Dr. Ameen, ENT Specialist in Kuala Lumpur

Greetings

Today, we will review a popular paper from the 2020 International Journal of Paediatric Otorhinolaryngology titled “Major Complications After Tongue-Tie Release: A Case Report and Systematic Review.” You can access the article here.

Ankyloglossia, or tongue-tie, is defined as limited tongue mobility due to a shortened lingual frenulum.

The most common reasons for undergoing tongue-tie surgery were infant breastfeeding problems, speech impediment, maternal breast/nipple pain and weight lost.

While tongue-tie release (lingual frenotomy) is generally considered a safe procedure, one must not be careless and should not overlook the potential risks it poses to the patient.

The minor & major complications post frenotomies are listed below:

1. Poor feeding

2. Bleeding

3. Bleeding with hypovolemic shock

4. Infected hematoma

5. Acute airway obstruction

6. Ludwig’s angina

7. Negative pressure pulmonary edema

8. Infected hematoma

9. Wound infection

10. Infected cyst

11. Submandibular abscess

12. Mucoceles

13. Massive submandibular edema from obliteration of Wharton’s duct

14. Excess scarring

15. Formation of a floor of mouth cyst

I have included the paper’s abstract below for your convenience:

Abstract

Introduction
The diagnosis of ankyloglossia, or tongue-tie, and the number of frenotomies performed has increased over 10-fold from 1997 to 2012 in the United States. The sharpest increase has been in neonates. For parents considering frenotomy for their breastfeeding newborn, there is controversy surrounding the evaluation of tongue-tie and the benefit of a frenotomy. Complications from tongue-tie procedures are thought to be low, though it is not well reported nor studied.

Objectives
The aim of this study is to describe a case of a sublingual mucocele after laser frenotomy in a neonate with tongue-tie and to investigate major complications reported after tongue-tie release in pediatric patients through a systematic review of the literature.

Case report
We present a 6-week-old female who underwent a laser frenotomy procedure performed by a dentist who presented with a new cyst under her tongue.

Material and methods
A systematic literature search of articles published from 1965 to April 2020 was conducted in Ovid MEDLINE(R), Ovid EMBASE, and Scopus. Citations were uploaded into a systematic review software program (DistillerSR, Ottawa, ON, Canada), followed by full text screening.

Results
47 major complications were reported in 34 patients, including our patient. Most of the cases were located in the United States and Europe. The most frequent indications for the procedure were breastfeeding problems (n = 18) and speech impediment (n = 4). The procedure was performed by dentists (n = 6), lactation consultants (n = 5), and otolaryngologists (n = 4). The bulk of the major complications after frenotomy included poor feeding (n = 7), hypovolemic shock (n = 4), apnea (n = 4), acute airway obstruction (n = 4), and Ludwig angina (n = 2).

Conclusions
Reporting of complications after frenotomy is lacking. Risks to neonates may be different than risks to older children and adults. Practitioners across different specialties should be monitoring and studying this more rigorously to better guide patients and families on the risks and benefits of this procedure.

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