Readhesion of tongue-tie following neonatal frenotomy: a prospective, observational study

Purpose: Frenotomy is the procedure of choice for treating ankyloglossia. The literature reports that readhesion of the frenulum occurs in 2.6-13% of cases. There is no published evidence to support performing tongue exercises to prevent this readhesion. We routinely recommend that parents perform them. We aimed to determine the recurrence rate of ankyloglossia necessitating a refrenotomy and the benefits of massage in the prevention of readhesion. Methods: Prospective, observational study of neonates who underwent a frenotomy between January and August 2024. Following the frenotomy, we recommended that all parents perform a series of exercises 6-8 times daily over 15 days. We followed the patients 10-15 days afterwards and assessed for ankyloglossia using the Hazelbaker tool, comparing pre- and post-frenotomy scores. Results: We enrolled 212 patients and observed a global rate of readhesion of 33.5% (71 cases), of which 17.9% were asymptomatic. Thirty patients underwent a refrenotomy due to persistent ankyloglossia (14.1%). Only 33 dyads mother/neonate continued to have symptoms following the first frenotomy (15.6%); all of them had readhesion. Thirty-nine mothers referred nipple pain post-frenotomy (18.4%). The appearance and function Hazelbaker scores were lower pre- than post-frenotomy in all cases. Only 59% of the families performed post-frenotomy exercises on the advised frequency. Most neonates were exclusively breastfed (142/212, 66.7%), whereas 61/212 were partially breastfed (28.6%) 10-15 days post-frenotomy. Conclusion: Recurrence of ankyloglossia was higher than published (33.5%), and higher when post-operative exercises were not correctly performed (72.7%). The Hazelbaker scores were lower pre-frenotomy, regardless of the performance of such exercises.