Immediate aftercare

It is important that your baby is breast or bottle fed after the procedure. This helps your baby relax. The procedure is not very traumatic. The babies reaction is similar to receiving a vaccination. They recover very quickly. Natural sugars in milk and being in their parents arms will help with recovery.

The first 24 hours

Occasionally the are reports of babies being a little irritable in the first 24 hours. Please continue to feed your baby as normal. This irritability settles. One can consider giving paractemol (calpol) to babies over 2 months old if you feel your baby is experiencing discomfort.

Wound massage

Currently there is divided opinion regarding wound stretching and massage as to whether it is worthwhile in preventing reattachment. There is no significant clinical evidence to support wound massage to prevent reattachment. The anecdotal evidence suggests an overall reattachment rate of 4% post frenotomy, with a reduction to 2% with wound massage.

I will often advise on wound massage when I feel there is a higher risk of clinically significant re-attachment.

When advised I recommend massaging the wound 3 times per day for 3 weeks. I recommend commencing the wound care after 24 hours. The massage involves direct circular pressure following by vertical linear pressure on wound site. This is followed by gently pushing the tongue backwards. The three motions should take about 20-30 seconds. One can use coconut oil to moisten the wound site before the massage.

Infection

Infection is very rare. Some studies suggest and infection rate of 1 in 10,000 while other studies report no infections associated with tongue release. . An infection would present as redness or swelling underneath the tongue at the wound site. Your child may have an associated fever. An infection is treated with an antibiotic. The antibiotic of choice would be flucloxacillin 125mg/5ml QDS for 1 week.

Reattachment

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 in some amount of reattachment.

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.

If you have any further queries regarding reattachments 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 reattachment over the phone.