A frenectomy is a minor surgical procedure designed to release a restrictive band of tissue in the mouth, often performed on infants and young children. This procedure resolves issues caused by a restrictive lingual or labial frenulum, commonly known as a tongue-tie or lip-tie. Because these anatomical variations interfere with essential functions like feeding and speech, this quick revision helps restore proper oral mobility and function.
The Anatomy: What is the Frenulum?
The frenulum is a small, ropelike fold of connective tissue that provides stability and support to the structures of the mouth. There are two primary types of frenulums relevant to this procedure. These tissues are found in every person, but their thickness and point of attachment vary widely.
The lingual frenulum is the thin strip of tissue that connects the underside of the tongue to the floor of the mouth. When this tissue is unusually short, thick, or tight, it restricts the tongue’s range of motion, a condition called ankyloglossia, or tongue-tie. This limitation can prevent the tongue from lifting or moving side-to-side correctly.
The labial frenulum connects the inside of the upper lip to the gum tissue, typically positioned between the two upper front teeth. A restrictive labial frenulum, often called a lip-tie, can hinder the upper lip from flanging outward sufficiently. Both a tongue-tie and a lip-tie can interfere with the coordinated movements required for proper oral function.
Recognizing the Need: Symptoms and Indications
The need for a frenectomy is determined by the functional problems caused by the restrictive tissue, not simply the presence of the frenulum itself. In infants, the most common indications relate to feeding difficulties and a subsequent failure to thrive. This can manifest as difficulty creating a proper seal or latch during breastfeeding, often accompanied by a distinct clicking sound during feeding.
For the mother, a baby with a tie can cause significant nipple pain or damage, and lead to complications like mastitis or blocked ducts because the breast is not being adequately drained. Signs that the infant is struggling include frequent, long feeding sessions, excessive fussiness, or falling asleep quickly due to fatigue without taking a full feed. These symptoms are often the first alert for parents to seek professional help.
As a child grows, the symptoms may shift to affect speech articulation, especially sounds requiring the tongue to elevate, such as “t,” “d,” “n,” and “l” sounds. Older children may also experience difficulty managing food in the mouth, like licking an ice cream cone or sweeping food debris from their teeth, which can compromise oral hygiene. A tight labial frenulum can also cause a noticeable gap between the front teeth or contribute to gum recession by pulling on the tissue. A diagnosis requires a functional assessment from a qualified professional rather than relying on visual inspection alone.
Who Performs the Procedure?
The question of who performs a frenectomy has several answers, as various specialists are qualified to perform this minor surgery. The most frequent providers are pediatric dentists, who specialize in children’s oral health and often use advanced laser technology for the procedure. Oral surgeons may be consulted for complex cases or when general anesthesia is required. Otolaryngologists (ENT specialists) also perform frenectomies, particularly when the restriction impacts breathing, swallowing, or speech development.
Lactation consultants play a supportive, non-surgical role by identifying functional issues and recommending a referral to a specialist. They are often the first professionals to recognize feeding problems associated with a tie and work with parents post-procedure to help the infant use their newly freed oral structures effectively.
The Procedure and Recovery Process
A frenectomy is a swift procedure, typically completed in just a few minutes, aiming to restore full mobility. The two main methods are the traditional approach with surgical scissors or a scalpel, or the increasingly common use of a soft-tissue laser. Laser ablation offers benefits such as minimal bleeding and a reduced need for sutures because the laser cauterizes the tissue while it cuts. Infants often receive only a topical numbing gel, while older children may receive a local anesthetic injection or light sedation. Immediately following the procedure, infants are encouraged to feed right away.
Post-procedure care is essential for a successful outcome and centers on preventing the surgical site from healing back together, a process known as reattachment. Parents are instructed to begin “stretching” or “active wound management exercises” within a day after the procedure. These exercises involve gently lifting the lip or sweeping a finger under the tongue to keep the wound open and prevent the edges from fusing prematurely. Stretches must be performed multiple times a day—often six times daily for the first two weeks—for a period of about four to six weeks. The wound site will initially form a white or yellowish scab, which is a normal part of healing. Pain management is typically handled with weight-appropriate doses of acetaminophen for the first 24 to 48 hours. Follow-up appointments with the provider and a lactation consultant or feeding therapist are recommended to ensure the child fully capitalizes on the restored mobility.