Kitsap Tongue-Tie Center
What is a Frenectomy?
A frenotomy of frenectomy is a procedure that consists of releasing the frenum under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) and/or a lip-tie causing restrictions in movement that can cause difficulty with breastfeeding, and in some instances, other health problems like dental decay or spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue laser.
Lip Tie
A tight upper lip frenum attachment may compromise lip flanging and may appear as a tight, tense upper lip during nursing or bottle feeding. This can result in a shallow latch during breastfeeding, resulting in nipple pain for the mother and excessive air intake for the child.
Tongue Tie
A tight lower tongue frenum attachment may restrict the mobility of the tongue and may or may not appear as a cupping or heart shaped tongue when the tongue is elevated. This can result in an inability to get the tongue under the nipple to create a suction to draw out milk. Long term, a tongue tie can result in speech problems, airway and palatal development issues and/or dental issues.
Symptoms and Assessment
Everyone has a frenum, but not every frenum is a “tie”. To know if a frenum is a problem, a physical and functional assessment must be completed. In breastfeeding families, both mother and baby must be assessed. Symptoms may include the following:
- Poor latch (breast or bottle)
- Leakage of milk from the mouth while eating
- Slides off nipple or falls asleep while attempting to latch
- Colic symptoms
- Reflux symptoms
- Poor weight gain
- Extended/continuous feedings
- Gumming or chewing of the nipple
- Thin smile/curled lip
- Creased, cracked, bruised or blistered nipples
- Bleeding nipples
- Incomplete breast drainage
- Infected nipples or breasts
- Plugged ducts
- Mastitis (inflammation of the breast Nipple thrush)
- Unable to take a pacifier or bottle
Procedure
Addressing a tight frenulum is simple in children less than 9 months old. Older children and some very strong infants may require the use of sedation. The procedure itself takes less than a minute for each frenum. Dr. Banks uses a laser that cuts and seals the tissues resulting in very little or no bleeding. We start by administering sugar water, Tylenol and using a specially compounded topical anesthetic (“numbing jelly”) on the frenum. After the numbing jelly is placed, the baby is swaddled and placed in our dental chair while being stabilized by a Dental Assistant to minimize movement during the procedure. Then the laser procedure is completed and cold wet gauze is immediately placed on the site. The baby and mom are left in the examination room to nurse or soothe. Babies will typically cry during the procedure but they are soothed almost immediately afterward. Parents and visitors are not allowed in the room during the procedure due to laser safety regulations.
Alternative Treatments
The alternative to laser treatment includes scalpel or scissor surgery using local anesthesia and/or sedation. The other alternative is to do no treatment. No treatment could result in some or all of the conditions listed under “Symptoms” above. Advantages (benefits) of laser versus scalpel/scissors include less bleeding and no sutures (stitches) or having to remove sutures. Disadvantages (risks) are included in the “Risks of Procedure” below.
Risks of Procedure
While the majority of patients have an uneventful procedure and recovery, a few cases may be associated with complications, which may include:
- Reattachment of the frenum requiring additional or repeated surgical procedures (this is the most common complication)
- Bleeding either at the time of the procedure or in the first 2 weeks after.
- Infection
- Pain
- Fussiness
- Damage to or infection of the sublingual gland, which sits below the tongue and which may require further surgery
- Temporary or permanent nerve damage
- Refusal to feed (nursing strike or bottle refusal)
- Impact on speech
- Lack of improvement
- Injury to the teeth, lip, gums, or tongue
- Alterations in child’s smile, including increased show of upper gums when smiling (for lip tie release)
- Burns from the equipment
- Swelling and inflammation, especially of upper lip
- Scarring
- Eye damage if baby looks directly into the laser beam (eye protection is always used)
- Inability to complete procedure (children who are too strong/resistant may need to be referred for sedation)
Post Op Instructions
Following the procedure, breastfeeding and bottle feeding will have to be retrained, so it may be difficult at first. Helpful supplies to have on hand include coconut oil and any post op pain management supplies including Tylenol, Ibuprofen or homeopathic remedies. Keeping the lip and tongue mobile is important during the healing time. Complete the wound care described on the post-op care handout you are given every 4 hours for the directed amount of time. A white/yellow patch around the treated area is normal. This is how the mouth forms a “scab”. Keep the area mobile until all the white is replaced by pink tissue. Many families find that “body work” by an experienced chiropractor, craniosacral therapist or physical therapist is critical to achieving successful results. A scheduled visit with your lactation consultant is recommended closely following the procedure.