A frenulotomy is a straightforward surgical procedure designed to release a frenulum, which is a small, restrictive fold of tissue. This tissue naturally connects various parts of the body, such as the tongue to the floor of the mouth or the lip to the gum. When a frenulum is unusually short or tight, it can restrict movement, and a frenulotomy serves to alleviate this limitation. The procedure involves making a precise incision in this tissue to improve mobility.
Indications for a Frenulotomy
The primary reason a frenulotomy is performed, particularly in infants, is a condition called ankyloglossia, commonly known as “tongue-tie.” This occurs when the lingual frenulum, the tissue connecting the underside of the tongue to the bottom of the mouth, is too short, thick, or extends too far to the tip of the tongue. A similar restriction can affect the upper lip, referred to as a lip-tie, where the labial frenulum attaches the inside of the upper lip too tightly to the gum tissue.
For infants, these restrictions can lead to a range of feeding difficulties. Babies with tongue-tie may struggle with latching onto the breast or bottle, often resulting in clicking sounds during feeding as they lose suction. This can contribute to poor weight gain or falling off their growth curve, and swallowing excessive air might cause gassiness or fussiness.
Mothers who are breastfeeding may also experience symptoms due to their infant’s tongue or lip-tie. These can include nipple pain, cracking, or bleeding as the baby struggles to achieve an effective latch. Recurrent mastitis or blocked milk ducts can also occur, indicating insufficient milk removal from the breast. Beyond infancy, an uncorrected tongue-tie can sometimes affect speech development or cause dental issues, such as gaps between the front teeth or gum recession.
The Frenulotomy Procedure
A frenulotomy is a quick, in-office procedure, completed within a few minutes. For infants, general anesthesia is not required; a topical numbing agent may be applied, or no anesthesia is used, as the tissue has minimal nerve endings and blood flow. The baby is swaddled and gently held to keep them still during the procedure.
The procedure involves either sterile surgical scissors or a soft tissue laser to release the frenulum. When using scissors, the practitioner carefully snips the restrictive tissue. Laser frenulotomy employs a concentrated beam of light to vaporize the tissue, which also helps to cauterize blood vessels, minimizing bleeding and reducing discomfort. Both methods aim to free the restricted movement. Healthcare professionals who perform this procedure include ear, nose, and throat (ENT) specialists, pediatric dentists, and pediatricians.
Post-Procedure Care and Healing
Following a frenulotomy, aftercare is necessary to ensure proper healing and prevent the reattachment of the released frenulum. A small amount of bleeding or spotting may occur in the first few days, particularly if the treated area is bumped. Applying gentle pressure with a clean, damp gauze pad can help manage this. Infants may be fussy for a few days, and pain relief, such as infant acetaminophen, can be administered as advised by a healthcare provider.
Post-procedure care involves performing regular stretching exercises. These stretches are designed to keep the wound open and prevent the raw surfaces from reattaching as they heal. For a tongue-tie release, gently lift the tongue towards the roof of the mouth and sweep under the tongue to maintain the depth and width of the diamond-shaped wound created by the procedure. For a lip-tie, the upper lip is gently lifted high towards the nose to ensure the space between the lip and gum remains open. These exercises are performed multiple times a day for several weeks, for three to six weeks, as directed by the practitioner.
As the area heals, a white or yellowish diamond-shaped patch may form under the tongue or lip, which is a normal part of the healing process and not a sign of infection. Improvements in feeding and other symptoms can be noticed within days or weeks, though continued practice and support from lactation consultants can further enhance outcomes.