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Frenectomy is a minor surgical procedure that involves the removal or modification of a small fold of tissue called the frenum using a laser performed to infants through the adult age. Frenuloplasty is only performed on 3 year olds or older and the surgeon will use a laser and scalpel with sutures.
There are three common types of frenectomies:
Labial Frenectomy addresses a condition known as lip tie, which occurs when the frenum connecting the upper lip to the gum tissue is too tight or extends too far down between the front teeth. This condition can cause difficulties with breastfeeding, oral hygiene, and speech articulation. The labial frenectomy involves releasing or reducing the frenum to improve lip mobility and reduce associated issues.
Lingual Frenectomy is performed to correct tongue tie, which happens when the frenum beneath the tongue restricts its movement. This condition can affect breastfeeding, speech development, and oral hygiene. During a lingual frenectomy, the frenum is either partially or completely detached and released, allowing for better tongue mobility and function.
Buccal Frenectomy is performed to correct buccal ties, which occur when the ties that connect the cheeks to the palate or the mandible are tight, restricting movement of the cheeks. When released, it causes less pull on the gum line connection and improves the function of the lips.
Adults and Children: If you have been diagnosed with a tongue-tie, releasing the lingual frenulum may allow a better resting position of the tongue to the palate. The tongue functions optimally when it is able to rest effortlessly up on the palate without any downward pull due to a tight lingual frenulum. The position of the tongue when initiating a swallow helps support the airway and throat. Tongue training with a physical therapist (postural training and myofunctional therapy) before the procedure will help you learn to position the tongue properly, strengthen and stretch before release. After frenectomy, tongue training with a physical therapist (myofunctional therapy) promotes optimal function of the tongue, restores optimal breathing pattern with the tongue resting on the palate, and includes head and neck manual therapy to optimize your posture.
Infants: Infants with tongue-tie having difficulty latching, sucking and swallowing would benefit from these procedures. If mom has painful nipples and breasts when nursing, mom will benefit from having the procedures performed on her infant. Infants are recommended to have at least 3 sessions of physical therapist care before frenectomy and possibly 2-3 more sessions more after the procedure, depending on the infant, and decrease the likelihood that the frenectomy will need to be repeated.
Time is of the essence for those infants that cannot nurse well and need to gain weight, but have failure to thrive. Our physical therapists will teach parents the intra-oral techniques to release the lips, back of the tongue, and undersurface of the tongue to help the baby stretch prior to the procedure, ideally at least one week before the procedure.
Infants: We recommend that the parents bring their infant to the office at least a week before the procedure is scheduled to learn the intra-oral techniques to help aid the healing process after the procedure. Specialized physical therapist care can also help with improving mobility of the infant’s soft tissues as well, and we will address any issues related to the cervical spine, torticollis or a tendency to favor one side.
After the procedure is performed, the parents will support the healing with the previously trained intra-oral techniques, and in-office treatment twice a week for two weeks will allow the incision site to be monitored and treated to heal vertically with soft tissue treatment to the lip and tongue, decreasing the likelihood of it reattaching to the floor of the mouth. Treatment in the day or two after the procedure will help ensure that you are performing your exercises properly and that the incision site is healing well.
Manual stretching of the soft tissues of the lip and tongue should be performed at least 3 to 6 times per day as tolerated to decrease the likelihood of reattachment of the healing tissues.
During the evaluation, we will also evaluate for plagiocephaly (flattened head) and/or torticollis (twisted neck), which can be treated post-frenectomy with osteopathic functional manual medicine during and after the post-frenectomy phase of treatment as needed. Learn more about Cranial Manual Therapy here. Collaboration with a lactation consultant to ensure the infant is breastfeeding effectively is also important after the procedure.
Any child or adult undergoing frenectomy should initiate tongue training or myofunctional therapy for at least 4 weeks prior to the procedure to minimize the risk of reattachment at the frenectomy site. Training the tongue to position on the palate and stretching the tight connective tissue around the lips and tongue promote a more successful procedure.
After the procedure, continuing training the tongue to function properly in its new range of motion and promoting proper oral posture of the tongue will promote proper swallowing and breathing habits. While the tongue-tie may be released, the tongue does not know how to function optimally with this new flexibility and increased range of motion. Continue tongue training until you have successfully attained the proper head and neck posture, good “oral” posture (tongue to palate, teeth gently meeting and lips together but completely relaxed), proper relaxed initiation of swallowing position and function, and functional nose breathing, which may be one to six months post frenectomy procedure.
During the procedure, one of the recommended frenectomy doctors will carefully cut the short frenulum to release the tongue using a laser, scissors or scalpel. Dr. Jenny and her team find that the laser causes much less bleeding and is more easier to tolerate though there are some frenectomy doctors that prefer using the scalpel. It is much more about the skill of the practitioner doing the procedure than the actual tool. This allows the tongue to move freely, which is super important for various everyday activities like eating, speaking, and even proper oral hygiene. For infant frenectomy, Dr. Jenny understands the importance of collaborating with a lactation consultant, to address the whole body for pre and post frenectomy care in preventing reattachment and promoting optimal outcome.
Dr. Jenny has trained with all of the experts that do frenectomies such as Dr. Larry Kotlow, Dr. Bobby Gahari, Dr. Soroush Zaghi, and Dr. Milton Geivelis. She and her team understands what the surgeon needs as pre and post op treatment to ensure good results.
For this procedure, patients hold their tongue gently sucked up on the palate, repeatedly performing the “Cave” exercise that they learned during their myofunctional therapy training during the release, which allows the doctor to see how far to release.
At least four to six weeks of tongue training/myofunctional therapy, posture and breathing training is recommended prior to this procedure. In some cases, several months of preparatory treatment will be recommended to ensure that you have achieved proper head and neck posture, correct mouth/tongue resting position, swallow pattern and tongue flexibility prior to the procedure. The post frenectomy protocol is twice per week for the first 2 weeks post procedure and continued training of the tongue for at the very least 6 -12 weeks once per week in clinic or via telehealth appointment to ensure a healthy trained tongue outcome.
Your Cranio-Facial physical therapist and SLP will promote proper vertical healing of the scar through manual techniques to help lengthen and not let the tongue re-attach. They will focus on achieving proper tongue-to-palate resting position, monitor and progress your post frenectomy exercises, mobilize the healing scar, and gently stretch the tongue with manual techniques.
The physical therapist will continue to improve your posture and breathing with manual techniques and exercises to the head, neck and spine.
After the initial 2 weeks post frenectomy, the physical therapist will continue myofunctional therapy until you are able to properly position your tongue for a functional swallow, properly chew your food, and create the proper resting position in the mouth with your newly flexible frenulums to help support your airway. Continued tongue training post procedure is recommended once per week for 6–12 weeks.
Infants: Many infants are able to latch properly immediately post frenectomy. Infants will have a small diamond open wound at the undersurface of their tongue that will form white granulated tissue as it is healing. Some infants who still have problems latching may benefit from additional physical therapist care and manual therapy. Our physical therapists will treat the intra-oral structures and fascia to decrease the likelihood that the frenectomy sites will reattach.
After 2 weeks, the therapist will teach the parents how to mobilize the scar as the baby continues to heal. After two months, when the site is healed and the scar is flexible, nursing may improve further. We recommend that intra oral techniques continue to be performed by the parent for 2 months post frenectomy.
The first 2 weeks post frenectomy (especially the first 3 days) are very challenging because the parent must perform the intra-oral stretches as the baby is crying and uncomfortable. Parents must be mentally prepared for the crying while performing the intra-oral stretches to ensure that the frenectomy sites don’t reattach.
Children and Adults: The first 24-72 hours post frenectomy are painful and you will want to rest. Homeopathic remedies for pain and swelling or over-the-counter pain medications can reduce discomfort. Tongue exercises must be performed the first day, which is painful. The pain will lessen with time and after two weeks the stitches will dissolve or be removed if stitches were used or if no stitches were used, the incision open site should have filled with white granulated tissues that slowly heals, leaving a healthy flexible scar. Many adults state that they feel lighter in the head and experience less tension and clenching in the face, neck and shoulders after the procedure is performed.
At two months, the undersurface of your tongue and the frenulum is much more flexible and no longer painful. Many do not realize that the released frenulum is still there. As you open and do the cave (suction up of the tongue to the palate while opening your mouth), they will still see a frenulum and the webbing of the connective tissue around the frenulum but it will be more flexible. Many patients progress from being able to put 1 finger width between their teeth while performing the “cave” exercise to being able to put 2 and even 3 finger widths stacked on top of each other inside the mouth during this exercise.
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