What is a Frenulum?
The lingual (tongue) frenulum is the band of tissue from the under surface of the tongue to the floor of the mouth. Some infants are born with a very tight lingual frenulum and have trouble breast feeding due to difficulty latching properly. Some may also have trouble bottle feeding since they are unable to maintain an adequate suck on the bottle nipple. Subsequently, they take in a lot of air and may develop reflux symptoms and bloating. A small percentage of children may also have speech articulation issues when they are older (ages 3 or 4) especially with “l” and “r” sounds.
We grade a lingual frenulum from a 1-4 with one being the most tethered anteriorly close to the tip of the tongue to 4 being posteriorly displaced into the muscle which is not usually visible.
The upper labial frenulum extends from the upper gingiva between the central incisors to the under surface of the upper lip. The severity is based on far it extends in between the two upper central incisors. Majority of the time there is no significant clinical necessity to perform these in infants unless there truly is a difficulty with feeding and there is no tongue tie present that appears to be contributing to the problem. Some parents wish to have them performed for cosmetic reasons. You can discuss your particular situation with Dr. Baktha to determine if the procedure will be beneficial.
How is a Tight Frenulum Treated?
Frenulectomies can be performed in the office in newborns up to about 10 weeks of age. After that they would need to be performed under sedation. They are very well tolerated by infants and they recover quite quickly and can begin feeding right after the procedure.
Postoperative Instructions for a Frenulectomy
Most infants that undergo frenulectomies in the office do not require any pain medication afterwards but you may elect to give Tylenol based on infant weight. Typically, they will not be able to take ibuprofen yet. Oftentimes breast feeding or bottle feeding may be enough to sooth them. You may resume normal feeding schedules after the procedure. We typically hold pressure with Afrin® (oxymetazoline) soaked gauze after the procedure to stop any bleeding and any residual oozing will stop shortly thereafter. If there are any concerns at home then contact the office.
Upper labial frenulectomies will have silver nitrate cautery applied to stop any bleeding after the procedure. This tends to leave a gray colored residue on the mucosa, but it will resolve within one week. The residue may stain the gums temporarily but will dissolve.
At home it is recommended to perform stretching exercises under the tongue and/or upper lip in an attempt to prevent significant re-scarring. It is never possible to completely prevent re-scarring but moving your finger back and forth at the site of the incision starting 24 hours after the procedure can help reduce the re-scarring. This can be done several times a day during feeding for the first week.
Download info page: Frenulectomy.pdf