Thread by @astuebe

Next session: Yvonne LeFort on Ankyloglossia & the breastfeeding dyad #ABM2022

Lots to cover in 45 minutes... #ABM2022

Context: many factors impact effective and comfortable breastfeeding - not just the frenulum... #ABM2022

Early case report on tongue tie - Celsus, born 25 BCE #ABM2022

[My quick pubmed search -> "Much ado about nothing: two millenia of controversy on tongue-tie" #ABM2022 pubmed.ncbi.nlm.nih.gov/19707023/

More recent literature - study in 2000 -> 4.8% incidence of TT, concluded treatment not indicated #ABM2022

There's been a publication explosion in papers about tongue tie - lots of narratives about why... #ABM2022

Cochrane review -> 5 RCTs cochranelibrary.com/cdsr/doi/10.10… "Frenotomy reduced breastfeeding mothers’ nipple pain in the short term. Investigators did not find a consistent positive effect on infant breastfeeding... 1/

... Researchers reported no serious complications, but the total number of infants studied was small. The small number of trials along with methodological shortcomings limits the certainty of these findings... 2/

...Further randomised controlled trials of high methodological quality are necessary to determine the effects of frenotomy." 3/

[Wondering if anyone can name a Cochrane review that does not end with "further randomised controlled trials of high quality are necessary..."] #MedTwitter🤔#ABM2022

What's the dream RCT for tongue tie? LeFort lays out some parameters... #ABM2022

Another element - consider photography to verify depth of frenotomy, with pre- and post-images... #ABM2022

LeFort's technique for frenotomy is a minor office procedure... #ABM2022

Marked increase in diagnosis - 8.7x in the US in the past decade... what's changed? #ABM2022

What's changed? New classification w/ 4 types of tongue tie, emergency of multple assessment tools... but assessment tool is not a diagnosis... #ABM2022

One study found a standard instrument reduced [over]diagnosis and intervention pubmed.ncbi.nlm.nih.gov/30173975/

Mills found that the frenulum is a dynamic structure - which may explain discrepancies in diagnosis... pubmed.ncbi.nlm.nih.gov/30701608/ #ABM2022

"If you are looking for tongue ties, you tend to see them." #ABM2022

Pamela Douglas has reflected on posterior tongue tie & potential limitations of the diagnosis #ABM2022 pubmed.ncbi.nlm.nih.gov/24143939/

[As with any diagnosis and intervention, there is under-, over-, and appropriate diagnosis... like Goldilocks, we're looking for "just right"] #ABM2022

LeFort notes that there is not evidence to support "active wound management" following frenotomy #ABM2022 pubmed.ncbi.nlm.nih.gov/35716239/

Dr. Google has a signficant presence re Tongue Tie: "Parental and provider perspectives on social media about ankyloglossia" #ABM2022 pubmed.ncbi.nlm.nih.gov/33964675/

What's needed? LeFort calls for global collaboration to advance diagnosis & management of frenotomy #ABM2022

Q: Some patients presenting w/ pain & poor milk transfer often have been pumping frequently, and have areola/nipple edema - might increasd dx of tongue tie be driven by increase w/ pumping? A: Don't know... #ABM2022

LeFort: Any tool is just one part of the assessment... an algorithm could take them a step further... #ABM2022

Here's the algorithm that reduced TT diagnoses in New Zealand... #ABM2022 sciencedirect.com/science/articl…