Readhesion of Tongue-Tie Following Neonatal Frenotomy: Incidence and Impact of Postoperative Exercises in a Prospective Observational Study

<b>Background/Objectives:</b> Frenotomy is the procedure of choice for treating ankyloglossia. The literature reports that readhesion of the frenulum occurs in 2.6-13% of cases. There is no published evidence to support performing tongue exercises to prevent it. We aimed to determine the readhesion rate of ankyloglossia, the benefits of tongue exercises to prevent it, and the characteristics of patients who experienced readhesion. <b>Methods</b>: This is a prospective, observational study of neonates who underwent a frenotomy between January and August 2024. Following the frenotomy, we recommended that all parents perform a series of exercises 6-8 times daily over 15 days. Patients were re-evaluated 10-15 days post-procedure for signs of ankyloglossia using the Hazelbaker tool and clinical variables such as nipple pain or cracks. <b>Results</b>: We enrolled 212 patients; thirty patients underwent a refrenotomy (14.1%). The raw risk of readhesion in our study was 0.335 (95%CI 0.275-0.401), and for symptomatic readhesion, 0.156 (95%CI 0.113-0.211). Adjusted by sex, the risk of readhesion for female patients was 0.236 (95%CI 0.155-0.344), and for males, 0.390 (95%CI 0.312-0.474). The appearance and function Hazelbaker scores were significantly lower before the frenotomy than post-procedure in all cases. In females, not following the exercise protocol multiplied the risk of readhesion by 1.61 (95%CI 1.03-2.56), whereas in males the risk was multiplied by 1.47 (95%CI 1.03-2.08). Symptomatic readhesion was significantly correlated with age at frenotomy and Hazelbaker score. <b>Conclusions:</b> Readhesion of tongue-tie was higher than previously published (33.5%); however, symptomatic readhesion was less frequent (15.6%). Proper adherence to post-frenotomy exercises significantly reduces the risk of readhesion, although it has less impact on symptomatic readhesion.