TONGUE-TIE

What is a Tongue Tie?

This is a piece of fleshy tissue running between the under surface of the tongue and the floor of the mouth. It is also called as the frenulum. The frenulum is present in most people but when thicker or shorter than normal it may restrict the movement of the tongue, particularly the ability to stick the tongue out of the mouth. A tongue tie may cause feeding difficulties, excessive drooling, and poor dental hygiene or be associated with speech problems.

General description

The aim of the procedure is complete release of the tongue-tie. In older children the operation is performed as a day case under general anaesthesia and will usually take about 15 to 20 minutes to perform. The procedure is only performed under general anaesthesia to reduce the risk of damage to the tongue together with its associated nerve and blood supply.

In neonates and infants the procedure can be performed with scissors or Laser at Perth Paediatrics. The Laser procedure is performed with topical anaesthesia.Dr Gera has Clinical Nurse to assist the procedure at Perth Paediatrics.

Preparations for Tongue tie repair under General anaesthesia

Your child will need to fast for solids and liquids generally for about 6 hours before the start of the procedure. In breast-fed babies or infants this time may be reduced after consultation with the anaesthetist. It is often helpful to bring your child’s favourite toy with you on the day.

Anaesthesia

You and your child will meet the anaesthetist on the morning of the procedure. After talking to you and briefly examining your child, they will take you through to the operating theatre. One parent is welcome to accompany your child until they are asleep. The anaesthetist puts your child to sleep via a face mask (with children 5 years and over there is the option of either a face mask or a needle with numbing cream).

Procedure

The mouth is cleaned with a mild antiseptic solution. The tongue-tie is divided using an electrical cautery device, which both releases the tongue-tie and seals any blood vessels in the frenulumLocal anaesthetic is then applied in the form of a gel to the wound. The local anaesthetic block usually lasts around 2 to 3 hours.

Initial recovery

Once the operation has fi nished, your child will be taken to the recovery area. Once awake, you will be called into the recovery ward. Often children appear mildly distressed and a little confused initially – there may be several reasons for this including residual effects of the anaesthetic, hunger and some discomfort. Generally they will settle quite quickly, especially if offered a drink or feed. The recovery and ward staff are also able to give pain relief medication once your child is awake and this is sometimes required. The nursing staff will check the wound and make sure you are happy before you go home. Usually this will be about 2 hours after the surgery.

Post-operative course

Paracetamol (‘Panadol’) should be given on the afternoon and evening of surgery, and in the morning of the following day. After that time, assess your child’s pain to see if further doses are required. Older children may require a stronger medication such as ‘Painstop Daytime’ or ‘PainstopNighttime’ if over one year of age. Follow the manufacturer’s dose instruction but never give more than 4 doses in a 24-hour period and never both at the same time.
There may be a small amount of blood that oozes from the wound in the first 24 hours.
Your child can begin eating when they get home. Start with clear liquids (apple juice, iceblocks) and add solid food slowly and in small amounts. Your child may vomit from the anaesthesia on the day of surgery. This should stop by the morning after surgery.

Return to activity

Your child may return to day care or school when comfortable, usually within 3-5 days.

Call our office or contact emergency department on the given numbers if:

  • You see any signs of infection: redness along the incision site, increased swelling, foul smelling discharge from incision.
  • Your child’s pain gets worse or is not relieved by painkillers.
  • There is bleeding (small ooze of blood in the first day or two is normal).
  • Your child has a high temperature
  • Vomiting continues on the day after surgery
  • You have any questions or concerns

Follow up 4-6 weeks after surgery.

Follow-up

Normally, I recommend review in 6 weeks. Please note that although the wound generally heals very quickly, usually withing a week of the procedure, the scar at the floor of the mouth remains pale for several weeks or months. This will not cause any functional problems.

Problems & further surgery

Whilst surgical release of tongue-ties is usually uneventful, there is always a 2-3% risk of bleeding after surgery. Please also be aware that surgical release of a tongue-tie will not always be associated with an improvement in a child with an established speech impairment. Further assessment by your speech pathologist after the surgery is recommended.

Clinical Pictures