A frenectomy is a minor surgical procedure involving the quick release of a restrictive band of tissue called the frenulum. This tissue connects the tongue to the floor of the mouth (lingual frenulum) or the upper lip to the gum (labial frenulum). When these tissues are unusually short or tight, they severely restrict movement, a condition known as “tongue-tie” (ankyloglossia) or “lip-tie.” For infants, a frenectomy addresses feeding difficulties caused by this limited mobility, which prevents a proper latch during nursing or bottle feeding. Releasing this tethered tissue restores full function, allowing the baby to feed more effectively.
Recognizing When a Frenectomy is Necessary
The decision to pursue a frenectomy typically arises from persistent feeding issues, with symptoms presenting in both the baby and the parent. In infants, signs of a restrictive frenulum include difficulty achieving a deep latch, extended feeding times that drain the baby’s energy, or a characteristic clicking sound during sucking. Poor weight gain, excessive gassiness, and frequent fussiness are also common indicators resulting from ineffective milk transfer. These functional limitations signal that the tongue or lip movement is inadequate for creating the necessary suction and compression.
For the breastfeeding parent, symptoms are usually physical and related to trauma or inefficient milk removal. These manifest as significant nipple pain, nipple blanching, or damage such as cracking and bleeding due to a shallow latch. Ineffective milk removal can lead to secondary issues like recurrent blocked milk ducts or mastitis, and a decrease in the overall milk supply.
There are two main types of tongue-tie. An anterior tongue-tie is easily visible, extending toward the tip of the tongue and often resulting in a heart-shaped appearance when the baby cries. In contrast, a posterior tongue-tie is submucosal and less obvious, located deeper beneath the mucous membrane at the base of the tongue. This posterior tie significantly limits the back-and-forth and lifting motions necessary for efficient sucking and is often diagnosed based primarily on functional symptoms rather than visual inspection.
How the Procedure is Performed
A frenectomy for an infant is a very fast procedure, often completed in seconds, and is usually performed without the need for general anesthesia. The goal is to precisely release the restrictive tissue to maximize the functional range of motion. For pain management, a topical anesthetic gel is typically applied to the area before the release.
The procedure uses one of two primary methods: traditional surgical scissors or a soft-tissue laser. The traditional method involves using a scalpel or sterile scissors to snip the frenulum. This method may involve more bleeding and occasionally requires sutures, leading to potentially increased post-operative discomfort.
The preferred method, especially for infants, involves a specialized laser. This device uses a concentrated beam of light to vaporize the tissue with high precision. A primary benefit of the laser is that it cauterizes the blood vessels as it cuts, which minimizes bleeding and reduces the risk of infection. The laser technique typically results in less post-procedure swelling and discomfort, often eliminating the need for stitches entirely and facilitating a quicker return to feeding immediately after the release.
Choosing the Right Specialist and Care Setting
Finding the right professional is important, as the success of the frenectomy depends on the skill of the practitioner and the comprehensive care model provided. The procedure is performed by specialists trained in diagnosing and treating tethered oral tissues. These providers include:
- Pediatric Dentists
- Otolaryngologists (ENTs)
- Oral Surgeons
Pediatric Dentists frequently specialize in the laser frenectomy technique and operate in a dedicated office setting. Otolaryngologists and Oral Surgeons also perform the procedure, sometimes utilizing the traditional surgical method, and may work in an outpatient clinic or hospital setting. For infants, the procedure is almost always an in-office appointment.
Consultation with an International Board Certified Lactation Consultant (IBCLC) is an important step before and after the procedure. The IBCLC is often the first to identify functional limitations and recommend a referral. They provide crucial pre-operative counseling and post-operative support, helping the baby learn how to use their newly freed oral structures for efficient feeding. A multidisciplinary team approach can significantly improve the overall outcome.
Post-Procedure Recovery and Functional Improvement
Recovery from an infant frenectomy is generally rapid due to the quick healing time of oral tissues. Immediately following the procedure, the release site will appear as a small, diamond-shaped wound that often turns white or yellowish as it heals over the next few days. Minimal discomfort is common, and parents can usually manage this with comfort measures like holding or nursing immediately after the release.
To ensure a successful long-term result, the most important element of aftercare is the consistent performance of post-operative stretching exercises, sometimes called wound management. The mouth heals quickly, and there is a risk of the tissue reattaching, which would limit mobility again. These stretches are non-forceful, brief movements of the lip and tongue performed multiple times a day for several weeks to keep the wound open and flexible.
Functional improvement is often a gradual process, as the baby must learn new muscle patterns. While some mothers report an immediate improvement in latch, full functional gains may take two to four weeks. Continued support from a Lactation Consultant is necessary during this time to help the baby retrain their sucking motion and maximize the release’s benefits.