Tongue-Tie children with a severe Hazelbaker score or difficult breastfeeding greatly benefit from frenotomy or frenuloplasty with/without anaesthesia - First do or do no harm?

Tongue-tie (ankyloglossia) is a relatively common congenital anomaly characterised by an abnormally short lingual fraenulum, causing limitation of tongue mobility. There have been immense controversies regarding diagnosis, clinical significance and management of such condition hitherto. Although most tongue-tie babies are asymptomatic without feeding difficulties, operative corrections may be necessary in some cases to improve their breastfeeding. Using a meta-narrative reviewing study design, the aim of this concise review was to demonstrate the current evidences for surgical indications, optimal type and timing, and functional improvement from tongue-tie surgery. We reviewed and discussed the included evidences based on five topics: (1) basic sciences, (2) clinical equipoise, (3) anaesthesia during childhood, (4) evidence-based practice and surgical meta-analyses, and (5) appropriate patient assessment in routine paediatric practice.