause breastfeeding problems that affect infants' weight gain, malocclusion, and speech disorders.[4] Frenotomy in infant ankyloglossia is performed if there are problems with breastfeeding, poor sucking, slow weight gain, and recurrent mastitis.[4] This study observes the frenotomy efficacy in gaining weight of exclusively breastfed infants with ankyloglossia.

 Methods



This study is an observational study using a retrospective cohort method from patient medical records. We collected the medical record from a private hospital in Jakarta, Indonesia. The research subject is a total sampling of patient medical records secondary data. We collected 68 subjects from medical record data from January 2015 to December 2015. We divided the patient into two groups, the first group is patients whose frenotomy was done before the age 1 month, and the second group is patients whose frenotomy was done at 1–3 months old. We assessed the weight gain between the two groups.

 Results



The subject's characteristic is shown in [Table 1]. We used Coryllos grade of ankyloglossia to classify the patients.[5] There were 34 subjects in group 1 and 34 subjects in group 2. There were more male patients in the first group and more female patients in the second group. The highest prevalence is ankyloglossia type 4 (41 patients).{Table 1}

The mean weight at birth in the first group was 3118.1 g. In the second group, the average birth weight was 3047.8 g. We used normality analysis using the Shapiro–Wilk test for each group of 34 subjects. The results of the Shapiro–Wilk test showed that the birth weight of the two groups was normally distributed with a significance value of 0.926.

[Table 2] shows the age at frenotomy in the first group; the median value was 6 days, with a minimum value of 4 days and a maximum age of 29 days. In the second group, the median age was 40 days.{Table 2}

The average body weight of subjects when frenotomy was performed in the first group was 3301.2 g. The second group had an average body weight of 4020.3 g.

The mean weight of the subjects during postfrenotomy control for the first group was 3616.1 g and in the second group was 4120 g. The normality test for postfrenotomy control days with the Shapiro‒Wilk test showed that the data were not normally distributed, so the median value was used. The median number of days for postfrenotomy control in the first group was 7.0 days, whereas the median number of days for the second group was 7.5 days.

For the weight gain of subjects in the first group, the median value was 7.3 g/day, and for the second group, the mean value was 21.1 g/day. The mean weight gain of subjects in the first group was 33.4 g/day with a median value of 17.3 g/day for the second group. During postfrenotomy control, the first group showed a rise in the average weight to 3616.1 g with an increase of 315 g compared to the second group with an increase to 4185 g which showed an increase of 165.3 g.

Comparison of the percentage of weight gain before and after frenotomy [Figure 1] shows that in the first group, there was a percentage gain of 11.4% in body weight of the subjects and during postfrenotomy control, the percentage of weight gain in this group increased to 111, 4%. In the second group, the percentage of weight gain before the frenotomy was 70.6%, whereas the postfrenotomy control was only 57.7%.{Figure 1}

 Discussions



Ankyloglossia type 4 makes the tongue elevation movement not optimal, causing difficulty in infants to breastfeed. This study found most of the subjects had ankyloglossia type 4 (60%). This shows that type 4 ankyloglossia is the type that causes the most complaints of difficulty in breastfeeding. Ankyloglossia type 4 has a thick, fibrous, and inelastic frenulum with superior attachment to the submucosa and inferior attachment to the floor of the mouth. The thick and inelastic frenulum causes limited tongue movement. The infant with type 4 ankyloglossia has more complaints than other types and makes parents take their children to the doctor.[6]

Our study found that the comparison of male and female subjects was 1.3: 1. The results of this study are also similar to other studies in 2010 in that the prevalence of male subjects with ankyloglossia is higher.[1],[7]

Characteristics of the average birth weight in the first group was 3118.1 g and in the second group is 3047.8 g. The average bodyweight of the subjects in the first group was 3301.2 g and in the second group was 4020.3 g. The comparison of the average weight gain between the two groups with normal weight gain shows a difference between the first and second groups. Before frenotomy, the median weight gain for the first group was 7.3 g/day and the second group was 21.5 g/day. In follow-up at 7 days after frenotomy, the average weight gain in the first was 34.5 g/day and the second group was 18.9 g/day, compared to the normal weight gain of 30 g/day. From the results of this study, we found that before the frenotomy was done, there was a smaller weight gain than the expected weight gain, both in the first and second groups.

After a frenotomy, there was an increase in average body weight greater than normal only in the first group compared to the second group who experienced a smaller than normal weight gain. During the postfrenotomy control, the mean weight of the first group almost doubled compared to the second group. The result was also similar to another study that the sooner the frenotomy is performed, the better the acceleration of weight gain.[2] This is related to the process of lactogenesis which is the period when the mother produces the most milk at birth to 8 days after birth. If the infant is given a frenotomy at the optimal time, it will make the breastfeeding process more optimal to stimulate more breastmilk production. In the second group, the average weight gain after frenotomy was lower than in the first group because milk production is not optimally stimulated, causing a decrease in milk production.

Our study found that the postfrenotomy weight gain in the first group was very significant, whereas there was a decrease in the second group, although it was not significant. Therefore, we concluded that frenotomy at an early age could accelerate the process of weight gain. The weight gain in the <1-month group showed only 11.4%. After the frenotomy, the weight gain in this group was 111.4%. The weight gain in the group 1–3 months before frenotomy was 70.6%, while after frenotomy. The ability to gain weight decreased to 57.7%. This result is similar to other studies showing a higher weight gain after frenotomy at an earlier age.[2],[8]

 Conclusion



Our study found the frenotomy efficacy in gaining weight of exclusively breastfed infants with ankyloglossia. Our study also found there is a significant difference in the weight gain of infants with ankyloglossia who underwent frenotomy at the age of exclusive breastfeeding before the age of 1 month and between the ages of 1–3 months. This research is expected to be developed into further research using a prospective cohort study design to knowing the increase in the weight of ankyloglossia babies carried out frenotomy.

Ethics approval

This study has been approved by the Ethics Committee of Faculty of Medicine Universitas Indonesia with an official letter of March 7, 2016, Number 180/UN2.F1/ETIK/2016. We clarify cases which were suitable to our inclusion criteria.

Acknowledgments

We are grateful for the medical staff in Brawijaya hospital, and for Dr. Joedo Prihartono, MPH Universitas Indonesia for the help in statistical analysis, and DM for the language editor.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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