For Anterior Tongue Tie

a. Begin at the free border and proceed posteriorly,

closer to the tongue than to the floor of the mouth.

b. In most cases, a single cut will free the tongue sufficiently.

c. Occasionally, 2 to 3 small, sequential cuts (1 to

3 mm) are required.

d. Each subsequent cut allows improved retraction

and visualization for the next cut.

Fig. 57.3. Grooved retractor used to raise tongue and visualize

the frenulum. Notice how thin and membranous the anterior

edge is.

Chapter 57 ■ Lingual Frenotomy 399

e. Divide frenulum anterior to the vascular bundle, until

the tongue is freed and can extend past lower alveolar

ridge and lips and elevate to the roof of the mouth

(equally important for breast-feeding) (Fig. 57.5).

f. Observe for posterior tongue tie, which may have

been obscured by anterior tongue tie (Fig. 57.2). If

present, the next step may be required.

For Posterior Tongue Tie (should be performed

only by practitioners with experience in

treating posterior tongue tie)

a. Visualize the sublingual area. A membranous small

band may or may not be visible. (Fig. 57.2)

b. Diagnosis is made by palpation. With the index finger nail down push the midline posteriorly. A posterior tongue tie will feel like a vertical tight band

under the mucous membrane.

c. Clip in center of band with iris scissors as narrowly

as possible (Fig. 57.6), until diamond shape opens

(Fig. 57.7).

d. Palpate edges of the “diamond.” There can be taut

edges laterally, which may need a clip of another

millimeter until no longer taught and “diamond” is

wide open (Fig. 57.8).

10. Control any bleeding (usually minimal) with direct

pressure applied with a sterile gauze pad. There is generally more bleeding with posterior frenulum clipping.

If excessive bleeding (more than 3 to 5 cc)

a. Continue to apply pressure. Steps b, c, and d (below)

are rarely required.

b. Apply topical Neo-Synephrine (Afrin) as vasoconstrictor on cotton swab, or

c. Apply small piece of Gelfoam or

d. Dab with silver nitrate stick

11. Inform mother that breast-feeding may resume immediately.

Mothers frequently note an immediate and dramatic improvement in breast-feeding, with reduced

Fig. 57.6. Initial clip of posterior tongue tie, in very center.

Note use of finger as an alternative to grooved retractor used in

Figure 57.5. (Photograph courtesy of Evelyn Jain BA, BSc, MD,

FCFP.)

Fig. 57.7. A second, smaller, clip of posterior tongue tie to

open the “diamond” and remove tautness laterally. (Photograph

courtesy of Evelyn Jain BA, BSc, MD, FCFP.)

Fig. 57.4. Grooved retractor used to raise tongue. Iris scissors

make incision.

Fig. 57.5. After incision, minimal blood noted. Tongue now

extends past lower alveolar ridge.