Ankyloglossia, commonly known as a tongue tie, is a congenital condition where an unusually short, thick, or tight band of tissue, called the lingual frenulum, tethers the underside of the tongue’s tip to the floor of the mouth. This restriction in movement can interfere with an infant’s ability to latch effectively for feeding, leading to difficulties for both the baby and the parent. To correct this, healthcare providers often recommend a minor surgical procedure known as a frenotomy or frenulectomy, which improves tongue mobility and resolves issues like poor weight gain or maternal nipple discomfort.
Managing Discomfort During the Procedure
The question of whether the procedure is painful is understandable, and the sensation varies depending on the patient’s age and the technique used. In newborns and young infants, the procedure is often performed without traditional injectable anesthetics because the lingual frenulum contains few nerve endings and blood vessels. Instead, non-pharmacological comfort measures are prioritized.
A common technique involves administering a sweetened solution, like oral sucrose or cold breast milk, just before the release, which provides a temporary analgesic effect. The procedure itself is extremely fast, often lasting only a few seconds. Immediate skin-to-skin contact and feeding right after the release are powerful tools for soothing the infant.
For older infants, children, or adults, where the frenulum tissue may be thicker, a local anesthetic is frequently used. The provider may apply a topical numbing gel or cream before administering a small injection to ensure the area is desensitized. This local numbing ensures that the patient feels pressure rather than pain during the actual release.
What Happens During the Frenotomy
A frenotomy is typically performed in a clinician’s office, a hospital nursery, or a specialized dental clinic, rather than a formal operating room. For infants, the process begins with the child being swaddled and gently but firmly restrained to ensure their safety and immobility during the brief procedure. The provider carefully lifts the tongue to make the tight frenulum visible.
The release is performed using sterile, sharp scissors, a scalpel, or a soft-tissue laser, each method designed to divide the restrictive tissue. The traditional scissor method is often the quickest, while a laser may offer the benefit of cauterizing the tissue as it cuts, which can minimize bleeding. Regardless of the instrument, the goal is to create a clean, diamond-shaped wound that allows for immediate, improved tongue mobility.
Minimal bleeding is generally expected, often just a drop or two of blood, which typically stops almost immediately, especially once the infant is placed at the breast or given a bottle. Once the frenulum is released, the provider will assess the new range of motion before the patient is discharged.
Post-Procedure Care and Healing
Post-operative care is a structured process that significantly influences the success of the procedure, focusing on managing discomfort and preventing tissue reattachment. The incision site will be sore for the first 24 to 48 hours, and parents should anticipate some fussiness during this period. Discomfort can be managed by administering over-the-counter pain relievers, such as weight-appropriate doses of acetaminophen for infants under six months or ibuprofen for those over six months, as recommended by a healthcare provider.
The healing site will develop a distinct appearance, often forming a white, yellow, or grayish diamond-shaped patch within the first day. This is not a sign of infection but rather a protective scab that forms naturally as the oral mucosa heals, and it may take two to four weeks to fully resolve.
The most important component of the recovery phase is the performance of wound management exercises, often referred to as stretches. These stretches are designed to keep the released tissue separated and prevent the raw edges from fusing back together, a process known as reattachment. Parents are typically instructed to perform these gentle, specific exercises three to five times a day for several weeks, often before or after a feeding.
The technique involves using a clean finger to gently lift the tongue toward the roof of the mouth and massage the floor of the mouth where the diamond-shaped wound is located. If the stretches are neglected, the risk of the frenulum re-growing to a restrictive length increases, which may necessitate a repeat procedure. Parents should monitor the site for signs that warrant a call to the provider, such as excessive, non-stop bleeding, a spreading redness or swelling around the wound, or a high fever.