Ear, Nose & Throat Treatment Frenulotomy Surgery to Correct Tongue-Tie Print By Kristin Hayes, RN | Medically reviewed by Susan Olender, MD Updated October 02, 2018 AzmanL/istockphoto More in Ear, Nose & Throat Treatment Diagnosis Coping ENT Disorders Pediatric ENT Disorders 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 everyone needs a frenulotomy. Frenulotomy may be recommended if your child with tongue-tie has: difficulty feeding and poor weight gainspeech difficultiesdifficulty swallowinginability to lick an ice cream cone or suckerdifficulty moving the tongue (side to side, sticking it out, touching the roof of the mouth)significant dental problems How Frenulotomy Is 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 chlorhexidine. 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 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. Three 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 child's 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 One of the common reasons for performing a frenulotomy is due to difficulty with breastfeeding. Your baby will be able to resume taking a bottle or breastfeeding as soon as surgery is complete. However, your child may have difficulties with breastfeeding initially. 77 percent of babies do well with breastfeeding 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 Complications as a result of this surgery are rare and your child will most likely not have any discomfort. Risks include: bleedinginfectionsubmandibular 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 linguaeFrenuloplasty or "Z-plasty" - plastic surgical repair used if frenulotomy is unsuccessful Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you reach your 2019 goals. Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources American Academy of Otolaryngology - Head and Neck Surgery. Fact Sheet: Tounge Tie. Isaacson, G.C. (2016). Ankyloglossia (Tongue-tie) in Infants and Children. 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 Continue Reading