Frenotomy For Babies: A Guide

A Brief History Of Frenotomy

Frenotomy, also known as tongue-tie release, has been used in babies with feeding difficulties for many years. The procedure involves cutting or releasing the frenulum, a small fold of tissue that connects the underside of the tongue to the floor of the mouth, to improve the range of motion and function of the tongue.

While the history of frenotomy is not well-documented, there are references to similar procedures being performed as far back as ancient Egypt and Greece. In more recent times, frenotomy has been used in Western medicine for over a century, with early reports of the procedure being performed as early as the 1800s.

Frenotomy In Ancient Times

In ancient Egypt and Greece, there are references to similar procedures being performed that are believed to be similar to frenotomy. However, the precise details of these procedures and the reasons they were performed are not well-documented.

In ancient Egypt, there are references to the use of a sharp instrument to make a small incision under the tongue to treat various ailments, including difficulty speaking, breathing, and swallowing. This procedure was performed by physicians known as “Priests of Anubis,” who were responsible for treating disorders of the head and neck.

In ancient Greece, there are references to a similar procedure, known as “ankyloglossia,” which involved cutting the frenulum of the tongue to improve speech and breathing. The procedure was performed by physicians such as Hippocrates, who is credited with describing the condition and its treatment.

It is worth noting that the use of these procedures in ancient times was based on the limited medical knowledge and understanding of the human body at the time. Additionally, the procedures were likely performed without the benefit of modern medical technology or anesthesia, which could have made them more dangerous and painful.

Frenotomy In Western Medicine

In Western medicine, frenotomy has been used since at least the early 1800s to treat a variety of conditions related to tongue tie, including difficulty with breastfeeding, speech, and oral hygiene. However, the use of frenotomy was not widespread or well-accepted in the medical community at that time.

One of the earliest descriptions of frenotomy in Western medicine was by the French physician Jean Baptiste Fouchard in 1751, who described using a scalpel to cut the frenulum in infants with difficulty nursing. However, the procedure was not widely adopted, and many physicians at the time believed that the benefits of the procedure were not worth the risks and potential complications.

It wasn’t until the late 1800s and early 1900s that frenotomy began to gain more widespread acceptance as a treatment for tongue-tie. During this time, several physicians, including the American dentist George Snow and the British surgeon Victor Negus, developed modified techniques for frenotomy that were safer and more effective. These techniques involved using scissors or a scalpel to carefully release the frenulum while minimizing the risk of bleeding and other complications.

Frenotomy In Recent History

Today, frenotomy is a commonly performed procedure in many countries and is generally considered safe and effective for infants with feeding difficulties related to tongue-tie. The current frenotomy methods used can vary depending on the healthcare provider and their preference. However, there are several common methods used for performing frenotomy:

1. Scissor Method: This is the most common method used for performing frenotomy. The healthcare provider uses a pair of sterile scissors to make a small incision in the frenulum, then lifts and separates the tongue from the floor of the mouth. This method is relatively quick and can be done without anesthesia in some cases.
2. Laser Method: Some healthcare providers use a laser to perform a frenotomy. The laser heats and cuts the frenulum tissue, creating a clean and precise incision. This method is less invasive than the scissor method and may result in less bleeding and discomfort for the baby.
3. Radiofrequency Method: In this method, a small needle is inserted into the frenulum, and radiofrequency energy is used to create a small burn. This method is less invasive than the scissor method and can result in less bleeding and pain.

Regardless of the method used, frenotomy is typically performed on an outpatient basis and does not require hospitalization. The procedure typically takes only a few minutes, and the baby can usually breastfeed immediately afterward. Some healthcare providers may recommend stretching exercises or massage to prevent the frenulum from reattaching during the healing process.

However, it is important to note that the use of frenotomy has been a controversial topic in the medical community, with some experts advocating for its routine use in infants with breastfeeding difficulties, while others caution that it may be overused and unnecessary in many cases. As with any medical procedure, the decision to perform a frenotomy should be made on a case-by-case basis after careful evaluation of the baby’s feeding difficulties and overall health.

What Are The Risks Of Frenotomy?

Frenectomy is a surgical procedure that involves removing or modifying the frenum, a small piece of tissue that connects the lips, tongue, or cheeks to the underlying bone or gums. A frenectomy is often performed to correct various oral health problems, such as tongue-tie or a tight labial frenum.

Like any surgical procedure, a frenectomy may carry some risks and potential negative effects. Although all of the below risks are small they have occurred during frenectomy Some of these risks and effects include:

1. Bleeding: Frenectomy can cause bleeding, which can be a problem for people with bleeding disorders or those taking blood thinners.
2. Infection: Any surgical procedure carries the risk of infection, which can be serious and lead to complications.
3. Pain and discomfort: Frenectomy can cause pain and discomfort, especially during the healing process.
4. Nerve damage: Frenectomy can cause nerve damage, which can lead to numbness or altered sensation in the tongue, lips, or cheeks.
5. Scarring: Frenectomy can cause scarring, which may affect the appearance of the mouth.
6. Relapse: In some cases, the frenum may grow back or scar tissue may form, which can require additional treatment.
7. Speech difficulties: Frenectomy can sometimes cause temporary or permanent changes to speech, particularly if the tongue frenulum was cut.

It is important to discuss these risks and potential negative effects with your healthcare provider before undergoing a frenectomy procedure. Your healthcare provider can also help you understand the potential benefits of the procedure and provide guidance on post-operative care to minimize the risks of complications.

Do all babies with tongue ties have difficulty breastfeeding?

Not all babies with tongue ties have difficulty breastfeeding, but some do. Tongue tie, also known as ankyloglossia, is a condition where the frenulum (a piece of tissue that connects the tongue to the floor of the mouth) is too tight or short, which can restrict the movement of the tongue.

Pain With Breastfeeding

For some babies with tongue ties, the restricted tongue movement can make it difficult for them to latch onto the breast, maintain a good seal, and effectively transfer milk. This can lead to problems such as nipple pain, low milk supply, and poor weight gain in the baby. Most studies on frenotomy support a small statistically significant change in nipple pain with breastfeeding that does not reach a minimal detectable change of 2 points or more on the 0-10 pain scale.

However, not all babies with tongue tie experience these difficulties. Some babies are able to compensate for their tongue tie by using other muscles in their mouth, or by adjusting their latch or feeding pattern. Additionally, not all cases of tongue tie are severe enough to cause breastfeeding problems.

Reflux

Although maintaining a good seal and overall breastfeeding quality does get anecdotally attributed to reflux, there is a lack of evidence in the Pubmed database attributing hard reasons for reflux. Many interventions are ineffective including frenotomy. In a study looking at the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R) there was no change in reflux following frenotomy.

Conclusion

If you suspect that your baby has a tongue tie, it’s important to consult with a healthcare provider who can evaluate your baby’s tongue and assess whether a tongue tie release procedure (also known as a frenotomy or frenuloplasty) is necessary. They can also provide support and guidance to help you with breastfeeding.