Dr. Dermot Murnane Clinics:   Nenagh: Mondays, Tullamore: Wednesdays 086 144 9583

Our services

The Procedure for Tongue Tie Release

Dr Dermot J Murnane, Specialist Oral Surgeon

Laser Tongue Tie Surgery

 

NOTE: Tongue tie, its existence and the benefit of release in infants is disputed by many clinicians. The number of Dr’s providing tongue tie release is constantly increasing and  NICE guidelines do exist for this procedure.

NICE Guidelines tongue tie

Back Ground to NICE Guidelines on Tongue Tie

NOTE: Labial frenectomy in infants is not as widely known nor is the procedure of Labial Frenectomy as widely practised in infants. No NICE guidelines exist for this procedure at this time.

_____________________________________________________________

 

THE PROCEDURE

The  release of  a tongue-tie is called a Frenectomy. It can be done with a scissors  or with a laser. A laser allows a more complete release and can be used in a wider range of patients. Dr Murnane has been using a laser for longer and has more experience in the release of tongue and lip ties in breast feeding babies longer than any other doctor  in Ireland.

It helps if babies are hungry at the time of the tongue and or lip tie surgery to encourage immediate breastfeeding afterwards, feeding will distract the baby and help them to settle.

If your baby is older than 8 weeks old is is advised that they be given age appropriate calpol 30 minutes before you arrive at the clinic.

Dr Murnane sits knee to knee with the parent. The babies body is on the parents lap and the babies head is on Dr Murnane’s lap, so the baby can see the parent and Dr Murnane can control movement of the babies head.
The baby is wrapped or swaddled in a blanket or simply gently restrained by the parent to keep the baby still.

Several drops of local anaesthetic (dental injection) are administered into the lip tie and into the tongue tie if it is a posterior tongue tie. This is similar to a vaccination. A baby is expected to cry for several minutes and should settle quickly with a cuddle.

It is often stated that anaesthetic is not necessary as there are no nerve endings in a tongue tie. There is absolutely no scientific evidence to suggest there are no nerve endings in a tongue tie and there is no reason to suggest a baby will not feel pain if anaesthetic is not used.

With a parent holding the babies hands and keeping the chest still, the upper lip is held up and a Soft Tissue (Diode) laser is used to release the lip tie leaving a grey/black area. If the baby is upset at this stage they are given a cuddle by a parent and allowed to settle. After a baby has settled 2 fingers or a tongue retractor are placed under the tongue and the tongue pushed up and back to demonstrate the tongue tie and a Diode laser is used to release the tongue tie.

If the baby can be held still the procedure should only take several minutes.The baby is immediately handed back to the mother for feeding and will normally settle very quickly.

A complete Frenectomy or Tongue Tie release is demonstrated by the formation of a diamond shaped wound under the tongue which will turn into an ulcer and heal in 7 to 10 days. The size of this can vary from approximately 3-10mm.

Dr Lawrence Kotlow has produced some excellent presentations which will demonstrate the procedure and post op care.  These video’s can be seen on his web site.

Following release of a Tongue and Lip tie follow up care from a Lactation Consultation or other breast feeding specialist at about 2 weeks is important if the full benefit of this procedure is to be realised.

The intended benefits of Tongue Tie release are:

  • Improved tongue mobility
  • More efficient feeding
  • Faster feeding
  • Pain free feeding
  • A happier child
  • A better breast feeding experience for mum
  • The ability to breast feed for longer
  • A reduction in breast symptoms

In Older children Tongue Tie may cause problems with swallowing solids. Some children may gag on foods or be overly fussy as to what they will eat as they find certain foods difficult to swallow.

A small number of children may have speech issues

The risks of Surgical release of a tongue Tie are;

  • Pain
  • Bleeding
  • Infection
  • Recurrence
  • Scarring/Adhesions

Pain

The baby will experience some pain and discomfort after the procedure until the ulceration has healed and baby should be given age appropriate paediatric analgesics during the healing phase. It is helpful to give the first dose of analgesic before treatment is carried out. For babies under 8 weeks old the analgesic is the sucrose and other sugars in breast milk.
Most babies will cry during the procedure, faces may go red and the baby may cry. They are not in pain as anaesthetic has been given but objecting to being held and the intrusion into their mouth. Babies settle once they are reunited with their mother and begin to breastfeed. The rapidly absorbed sugars present in breast milk are a very effective pain reliever. They need to be hungry at the time of the procedure so they will feed quickly post procedure.
Some babies are a little unsettled for several days after the procedure, The upper lip may swell slightly for 24 to 48 hours. Babies may be difficult to feed for several days as moving the upper lip and tongue may be uncomfortable for baby.

Bleeding

The only blood normally seen is several drops from the injection site. The laser will seal any blood vessels as it evaporates tissue.
If a baby accidentally scratches the wound (very rare) the wound may bleed. Sit the baby up on your lap and with a clean tissue apply pressure to the wound for several minutes. If you are worried seek medical advise. Bleeding after laser surgery is extremely rare. Placing socks on babies hands for 48 hours should prevent scratching the wound.

Infection

This is a very rare complication. But infection is possible after any surgery however minor. Infection will cause pain, swelling, redness, reluctance to feed and possible bleeding. If you suspect infection you should bring your baby to your medical practioner straight away.

Recurrence and Adhesions after Tongue Tie Surgery

Following Frenectomy once the baby has fed if you look under the baby’s tongue you should see a small diamond shape patch which can vary in size from approximately 4-10mm, this will be grey/ black in colour. After several days as it heals it resembles an uncer, a yellow/greenish diamond shaped area, this is normal healing of tissue in the mouth and is not an infection.
Recurrence of tongue-tie is not due to the membrane growing back, it is due the diamond shaped wound of the frenectomy adhering/sticking or scarring and then the resultant scar contracting. It is estimated that there is a 4% incidence of scarring causing the tongue to tighten again after release.

To ensure optimum surgical outcome of frenectomy is necessary to try and ensure that the wound heals without scarring or tightening of the wound.

Recurrence of Tongue Tie, if it does happen will take several months, the recurrence will be incomplete and for most mum’s they are already weaning their baby so a small recurrence at this stage is of no importance and needs no treatment.

Alternatives to Tongue Tie Surgery

Alternatives to the procedure are:

  • Expressed breast milk offered to the baby in a bottle. It can be difficult for some mothers to maintain and increase milk supply as their baby grows using a pump or hand expression alone.
  • Some tongue-ties resolve spontaneously as baby grows they may break or reduce it by putting toys or other objects in their mouth.

What to expect after Tongue Tie Release

Following the procedure some mothers and their babies find an immediate improvement in feeding.

For others it will take longer, sometimes a week or more for feeding to improve as the baby acquires new skills to breastfeed.

Whilst having a tongue-tie both mother and baby acquire adaptations to their feeding to work around their difficulties. After the procedure, it can take some time for some mothers to gradually transition from the use of for example, nipple shields, expressed breast milk or artificial milk, whilst their breastfeeding gradually improves.
It is important that you view frenectomy as part of a plan to improve your feeding; it is not always an instant fix.

The help of a Lactation Consultant or other breast feeding specialist is important if you wish to gain maximum benefit from the procedure. The following link will help you find your nearest Lactation Consultant.