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New research raises the question of whether too many infants undergo tongue and lip attachment surgery (also called frenulectomy) to help improve bad-feeding, despite the lack of medical evidence at the clinic. Support of the procedure. In a new study, published July 11 in JAMA Otolaryngology – Surgery of the head and neckalmost 63% of the children who had been referred to a pediatric surgeon for nose and throat for a tongue and / or upper lip attachment had no longer needed the procedure and were able to badfeed successfully after thorough nutrition badessment by a multidisciplinary team of clinicians, including a speech therapist. A diet evaluation program implemented on a larger scale could prevent children from undergoing surgery that might not be beneficial to improve badfeeding, according to the authors of the report. ;study.
"We have seen a dramatic increase in the number of surgeries with tongue and lip loosening, with no real data indicating that these interventions are effective for badfeeding," said Christopher J. Hartnick, MD, director of the Division of Pediatric Otolaryngology. and the Pediatric Center for Airways, Voice and Swallowing at Mbadachusetts Eye and Ear. "We do not have a crystal ball that can tell us which infants could benefit the most from the release of the tongue or upper lip, but this preliminary study provides concrete evidence that this pathway Multidisciplinary dietary badessment helps prevent babies from getting procedure. "
The tongue attachment, or ankyloglossia, is a disease in which a baby is born and in which a piece of tissue, called lingual brake, connects too closely from the tongue to the floor of the mouth. Infants may also have upper lip scarring when a different tissue, the upper lip brake, is connected to the gum. In some cases, this restriction of movement may result in difficulties with badfeeding or, in rare cases, impaired dental health or speech later in childhood.
Breastfeeding is recommended by many health organizations around the world as the preferred method of infant feeding for newborn growth and development. When there are difficulties in badfeeding, especially if the baby is not badfeeding, not gaining weight, or if the mother is in pain, many new parents request a consultation, which may result in surgery for cut the tongue of the tongue, sometimes called frenotomy, frenectomy. or frenulectomy.
Despite the lack of medical literature linking surgery to improved badfeeding, the number of such procedures has increased rapidly in recent years, the authors note, noting that the US database of inpatients estimated that 10 times the size of the language. from 1,279 in 1997 to 12,406 in 2012.
Because of this rising rates and the influx of parents looking for a second opinion, Dr. Hartnick and his colleagues have formed a multidisciplinary program of food badessment at Pediatric Airway, Voice and Swallowing Center of Mbad. Eye and Ear, made up of clinicians from different specialties in otorhinolaryngology, pneumology, gastroenterology and speech therapy, including Mbadachusetts General Hospital staff.
The researchers examined 115 newborns who were referred to the clinic for tongue surgery with a pediatric ENT. There, each mother-newborn couple met with a pediatric speech therapist, who performed a complete nutritional badessment including clinical history, an oral exam and a badfeeding observation. They then offered real-time information and strategies to tackle the hypothetical cause of their badfeeding problems.
As a result of the multidisciplinary feeding badessment, 62.6% of newborns did not undergo surgery. Although all patients were specifically operated on the tongue, 10 patients (8.7%) were operated on only for the lips and 32 (27.8%) underwent surgery.
Future multi-center trials are being planned and researchers are also planning follow-up studies comparing infants who have had an operation with the language and who have not had one.
The authors of the study requested that best practice guidelines be developed to facilitate decision-making throughout the medical community.
"We learned that interdisciplinary collaboration is essential to an in-depth evaluation of the diet," said Cheryl Hersh, co-author of the study, MS CCC-SLP, Pediatric Speech-Language Pathologist at the University of Toronto. MbadGeneral Hospital for Children, which sees patients at Mbad. Pediatric center, voice and swallowing for the eyes and ears. "It's still a work in progress, but we've learned a lot about what we can do differently to help our patients and their families, so we've been able to identify many babies who have badfeeding problems who are not not related to their anatomy of the lips and tongue.
Tongue and upper lip attachment release surgery is a relatively safe outpatient procedure performed under local anesthesia, with risks similar to any surgical procedure, including pain and infection. The parents also reported experiencing psychological pain or guilt related to feeding difficulties and the resulting surgery. The procedure can result in significant costs for the procedure, as providers who undergo a frenotomy vary widely. Dentists, otolaryngologists and neonatologists provide this service at an often unpredictable cost and underwritten by health insurance.
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Authors of the JAMA Otolaryngology include Drs. Hartnick, Christen Caloway and Gillian Diercks of Mbadachusetts Eye and Ear / Harvard School of Medicine; Cheryl J. Hersh, MS, CCC-SLP, Rebecca Baars, MS, CCC-SLP, Sarah Sally, MS, CCC-SLP, Mbadachusetts General Hospital. No funding was obtained for this study.
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