Frenectomy FAQ
Co2 Tongue Tie Release Procedure Frequently Asked Questions
Q: What is a frenectomy?
A: An outpatient, noninvasive procedure that releases restriction of oral frenula allowing for normal range of motion and function. (Frenectomy is also referred to as frenotomy)
Q: Why is this procedure sought out?
A: Releasing restriction of oral frenula, such as ankyloglossia, allowing for normal range of motion and function may be necessary where feeding is concerned to avoid failure to thrive in babies. This tongue restriction, along with lip ties and buccal ties, often interfere with breast feeding, forcing babies to compensate to hold on to the nipple instead of achieving a seal on the breast, which typically presents as a shallow, painful latch which may lead to health problems in the mother as well as the baby. There are many benefits to children and adults as well.
Q: What is Ankyloglossia?
A: Commonly referred to as tongue-tie, ankyloglossia is an unusually short and/or thick lingual frenulum, often restricting the tongue from extending beyond the gum line and also from lifting and reaching the palate, the tongue’s normal resting position in the mouth.
Q: Does the Frenectomy procedure interfere with breastfeeding?
A: No. This procedure is meant to compliment breastfeeding and improve it and in many cases enable breastfeeding of the non-latching baby. It is recommended breastfeeding continue uninterrupted.
Q: Is the Frenectomy procedure painful?
A: Performed as an outpatient procedure without need for sedation or medication to numb the sight(s), the frenectomy itself is best described as uncomfortable during the actual procedure with sore muscle pain felt immediately afterwards and lasting for up to a week.
Q: How is pain best managed?
A: Anti-inflammatory medications such as Arnica or other homeopathic remedies are very effective for pain management and considered current best practice for the management of any associated discomfort for infants, children and adults.
Q: What else can I do to offer my baby comfort?
Discomfort for the few days immediately following the procedure is to be expected. Diligence with appropriate ongoing pain management is very important as well as constant support of the autonomic nervous system (ANS). The tongue will be free and functioning differently than before and sometimes might seem like it’s “in the way”. The younger baby has amazing reflexes that support learning the new and correct way of breastfeeding and eating. Latch improvement is expected towards the end of the first week after release (if not sooner), and should continue to gradually improve without setbacks. Any regression noticed should be immediately discussed with your healthcare team.
Q: Is physical therapy a necessary part of the frenectomy procedure?
A: Yes. Just as with any procedure, physical therapy is a necessary component to achieve best outcomes.
Q: What kind of physical therapy is done for babies that have this procedure?
A: Babies will have "bodywork" in addition to oral stretching exercises to achieve optimal outcome of this procedure. When a baby has been forced to compensate, which happens when adapting around restriction, typically incorporating and using muscles incorrectly, this adaptation can lead to further muscle tension in addition to the nature of the restrictive tension of frenums being released. Bodywork does many things to enable the baby to latch correctly, encouraging normal swallowing and oral development. This therapy ideally begins before release of oral restrictions and may include the relaxing of some muscles and strengthening of others. Therapy will vary as will care plans. Ideally parents are provided with gentle exercises to do at home that might include massage to certain muscles or muscle groups, and/or gentle stretching to help facilitate oral habilitation.
Q: Is it ok if my baby continues to breathe through the mouth instead of the nose?
A: No. It will be very important to correct any mouth breathing by gently keeping baby’s sinuses clear and supporting breathing through the nose with specific exercises provided. Mouth breathing is unhealthy and leads to many health issues, both physical and mental, alters normal and optimal growth and development, and reduces or ceases nasal passage flow of oxygen. Continuing effort to help baby learn to breathe through the nose is very important and encouraged throughout this process and beyond if necessary.
Q: Exactly what is the correct tongue position for my baby?
A: Correct tongue positioning, referred to as normal resting tongue posture is when the tip of the tongue sits just behind the front teeth or gum line with the entire tongue including the back (or base) pressing against the roof of the mouth (palate), with lips together and sealed. So basically your baby’s tongue should be suctioned up into their palate at all times unless babbling or talking. It should even remain up when swallowing.
Q: Which type of procedure is best for babies?
A: Enough evidence now exists in support of laser procedures, specifically the Co2 laser, for both consistency of full release and for minimal discomfort for the patient. Other benefits also include shorter duration of discomfort, minimal to no bleeding and optimal wound healing with extremely minimal scarring. Ultimately the skill and experience of the provider performing this procedure is very important and will effect outcomes. This tool is recommended for the newer release provider since training is mandatory and included with the purchase of the laser, whereas some tools sold do not have strict policies in place. This area is continuing to evolve.
Q: Are post frenectomy exercises necessary?
A: Yes, stretching exercises are necessary whenever a complete release is performed on a baby. If not done regularly or adequately, full function may not be achieved and reattachment is possible. Oftentimes when post frenectomy exercises are not provided or recommended this will mean only a partial release is being performed and therefore stretching would not be indicated.
Q: How often and for how long are the stretching exercises necessary?
A: Exercises vary by provider but usually take between 15 to 60 seconds to complete each set and will need to be performed not less than 3 times every 24 hours and for at least 3 weeks. Often these exercises are recommended about twice as often and as long, at 4-6 times every 24 hours for 4-6 weeks. These exercises are used to encourage ‘healing by secondary intention’, meaning purposefully encouraging very slow, gradual healing, (as opposed to primary intention healing), thereby maintaining tongue mobility and unrestricted function in the patient.
Q: Is it ok if the wound bleeds?
A: Yes. Bleeding may occur during the procedure but should be minimal and stop very soon after. Also, spontaneous minimal bleeding may happen immediately following a wound stretching exercise, as with cases of too rapid healing has begun to occur and is opened back up. This may occur any time during the first couple of weeks. As long as bleeding is minimal and stops soon after stretching, some minimal bleeding is considered within the range of normal. Your frenectomy provider will ask about any family history of bleeding and if your baby was given vitamin K at birth.
Q: What is reattachment?
A: Reattachment typically refers to the return, continuance or worsening of symptoms relating to tongue-tie. It’s important to note that returning issues that resolved or were resolving after the procedure is what guides providers and not so much the appearance of the frenulum post procedure, once healed. The tongue’s positioning in the mouth indicates many things, including restricted movement, reattachment or even some frenulum previously inaccessible to the release provider at the time of release.
Q: Can reattachment be avoided? If so, how?
A: Yes, reattachment is avoidable in the vast majority. Finding a knowledgeable frenectomy provider team is key. These providers will be well known in the tongue tie community. In most cases these teams will consist of a “tie-savvy” IBCLC, a “bodyworker”, Oral Myofunctional Therapist (OMT) and frenectomy release provider.
The IBCLC will provide a referral to either the frenectomy provider or to the bodyworker depending on their evaluation and suck assessment findings. Very specific instructions (and videos) are provided to guide families and continuing follow up care and management by the IBCLC is imperative for an optimal outcome. “Wound checks” are often recommended for the baby that is identified as vulnerable to reattachment.
Q: Is a “clicking” sound during nursing ok?
A: Clicking may begin or seem to worsen temporarily after the procedure and can be associated with “low tongue posture”. It is important to work very closely with your care team for the encouragement, habilitation and conditioning of the tongue to rest normally up in the palate. As with any procedure, physical therapy will be recommended for the best possible outcome. When working closely with a knowledgeable IBCLC providing support with special attention to optimal latch and positioning for normal suck/swallow/breathe function in the baby, clicking is considered temporary and expected to fully resolve.
Q: Although improved, my baby’s latch is still uncomfortable. Is this normal?
A: Sometimes babies can’t open wide enough to achieve a comfortable latch even after the release of ties. A small gape is expected to be temporary while continuing with physical therapy working to get ahead of previous compensations and remaining muscle tension.
Q: Is it ok that my baby is struggling even more than before to latch well?
A: A feeling of “setback” and even regret for having the procedure should be temporary if the frenectomy procedure was complete. This can be due to discomfort for the few days immediately following the procedure. Diligence with appropriate ongoing pain management will be very important as well as constant support of the autonomic nervous system all during the entire week after the frenectomy. Any regression noticed should be immediately discussed with your healthcare team.
Q: My baby still can’t open her mouth very wide even after the frenectomy. Why is this?
A: A small gape is expected to be temporary up to a few weeks while working to get ahead of muscle tension from compensation, dysfunction or birth trauma through the physical therapy recommended by your bodyworker. Further evaluation may be necessary if improvement is not noticeable and deeper latching at breast achieved.
Q: Is it normal for baby to spit up even more than before?
A: Parents may notice an increase in spit up due to greater intake of food than before with improved tongue function and swallowing. Most babies will adjust and down regulate intake automatically. Be sure to communicate concerns and changes with your baby's team and know that when healing is going well, this too shall pass.
Q: What other temporary changes might I notice?
A: Other changes may include a very sleepy baby, an increase in drool, and possible tummy upset. Again, this would be temporary.
Q: What are some benefits I might notice?
A: Many parents notice improved temperament in their little ones including more pleasant car rides, resolution in colic and reflux, improvement in rashes or other skin allergy issues and better sleep and other milestones may be achieved during this process. Toddlers often begin eating a broader variety of foods, speaking clearer, more often and use many new words. Sleep often improves, and teeth grinding should cease. Teeth brushing often improves and tooth decay, even when common in families and siblings, might be avoided entirely. Adults typically report reduction or resolution in headaches/migraines, improved sleep and breathing in general. Reduced or resolved neck, back or TMJ pain and issues are also commonly noticed.
For more information, questions or concerns please contact us.
Co2 Tongue Tie Release Procedure Frequently Asked Questions
Q: What is a frenectomy?
A: An outpatient, noninvasive procedure that releases restriction of oral frenula allowing for normal range of motion and function. (Frenectomy is also referred to as frenotomy)
Q: Why is this procedure sought out?
A: Releasing restriction of oral frenula, such as ankyloglossia, allowing for normal range of motion and function may be necessary where feeding is concerned to avoid failure to thrive in babies. This tongue restriction, along with lip ties and buccal ties, often interfere with breast feeding, forcing babies to compensate to hold on to the nipple instead of achieving a seal on the breast, which typically presents as a shallow, painful latch which may lead to health problems in the mother as well as the baby. There are many benefits to children and adults as well.
Q: What is Ankyloglossia?
A: Commonly referred to as tongue-tie, ankyloglossia is an unusually short and/or thick lingual frenulum, often restricting the tongue from extending beyond the gum line and also from lifting and reaching the palate, the tongue’s normal resting position in the mouth.
Q: Does the Frenectomy procedure interfere with breastfeeding?
A: No. This procedure is meant to compliment breastfeeding and improve it and in many cases enable breastfeeding of the non-latching baby. It is recommended breastfeeding continue uninterrupted.
Q: Is the Frenectomy procedure painful?
A: Performed as an outpatient procedure without need for sedation or medication to numb the sight(s), the frenectomy itself is best described as uncomfortable during the actual procedure with sore muscle pain felt immediately afterwards and lasting for up to a week.
Q: How is pain best managed?
A: Anti-inflammatory medications such as Arnica or other homeopathic remedies are very effective for pain management and considered current best practice for the management of any associated discomfort for infants, children and adults.
Q: What else can I do to offer my baby comfort?
Discomfort for the few days immediately following the procedure is to be expected. Diligence with appropriate ongoing pain management is very important as well as constant support of the autonomic nervous system (ANS). The tongue will be free and functioning differently than before and sometimes might seem like it’s “in the way”. The younger baby has amazing reflexes that support learning the new and correct way of breastfeeding and eating. Latch improvement is expected towards the end of the first week after release (if not sooner), and should continue to gradually improve without setbacks. Any regression noticed should be immediately discussed with your healthcare team.
Q: Is physical therapy a necessary part of the frenectomy procedure?
A: Yes. Just as with any procedure, physical therapy is a necessary component to achieve best outcomes.
Q: What kind of physical therapy is done for babies that have this procedure?
A: Babies will have "bodywork" in addition to oral stretching exercises to achieve optimal outcome of this procedure. When a baby has been forced to compensate, which happens when adapting around restriction, typically incorporating and using muscles incorrectly, this adaptation can lead to further muscle tension in addition to the nature of the restrictive tension of frenums being released. Bodywork does many things to enable the baby to latch correctly, encouraging normal swallowing and oral development. This therapy ideally begins before release of oral restrictions and may include the relaxing of some muscles and strengthening of others. Therapy will vary as will care plans. Ideally parents are provided with gentle exercises to do at home that might include massage to certain muscles or muscle groups, and/or gentle stretching to help facilitate oral habilitation.
Q: Is it ok if my baby continues to breathe through the mouth instead of the nose?
A: No. It will be very important to correct any mouth breathing by gently keeping baby’s sinuses clear and supporting breathing through the nose with specific exercises provided. Mouth breathing is unhealthy and leads to many health issues, both physical and mental, alters normal and optimal growth and development, and reduces or ceases nasal passage flow of oxygen. Continuing effort to help baby learn to breathe through the nose is very important and encouraged throughout this process and beyond if necessary.
Q: Exactly what is the correct tongue position for my baby?
A: Correct tongue positioning, referred to as normal resting tongue posture is when the tip of the tongue sits just behind the front teeth or gum line with the entire tongue including the back (or base) pressing against the roof of the mouth (palate), with lips together and sealed. So basically your baby’s tongue should be suctioned up into their palate at all times unless babbling or talking. It should even remain up when swallowing.
Q: Which type of procedure is best for babies?
A: Enough evidence now exists in support of laser procedures, specifically the Co2 laser, for both consistency of full release and for minimal discomfort for the patient. Other benefits also include shorter duration of discomfort, minimal to no bleeding and optimal wound healing with extremely minimal scarring. Ultimately the skill and experience of the provider performing this procedure is very important and will effect outcomes. This tool is recommended for the newer release provider since training is mandatory and included with the purchase of the laser, whereas some tools sold do not have strict policies in place. This area is continuing to evolve.
Q: Are post frenectomy exercises necessary?
A: Yes, stretching exercises are necessary whenever a complete release is performed on a baby. If not done regularly or adequately, full function may not be achieved and reattachment is possible. Oftentimes when post frenectomy exercises are not provided or recommended this will mean only a partial release is being performed and therefore stretching would not be indicated.
Q: How often and for how long are the stretching exercises necessary?
A: Exercises vary by provider but usually take between 15 to 60 seconds to complete each set and will need to be performed not less than 3 times every 24 hours and for at least 3 weeks. Often these exercises are recommended about twice as often and as long, at 4-6 times every 24 hours for 4-6 weeks. These exercises are used to encourage ‘healing by secondary intention’, meaning purposefully encouraging very slow, gradual healing, (as opposed to primary intention healing), thereby maintaining tongue mobility and unrestricted function in the patient.
Q: Is it ok if the wound bleeds?
A: Yes. Bleeding may occur during the procedure but should be minimal and stop very soon after. Also, spontaneous minimal bleeding may happen immediately following a wound stretching exercise, as with cases of too rapid healing has begun to occur and is opened back up. This may occur any time during the first couple of weeks. As long as bleeding is minimal and stops soon after stretching, some minimal bleeding is considered within the range of normal. Your frenectomy provider will ask about any family history of bleeding and if your baby was given vitamin K at birth.
Q: What is reattachment?
A: Reattachment typically refers to the return, continuance or worsening of symptoms relating to tongue-tie. It’s important to note that returning issues that resolved or were resolving after the procedure is what guides providers and not so much the appearance of the frenulum post procedure, once healed. The tongue’s positioning in the mouth indicates many things, including restricted movement, reattachment or even some frenulum previously inaccessible to the release provider at the time of release.
Q: Can reattachment be avoided? If so, how?
A: Yes, reattachment is avoidable in the vast majority. Finding a knowledgeable frenectomy provider team is key. These providers will be well known in the tongue tie community. In most cases these teams will consist of a “tie-savvy” IBCLC, a “bodyworker”, Oral Myofunctional Therapist (OMT) and frenectomy release provider.
The IBCLC will provide a referral to either the frenectomy provider or to the bodyworker depending on their evaluation and suck assessment findings. Very specific instructions (and videos) are provided to guide families and continuing follow up care and management by the IBCLC is imperative for an optimal outcome. “Wound checks” are often recommended for the baby that is identified as vulnerable to reattachment.
Q: Is a “clicking” sound during nursing ok?
A: Clicking may begin or seem to worsen temporarily after the procedure and can be associated with “low tongue posture”. It is important to work very closely with your care team for the encouragement, habilitation and conditioning of the tongue to rest normally up in the palate. As with any procedure, physical therapy will be recommended for the best possible outcome. When working closely with a knowledgeable IBCLC providing support with special attention to optimal latch and positioning for normal suck/swallow/breathe function in the baby, clicking is considered temporary and expected to fully resolve.
Q: Although improved, my baby’s latch is still uncomfortable. Is this normal?
A: Sometimes babies can’t open wide enough to achieve a comfortable latch even after the release of ties. A small gape is expected to be temporary while continuing with physical therapy working to get ahead of previous compensations and remaining muscle tension.
Q: Is it ok that my baby is struggling even more than before to latch well?
A: A feeling of “setback” and even regret for having the procedure should be temporary if the frenectomy procedure was complete. This can be due to discomfort for the few days immediately following the procedure. Diligence with appropriate ongoing pain management will be very important as well as constant support of the autonomic nervous system all during the entire week after the frenectomy. Any regression noticed should be immediately discussed with your healthcare team.
Q: My baby still can’t open her mouth very wide even after the frenectomy. Why is this?
A: A small gape is expected to be temporary up to a few weeks while working to get ahead of muscle tension from compensation, dysfunction or birth trauma through the physical therapy recommended by your bodyworker. Further evaluation may be necessary if improvement is not noticeable and deeper latching at breast achieved.
Q: Is it normal for baby to spit up even more than before?
A: Parents may notice an increase in spit up due to greater intake of food than before with improved tongue function and swallowing. Most babies will adjust and down regulate intake automatically. Be sure to communicate concerns and changes with your baby's team and know that when healing is going well, this too shall pass.
Q: What other temporary changes might I notice?
A: Other changes may include a very sleepy baby, an increase in drool, and possible tummy upset. Again, this would be temporary.
Q: What are some benefits I might notice?
A: Many parents notice improved temperament in their little ones including more pleasant car rides, resolution in colic and reflux, improvement in rashes or other skin allergy issues and better sleep and other milestones may be achieved during this process. Toddlers often begin eating a broader variety of foods, speaking clearer, more often and use many new words. Sleep often improves, and teeth grinding should cease. Teeth brushing often improves and tooth decay, even when common in families and siblings, might be avoided entirely. Adults typically report reduction or resolution in headaches/migraines, improved sleep and breathing in general. Reduced or resolved neck, back or TMJ pain and issues are also commonly noticed.
For more information, questions or concerns please contact us.
