A frenotomy or frenectomy is a procedure that consists of releasing the frenum under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) and/or a lip-tie, causing restrictions in movement of the tongue or lip. These restrictions can cause difficulty with breastfeeding or other health problems such as dental decay, misaligned spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue laser.
Many mothers are told, or mistakenly assume, that there is something wrong with them if they cannot successfully breastfeed. In fact, this is often not true. Infants may be born with a combination of limiting conditions called a tongue-tie (ankyloglossia) and/or a lip-tie that can complicate efforts to breastfeed.
Tongue-ties are normally straightforward to diagnose and fairly easy to treat: the tongue is heart-shaped when the baby cries, and there is an obviously tight frenulum underneath that runs from the floor of the mouth to an area close to the tip of the tongue. Tongue-ties can vary in severity and can include what we call “posterior tongue-tie,” which is much more difficult to diagnose and recognize. In such a case, the frenulum looks nonexistent, making it appear tongue-tie cannot be the issue. Instead, the tongue looks squared off, with the floor of the mouth webbing/tenting the tongue. The edges of the tongue form a cup when the infant cries, as it is unable to elevate, and the tongue will twist rather than move side to side. Most notably, the tongue absolutely cannot stick out when the mouth is wide open (even if it can stick out somewhat when the mouth is partially open), which is the ideal position for breastfeeding.
Post-procedure stretches are key to getting an optimum result. The mouth tends to heal so quickly that the frenum may prematurely reattach, causing a new limitation and/or the persistence or return of symptoms. Because wounds tend to contract towards their center as healing occurs and raw wound surfaces in the mouth in close proximity will tend to reattach, it is important to keep them stretched open.
As you undertake these exercises, it is important to remember to stay relaxed, smiling, and positive. You should show your baby or child that the activity is nothing to be fearful about. The exercises are not meant to be forceful or prolonged. Stretching exercises with quick and precise movements are best. A small amount of spotting or bleeding is common while doing the exercises, especially in the first few days.
The upper lip is the easier of the 2 possible frenectomy sites to stretch. If you are doing both lip and tongue, start with the lip. Place your clean finger under the lip and move it up as high as it will go, until you feel resistance. Then gently sweep from side to side for several seconds. Remember, the goal is to open the opposing surfaces of the lip and gum so they cannot stick together.
Insert index finger under the tongue and lift it towards the roof of the baby’s mouth. The tongue needs three separate stretching motions to keep the diamond-shaped wound from reattaching before it heals:
Once you are under the tongue, pick up the posterior part of the tongue as high as it will go towards the palate. Hold it there for 3 seconds, relax, and do it again. The goal is to completely unfold the diamond so that you can see it all completely. The fold of the diamond across the middle is the first place it will reattach.
Place your finger in the middle of the diamond and do a gentle circular stretch for several seconds to dilate or open up the diamond.
Turn your finger sideways and do a rolling pin motion to try and keep the diamond as deep as possible. Start at the fold “center” of the diamond and move to either side of the diamond top and bottom to loosen up the muscles of the tongue and floor of the mouth.