Aims Tongue tie effects at most 2% of infants and may be a normal variant. National Institute of Clinical Excellence has recently supported the use of frenotomy, while acknowledging that evidence is limited. The Dutch have recently abandoned frenotomy nationally. Thus we looked for secondary evidence via a systematic review.

Methods PubMed, Cochrane and DARE databases were searched. References of included studies were reviewed (last search: 26 November 2010). We included controlled and uncontrolled studies involving term infants with ankyloglossia and breastfeeding difficulties undergoing frenotomy. Studies without adequate patient data, those focusing on problems other than breastfeeding, of preterm infants, of infants with severe congenital abnormalities were excluded. Two reviewers applied selection criteria and extracted data independently. Health related outcomes considered were: Duration of breastfeeding, LATCH score, Subjective measure of latch or suck, Maternal breast symptoms, Infant weight gain.

Results In 17 studies, 733 infants with ankyloglossia and breastfeeding difficulties were included, 680 of whom underwent frenotomy. Generally, performing frenotomy for ankyloglossia was associated with improvements in breastfeeding characteristics. 67.2% (275/409) of infants were breastfeeding at 3 months post-frenulotomy. Maternal nipple pain was significantly reduced following frenulotomy in all studies at follow-up. A significant improvement in an objective measure of latch (LATCH score) was demonstrated in two of the three studies using this outcome measure. Few adverse events were reported; 1% of infants had minor complications.

Conclusion Our review suggests that frenotomy is a safe procedure that may facilitate breastfeeding in women who may otherwise have given up, due to tongue tie. BUT most studies were not randomised. What is needed here is a properly designed RCT to determine if there is any true benefit for outcomes such as breast feeding at 6 weeks post procedure.