Breastfeeding effectiveness after lingual frenotomy in infants with tongue-tie assessed by Visual Analogue Scale

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Abstract Infants with a short lingual frenulum may experience various difficulties during breastfeeding. Objective In this study, the authors evaluated the clinical impact of frenotomy on breastfeeding effectiveness using the Visual Analogue Scale (VAS) in a single-arm pre–post design aimed at assessing changes within the treated group. Materials and methods This retrospective descriptive case series study was conducted from November 2018 to October 2024. A total of 131 neonates were examined as part of the clinical evaluation. Of these, 106 infants were diagnosed with functionally significant ankyloglossia and underwent frenotomy. The remaining 25 infants showed normal or physiological sucking patterns and did not receive surgical treatment. The authors treated 106 neonates aged from 1 to 16 weeks (with an average age of 3.8 weeks) presenting ankyloglossia classified as class II, III or IV, according to Kotlow’s classification. Videos were recorded during breastfeeding to analyze the movements of the mandible, the oral floor, and the facial muscles. Results The most significant improvements were observed in infants with Class IV ankyloglossia, followed by those with less severe forms (Class III and II), suggesting a correlation between the severity of the frenulum and the postoperative improvement. Statistical analysis confirmed that the differences in sucking effectiveness (VAS scores) across timepoints were significant (p < 0.0001), particularly in Class IV infants, who showed the greatest functional recovery after frenotomy. Conclusions In conclusion, the results of the present study demonstrate a significant improvement in suction strength, enhancement of the lateral tongue reflex, and a reduction in maternal discomfort during breastfeeding, particularly in newborns with high-grade ankyloglossia (grade III and IV). These findings support the indication for frenotomy in more severe cases, while suggesting a more cautious approach in mild forms.