07/24/2022
When should you consider doing a frenotomy?
I get asked this question all the time. I have some fairly simple responses that I hope make sense.
1) I recommend a frenotomy when the symptoms associated with NOT doing the frenotomy are worse. Keep in mind that this includes any aftercare wound management. In my hands, doing a frenotomy on an infant takes about 10-15 seconds. But because I demand a wound aftercare protocol that is intensive, that has to be considered as a very important piece of the puzzle. How does this translate? Well, if a tongue tie is identified but overall feeding symptoms aren’t severe, it’s not unreasonable to keep an eye on things rather than jumping to a procedure.
2) I recommend a frenotomy when non-surgical options have failed. Infant feeding problems are multifactorial and can include things that have nothing to do with a tongue tie. This is why I demand the evaluation and treatment by an IBCLC before I even allow an appointment to be made. In most cases, surgery for tongue tie should not be the first option (the exception is a baby with an obvious anterior tongue tie).
3) I do NOT recommend a procedure to prevent future problems (again, the exception being an obvious anterior tongue tie). To put a family through an extensive aftercare protocol for a symptom that hasn’t shown up yet OR will never show up makes no sense at all. The existing scientific literature does not support prophylactic treatment of tongue ties.
4) If I am treating an obvious anterior tongue tie and symptoms aren’t horrible, I will consider doing a simple anterior release (like most people do as their standard/only option). When I do this, there’s no wound so there’s no aftercare. That being said, I’m leaving that baby with a residual posterior tongue tie. I inform parents of this anatomy because some babies need the remainder released to improve feeding in infancy. If the conservative release helps contemporary feeding problems, I still tell the parents to be on the lookout for possible future issues and to return for reevaluation.
I hope this helps!
