Tongue/Lip Tie

A consult with an IBCLC (International Board Certified Lactation Consultant) will be required prior to scheduling for possible infant frenotomies.

Frenotomy

Everyone has a small strand of tissue, called a frenum, which connects the tongue to the floor of the mouth, and the lips to the gums. Most of the time frenums do not cause any problems. In a small percentage of the population a frenum can be too tight or thick which can inhibit the lips and/or tongue from proper function. This can lead to difficulty with nursing, speaking, and can affect the development of the mouth. These restrictions are known as lip and tongue ties (ankyloglossia). A frenotomy is the procedure to remove this excess tissue and allow full oral function.

Symptoms

When a lip and/or tongue tie is present, the infant tries to accommodate by creating the latch with the lips only, or is unable to latch at all. What follows is a painful process where the mother and infant are unable to enjoy a happy and healthy breastfeeding relationship. Infants and nursing mothers may experience any of the following symptoms:

Baby’s Symptoms

Poor latch
Falls asleep while attempting to nurse
Slides off the nipple when attempting to latch
Colic Symptoms
Reflux symptoms
Poor weight gain
Gumming or chewing of nipple when nursing
Unable to hold a pacifier in his/her mouth
Short sleep episodes requiring feeding every 2-3 hours

Mother’s Symptoms

Creased, flattened or blanched nipples after nursing
Cracked, bruised or blistered nipples
Bleeding Nipples
Severe pain when you infant attempts to latch
Poor or incomplete breast drainage
Infected nipples or breasts
Plugged ducts
Mastitis or nipple thrush

Due to the impact these symptoms can have on the relationship between mother and baby, we strive to make time available so we can see you promptly, if not same day.

The following video is a great visual of the ways lip and tongue ties can inhibit breastfeeding. Without full flexibility of the lip, babies are unable to properly flange it around the breast. Without the ability to fully lift the tongue to the palate, babies are unable to successfully expel and transfer milk.

Procedure

General anesthesia is not utilized in the office and is almost never needed to perform the procedure.
Due to laser safety regulations, parents are not allowed in the treatment room during the procedure. We will carry your baby to and from the room, and the approximate time away from you is about 3 minutes. The actual time of lasering is 15-30 seconds.
For babies under the age of 12 months, a topical numbing cream may be applied to the area(s) that will be treated. This medication works very quickly.
For children 12 months of age or older, numbing cream is applied. In some instances, an injected local anesthetic may be applied for additional anesthesia.
Crying and fussing are common during and after the procedure.
You may breastfeed, bottle-feed, or soothe your baby in any manner you'd like following the procedure. You may stay as long as necessary.
We recommend you follow-up with your lactation specialist after the procedure.
A follow up appointment should be made with our office 1-2 weeks after the frenectomy.

Aftercare

We feel that post-procedure stretches are key to getting an optimal result.

Please click the following link for more detailed pictures and videos demonstrating these stretches and proper wound healing: Dr. Ghaheri Aftercare

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.

Other helpful suggestions:

It is normal for swelling to occur in the lasered areas. This will usually go down after about a day and a half.
The baby can be fussy the afternoon and evening following the procedure and may not nurse as much. This is normal and will subside.
You may administer Infant’s TYLENOL if needed.
- 6-11 lbs – 1.25 ml (1/4 tsp)
- 12-17 lbs – 2.5 ml (1/2 tsp)
If the lip is bumped the area may bleed a small amount. It should stop on its own.
Stretching Information: Perform these stretches before every time you nurse. You may skip stretches at the night feedings. Very Important, can determine the success of surgery.
- Wash your hands thoroughly.
Containing your babies’ hands will help as you perform the stretches. You may swaddle the baby, tuck each arm under each of your legs, or have someone hold your babies’ hands.
Place the baby’s head in your lap to aid in proper direction and force.
The stretching process should not take more than 15-20 seconds.
- For the lip : lift the lip up to full extension with mild to moderate force. You want to see the entire lasered area.
- For the tongue : lift the tongue up from the sides to the full extension with mild to moderate force. You may use your fingers or q-tips. You want to see the entire lasered area.
There are generally no breastfeeding restrictions after a frenotomy; you are free to nurse your baby as often as she/he needs to nurse. Some babies will immediately have a corrected latch after frenotomy, some may need some time to learn how to nurse effectively with their tongue’s (or lip’s) newfound range of motion. Be patient; you both are learning a new skill and it may still take some practice to master the skill of breastfeeding. We recommend you continue working with your lactation consultant.