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Practice Clinical Opinion

Posterior tongue tie and lip tie: a lucrative private industry where the evidence is uncertain

BMJ 2020; 371 doi: (Published 26 November 2020) Cite this as: BMJ 2020;371:m3928

Rapid Response:

Re: Posterior tongue tie and lip tie: a lucrative private industry where the evidence is uncertain: Complications following surgery

Dear Editor

The statement that division of tongue tie is "generally a well established and safe procedure" is without scientific basis since there is no formal mechanism of determining how many such procedures are performed, and how many complications are seen.

In my hospital we have admitted children with haemorrhage and serious soft tissue infections of the floor of the mouth following division of "tongue-tie". We have also seen babies who have had the procedure performed repeatedly in the mistaken belief that "tongue tie" was the cause of their poor feeding and poor growth, which subsequently proved to be due to organic illness, for example, Leigh encephalopathy.

A prospective study over 2 years looking at complications of frenotomy in New Zealand noted 16 cases with pain, poor feeding, respiratory problems, bleeding, and weight loss all being recorded [1]. The majority (75%) needed admission to hospital for interventions including supplementary feeding, surgery, analgesia and blood products. The annual incidence of these complications affecting babies aged less than 1 year was 13.9/100,000; if extrapolated to UK births this would approximate to almost 1,000 cases per year.

It is shocking that any health practitioner would subject infants to a surgical procedure for which there is no scientific justification, particularly when there exists a tangible risk of harm and only wishful thinking that there will be any benefit.

[1] Complications following frenotomy for ankyloglossia; A 24-month prospective New Zealand Paediatric Surveillance study Hale M, Mills N, Edmonds L, Dawes P, Dickson N, Barker D, Wheeler B. JPaeds & Child Health 56 (2020); 557-562

Competing interests: No competing interests

09 December 2020
Paul A.J. Heaton
Consultant Paediatrician
Yeovil District Hospital
Higher Kingston, Yeovil BA21 4AT