A frenotomy is a minor surgical procedure designed to release a frenulum, a small fold of connective tissue that can restrict movement in the mouth. These bands of tissue are found under the tongue and inside the upper and lower lips. When a frenulum is unusually short or tight, it can limit the normal range of motion of the tongue or lips. The procedure corrects this by cutting or modifying the restrictive tissue to improve function.
Reasons for a Frenotomy
A frenotomy is often recommended when a restrictive frenulum, a condition known as ankyloglossia or tongue-tie, causes significant difficulties, particularly for infants. Feeding challenges are a primary concern, as a tight lingual (tongue) frenulum can prevent a baby from latching onto the breast properly. This can result in a shallow latch, causing nipple soreness for the nursing parent and inefficient milk transfer for the baby. Inadequate milk intake can lead to poor weight gain and may cause the infant to swallow more air, resulting in gassiness and discomfort.
Parents and lactation consultants may notice specific signs during feeding that point to a restrictive frenulum. These can include a clicking sound as the baby loses suction, fatigue during nursing, or fussiness at the breast. The tongue’s limited movement can hinder the baby’s ability to create the necessary vacuum to draw milk. In some cases, a tight labial (lip) frenulum can also interfere with a proper seal, further complicating feeding.
While feeding issues are the most immediate reason for a frenotomy in infants, a restrictive frenulum can sometimes be associated with other challenges as a child grows. These may include difficulties with moving food around the mouth when starting solids, potential issues with dental spacing such as a gap between the front teeth, or challenges with speech articulation. However, research has not definitively linked tongue-tie to speech disorders, and speech therapy is often a more appropriate intervention for older children. The decision to proceed is based on current functional problems rather than preventing potential future ones.
The Frenotomy Procedure
A frenotomy is a quick and straightforward procedure, often performed in an office setting by a trained professional like a pediatric dentist, an ear, nose, and throat (ENT) specialist, or a physician. Releasing the tissue usually lasts less than a minute. Parents are present and may be encouraged to feed their baby immediately afterward to provide comfort and help stop any minor bleeding.
Two common methods are used to perform a frenotomy: sterile scissors or a soft-tissue laser. A laser frenectomy has become popular due to its precision and tendency to cause minimal bleeding.
For very young infants, pain management is minimal because the frenulum has few nerve endings. A topical anesthetic or numbing gel is often applied to the area just before the procedure. For newborns, no anesthetic may be used at all. The discomfort is brief, and any crying typically subsides once the baby begins to feed.
Recovery and Aftercare
Following the procedure, the recovery period is quick, with the site often healing within one to two weeks. Immediately after the frenotomy, there might be a small amount of bleeding, but this usually stops once the infant starts feeding. Over the first week, it is normal for a white or yellowish patch to form over the treated area; this is a sign of healing and not an infection.
To ensure the tissue does not reattach as it heals, parents are instructed to perform specific post-procedure stretches. These exercises involve gently lifting the tongue or lip to separate the healing surfaces. Your provider will give detailed instructions on how and when to perform these stretches.
Parents should monitor the site for any signs of infection, such as significant swelling or persistent bleeding, although such complications are rare. Mild discomfort may be present for a few days but resolves quickly. Some parents report an immediate improvement in feeding, while for others, the improvement may be more gradual as the baby learns to use their newly mobile tongue.
Non-Surgical Management
Several non-surgical management options can be explored, either before surgery or as a complementary approach. Working with an International Board Certified Lactation Consultant (IBCLC) is often a first step for infants experiencing feeding difficulties. An IBCLC can provide specialized support with breastfeeding positions and latch techniques that may help compensate for a restrictive frenulum.
In addition to lactation support, some parents seek out other therapies to address oral function and tension. Oral motor therapy, provided by speech-language pathologists or occupational therapists, can include exercises to strengthen the tongue and improve coordination.
Another avenue is myofunctional therapy, which involves specific exercises to correct tongue posture and oral habits. These approaches can be effective alternatives or adjuncts to a frenotomy, depending on the severity of the restriction and the specific challenges being faced.