Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns

Ray, Shagnik; Golden, William; Walsh, Jonathan M.

doi:10.1001/jamaoto.2019.2302

Cited by 12 publications

(12 citation statements)

References 17 publications

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“…Anatomical studies such as our own have failed to show a link between appearance of the maxillary frenulum and breastfeeding ability 18 . Other variables, such as length, flexibility, extensibility, and lip attachment site of the maxillary frenulum may therefore be more important in evaluating the impact of the frenulum on breastfeeding 7,19 . This is similar to the growing body of evidence on tongue tie, showing that anatomy alone is insufficient to determine impact on breastfeeding, and that the function of important oral structures (tongue, lips) must also be considered.…”

Section: Discussionsupporting

confidence: 56%

Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia

Shah

Allen

Walker³

et al. 2020

The Laryngoscope

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Objectives There is debate among otolaryngologists and other practitioners about whether upper lip tie contributes to difficulty with breastfeeding and whether upper lip tie and ankyloglossia are linked. Our objectives were to evaluate the anatomy of the upper lip (maxillary) frenulum, to determine if the visual anatomy of the upper lip has an effect on breastfeeding, and to determine whether the occurrence of lip tie and tongue tie are correlated. Methods A prospective cohort study of 100 healthy newborns was examined between day of life 3–7. Surveys were completed by the mother at the time of the initial exam and 2 weeks later. The maxillary frenulum was graded based on the Stanford and Kotlow classifications by two independent reviewers. Inter‐rater reliability and relationships between tongue tie, lip tie, and the infant breastfeeding assessment tool (IBFAT) were calculated. Results Inter‐rater reliability showed fair agreement (κ = 0.302) using the Kotlow scale and better agreement using the Stanford classification (κ = 0.458). There was no correlation between the upper lip tie classification and breastfeeding success score. Lastly, there was a modest inverse correlation in the degree of tethering for the tongue and lip. Conclusions There was no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch. There was also no relationship between tip to frenulum length (tongue tie) and visualized lip anatomy, suggesting that tongue tie and lip tie may not cluster together in infants. Level of Evidence 2 Laryngoscope, 131:E1701–E1706, 2021

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Section: Discussionsupporting

confidence: 56%

Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia

Shah

Allen

Walker³

et al. 2020

The Laryngoscope

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“…Later on it recedes and takes more apical position. 19,23 If the continuous band of maxillary labial frenum crosses in between the two maxillary central incisors, it causes midline diastema and is also reported to affect the growth of premaxillary region. 1,24,25 In this instance, the papillary and papillary penetrating frenum attachment are the only two considered as pathological.…”

Section: Discussionmentioning

confidence: 99%

Variations in Maxillary Frenal Morphology in a Sample of Newari Children of Bhaktapur

Joshi

Pradhan

Neupane

et al. 2021

J Nepal Soc Perio Oral Implantology

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Introduction: Frenum attachments are fold of mucous membrane attaching the lips to alveolar mucosa and underlying periosteum. Aberrant location of attachment of maxillary labial frenum poses many clinical problems such as mucogingival problems and midline diastema. Objective: The study was performed to assess the variations in morphology of maxillary labial frenum in a sample of Newari children of Bhaktapur, Nepal. Methods: A descriptive cross-sectional study was performed enrolling 340 Newari children residing in Bhaktapur from August 14, 2020 to March 30, 2021. The study comprised both genders within age group of 6 to 16 years. The frenal attachment was recorded according to Mirko and Sewerin classification. The data was analysed with Statistical Package for the Social Sciences version 16 using descriptive statistics. Results: In total, 340 Newari children participated in this study. The mucosal type was observed in 204 (60%) of the participants followed by gingival type 101 (29.7%). More than 80% of the participants had simple frenum (283, 83.2%). The frenum with nodule was present in 25 (7.4%) and frenum with appendix in 22 (6.5%) of study participants. Frenum with appendix was mostly present in males 18 (10.1%) than females 4 (2.5%). Conclusion: Within the Newari children, the mucosal type of maxillary labial frenum was more prevalent followed by gingival type. The simple frenum was the most common type on basis of morphology.

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“…The author's concluded that the"… classification system proposed by Kotlow has not been found reliable both in terms of inter and intraobserver agreement and in terms of predicting the severity of the breastfeeding difficulties." Another exciting new publication suggests that a more meaningful assessment of the magnitude of frenulum tethering would necessitate a compilation of parameters including distance from alveolar ridge, width of attachment, length of free lip, and flexibility of frenulum, not the location of frenulum insertion alone [ 35 ]. It is of further interest to note that, in a study by Dollberg et al [ 28 ], follow-up interviews 2 weeks following birth found no association between the most severe cases of "tongue" or "lip-tie" with mothers who choose to cease breastfeeding due to difficulties.…”

Section: Discussionmentioning

confidence: 99%

Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study

2021

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Background: The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severe maxillary frenulum are needed.Purpose: No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended followup of these newborn infants.Methods: This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likelihood of eventual feeding or oral disorders.Results: The convenience sample comprised of 61 consecutively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (<i>P</i><0.01). There were no intergroup differences in other types of feeding difficulty, dental hygiene, pronunciation, or speech development.Conclusion: Our findings suggest that a tethered labial frenulum is not associated with an increase in breastfeeding disturbances or oral disorders. These data encourage clinicians to question the need to intervene in cases of tethered maxillary frenula.

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Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns

Cited by 12 publications

References 17 publications

Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia

Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia

Variations in Maxillary Frenal Morphology in a Sample of Newari Children of Bhaktapur

Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study

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