Frenotomy – Aftercare

The goal of exercises post-frenotomy is to help minimise the chance of premature reattachment at the site of either the tongue or lip, causing a new limitation in mobility and the persistence or return of symptoms. The exercises are not meant to be held for long, nor do they require much force.

See below videos from Dr Bobby Ghaheri for a demonstration of how best to perform these exercises. You will find a more extensive explanation on wound aftercare here, as well as answers to many commonly asked questions on tongue ties.

Tongue: Dr Bobby Ghaheri

Protocol:

Insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers to dive under the tongue and pick it up, towards the roof of baby’s mouth. The tongue needs three separate stretching motions:

  1. Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby’s mouth). Hold it there for 1-2 seconds and then relax. The goal is to completely unfold the diamond so that it’s almost flat in orientation (remember, the fold of the diamond across the middle is the first place it will reattach). The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up. Picture how a forklift works: If you don’t get the forklift tynes completely under the pallet, lifting the pallet up will cause it to tip backwards. If you get the tynes completely under the pallet, you can lift the pallet straight up. I recommend pushing your index fingers together to prevent them from separating, then push at the top of the diamond into the tongue (in the direction of the tonsils). Once you are under the tongue, then lift the tongue so that the middle of the tongue comes up with you. If your fingers separate and go on either side of the diamond, your lifting pressure will be directed at the sides of the tongue and not at the diamond itself. (Duration: 1 second lift and hold)
  2. With one finger propping up the tongue, place your other finger in the middle of the diamond and turn your finger sideways and use a lifting motion from low to high to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across that diamond. Make sure your finger starts within the diamond when doing this stretch. This stretch should not be forceful or rough within the wound. (Duration: 5 seconds)
  3. Massage on either side of the diamond (outside the diamond) to loosen up the musculature of the remainder of the floor of mouth. You can use more pressure when doing these stretches because you aren’t in the wound at this point. (Duration: 5 seconds)

Timing:

  1. One stretch on the first evening following frenectomy
  2. Next stretch on the morning after the procedure. Then 6 x times per day for 3 weeks. Do 5 stretches during the day around nappy changes, and one overnight. Do not go more than 6 hours between stretches.
  3. From the 4th week, drop one stretch per day before stopping completely by the end of week 4.

Lip: Dr Bobby Ghaheri

Protocol:

Typically, babies don’t like either of the stretches and may cry, so starting with the lip allows you to get under the tongue easier once the baby starts to cry. For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). Then gently sweep from side to side. (Duration: 1-2 seconds.)

The main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can’t stick together.

Timing:

  • 4 x per day for 2 weeks

Sucking Exercises

Pre and post-procedure suck training exercises: Lisa Lahey

It’s important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. Starting these exercises from the moment you make your appointment can speed up your recovery after the procedure. The following exercises are simple and can be done to improve suck quality.

Protocol (Dr Ghaheri):

  1. Slowly rub the lower gumline from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
  2. Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
  3. Let your child suck your finger and apply gentle pressure to the palate. Once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you. Listen for a seal break and then put your finger back up into the palate to re-stimulate sucking. Repeat as tolerated.
  4. With one index finger inside the baby’s cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.

Timing:

  1. In the lead up to the procedure: 4 times per day
  2. Post-procedure: begin on day 3 after the procedure, 30-45 sec on each stretch, prior to wound stretches.
  3. No night time stretches required
  4. Cease at end of week 4, after consultation with Osteopath/Lactation Consultant.