Frenotomy and Frenuloplasty Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the indications for a frenotomy and a frenuloplasty?

Surgery for a tongue tie (ankyloglossia) is controversial, especially if there are no apparent problems. In infants with evidence of tongue tie and associated difficulty feeding, a simple in-office procedure called a frenotomy can be performed without the need for anesthesia. In older children with tongue tie and an associated speech abnormality, a frenotomy or a frenuloplasty can be performed with local anesthesia or general anesthesia. When indicated, these simple procedures can yield a significant improvement in patients who are symptomatic.

What is frenotomy?

A frenotomy is a simple procedure that can be performed in the office by retracting the tongue up and making an incision into the frenulum. Typically, bleeding is minimal (1-2 drops) and no addition closure is necessary. In infants less than six weeks, pain is minimal and anesthesia and post-procedure pain medication is not necessary. Breast feeding or bottle nursing can be resumed immediately. In toddlers and older children, local anesthesia may be used. General anesthesia can be considered if the child is unable to tolerate the procedure in the clinic.

What is frenuloplasty?

In some cases, the frenulum can be too thick for a simple frenotomy. In addition, the tongue tie can recur after a frenotomy if the frenulum reattaches to the floor of the mouth. In these cases, a frenuloplasty can be performed under general anesthesia. The frenulum is incised and a local mucosal flap is elevated. The flaps are then re-oriented and sutured in place using dissolvable sutures.

What should I expect before surgery?

• There is no special preparation before a frenotomy or frenuloplasty. In general, the patient should avoid any medication that can thin out blood such as NSAIDs products, aspirin, ibuprofen, naproxen, or vitamin E.
• While our office will make every attempt to keep the patient’s primary care physician informed before and after your surgery, it is important that you personally inform him/her that you or your child is planning to have a frenotomy or frenuloplasty.
• Due to the frequently changing operating room schedule, the surgery center will usually call you one business day before your surgery date to inform you of your surgery time. Depending on the time of your or your child’s surgery, the center will instruct you on the specific time to stop feeding before surgery.

What should I expect during surgery?

If the frenotomy is performed in the clinic, it will usually involve your surgeon and an assistant. You may hold your infant during the procedure. It will usually take about 5 minutes and you may immediately feed your child if appropriate.

If the procedure is performed under anesthesia, the surgical team will include your surgeon, an anesthesiologist, a scrub nurse, a circulating nurse, and additional supporting staff dedicated to ensuring that your surgery is safe. The frenuloplasty will usually take about 20 to 30 minutes with minimal blood loss.

What should I expect after surgery?

• Pain is minimal with both a frenotomy and frenuloplasty. With infants, no additional pain medication is needed. In toddlers, older children, and adults, Tylenol is usually adequate. Stronger pain medications will be provided if needed.
• There may be some mild bleeding after a frenotomy and a frenuloplasty. In general, this should subside by the next day.
• In most cases, you or your child may resume a regular diet immediately after a frenotomy. If a frenuloplasty is performed, a soft diet should be maintained for 2 days after the procedure.

What are the risks of frenotomy or a frenuloplasty?

As with any surgical procedure, a frenotomy and a frenuloplasty have associated risks. With meticulous planning and appropriate precautions, complications from surgery are very rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. These risks may include:

• Stenosis of salivary duct: The submandibular glands drain saliva into the Wharton's ducts that are located on each side of the frenulum. If the ducts are injured, obstruction of the salivary gland can occur. The ducts are visible and can be avoided when carefully identified.
• Recurrence of disease: Although rare, the frenulum can reattach to the floor of the mouth, requiring revision surgery.
• Other risks: Other risks include pain and bleeding, which is often minimal.

What restrictions will I have during the postoperative recovery period?

There are typically no restrictions after a frenotomy and a frenuloplasty. You or your child should maintain good oral hygiene. If a frenuloplasty is performed, a soft diet should be maintained for 2 days after surgery.

Your surgeon is committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of your condition and treatment plan. Please feel free to ask questions about any aspect of your care. Learn more about tongue-tie (ankyloglossia).