Re-attachment
Reattachment occurs in approximately 1 in 20 cases of posterior tongue tie and in 1 in 40 cases of anterior tongue tie. I have outlined exercises and a gentle wound massage below that help to reduce the risk of re-attachment.
The frenotomy procedure involves dividing the frenulum tissue and leaving behind an open wound where the tongue meets the floor of the mouth. This wound heals over a 2-3 week period. The wound will fills with granulation tissue which is tissue involved in the healing process. This tissue has a yellow/white appearance. The healing process will always result is some amount of re-attachment.
The aim of the exercises and massage are to help avoid what I call a ‘clinically significant’ re-attachment. A clinically significant re-attachment will reveal itself by the return of breastfeeding difficulties that were present before the procedure. This usually occurs at around 2-3 weeks after the procedure.
Should one get a repeat division of the re-attached clinically significant tongue tie?
Unfortunately if a tongue tie has re-attached once there is a 1 in 2 chance it will re-attach following a repeat procedure. One would also be expected to do a deeper wound massage during the aftercare to reduce the chance of further re-attachment. This deeper wound massage is very difficult to do and most parents struggle to do it as it causes l lot of distress for babies and parents.
Overall I do not recommend repeat divisions for the above reasons. I am happy to reassess re-attachments and I would consider repeat frenotomy for certain cases.
If you have any further queries regarding re-attachments or you would like a reassessment then I would advise one to book an appointment at the clinic as it impossible to assess the degree of re-attachment over the phone.
Reducing the risk of re-attachment and improving tongue mobility
Regular breastfeeding
In the 5 days following the procedure it is especially important that the baby is breastfed 2-3 hourly during the course of each 24 hours. This often means waking the baby to ensure that they feed, if they are having supplements by syringe or bottle, it is important to ensure that they are breastfed for at least 15-20minutes before the supplement is offered.
Exercises
There are also mobility exercises which help encourage tongue movement and help to improve range of tongue movement.
Please click link below to view video to assist you with exercises.
Gentle massage of wound
I recommend gentle massage of the wound site for 5 seconds 4-6 times per day for 4 weeks. I will instruct how to perform this massage during the consultation. It involves light pressure on the wound site.
This video will repeat some of the mobility exercises but it will also guide you with performing the wound massage.
Bleeding
There have been reported cases of bleeding which has occurred sometime after tongue-tie division, usually on the same day, when the babies have returned home. If this occurs the bleeding is usually very light and is triggered by strenuous crying ( resulting in the tongue lifting and disturbing the wound) or when the wound is disturbed during feeding, particularly if the wound is caught by a bottle teat or tip of a nipple shield.
- If you notice any blood in your baby’s mouth then offer the baby the breast or bottle and feed them. This will usually stop the bleeding within a few minutes just as it did immediately after the procedure. If the baby refuses to feed then sucking on a dummy/pacifier or your clean finger will have a similar effect.
- If the bleeding is very heavy or does not reduce with feeding and stop within 15 minutes then apply pressure to the wound under the tongue with one finger using a clean piece of gauze or muslin for 5 minutes. Do not apply pressure under the baby’s chin as this can affect breathing.
- If bleeding continues after this time continue to apply pressure to the wound and take your baby to hospital (call an ambulance if you live more than a very short distance from the Accident and Emergency Department).