Purpose or Case Report: Infants with ankyloglossia frequently experience difficulty breastfeeding, due at least in part to maternal discomfort. The pain experienced by many nursing mothers improves after frenulectomy, encouraging them to continue breastfeeding. The purpose of this study was to use ultrasound to evaluate the oral mechanics during breastfeeding in infants with ankyloglossia before and after frenulectomy, with particular attention to the change in the interalveolar distance.
Methods & Materials: Thirty infants with classic membranous ankyloglossia on whom frenulectomy was going to be performed were enrolled in the study and consented by the otolaryngologist who performed the procedures. Using a high-frequency linear tranducer oriented craniocaudally along the nasolabial fold, pre-frenulectomy and immediate post-frenulectomy ultrasounds were performed while the infant was breastfeeding. The nasal cartilage, maxillary ridge, tongue, and mandible were included in the field of view. Multiple cine clips were recorded while the baby breastfed. After the exam was completed, measurements of the interalveolar distance on maximal opening and closure of the mouth during breastfeeding were performed.
Results: Mean interalveolar distance during maximal opening was 14.2 ± 2.3 mm pre-frenulectomy and 12.9 ± 2.7 mm post-frenulectomy, (p<.06). Mean interalveolar distance during maximal closure was 8.6 ± 2.4 mm pre-frenulectomy and 9.2 ± 2.2 mm post-frenulectomy. The mean change in interalveolar distance was 5.3 ± 1.1 mm pre-frenulectomy and 3.59 ± 1.1 mm post-prefrenectomy (p<.001), resulting in a mean increase in interalveolar distance of 1.74 ± 1.1 mm post-frenulectomy, a change of 32.24 ± 16.7%.
Conclusions: The change in interalveolar distance while breastfeeding decreases after infants with ankyloglossia undergo frenulectomy, resulting in less compression of the nipple by the infant's alveolar ridges. Prior studies have attempted to evaluate change in the motion of the tongue after frenulectomy, which may affect the infant's ability to latch to the nipple and improve the sucking mechanism, but these changes do not satisfactorily explain improvement in pain experienced by the nursing mother. The results of this study provide additional insight into the change in the oral mechanics after frenulectomy which may make breastfeeding more comfortable for the nursing mothers.