Frenectomy for the Correction of Ankyloglossia: A Review of Clinical Effectiveness and Guidelines

The National Institute for Health and Care Excellence in the UK released guidance in 2005 which reported that current evidence was suggestive of no major safety concerns with frenectomy, and that there was limited evidence that it might improve breastfeeding.10 Considering uncertainties regarding the clinical effectiveness and appropriateness of the procedure, and the development of new technologi [...] The procedures conducted in the RCT and NRSs included simple frenectomy,41,43-45 and frenotomy plus advice on breastfeeding technique and positioning.42 Breastfeeding advice or lactation support may have been provided in some of the other studies as part of the intervention, but it was not discussed. [...] The other SR reported mixed study quality, with RCTs generally being higher quality and NRSs and case series or reports typically being of lower quality, and the strength of evidence being low to insufficient for the majority of outcomes.4,39 Method of Pooling and Publication Bias One SR40 conducted meta-analyses for several outcomes; however, the appropriateness of this approach is debatable. [...] The other SR4,39 which reviewed all of the same primary clinical studies, concluded that “the small number of studies, the study designs and the heterogeneity of interventions and outcomes made a meta-analysis inappropriate” (page 43).4 Consistent with this, the meta-analytic results of Ito et al.,40 included a maximum of three studies per outcome, 2 and all analyses reported high heterogeneity (I [...] The intervention of interest was clearly described by four of the studies.41,43-45 One study42 only gave the name of the intervention (i.e., frenotomy) and did not provide detail regarding the specific method of conduct.