Frenulotomy Surgery to Correct Tongue-Tie

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 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

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 of 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 infant's 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 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.

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.

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.

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