The Procedure

This is a straight forward low risk procedure called a frenulotomy. A frenulotomy can be done without the need for anesthesia for an infant under the age of 6 months. For children older than that, it is usually done under general anesthesia in a same-day surgery facility.

Make sure baby was not fed for at least an hour before the procedure. Immediately after the procedure your baby needs to feed in the privacy of the rooms. This will ensure your little one is hungry to feed and will have forgotten about the possible discomfort of the procedure within the first few gulps. Be prepared to experience your best feed ever.

Post Operative Instructions

THERE ARE TWO IMPORTANT CONCEPTS TO UNDERSTAND ABOUT ORAL WOUNDS:
1.) Any open oral wound likes to contract towards the center of that wound as it is healing (hence the need to keep it dilated open).
2.) If you have two raw surfaces in the mouth in close proximity, they will reattach.

Post-procedure stretches are key to getting an optimal result. These stretches are NOT meant to be forceful or prolonged. It's best to be quick and precise with your movements. The main risk of a frenotomy is that the mouth heals so quickly that it may prematurely reattach at either the tongue site or the lip site, causing a new limitation in mobility and the persistence or return of symptoms. The exercises demonstrated below are best done with the baby placed in your lap (or lying on a bed) with the feet going away from you.

The procedure involves holding the tongue up towards the roof of the mouth to make the frenulum taut, then cutting through the white, fascia-like tissue along a line parallel with, and fairly close to, the tongue. The cut is made in a single motion in less than a second. The only risk is excessive bleeding. But normally, there is only a drop of blood or less.

STRETCHES
A small amount of spotting or bleeding is common after the procedure, especially in the first few days. Wash your hands well prior to your stretches (gloves aren't necessary). Apply a small amount of the teething gel to your finger prior to your stretches.

Stretches can be done 6 times a day for the first 3 weeks, and then spending the 4th week quickly tapering from 6 to 5 to 4 to 3 to 2 to 1 per day before quitting completely at the end of the 4th week. Parents can do 5 of the stretches during their waking hours and one of those stretches in the middle of the night, taking care to not go more than 6 hours between stretches.

The Upper Lip is the easier of the 2 sites to stretch. If you must stretch both sites, start with the lip. Typically, babies don't like either of the stretches and may cry, so starting with the lip allows you to get under the tongue easier once the baby starts to cry. For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). Then gently sweep from side to side for 1-2 seconds. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can't stick together.

THE TONGUE SHOULD BE YOUR NEXT AREA TO STRETCH
Insert both index fingers into the mouth and under the tongue. Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby's mouth). Hold it there for 1-2 seconds and then relax. The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up.

With one finger propping up the tongue, place your other finger in the middle of the diamond and turn your finger sideways and use a lifting motion from front to back to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across that diamond. Make sure your finger starts within the diamond when doing this stretch. Once it's done, repeat the motion on either side of the diamond (outside the diamond) to loosen up the musculature of the remainder of the floor of mouth.

SUCKING EXERCISES
It's important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises.

1.) Slowly rub the lower gumline from side to side and your baby's tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
2.) Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
3.) Let your child suck your finger and apply gentle pressure to the palate, and then roll your finger over and gently press down on the tongue and stroke the middle of the tongue.

WOUND HEALING
Starting several days after the procedure, the wound(s) will look white and/or yellow. This is a completely normal inflammatory response and is the start of tissue granulation. Do not let your child's regular doctor, lactation consultant, friend who thinks they're an expert, or anyone else make the determination for you. If you think an infection exists, give our office a call.

It is essential that you follow-up with your lactation consultant after the procedure to ensure optimal results.
CALL US FOR ANY OF THE FOLLOWING:
Uncontrolled bleeding
Refusal to nurse or take a bottle
Fever