Frenulotomy Surgery to Correct Tongue-Tie

smiling baby with tongue out

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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% of infants are born with this condition, but not everyone needs a frenulotomy.

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

  • speech difficulties
  • difficulty swallowing
  • difficulty moving the tongue (side-to-side, sticking it out, touching the roof of the mouth)
  • significant dental problems

In the past, frenulotomy was recommended to help resolve problems with breastfeeding. However, recent research is questioning the effectiveness of the procedure as a solution. Before considering it for your child, it's a good idea to seek a second opinion.

How Frenulotomy Is Performed

Your child will be given general anesthesia before the frenulotomy is performed, either in a doctor's office or a same-day surgery facility. In preparation for the procedure, your child's mouth will be cleaned inside and outside of an antiseptic called chlorhexidine.

Once the anesthesia is working, your child will need to be restrained for the frenulotomy to reduce the risk of any complications. Three main methods are used to ensure your child is appropriately restrained: swaddling, using a papoose board (board with six wings that wrap to completely immobilize your child), or the burrito or "superhero cape" way of wrapping and restraining the arms of your child with a sheet.

Once restrained, an assistant will hold your infant's head still while your doctor lifts your child's tongue with forceps or with two 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 the 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.

Risks

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
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Article Sources
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  1. Yousefi J, Tabrizian namini F, Raisolsadat SM, Gillies R, Ashkezari A, Meara JG. Tongue-tie Repair: Z-Plasty Vs Simple Release. Iran J Otorhinolaryngol. 2015;27(79):127-35.

  2. Campbell, J. Frenotomy for tongue-tie in newborn infants. International Journal of Nursing Studies. Volume 91, March 2019, Pages 146-147. doi:10.1016/j.ijnurstu.2018.03.022

Additional Reading
  • 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 BH, Milroy CJ. A quick snip - A study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. J Plast Reconstr Aesthet Surg. 2010;63(9):e683-5. doi:10.1016/j.bjps.2010.04.003

  • 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

  • American Academy of Otolaryngology - Head and Neck Surgery. Fact Sheet: Tounge Tie.