What is a Frenotomy?
A frenotomy or frenectomy is a procedure used to correct a congenital condition in which the lingual (tongue) or labial (upper lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding, and in some instances, other health problems like dental decay or spacing, speech difficulties and digestive issues. When it affects the lingual frenulum, this condition is commonly called a tongue tie (the medical term is ankyloglossia). Approximately 5% of the population has this condition, so your lactation consultant or doctor may feel that a procedure is warranted to improve symptoms.
How to prepare for the procedure
The use of Tylenol 30-60 minutes prior to the procedure can help to minimize discomfort.
Dosage: Using the dropper in the manufactures packaging:
- 6-11 pounds – 1.25mL
- 12-17 pounds – 2.5mL
- 18-23 pounds – 3.75mL
- 24-35 pounds – 5.0mL
For children 6 months of age or older, you may use ibuprofen instead (or with Tylenol). Please follow the dosing instructions on the package.
You may use whatever works for your family. This includes homeopathic remedies like arnica or Rescue Remedy, or nothing at all. Because numbing medicine is used during the procedure not everyone needs a medication beforehand.
What to expect
In general, the procedure is very well-tolerated by children. We take every measure to ensure that pain and stress during the procedure is minimized.
- General anesthesia is not utilized in the office and is almost never needed to perform the procedure.
- Due to safety regulations with the surgery and use of laser, parents are not allowed in the treatment room during the procedure. I will carry your baby to the room, and the approximate time away from you is about 10 minutes. Once we are done with the procedure we will bring you back to the treatment room to be with your baby / child.
- For babies under the age of 12 months, a topical numbing cream is applied to the area(s) that will be treated. This medication works very quickly.
- For children 12 months of age or older, numbing cream is applied. In some instances, an injected local anesthetic may be applied for additional anesthesia.
- Crying and fussing are common during and after the procedure.
- You may breastfeed, bottle-feed, or soothe your baby in any manner you’d like following the procedure. You may stay as long as necessary.
Why does tongue tie pose a problem in breastfeeding?
As simple as it sounds, breastfeed for the baby is quite a workout! Babies with ties of upper lip and tongue have to work harder and many times adapt to obtain milk.
During breastfeeding the babies tongue has to be able to perform a complex type of sucking (notice the normal tongue position for breastfeeding seen below).
A baby with a tongue-tie finds it difficult and many times impossible to move the tongue up, down and out, which is needed in order to nurse (compare pictures below – notice the pink tongue position in the different nursing scenarios).
Post Op Instructions
A small amount of spotting or bleeding is common after the procedure, especially in the first few days.
The upper lip is the easier of the 2 sites to stretch. If you must stretch both sites, I recommend that you start with the lip. Typically, babies don’t like either of the stretches and may cry, so starting with the lip allows you to get under the tongue easier once the baby starts to cry. For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). Then gently sweep from side to side for a several seconds. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they do not stick together.
The tongue should be your next area to stretch. Insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers to dive under the tongue and pick it up, towards the roof of the baby’s mouth. The tongue needs three separate stretching motions:
- Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby’s mouth). Hold it there for 1-2 seconds, relax and do it once more. The goal is to completely un-fold the released tissue attachment from the procedure.
- With one finger propping up the tongue, place your other finger in the middle of the surgical site and do a gentle circular stretch for several seconds to dilate the area.
- Once that is done, turn your finger sideways and use a roller pin motion to try and keep the surgical site as deep as possible. Once it’s done, repeat the motion on the other side.
Most babies experience only minimal discomfort after the procedure, and breastfeeding provides natural pain relief. If your baby seems uncomfortable Tylenol (acetaminophen) can be given to help with the discomfort.
Call our office for any of the following:
- Uncontrolled bleeding
- Refusal to nurse or take bottle
- Fever > 101.5
Starting several days after the procedure, the wound(s) will look white and/or yellow and will look very similar to pus. This is a completely normal inflammatory response. Do not let your child’s regular doctor, lactation consultant, friend who thinks they’re an expert, or anyone else worry you about this normal healing process. If you think and infection exists give our office a call at (719) 424-4668.
We Can Help
At Kids Rock Pediatric Dentistry you will find the most up to date technology with the use of the Biolase laser for the frenotomy procedures. This laser provides a faster procedure and a shorter recovery. Please call the office at (719) 424-4668 if you have any questions or would like to schedule a consultation.