What is a Frenectomy?
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 best way to prepare for the procedure is to have the medications that you will need on hand so you can focus on your child following the procedure. None of these need to be given prior to the procedure.
Tylenol – Dosage: Use the dropper in the manufacturer’s packaging. This can be given every 6-8 hours after the procedure.
- 6-11 pounds – 1.25 ml
- 12-17 pounds – 2.5 ml
- 18-23 pounds – 3.75 ml
- 21-35 pounds – 5 ml
*Arnica (Montana 30X) – for those who prefer homeopathic remedies.
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 laser safety regulations, parents are not allowed in the treatment room during the procedure. I will carry your baby to and from the room, and the approximate time away from you is about 5 – 10 minutes. The actual time of lasering is 10-15 seconds.
- 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.
- 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.
There are two important concepts to understand about oral wounds:
1: Any open oral wound likes to contract towards the center of that wound as it is healing (hence the need to keep it dilated open). If you have two raw surfaces in the mouth in close proximity, they will reattach.
2: The post-procedure stretches/exercises are keys to getting an optimal result. These stretches are NOT meant to be forceful or prolonged. It is best to be quick and precise with your movements. I feel that getting an affordable LED headlight (like a camping headlight) allows you to get the best results. ( a video can be watched for post procedure stretches and exercise at our website www.toothtoothtooth.com)
The main risk of frenotomy is that the mouth heals so quickly that it may prematurely reattach at either the tongue site or the lip site, causing a new limitation in mobility and the persistence or return of the symptoms. The exercises demonstrated here are best done with the baby placed in your lap (or lying on a bed) with the feet going away from you.
A small amount of spotting or bleeding is common after the procedure, especially in the first few days. Because a laser is being used, bleeding is minimized, wash your hands well prior to your stretches (gloves aren’t necessary).
Do one stretch on the evening of surgery. Then, skip ahead to the next morning (keep in mind that this is the only time that you should skip the overnight stretch). My recommendation is that stretches be done 6x/day for the first three week, and then spending the 4th week quickly tapering from 6 to 5 to 4 to 3 to 2 to 1 per day before quitting completely at the end of the 4th week. I find it easiest for parents to do 5 of the stretches during their waking hours and one of those stretches in the middle of the night, taking care to not go more than 6 hours between stretches.
Stretches: The Upper Lip
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 crying.
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 1-2 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 can’t stick together.
Stretches: The Tongue
The 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 baby’s mouth. The tongue needs three separate stretching motions:
1: 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 and then relax. The goal is to completely unfold the diamond so that its almost flat in orientation (remember, the fold of the diamond across the middle is the first place it will reattach). The key to the success of this stretch Is that your fingers are placed deep enough prior to lifting the tongue up. Picture how a forklift works; if you don’t get the forklift tines completely under the pallet, lifting the pallet up will cause it to tip backwards. If you get the tines completely under the pallet, you can lift the pallet straight up. I recommend placing your fingers on either side of the diamond and pushing into the sides of the diamond before lifting up on the tongue. To make the stretch effective make sure the tongue goes up and not backwards.
2: With one finger propping up the tongue, place your other finger in the middle of the diamond and turn your finger sideways and use a lifting motion from front to back to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across the diamond.
3: Once it’s done, repeat the motion on either side of the diamond (outside the diamond) to loosen up the musculature of the remainder of the floor of mouth.
It’s important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. The following exercises are simple and can be done to improve suck quality.
1: Slowly rub the lower gum line from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
2: Let your child suck on your finger and do a tug-of-war slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
3: Let your child suck your finger and apply gentle pressure to the palate, and then roll your finger over and gently press down on the tongue and stroke the middle of the tongue.
Soothing Baby – After the procedure your baby will be a little fussy/cranky; its best to try what some techniques that can help him/her soothe. Here are some techniques that you can try to soothe your crying/ fussy baby:
Swaddling – as we know, babies like to feel as if they’re back in the womb. Swaddling helps achieve this sensation by helping your baby feel warm, secure and by keeping her little arms in place.
Infant Massage – you don’t need to have specific technique or be skilled in massage therapy to be effective at infant massage. Whether it’s the gentle pressure or simply human contact. Gently rubbing baby arms, legs and tummy can temporary provide some needed relief.
Skin-to-Skin Contact – Particularly effective with newborns, having some skin to skin contact can help comfort and calm your baby.
Bath Time – Warm baths can actually calm a baby. Make sure water is the optimal temperature, too cold and he’ll scream even louder. If he still doesn’t like the tub, try getting in with him and see if that helps.
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.
Call our office if you think an infection exists.