What Is a Frenulotomy?

Ankyloglossia Corrective Surgery

Frenulum Linguae
Frenulum Linguae. Klaus D. Peter, Wiehl, Germany [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY 2.0 de (http://creativecommons.org/licenses/by/2.0/de/deed.en)], via Wikimedia Commons

Frenulotomy

Also known as: simple release, frenotomy,

Frenulotomy is a surgical procedure used to correct a congenital condition in which the lingual frenulum (the part that connects the bottom of the mouth to the underside of the tongue) is too short, causing restricted tongue movement (ankyloglossia). This condition is commonly called a tongue-tie. Approximately 3 to 5 out of 100 infants are born with tongue-tie of the population has this condition, but not every one needs a frenulotomy.

Frenulotomy may be recommended if your child with tongue-tie has:

  • difficulty feeding and poor weight gain
  • speech difficulties
  • difficulty swallowing
  • inability to lick an ice cream cone or sucker
  • difficulty moving the tongue (side to side, sticking it out, touching the roof of the mouth)
  • significant dental problems

How is Frenulotomy Performed

A frenulotomy can be done in a doctor's office without the need for anesthesia for an infant under the age of 6 months. For children older than that, it is usually done under general anesthesia in a same-day surgery facility. In preparation for the procedure, your infant will have the inside and outside of their mouth cleaned with an antiseptic called chlorhexadine. A much lower concentration is used in the mouth to reduce irritation.

Once the mouth is cleaned, an anesthetic paste will be applied to the frenulum linguae (under the tongue) and tongue to numb the area.

The paste will be something like a mixture of 2.5% lidocaine and 2.5% prilocaine. You will then have about a 5 minute wait for the topical anesthetic to work.

Once the anesthetic is working, your child will need to be restrained for the frenulotomy to reduce the risk for any complications. 3 main methods are used to ensure your child is appropriately strained.

They may choose to either: swaddle, use a papoose board (board with 6 wings that wrap to completely engulf your child), or the burrito or "superhero cape" (way of wrapping and restraining the arms of your child with a pillow-sheet).

Once restrained, an assistant will hold your infants head still while your doctor lifts your childs tongue with forceps or with 2 fingers from their non-dominant hand. Once the tongue is appropriately positioned so that your doctor can see clearly, they will cut the frenulum linguae close to the tongue. The reason they will cut closer to the tongue than the floor of the mouth is because of nerves and submandibular ducts (related to secretion of saliva) are close to that same location. The cut is made parallel to the tongue and no sutures are necessary for healing. Following the procedure, a little bit of pressure with gauze is used to minimize any bleeding or oozing. Bleeding is rarely an issue with a frenulotomy.

Benefits of Frenulotomy

One of the common reasons for performing a frenulotomy is due to difficulty with breast feeding.

You baby will be able to resume taking a bottle or breast feeding as soon as surgery is complete. However your child may have difficulties with breast feeding initially. 77 percent of babies do well with breast feeding within 2 weeks of having a frenulotomy performed. Babies also show improvement in weight gain as a result of improved ability to suck.If this procedure is performed later in your child's life and speech problems exist, speech therapy may still be necessary to correct a speech disorder. 

Risks Associated with Frenulotomy

Complications as a result of this surgery are rare and your child will most likely not have any discomfort. Risks include:

  • bleeding
  • infection
  • submandibular duct damage

If the child had difficulty speaking before the surgery, she may require speech therapy afterward to correct a speech impediment.

Alternate Options

  • Frenulectomy - surgically removing the frenulum linguae
  • Frenuloplasty or "Z-plasty" - plastic surgical repair used if frenulotomy is unsuccessful

Sources:

American Academy of Otolaryngology - Head and Neck Surgery. Fact Sheet: Tounge Tie. Accessed August 26, 2010 from http://www.adhb.govt.nz/newborn/Guidelines/Nutrition/Ankyloglossia.htm

Isaacson, G.C. (2016). Ankyloglossia (tongue-tie) in infants and children. Accessed on 2/23/2016 from http://www.uptodate.com

Junqueira, M.A., CUNHA, Costa e Silva, L.L., Araujo, L.B., Moretti, L.B.S., Couto Filho, C.E.G. & Sakai, V.T. (2014). Surgical techniques for the treatment of ankyloglossia in children: a case series. J Appl Oral Sci. 22(3): 241–248. doi: 10.1590/1678-775720130629

Miranda, B.H. & Milroy, C.J. (2010). A quick snip – A study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. Journal of Plastic. Reconstructive & Aesthetic Surgery. 63(9):e683–e685.

Sethi, N., Smith, D., Kortequee, S., Ward, V.M.M. & Clarke, S. (2013). Benefits of frenulotomy in infants with ankyloglossia. International Journal of Pediatric Otorhinolaryngology, 77(5):762-765

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