Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study

Abstract

Background: The study aims to describe the lingual laser frenotomy perioperative protocol for newborns with ankyloglossia with or without breastfeeding difficulties developed by Odontostomatology and Neonatology and Neonatal Intensive Care Units of the Aldo Moro University of Bari.

Methods: Authors carried out a prospective observational cohort study. Newborns with ankyloglossia (classified by using both Coryllos' and Hazelbaker's criteria) with or without difficult breastfeeding (according to Infant Breastfeeding Assessment Tool) underwent diode laser frenotomy (800 ± 10 nm; 5 W; continuous wave mode; contact technique; under topical anesthesia) and follow-up visits after seven and thirty days postoperatively. The authors analyzed as main outcomes the perioperative pain intensity measured by the C.R.I.E.S. scale, the occurrence of complications and quality of healing, the quality of breastfeeding, newborn's postoperative weight gain, maternal nipple pain, and the presence of lesions as secondary outcomes.

Results: Fifty-six newborns were included in the current study. Intraoperative mean pain intensity was 5.7 ± 0.5 points, resolved within thirty postoperative minutes. Observed complications were mild punctuating bleeding, carbonization of the irradiated site, and transitory restlessness. All wounds were completely healed within the thirtieth postoperative day. During follow-up, a significant breastfeeding improvement was evident with satisfactory newborns' weight gain and a significant reduction of nipple pain and lesions (p < .05).

Conclusion: Our lingual laser frenotomy protocol provided significant breastfeeding improvement in the mother-newborn dyads with low intraoperative pain and no significant complications.

Keywords: Ankyloglossia; Breastfeeding; Laser frenotomy; Laser surgery; Newborns.

Fig. 1

Perioperative Pain Intensity Curve. The current figure summarizes the variations in newborns’ pain intensity throughout the perioperative period (before surgery, during laser frenotomy, immediately after surgery, and thirty minutes after the end of surgery). The mean difference between each time-point and the following is statistically significant (p < .001). Abbreviations: C.R.I.E.S. Cry—Requires Oxygen—Increased Vital Signs—Facial Expression – Sleeplessness

Fig. 2

Lingual Laser Frenotomy - Wound Healing. The figure shows two examples among all included newborns; both cases comprehend preoperative, immediate postoperative, and follow-up pictures. Immediately after the laser frenotomy, all newborns showed diamond-shaped wounds covered by irradiated tissue. During the seventh postoperative day, the wounds were covered by a fibrin coat and surrounded by inflammatory erythema. During the thirtieth postoperative day, all newborns showed wounds covered by pink mucosa

Fig. 3

Treated Newborns’ Weight Curve. Newborns gained weight throughout the whole postoperative period: each box plot depicts data about weight (in g) recorded the day before surgery, during the seventh postoperative day, and during the thirtieth postoperative day. At each time point after surgery, the mean weight was significantly higher than the previous measurement, thus, the presence of surgical wounds did not harm the growth of the newborns. Abbreviations: g gram

Fig. 4

Nipple Pain (10 cm -VAS) Curve. Those boxplots depict how maternal nipple pain decreased throughout the postoperative period. The recorded mean VAS score decreased significantly both seven and thirty days after frenotomy. Furthermore, it is interesting to observe the maximum pain experienced by mothers: before surgery, some mothers reported 10 points; after one week, the maximum pain felt was measured at 6 points; after a month, the worst pain was 3 points. Abbreviations: cm centimeters, VAS Visual Analogical Scale