A tongue-tie (ankyloglossia) is a membrane connecting the underside of the tongue to the floor of the mouth which may decrease tongue mobility and give the appearance of the tongue being short and thick. An upper lip-tie is where a membrane under the baby’s upper lip is short or thick and is tightly attached to the upper gum. An upper lip-tie can be present also with a tongue-tie.
Tongue-ties and lip-ties can cause problems with breastfeeding such as (but not limited to):
- nipple pain, cracked
- mastitis
- latch problems
- prolonged feed
- maternal milk supply issues
- infant weight gain issues
- aerophagia
Research shows that frenectomy is a safe and effective treatment. Possible complications may include bleeding, swelling, infection, salivary gland trauma, re-attachment.
Not all tongue-ties or lip-ties need to be clipped, only those that are causing breastfeeding problems.
Types of ties:
- Anterior tongue-ties are closer to the tip of the tongue and are very obvious to see.
- Posterior tongue-ties are thicker and further back. Not always visible, but felt with the fingers
- Lip-ties may restrict movement of the upper lip and may make it difficult for baby to latch and/or create an effective labial seal.
Procedure:
The dentist will do the procedure with his assistant. Everyone in the operating room will need to wear laser safety glasses. The intervention, which lasts 30-60 seconds, is performed using an 810nm diode laser. Laser advantages are numerous: no sutures, hemostatic, bactericidal, less damage to adjacent tissues, faster healing, less sensitivity post-op. The surgical site is prepared with topical EMLA. Baby is swaddled and put in a specially designed board. It is recommended to bring baby to the breast right after the surgery, as breastfeeding and breast milk helps with any bleeding, aids healing and is soothing for the baby. It might take a minute or two for the baby to settle and start breastfeeding. Many mothers feel less nipple pain and a better latch almost immediately. Others may take a couple of weeks to feel a noticeable difference in latch and/or nipple pain.
After the procedure
The dentist will examine your baby and make sure the bleeding has stopped before you leave the clinic. It is unlikely that the frenectomy site will re-bleed, but if this does happen:
- Breastfeed your baby: this will help to stop any bleeding
- If this doesn’t work, place a cotton gauze over the bleeding and apply pressure. Then re-offer the breast. You may also pour some of your expressed milk on the site.
- At_______ , your baby received_____ml of infant acetaminophen. If your baby is irritable or seems in pain during the next 24-48 hours, you may give her/him________mls , every 6 hours as needed. The next dose should be given if necessary at__________.
- For the next 24 hours, avoid placing objects in the baby’s mouth, especially under the tongue (except feeding devices)
- The following tongue and/or lip exercises are important to do and should be done 4 times a day, before feeds, until the next appointment. You should start doing the exercises the day of the surgery:
Wash your hands with soap and water
- Rub your finger along the gum line of the baby and allow the baby’s tongue to follow your finger. Rub both lower and upper gums.
- Place your finger on the baby’s tongue, allow the baby to suck and then slowly pull your finger out of baby’s mouth while the baby keeps sucking. This will help him/her stick the tongue out.
- Place both index fingers under the baby’s tongue, one on each side of the incision. Push backwards and upwards while stretching and lifting the tongue until you see the diamond shape under the tongue. This will help decrease the risk of the frenectomy site reattaching, allow proper healing and help the tongue move well. Some parents find it easier to use the side of a finger, placing it under the tongue on the à pushing back and lifting the tongue up.
- Now gently rub the diamond area, it should feel smooth.
- For lip-ties, place your finger under the upper lip, push back along the gums and rub finger from side to side. Also, pull upper lip out and up away from gumline. You want to see a triangle shape as you pull out and lift up the upper lip.
After the exercises, wash your hands again with soap and water. These exercises may cause some minor bleeding. If this happens, breastfeed the baby again. If they make your baby feel irritable or seem painful, you may contact us but it is still important to continue doing the exercises and breastfeed after.
Generally, there is minimal bleeding and this is stopped by baby breastfeeding. If breastfeeding does not stop the bleeding, apply direct pressure to the site under the tongue with clean gauze. If the upper lip bleeds apply pressure with your finger on the upper lip or directly at the surgical site. Call the clinic or go to the emergency room with the document you were provided.
You may notice that:
- Your baby has a few black or dark stools after the frenectomy, if he/she has swallowed some blood during the procedure.
- Your baby refuses the breast after the frenectomy – do not force him/her to take the breast if this happens. Continue to offer the breast at the same times that he/she was taking before the frenectomy was done. If he/she continues to refuse to feed from the breast, you may offer him/her some expressed breastmilk in a cup or syringe. Re-offer him/her the breast after this. Please contact us if you are worried about your baby’s feeding behavior.
- You may notice that the frenectomy site may turn white, beige or grey. This will soon disappear.
- It is important to breastfeed as often as possible to help your baby learn how to use his/her tongue’s new abilities. It may take several days or up to 2-3 weeks for you to feel a difference in latch and pain.
- Your next appointment at the clinic will be around 2 weeks following the frenectomy, at which moment we will evaluate baby’s healing, how mom is doing, re-assess the exercises and clean the surgical site if needed.
- If you have any concerns, or your baby has more bleeding, is irritable or has a fever: contact us at (514) 722-5350 or (514) 694-5716 or (514)923-8606. If needed you may go the ER (such as Montreal Children’s Hospital or Sainte-Justine Hospital) or contact your physician and bring along this information sheet with you, so that the doctors will know what kind of procedure your baby had.
We closely work with medical doctors, IBCLC lactation consultants, CLSC nurses, osteopaths, and chiropractors in order to deliver best possible care. It is important that you follow our post-op recommendations to ensure optimal results for yourself and your baby.
(Reference: Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic)