Today we would like to discuss the topic of massage after frenotomy in this review of a scientific publication. Tongue-tie (ankyloglossia) due to the presence of a short lingual frenulum is a fairly common occurrence in newborns, with an estimated overall incidence ranging from 4 to 16% (1,2).

A frenotomy is a surgical procedure performed in infants when other less invasive treatments for tongue-tie, such as improving breastfeeding technique, promoting postures that allow a deep latch such as laid back and upright position or physiotherapy have not been successful and breastfeeding continues to be compromised. 

After frenotomy, the possibility of recurrence of tongue-tie has been described, either due to lack of elasticity or retraction of the scar tissue or due to closure of the open issues when this technique is performed. The recurrence rate requiring repeat frenotomy ranges from 2.6% to 13% (3, 4). To reduce recurrence and to avoid the need for a repeat procedure, some experts recommend tongue massage, tongue stretching and tongue exercises after frenotomy. However, the question arises about the potential benefit of these procedures as they generate much anxiety in families and infants because of the difficulty in performing this massage. 

To date, there is no scientific consensus supporting the practice of tongue massage after frenotomy. Last month a scientific article was published in the Maternal and Child Health Journal (5) assessing the need for tongue massage after frenotomy in relation to the recurrence rate and improved breastfeeding.

Massage after frenotomy 

This study involved 599 families, of which 282 were assigned to the “post frenotomy massage” group and 317 to the “no post frenotomy massage” group. The study observed a recurrence rate of 0.66%, with only four infants out of 599 participating. No significant differences were observed between the two groups in the improvement of breastfeeding after frenotomy. Therefore, this study concludes that tongue massage after frenotomy should not be recommended until further studies demonstrate a significant benefit.

However, the study has certain limitations in its design and methodology that could bias or misinterpret the results. Families were not randomly assigned to the groups; in the hospital where the study was conducted, certain medical professionals routinely recommended performing the massages, and others did not. And the families were placed in groups according to whether or not the professional recommended the procedure. 

This non-randomized design may introduce bias. It is possible that the expertise of each professional in performing the procedure is being evaluated, rather than the effect of tongue massage after frenotomy. After the surgical intervention, the families were monitored for one year with follow-up telephone calls to assess breastfeeding after the intervention. However, only 92 of 282 families in the massage group and 102 of 317 in the non-massage group could be contacted, so much of the data from this study has been lost, and we have no information on what happened to most of the participants. 

Within the massage group, only 40 families followed the massage instructions as advised. Therefore the sample size of the actual intervention group is 40 and not 317 because although they were in the massage group and were instructed to do so, the families either did not do it or could not be contacted. Therefore we have no information about them. 

In conclusion, this new study provides evidence of the risk-benefit of performing tongue massage after frenotomy. However, studies must keep within scientific rigour to reach more precise conclusions. In any case, more research is needed in this area to provide quality care in situations of tongue-tie due to a short sublingual frenulum.

References: 

1. Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA. Newborn tongue-tie: Prevalence and effect on breast-feeding. J Am Board Fam Pract. 2005;18(1):1–7.

2. Ingram J, Johnson D, Copeland M, Churchill C, Taylor H, Emond A. The development of a tongue assessment tool to assist with tongue-tie identification. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F344–8.

3. Klockars T, Pitkäranta A. Pediatric tongue-tie division: Indications, techniques and patient satisfaction. Int J Pediatr Otorhinolaryngol [Internet]. 2009;73(10):1399–401.

4. Argiris K, Vasani S, Wong G, Stimpson P, Gunning E, Caulfield H. Audit of tongue-tie division in neonates with breastfeeding difficulties: How we do it. Clin Otolaryngol [Internet]. 2011;36(3):256–60.

5. Bhandarkar KP, Dar T, Karia L, Upadhyaya M. Post Frenotomy Massage for Ankyloglossia in Infants — Does It Improve Breastfeeding and Reduce Recurrence ? Matern Child Health J. 2022;