A frenectomy is a minor surgical procedure designed to release a frenulum, which is a small band of connective tissue in the mouth. In young children, this procedure is most commonly performed to address a restricted lingual frenulum, known as a tongue-tie (ankyloglossia), or a restricted labial frenulum, called a lip-tie. These restrictions can prevent the tongue or lip from moving through its full range of motion, potentially leading to functional difficulties. Releasing the tight tissue is a quick intervention performed to allow for improved mobility, often with the goal of supporting more effective feeding in infants.
Recognizing Symptoms of Restricted Frenulum
Parents and caregivers often seek professional help after noticing specific feeding challenges in their infant. A baby with a restricted frenulum may have difficulty achieving a deep latch during breastfeeding, often resulting in a painful or shallow suck. This mechanical issue can cause the infant to make clicking sounds or pop off the breast frequently, indicating an inability to maintain proper suction.
The baby’s restricted oral movement can also lead to symptoms such as poor weight gain, prolonged feeding times, and excessive gassiness or reflux-like symptoms due to the ingestion of too much air while struggling to feed. When the tongue is tethered, it may appear notched or heart-shaped when the child attempts to lift it or stick it out. For the breastfeeding parent, common signs that the baby may have a tie include nipple pain, cracked or damaged nipples, and a low milk supply due to ineffective milk transfer.
Professional Roles in Diagnosis
The journey to diagnosis typically involves a multidisciplinary team, starting with professionals who observe the infant’s function. Lactation consultants, especially International Board Certified Lactation Consultants (IBCLCs), are often the first to identify the signs of a restrictive frenulum because they specialize in assessing breastfeeding mechanics. They perform a functional assessment, observing the baby’s latch and suck, and evaluate whether the feeding difficulties persist despite attempts to improve positioning.
Pediatricians and primary care physicians play a role in the initial screening and physical examination of the infant, looking for visible signs of restriction. For a more definitive diagnosis, the child is often referred to a specialist trained in the surgical release. These specialists include pediatric dentists, Ear, Nose, and Throat (ENT) physicians (otolaryngologists), or oral surgeons. Diagnosis involves a physical assessment of the frenulum’s appearance and elasticity to grade the severity and impact on function.
Techniques Used in the Frenectomy Procedure
The decision to perform a frenectomy is made by a specialist, most often a pediatric dentist or ENT physician. The procedure itself is quick, typically lasting only a few minutes in an outpatient setting. For infants, general anesthesia is usually avoided; the area may be treated with a topical numbing agent or sometimes no anesthesia is used, given the speed of the intervention.
The two primary techniques utilized are the traditional surgical method and the laser method. The traditional method uses sterile surgical scissors or a scalpel to make a precise cut, releasing the tight tissue. This method is fast, but the vascular tissue can lead to immediate bleeding, which may obscure the site and risk an incomplete release.
The laser frenectomy, often performed with a CO2 or diode laser, has become increasingly favored due to its precision. The laser beam vaporizes the restrictive tissue and simultaneously cauterizes blood vessels, resulting in minimal bleeding. This hemostatic effect provides the practitioner with a clear view, allowing for a more complete release of the tethered fibers. The laser method may also reduce post-procedure discomfort and the risk of infection.
Post-Procedure Care and Expected Outcomes
Immediate post-procedure care focuses on ensuring comfort and preventing the surgical site from healing back together. Parents are typically advised to manage discomfort with over-the-counter pain relievers, such as baby acetaminophen, if recommended by the provider. The most crucial element of aftercare is wound management, which involves a specific regimen of stretching exercises.
These stretches are designed to keep the “diamond-shaped” wound site open and prevent the rapid reattachment of tissue, which is the primary risk following the procedure. Parents must gently lift the lip and the tongue several times a day for three to six weeks to encourage a functional healing pattern. The exercises are not meant to be forceful but should be firm enough to stretch the newly released tissue.
In terms of functional outcomes, some infants show an immediate improvement in their latch and feeding ability. However, for many, the full benefit may take days or weeks as the infant learns to use their newly mobile tongue and lip muscles. Follow-up appointments with the diagnosing professional, such as a lactation consultant, are recommended to ensure the infant utilizes the improved range of motion effectively for better feeding success.