Comparative Effectiveness of Myofunctional Therapy and Breastfeeding Education for Ankyloglossia: A Randomized Controlled Trial

Background: While breastfeeding support and feeding therapy are first-line interventions for ankyloglossia, specific oral-motor protocols, often categorized as passive Myofunctional Therapy (MFT), have mainly been studied as an adjunct to surgery. Evidence on their effectiveness as a primary conservative approach in infants remains limited, highlighting the need for randomized controlled trials. Research Aim: To compare the effectiveness of an infant-appropriate oral-motor MFT protocol on lingual frenulum function, breastfeeding establishment, and nipple pain, compared with breastfeeding education (BE) in infants with ankyloglossia. Methods: This two-arm, single-blind randomized trial (July–November 2023) assigned 200 infants to passive MFT (oral-motor stretches and massages; n = 100) or BE ( n = 100) for 1 month. The primary outcomes were lingual frenulum function (Assessment Tool for Lingual Frenulum Function, ATLFF), and breastfeeding establishment (LATCH scale). Maternal nipple pain (Visual Analogue Scale, VAS) was the secondary outcome. Results: No significant differences were found in ATLFF-Appearance scores pre- and post-intervention ( p = 0.28, p = 0.42). Post-intervention, the MFT group showed higher ATLFF-Function scores ( r = 0.33; p < 0.001), lower maternal nipple pain ( r = -0.38; p < 0.001), and higher LATCH scores ( r = 0.26; p < 0.001). Infants receiving MFT were more likely to avoid surgery ( OR = 4.63; p = 0.005), particularly with higher LATCH ( OR = 2.74; p < 0.001) and ATLFF-Function scores (OR= 1.83; p < 0.001). Conclusion: An infant-appropriate MFT protocol based on passive oral-motor techniques significantly improved tongue function, breastfeeding establishment, and reduced nipple pain, with a higher likelihood of avoiding surgery compared to BE.