(304) Maxillary Frenotomy Relapse Rate is High

Introduction: The frequency of pediatric maxillary frenotomy has significantly increased in the last decade. Our purpose was to determine whether maxillary frenotomy results in a sustained change in the depth of insertion of the frenulum.

Methods: All children who visited a pediatric otolaryngology clinic between July 1 and December 1, 2022, had their maxillary frenulum scored using the Kotlow classification system. History of maxillary frenotomy, age, gender, and race were recorded.

Results: A total of 570 children were included, out of which 23 had undergone maxillary frenotomy. There was no significant difference in the Kotlow score between children who had undergone maxillary frenotomy and those who had not undergone the surgery (p=.81). Among unoperated children, 21 (4%) had a class 1 frenum, 127 (23%) had a class 2 frenum, and 262 (48%) had class 3 and 137 (25%) had class 4. Of the children who had undergone frenotomy, 3 (13%) had a class 1 frenum, 4 (17%) had a class 2 frenum, 10 (44%) had a class 3 frenum, and 6 (26%) had a class 4 frenum. Kotlow scores tended to decrease as the child’s age increased. The mean age of children with a class 1 frenum was 8.7 years, compared to 1.3 years for a class 4 frenum (p <.001).

Among the 513 unoperated children whose race was identified by their parent, class 1 frenulae occurred in 12 (27%) children who identified as Black/African American and 7 (1.5%) children who identified as Caucasian (p <.001). Of the 23 children who had undergone maxillary frenotomy, 20 (87%) were Caucasian and 3 (13%) were Hispanic.

Conclusions: At least one-quarter of children who undergo maxillary frenotomy still have a low-lying frenulum later in childhood. The results suggest a significant relapse rate with this procedure.