A lip tie (restrictive labial frenulum) occurs when the thin band of tissue connecting the upper lip to the gum line is too tight or short. This restriction limits the upper lip’s range of motion, which is necessary for proper oral function. When this restriction creates challenges, particularly in infancy with establishing an effective latch during feeding, a minor surgical procedure called a frenectomy may be recommended. Releasing this tissue aims to restore full lip mobility, supporting better nutrition, oral hygiene, and jaw development.
Qualified Medical Professionals Who Perform Frenectomies
The decision of which specialist performs a frenectomy is based on the provider’s specific training, preferred technique, and the patient’s age. The procedure is performed by professionals with advanced training in oral and maxillofacial structures, who have distinct focuses that guide their approach to diagnosing and treating a restrictive labial frenulum.
Pediatric Dentists
Pediatric Dentists frequently perform frenecties, specializing in the oral health and development of children. Many pediatric dental offices are equipped with advanced soft-tissue lasers, allowing them to perform the release in a minimally invasive manner. Their expertise centers on the oral cavity, making them skilled in evaluating the functional impact of the frenulum on feeding and dental health. They often work collaboratively with lactation consultants and other feeding therapists.
Oral Surgeons
Oral Surgeons (Oral and Maxillofacial Surgeons) are qualified to perform the procedure, often dealing with complex surgical cases involving the mouth and jaw. They may be consulted when the frenulum is particularly thick, or if the case involves scar tissue from a previous, unsuccessful release. Oral surgeons possess extensive training in surgical techniques, including both traditional scalpel and advanced laser methods.
Otolaryngologists
Otolaryngologists (ENTs) represent a third group of medical doctors who perform frenectomies. Their specialization covers the entire head and neck region, providing a broader perspective on how the restriction may affect breathing, sleep, and overall airway function. While many ENTs utilize laser technology, their practice scope extends beyond the oral cavity, benefiting cases with co-existing airway issues.
Surgical Techniques Used for Lip Tie Correction
The release of a restrictive labial frenulum is accomplished through one of two primary surgical approaches: the traditional method or the laser method. The choice of technique impacts the procedure time, the need for anesthesia, and the post-operative recovery experience. Both methods aim to fully release the restrictive tissue to maximize lip movement.
The traditional method
The traditional method involves using sterile surgical instruments, such as a scalpel, surgical scissors, or electrocautery, to cut the frenulum. When scissors or a scalpel are used, the procedure requires local anesthesia to manage discomfort. Due to the highly vascular nature of the tissue, this approach often results in more bleeding and may necessitate sutures to close the wound and control blood loss.
A laser frenectomy
A laser frenectomy utilizes specialized dental lasers (such as CO2 or diode lasers) to precisely vaporize the restrictive tissue. The laser provides simultaneous hemostasis, sealing the blood vessels as it cuts, which minimizes bleeding. This precise technique reduces discomfort, swelling, and the need for sutures, leading to a faster recovery time compared to the traditional scalpel method. The procedure is often completed in minutes and may not require general anesthesia, especially in young infants.
Essential Post-Surgical Care and Wound Management
The success of a frenectomy relies on meticulous post-operative care provided by the caregiver to prevent the tissue from reattaching. The primary complication is re-adhesion, where the wound edges stick back together during the initial healing phase. The site of the release appears as a small, diamond-shaped wound that normally turns white or yellowish within a few days, indicating normal healing granulation tissue.
Specific wound management exercises
Specific wound management exercises, often referred to as stretches, are performed multiple times daily to keep the surgical site open and promote healing in a lengthened state. Caregivers are instructed to perform these stretches three to five times per day for two to six weeks. For the upper lip, the exercise involves gently lifting the lip high toward the nose, fully exposing the surgical diamond, and holding the stretch for five seconds.
Pain management
Pain management is important during the first 24 to 48 hours following the procedure, and may involve administering infant acetaminophen every four to six hours as directed by the provider. Offering frequent feedings (which serve as a form of functional exercise) and providing comforting skin-to-skin contact can help soothe the infant. Consistent follow-up with a lactation consultant or feeding therapist is recommended to help the infant use their newly freed oral structures effectively for feeding.