A frenectomy is a swift, minor surgical procedure designed to alleviate restrictions caused by a tight band of tissue within the mouth called the frenulum. When the frenulum is unusually short or thick, it limits mobility. The procedure releases this restrictive tissue to restore normal function, allowing the tongue or lip to move freely. This supports the proper mechanics required for effective nursing or bottle feeding.
Understanding Tongue and Lip Ties
A frenectomy is necessary when a baby presents with a restrictive frenulum, commonly referred to as a “tie.” The two primary conditions are Ankyloglossia (tongue-tie) and a restrictive labial frenulum (lip-tie). Ankyloglossia involves an overly tight lingual frenulum tethering the underside of the tongue, inhibiting elevation and extension. A lip-tie involves the labial frenulum connecting the upper lip too tightly to the gum line, preventing the lip from flanging out properly during feeding.
These restrictions affect a baby’s ability to feed efficiently. Symptoms include a poor latch, clicking sounds during nursing, prolonged feeding times, and poor weight gain. Mothers may also experience nipple pain or recurrent issues like mastitis due to the shallow latch. Diagnosis is made through a functional assessment, observing feeding patterns, and a visual examination of the frenulum to check for limited range of motion.
The Frenectomy Procedure
The frenectomy procedure itself is a straightforward intervention where the restrictive frenulum is released to allow for full range of motion. The two main techniques used for infants are the traditional scissors or scalpel method and the laser frenectomy.
Scissors or Scalpel Method
The scissors technique involves a quick snip of the tissue, often using a topical or local anesthetic. This method is fast and does not require specialized equipment. However, it may result in more immediate bleeding and potentially a higher risk of reattachment if the cut is not deep enough.
Laser Frenectomy
A laser frenectomy, often using a CO2 laser, is gaining preference due to its precision and cauterizing properties. The concentrated light beam releases the tissue while simultaneously sealing blood vessels and nerve endings. This results in minimal bleeding during the procedure and reduced post-operative discomfort.
Both methods are extremely quick, typically lasting only a few seconds to minutes, and are performed in an outpatient setting with minimal or topical anesthesia. The procedure is commonly performed by trained practitioners such as pediatric dentists, oral surgeons, or Ear, Nose, and Throat (ENT) physicians, often in collaboration with a lactation consultant.
Recovery and Post-Care Essentials
The immediate period following a frenectomy is characterized by rapid healing and the adjustment to new oral mobility. Post-procedure stretching exercises, also known as wound management, are a crucial component of recovery to prevent the raw surfaces from reattaching as they heal. Parents are typically instructed to perform these gentle stretches every few hours for the first two weeks, often 5 to 6 times per day, to keep the surgical site open.
The wound typically heals within a few days to one week. It is normal for the area to turn white, yellow, or grey as it heals; this is not pus or infection, but a protective fibrin layer. While some babies show immediate improvement in feeding mechanics, others require several days or weeks of practice and coordination to fully utilize their newfound mobility. Parents should contact their provider immediately if they observe warning signs such as a persistent fever, excessive bleeding, or a complete refusal to feed.