Laser Lip and tongue tie revision
Our office works very closely with multiple IBCLS’s and speech therapist. We even have Valeri Gatlin IBCLC in our office on a regular basis during the revisions to help mothers achieve optimal feeding immediately following the procedure. Our doctors have completed many extra training courses specifically aimed at appropriate diagnosis, treatment and aftercare. We understand that the mother baby breastfeeding dyad is of the upmost importance and we have been able to offer many mothers the ability to successfully breastfeed their infant when they previously had significant difficulty!
What is a “Tongue tie or Lip Tie”
A tongue-tie or lip-tie is more common than one would think. It’s often misdiagnosed, or under-diagnosed, and thus the reason why it is so often missed at an early stage in life. It is a mid-line defect of the frenum, resulting in an excessively “tight” or taut fibrous attachment limiting the range of motion of the tongue and the lip. These limitations in movement can cause significant breastfeeding difficulties in addition to other health problems. These health problems include decay, crowding, spacing, speech difficulties/delays, improper food clearance, digestive issues, heightened muscle tension, airway compromise, sleep apnea, tension headaches, clenching, grinding, muscle fatigue and overall skeletal and craniofacial development.
What Is A Frenectomy or Frenotomy?
A frenectomy or frenotomy refers to a corrective procedure done to release a tight frenum. When done with a laser, the terminology is essentially interchangeable.
How Does the Laser Work?
Our office uses a CO2 laser. This is a cold, non-touch laser which allows for gentle treatment and optimal healing of the tissue. The laser seals the blood vessels as it works so there is little to no bleeding (unlike with scissors which often require an additional medicament to stop the bleeding). No sutures are needed. Additionally, the laser is bactericidal and sterilizes the wound and surrounding tissue. Therefore the risk of infection is very minimal.
How to prepare for the first appointment and what to expect
- Try to not nurse immediately before the procedure, being able to nurse following the procedure helps calm your infant and allow for you to feel the positive changes of increased tongue mobility.
- Please come to the appointment with all (patient portal forms) (hyperlink to forms) completed online in advance so that we can focus on your child from the beginning.
- We will spend the first portion of the appointment discussing your concerns, symptoms and completing a clinical exam. If we determine that your child would benefit from a frenectomy procedure there are situations in which we can complete the procedure in the same day.
- This procedure is a quick, in-office treatment. No general anesthesia is needed or recommended. During the procedure, everyone present in the room must wear protective eyewear.
- Numbing medication (local anesthetic: lidocaine) is used to completely numb the small area where the laser will be used.
- After the procedure is completed you will have the opportunity to use our private nursing room to nurse and soothe your infant. Many times mothers will experience improved breastfeeding immediately following the procedure.
What to expect after the procedure
Following the procedure there are a few main components for success:
- Post operative stretches (active wound management)
- Follow up with our office and other necessary professionals
- The post-operative stretches are the most important component to a successful revision. These stretches are aimed at keeping the wound open and promoting attachment in a new, guided position.
- When the frenum has been released, a cut or wound has been created. This wound will have a diamond-shaped appearance. This wound, as is natural, will want to heal very fast. Our goal is to keep this wound open and dilated, and guided to heal in a new, less-restrictive position.
- Prior to stretching, wash your hands with soap and water. Do not use hand sanitizers as they have chemicals and alcohols that burn the wound.
- We recommend doing the stretches from a 12 o’clock position, as you will be best able to visualize the wounds and proper lifts. Place your child on the bed, couch, changing table and stand behind their head to perform the following exercises.
- The stretches are to be done 3 times/day for 4 weeks. It’s important to get in the mouth, lift the lip/tongue and prevent premature reattachment. Think of it as needing to go in and air out the space that has not had that circulation for a few hours. The key to these stretches is not with regard to force or pressure, it’s about frequency, precision, elevation, and lift.
- Each individual stretch is done for a count of five.
- Upper Lip – this is the easier site to stretch and should be done first. Your child will likely become upset and cry during the stretch. Place your finger under the lip and move it as high as it will go (until you reach bone). You are now deep in the lip’s vestibule. Move your fingers in left-to-right motion (like you are brushing the gums with your finger) On your way out, flip/flange the lip out.
- Tongue – this is the harder site to stretch and should be done second. Your child likely is crying from the lip stretches and this will make lifting the tongue and visualizing the wound easier. Place both index fingers under the tongue (close together) and lift the tongue toward the palate. Like a forklift lifting a crate. Use your middle fingers to pull down on the chin. This helps stretch the tongue from the floor of the mouth as wide as possible. You should be able to visualize the full diamond with this stretch.
- The key to this stretch is making sure you are lifting the tongue upward and backward while doing the stretches. When properly lifted, you should be able to see the full diamond shape under the tongue.
- The following is recommended to aid in pain control and management as needed:
- OTC Pain Medication
- For children under 6 months: Infant Tylenol (appropriate dosing will be given after appointment)
- For children over 6 months: Ibuprofen (Motrin) or Tylenol
- Homeopathic Remedies
- Rescue Remedy
- Arnica: 30x or 200x (10 pellets dissolved in several tablespoons of breast milk and delivered via a dropper. Use 10 drops of the liquid every 60-90 minutes)
- Tongue Tie Solution
- Frozen breast milk to rub on the wound
- You also have the option to use nothing at all and many babies find the most comfort from breastfeeding
- Administer as needed for pain control. Use dosing recommendation on package and consult with your pediatrician (or our office) if you have any additional questions.
- Use gentle facial massage before during or after stretches, this helps to calm your baby and prevent them from becoming averse to your stretches
- Use clean hands (or gloves) for stretches
- Small amounts of bleeding can occur when stretching the site, it is like picking a scab and this is normal.
- Every person has a frenum under the tongue and lip. A new frenum attachment after the revision is expected and does not mean that there is re-attachment. Re-attachment simply refers to the frenum attachment in the previous position that is still fully or partially restrictive. This is the main risk of a frenectomy procedure.
- Tissue Healing
- The tissue will go through various stages of healing and coloration for the next few weeks. From red, to yellow, to white, and finally to a normal salmon pink. These are the NORMAL stages of healing (much like the formation of a scab on your skin) and do not indicate that something is wrong or an infection has started. Please don’t be alarmed by the color changes or appearance.
- Be prepared for a few days of fussiness and discomfort as your baby adjusts to the new mobility and the wound goes through its various healing forms. Some babies take to the procedure immediately, and some take time to adjust. Both forms are fine and do not define a successful/unsuccessful revision. Generally, most babies take a few steps back before they are able to start moving forward. Meaning that breastfeeding might actually be harder initially until things begin to organize and the mechanics start working together properly. There is new mobility of the lip and tongue and your baby needs time to re-learn how to use them. Follow-up appointments will be instrumental in working this out.
- Follow-Up Appointments
- We prefer to see patients about 1 week after the procedure to assess wound healing, re-attachment, daily stretches, and symptom changes. Further appointments can be scheduled on an as-needed basis. We will see each other for multiple appointments thereafter. It is important to commit to the follow-up visits to ensure proper healing and tissue formation.
- It is VERY important to follow up with your lactation consultant after the revision for continued work. Now that the lip/tongue has optimized mobility, it is very important to re-learn and organize the movements. The same techniques that may have not worked before may be far more effective now that your baby has the appropriately functioning tools. Additionally, many babies can benefit from other body work as needed. This helps detect and release body tensions to aid in a more appropriate breastfeeding relationship. We can discuss the benefits of this during your appointment.