The Frenotomy Procedure

The procedure to divide a baby’s Tongue-Tie is called a Frenotomy. A small piece of tissue under the baby’s tongue is divided to enable optimum tongue movement and function, to help mother and baby to breastfeed more effectively. Please note that I only treat babies up to 12 months old.

I perform the procedure on the same day as the assessment if we feel a frenotomy is clinically indicated and worthwhile for your baby.

Preparation

Babies need to be hungry at the time of the procedure to encourage immediate breastfeeding afterwards. This helps to soothe and comfort your baby. In babies over 3 months old I recommend giving the relevant dose of paracetamol suspension at one hour before the procedure. I feel analgesia pre-procedure will help to relieve potential discomfort. For babies under 12 weeks old the analgesia is the sucrose and other sugars in breastmilk.

Assessment

During the consultation we discuss your babies feeding history in detail and any other concerns you may have. I perform a physical assessment of the appearance and function of the tongue-tie. We then discuss the risks and benefits of the procedure in each particular case. The intended benefits of frenotomy are improved tongue mobility and as a consequence hopefully an improvement in feeding for both mother and baby and elimination of the risk of tongue related speech issues.

Understanding the Risks

Bleeding

A small amount of bleeding post division is common and to be expected. Allowing the baby to feed treats this best, as feeding will compress the floor of the mouth. There is a 1:300 chance of a minor bleed which may require pressure with a gauze for up to 5-10 minutes. There is a 1:10,000 chance of continued bleeding after this. There are certain contra-indications to having a frenotomy i.e. surgery should not be used because it may be harmful to the baby.

Family history of bleeding disorder e.g. Haemophilia, Von Willebrand’s Disease.

If your child did not receive Vitamin K at birth.

Infection

As for any surgical procedure there is a low risk of infection. I use only sterile disposable instruments. The risk of infection is approximately 1:10,000.

Reattachment

The frenotomy results in a diamond shaped wound underneath the tongue. The normal healing of tissue in the mouth may result in the wound sticking back together. The resulting scar may cause a recurrence. There appears to be a higher rate of recurrence in posterior tongue-ties.

The Procedure

The baby is wrapped or swaddled in a blanket to aid the assistant in keeping the baby still, the assistant holds the baby’s head still with the chin to chest. The instruments used are sterile and single use. The tongue is elevated to enable a clear view of the procedure site. The frenulum is then divided usually with one snip using barely open blunt tipped curved strabismus scissors. The procedure is then completed by using closed scissors or blunt dissection using a finger. Gauze is applied to the wound and the baby is taken immediately back to the mother for immediate breastfeeding.

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