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, restricted airway and speech issues. If your lactation consultant or doctor feels that this procedure is warranted, then the following is what you can expect.
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 diatom (gap between the teeth) can also occur.
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.
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 in the neonate 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
Symptoms in the early child to adulthood may include:
- Speech issues
- Feeding issues (gagging, texture issues, difficulty licking ice cream cone)
- Difficulty moving food in the mouth or clearing food from upper back molars
- Open mouth posture
- Forward head posture
- TMJ or TMD
- Malocclusion or crowded teeth
- Snoring or loudly breathing when sleeping
- Mouth breathing
- Periodontal disease
- High risk of cavities
- Allergies/ sinusitis
- ADHD or behavioral issues
- Dark circles under eyes
- Teeth grinding
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 (a laser removal of the frenulum attachment) and a very small amount of local anesthetic may be injected for frenectomies in older patients.
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. Once we return your baby 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 recommended that you follow the oral myology stretching exercises that our Certified Oral Myology Specialist customizes for your baby.
Wash your hands very well prior to performing the stretches. Short fingernails are a must. Rest baby on your lap or changing table, with his/ her head closest to your hips. Dr. Abramczyk recommends stretching using coconut oil infused with Calendula for wound management.
Perform these stretches on day 1 at dinner then six times a day for 3 weeks. Then five times a day for a week, four times a day for a week, then three times a day for a week. Continuing to decrease each week until one time daily. We do recommend continuing with stretching one time daily for one year based upon research that has shown oral wound healing up to one year. Dr. Abramczyk recommends following up with your lactation consultant within two days and as well as a Cranial Sacral Therapist. Stretches are of the upmost importance and a frenectomy procedure should not be performed if parents are not committed to getting the appropriate amount of stretches in daily. A white or yellow patch around the treated area is normal and this is the clotting material in the mouth. Keep the area stretched and mobile while the white is replaced by pink tissue and continue for one year. A new frenum will form; however, this does NOT indicate reattachment unless there is an impedance of function.
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-attachment, better visibility due to 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.
- 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. This can be reduced by doing the stretches the way we instruct, eliminating inflammatory foods and environmental markers, doing consistent and effective bodywork, wearing baby, tummy time, avoiding containers as much as possible, such as carseats, bumbo, swings or any item that puts the baby in a flexed state.
- Eye damage if baby looks directly into the laser beam. Complete eye protection is mandatory and will be worn by baby and staff.
PREPARING FOR THE PROCEDURE
- We require an IBCLC (International Board Certified Lactation Report) prior to releasing a breastfeeding baby.
- We require an SLP (Speech and Language Pathologist) report or similar trained expert to release a patient with feeding or speech issues.
- We require the Vitamin K injection on infants under 1 year of age based on the science and literature.