WHAT IS A FRENECTOMY?

Frenectomy is a procedure used to correct a congenital condition when the lingual (tongue) or labial (lip) frenulum is tight resulting in restriction of function potentially resulting in difficulty breastfeeding and other concerns such as dental, digestive and speech issues. If your lactation consultant or doctor feels that this procedure is warranted, then the following is what you can expect.

 

LIP TIE

A tight upper lip frenum attachment may compromise full lip flanging and appear as a tight, tense upper lip during nursing. This can result in a shallow latch during breastfeeding. Additionally, the tight, tense upper lip during nursing can result in decalcification and dental decay when the milk is not cleaned off these areas. This same issue can occur with bottle-feeding. If the frenum attaches close to the ridge or into the palate a future diastema (gap between the teeth) can also occur.

 

TONGUE TIE

A tight lower tongue frenum attachment may restrict the mobility of the tongue and appear as a cupping or heart shaped tongue when elevated. This can result in an inability to get the tongue under the nipple to create a suction to draw out milk. Long term tongue tie can result in speech problems and / or issues later with transferring food around the mouth for chewing. Approximately 3-5% of the population presents with this symptom.

 

SYMPTOMS

Some babies can have ties and not be symptomatic. To know if the ties are a problem we ask two major questions: “Is the baby getting enough to eat?” and “Is nursing comfortable for the mother?” Symptoms can be as follows:

 
- Poor Latch                                         

- Creased, cracked, bruised or blistered nipples
- Bleeding nipples                                

- Slides off nipple or falls asleep while attempting to latch
- Colic symptoms                                  

- Incomplete breast drainage
- Infected breast drainage
- Reflux symptoms                                 
- Plugged ducts
- Poor weight gain                                  

- Continuous feedings                           

- Mastitis (inflammation of the breast)

- Gumming or chewing of the nipple      

- Nipple thrush
- Unable to take a pacifier or bottle

PROCEDURE

The procedure is tolerated very well by babies and we try to ensure that discomfort is minimized. A light Scalpel CO, laser is used to detach and “vaporize” the frenum. It is common for babies to cry and/ or act fussy during and after the procedure. While your baby is treated in our Frenectomy suite, our staff will swaddle and hold the baby. Please feel free to nurse, bottle –feed and/ or cuddle your baby, depending on your preference after the procedure. Tylenol is recommended one hour prior to procedure.

 AFTER THE PROCEDURE

The main complication after the procedure is that due to the rapid healing capability of the mouth, the healing site may want to re-attach. Therefore, it is highly recommended that you follow the guidelines listed on stretching exercises for your baby. Failure to stretch with the pressure and frequency that Dr. Dias demonstrates may lead to re-attachment.

Wash your hands very well prior to performing the stretches. You may consider vitamin E, coconut oil and breast milk to aid in the stretches due to its slippery nature and anti-bacterial properties. Rest baby on your lap with his/her head closest to your hips. You can make these exercises fun if you sing a song or play when stretching. Please ensure the stretches happen as prescribed and that caretakers are proficient at stretching as well. If you are unable to perform stretches or caretakers are unable to do so, you may want to consider scheduling when proper care is available.

1.) Lift the upper lip to the nose pressing the finger until resistance is met then wiggle side to side (back and forth=1, repeat five times).

2.) Press the tongue up to the palate (not back into the throat area) with one index finger and with the other index finger, roll into the deep fibers of the fold like a “rolling pin” (up and down=1, repeat five times)

3.) Rub the gum line of the infant to encourage their tongue to follow your finger.



Perform these stretches prior to feeding at least six times a day for two weeks. Dr. Dias recommends following up with our office and/ or your lactation consultant within two weeks. A white or yellow patch around the lasered area is normal and this is the clotting material in the mouth. Keep the area stretched and mobile until all the white is replaced by pink tissue.

It is normal and expected for babies to be fussy. Most babies are fussy for 2 days, others fussy for 5 days, others are not fussy at all. Some babies may go on a “feeding strike” and this may last 5-6 hours. We understand this is a scary experience, but stay calm for your baby and focus on nurturing them through this time. If they refuse breast and/or bottle, try syringe feeding.