Frenotomy

Frenotomy is a surgery used to correct a congenital condition in which the lingual (tongue) or labial (lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding and, in some instances, other health concerns like dental, digestive and speech issues. When it affects the lingual frenulum, this condition is commonly called a tongue tie. Approximately 3-5% of the population has this condition. If your lactation consultant or doctor feels that a procedure is warranted, here is what you can expect.

What to Expect

In general, the procedure is very well tolerated by babies. We take every measure to ensure that pain is minimized.

  1. For a typical frenotomy (an incision of the frenulum), a topical numbing gel is applied once or twice and occasionally, if a frenectomy (frenulum tissue is removed) is needed, a small amount of local anesthetic may be injected.
  2. Crying and fussiness are quite common, and most children lose only a small amount of blood if any at all. Once numb, they are briefly treated in our laser treatment room, and then immediately brought back to you, where you have the option of immediate breastfeeding, bottle feeding or soothing depending on your preference. They will frequently drool afterward until the numbing medicine wears off.
  3. Tylenol may be used afterward but is often not even needed. Other helpful supplies to have on hand include Hyland's Teething Gel and any homeopathic remedies you want (Rescue Remedy, arnica, etc).
  4. You may notice some dark brown stools or spit-ups afterward as some blood may get swallowed after the procedure.

What to Do Afterwards

The main risk of a frenotomy or frenectomy is the fact that the mouth heals so quickly and the incision site may want to reattach. Here are some basic stretches and massage exercises to do after the procedure.

These exercises are often easiest if the infant is placed on your lap facing away from you so both your hands can be free. Just spend a short amount of time doing these exercises. Numbers 1 and 2 are essential but the rest of the exercises can be done when the infant is quiet and alert as a fun interactive time for both parent and baby.

  1. Lift the lip up towards the nose and roll your finger over the incision site like a “rolling pin”.
  2. Push the tongue up with two fingers and roll under the tongue like a “rolling pin”.
  3. Rub the gum line, the infant will follow your finger with their tongue.
  4. Let the infant suck on your finger and do a little “tug-o-war” to help the tongue strengthen.
  5. Let the infant suck your finger and apply gentle pressure to the palate then roll finger over and gently stroke the middle of the infant’s tongue.

Aim for repeating them 4-6 times a day for 3-4 weeks after the procedure. As the incision site heals it may look like a white or yellowish coating has formed; that is normal and does not indicate infection. Occasionally, more specific oral motor work is needed so it is essential that you continue to follow-up with your lactation consultant after the procedure to ensure optimal results.