Maxillary Frenulum in Newborns: Association with Breastfeeding

Abstract

Objective To relate maxillary and lingual frenulum configuration to breastfeeding success. Study Design Cross-sectional study. Setting Newborn nursery in tertiary care academic hospital. Subjects and Methods Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded. Results A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores ( P > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85). Conclusion We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.

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

“…Interestingly, in this study, the maxillary frenulum was defined based on its flexibility, rather than its classified by appearance. 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 .…”

Maxillary Frenulum and “Lip Tie”: What Parents Understand

“…Recently, there has been a dramatic increase in the number of articles related to tongue‐tie, breastfeeding, and frenotomy 12 . Concurrently, requests for maxillary frenotomy have also increased 11 . The lack of consensus regarding the appearance, structure, function, significance, and treatment of LT has led to vastly differing opinions among parents and physicians from different specialties, including otolaryngology, pediatrics, dentistry, lactation counseling, and speech pathology 13 .…”

“…11 This implies that it may be beneficial to focus on breastfeeding technique education prior to exploring surgical options. 11 Although maxillary and lingual frenula have been implicated in breastfeeding issues, 14 few studies have assessed the impact of LT without concurrent ankyloglossia. 7,22 Evidence has supported the link between ankyloglossia and breastfeeding difficulty.…”

“…However, this system exhibits low reliability among relevant medical professionals 10 . Although there are no standard measurements for the diagnosis of LT, parents increasingly bring their infants to otolaryngology clinics with requests for maxillary frenotomies (procedures for dividing frenula) to address breastfeeding difficulties 11 . The purpose of this study was to determine what information parents have regarding LT, the sources of this information, and their level of concern about the condition.…”

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

“…[26][27][28][29][30][31][32][33] Similarly, breastfed babies demonstrating back-arching, fussing, and pulling off the breast or whose mothers experience nipple pain are currently at risk of unnecessary lingual and/or labial frenotomy, which may also result in unintended outcomes. [34][35][36][37][38][39][40][41] Given these concerns, it is essential that every effort is made to optimise breastfeeding prior to considering medical or surgical intervention, yet current approaches to fit and hold are not demonstrated to help.…”