LINGUAL FRENOTOMY: CHANGES IN SUCKING AND SWALLOWING Irene Queiroz Marchesan, SLPs; Roberta Lopes de Castro Martinelli, SLPs; Reinaldo Jordão Gusmão, ENT INTRODUCTION Exclusive breastfeeding for 6 months has been recommended by the World Health Organization (WHO). Breast milk promotes sensory and cognitive development, and protects the infants against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. Ankyloglossia has been increasingly cited as a cause for breastfeeding difficulties, although with much controversy. Several studies have suggested an elective conduct, indicating frenotomy, taking into account maternal complaints and latch-on difficulties. In the literature, the relation between frenotomy and the functions of sucking and swallowing is not established. PURPOSE Identify changes in the functions of sucking and swallowing in infants after frenotomy. METHODS Approved by CEFAC Committee of Ethics in Research, No. 019-10. A prospective longitudinal study was carried out on full- term infants of both genders. The lingual frenulum protocol for infants, proposed by Martinelli et al (2012) was administered. 12 infants were diagnosed with ankyloglossia, being 10 males and 2 females. The parents were informed about the need for frenotomy. All surgeries were performed by an ENT. Immediately after frenotomy, infants were breastfed. Mothers reported presence or absence of pain, as well as possible differences in sucking. After 30 days, nutritive sucking was re-evaluated with the same protocol. Pre and post-surgical data were statistically analyzed by T Test. RESULTS Before frenotomy 5 infants had uncoordinated tongue movements, and all 12 had tongue cupping and strong sucks during non-nutritive sucking. During nutritive sucking, 4 infants showed frequent choking due to imprecise coordinating of suck-swallow-breathe. Table 1 Average number of suckings and pauses before and after frenotomy After frenotomy Immediately after frenotomy, mothers breastfed their children, and all reported pain absence and appropriated latch-on. In the re-evaluation, after 30 days, all mothers reported improvement in the feeding and sleeping cycles of infants. Post frenotomy data concerning nutritive sucking are described in Table 1. The 4 infants, who had frequent choking, were able to coordinate suck-swallow-breathe. Subjects Average number of pre-frenotomy suckings Average number of post-frenotomy suckings Average pre-frenotomy pauses (seconds) Average post-frenotomy pauses (seconds) S1 41 60.33 3.33 4.67 S2 15.33 51.67 5.67 4 S3 11 48 3 3.67 S4 24 48.33 5 S5 21.33 4.66 S6 47.33 66 S7 35 56.33 8.67 S8 16.33 S9 9.67 60 7.67 6 S10 12.33 56.67 S11 14.67 36.33 7 2.33 S12 50.33 10.33 2.67 p = 0.0000* p = 0,035419* CONCLUSION The functions of sucking and swallowing during breastfeeding improved after lingual frenotomy.