According to the limited research available, reattachment occurs in approximately 4% of frenotomy procedures.
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 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.
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 50% chance it will re-attach following a repeat procedure. One would also be expected to do deep 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 a 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 is impossible to assess the degree of re-attachment over the phone.
Reducing the risk of re-attachment and improving tongue mobility
In the first 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 15-20 minutes before the supplement is offered. I would also advise avoiding pacifiers/soothers for 5 days following the procedure.
There are also mobility and myofascial exercises which help encourage tongue movement and help to improve the tongue’s range of movement, and help to reduce re-attachment.
These exercises are easy to perform and are not traumatic.
I recommend performing the exercises 4 times daily.
Please click link below to view video to assist you with exercises.
Gentle massage of wound
There is no significant evidence at this time to suggest that wound massage will reduce the risk of re-attachment. I have consulted several experts from around the world who believe they have a 1-2% risk of re-attachment in infants that undergo post frenotomy wound massage. This is a reduction from 4% with no wound massage performed.
Some babies appear to tolerate wound massage while others do not.
I performed a frenotomy on my son who had an anterior tongue tie. He could not tolerate the wound massage. His frenulum re-attached to about 30%. He breastfed without difficulty but he did continue to suffer with reflux. The re-attachment may have contributed to this.
My daughter had a posterior tongue tie which I released. Again I was unable to perform the wound massage. She has perfect post procedure result with only 5% re-attachment and she had no feeding issues.
This is my personal experience that I felt I should share with parents. It not a clinically significant trial!
I advise attempting the wound massage and assessing how your baby responds. A reduction from 2% to 4% is significant but it does not guarantee that there will be no re-attachment.
After the procedure I will instruct you on how to perform a gentle wound massage. I do not advise on deep or aggressive stretching exercises which involve re-opening the wound.
If your baby tolerates the massage then I would advise performing the massage for 4 seconds, 4 times per day for 4 weeks.
There have been reported cases of bleeding which has occurred some time 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).