FRENECTOMY

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 upper lip may trap milk, resulting in constant contact of the milk to the front teeth. This can result in decalcification and dental decay can develop when the milk is not cleaned off of 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 cupping or a heart shaped tongue when the tongue is elevated. This can result in an inability to get the tongue under the nipple to create a suction to draw out milk. Long term a 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 condition.

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
  • Slides off nipple or falls asleep while attempting to latch
  • Colic symptoms
  • Reflux symptoms
  • Poor weight gain
  • Continuous feedings
  • Gumming or chewing of the nipple
  • Unable to take a pacifier or bottle
  • Creased, cracked, bruised or blistered nipples
  • Bleeding nipples
  • Incomplete breast drainage
  • Infected nipples or breasts
  • Plugged ducts
  • Mastitis (inflammation of the breast
  • Nipple thrush

PROCEDURE

Babies tolerate the procedure very well and we try to ensure that discomfort is minimized. A topical numbing gel is placed on the frenulum for frenectomies (an incision of the frenulum attachment) and a very small amount of local anesthetic may be injected for frenectomies (frenulum tissue removal).

It is common for babies to cry and/ or act fussy during and after the procedure. Babies typically lose only a small amount of blood, if any at all. Once baby is numb, they are treated in our laser treatment room and immediately returned to you. Please feel free to nurse, bottle-feed and/ or cuddle your baby, depending on your preference. Note that it is common for babies to drool after the procedure until the numbing dissipates.

Dr. Abramczyk recommends Hyland’s Teething Gel and any natural remedies you prefer (Arnica, Rescue Remedy, etc.)

Your baby may have brown spit ups or stools after the procedure if he or she swallows blood after the procedure.

AFTER THE PROCEDURE

A possible complication after the procedure is that due to the rapid healing capability of the mouth, the healing site may want to reattach. Therefore, it is recommend that you follow the guidelines listed on stretching exercises for your baby.

  • Wash your hands very well prior to performing the stretches. 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.
  • Lift the upper lip to the nose pressing the finger until resistance is met then wiggle side-to-side.
  • Press the tongue up with one index finger and with the other index finger roll into the deep fibers of the fold like a “rolling pin”.
  • Rub the gum line of the infant to encourage their tongue to follow your finger.
  • Let baby suck your finger and play “tug-of-war” to build strength.
  • Gently press the palate, roll the finger over and gently stroke the middle of your baby’s tongue.

Perform these stretches on day 1 at dinner then four times a day for 3 weeks. Then three times a day for a week, two times a day for a week, then one time a day for a week. Dr. Abramczyk recommends following up with your lactation consultant within a week and as well as a Cranial Sacral Therapist. A white patch around the treated 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.

ALTERNATIVE TREATMENTS

The alternative to laser treatment includes scalpel surgery using local anesthesia and/or sedation. The other alternative is to do no treatment. No treatment could result in some or all of the conditions listed under “Symptoms” above. Advantages (benefits) of laser vs. scalpel or scissors include lower probability of re-healing, less bleeding, no sutures (stitches) or having to remove sutures. Disadvantages (risks) are included in the “Risks of Procedure” below.

RISKS OF PROCEDURE

While the majority of patients have an uneventful surgery/procedure and recovery, a few cases may be associated with complications. There are some risks/complications, which can include:

  • Bleeding. This may occur either at the time of the procedure or in the first 2 weeks after.
  • Infection.
  • Pain.
  • Damage to sublingual gland, which sits below the tongue. This may require further surgery.
  • Injury to the teeth, lip, gums, or tongue.
  • Burns from the equipment.
  • The frenum can heal back and require further surgery.
  • Swelling and inflammation, especially of upper lip.
  • Scarring is rare but possible.
  • Eye damage if baby looks directly into the laser beam. Complete eye protection is mandatory and will be worn by baby and staff.

Frenectomy Pre-Op and Post-Op Instructions

Please watch this video prior to your appointment with Dr Abramczyk

Post Frenectomy Daily Stretches

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