Click below to download a PDF of our After Care Instructions.
Download InstructionsDiscomfort may be experienced by some patients more than others and usually diminishes greatly after the first 2 days. There also may be a peak pain day noted around day 3-5 postop. A baby is likely to be fussy in the first week following the procedure. Some babies are very sleepy and some cry a lot when they are awake. It is not uncommon for patients to complain about an earache or a sore throat after the lingual frenectomy. Some things you can do to offer comfort to your baby include skin to skin contact, swaddling, taking a warm bath together, singing, and cuddling with your baby.
Infant Tylenol is offered prior to the procedure. If after 4 hours of the first dose, you feel your baby needs an additional dose, you may give 1.25mL (6-11 lbs and 0-3 months of age) or 2.5mL (12-17 lbs and 4-11 months of age). Tylenol dosages for older/heavier infants and children are 3.75mL (18-23 lbs) and 5mL (24-35lbs). Please note that Infant Ibuprofen (Motrin or Advil) is NOT recommended for use under 6 months of age. If your child is over 6 months of age, Tylenol and Ibuprofen can be alternated every 3 hours at the dosage recommended on the bottle. Ibuprofen lasts longer and provides an additional anti-inflammatory property that Tylenol does not.
You may apply a small amount of our Tongue Tie Tincture, coconut oil, breastmilk, breastmilk or formula ice chips, or cold water to your fingers prior to stretching if you wish. For safety, AVOID Orajel, Hyland’s teething gel, and any gels containing benzocaine products. Pedialyte popsicles and frequent sips of cold water help with post op pain as well for older patients. Frequent hydration is of utmost importance postoperatively. Patients may eat soft foods as tolerated unless otherwise specified.
Minor bleeding is expected during the procedure and during the exercises and stretches following the procedure. You may hold gauze pressure with wet gauze and/or a wet black tea bag to help stop bleeding when needed. Afrin nasal spray on a dry gauze with applied pressure can help control a more aggressive bleed. Contact our office if bleeding continues after holding pressure. It is not uncommon to swallow some blood, which may lead to spit up containing blood, darker stools, and/or nausea. You may also notice pink tinged saliva.
Your child now has mobility of his or her mouth and will need some help learning what to do with it. Also, we want to help the areas heal most effectively. The more your child moves their mouth, the more they are stretching the surgical areas and strengthening the muscles.
To ensure optimal results, it is IMPERATIVE to complete stretches with your child 4-6 times per day for a minimum of 4 weeks. Please note that sites that are sutured (stitched) are not to be stretched until instructed to do so at the 1 week postop appointment or until the sutures are dissolved. It is, however, important for parents to gently look at the sutured sites daily to be sure that the sutures haven’t popped or that the wound has not reopened. If so, please contact our office for further guidance.
At the 4 week post op appointment, we will give guidance as to whether or not the stretches/exercises need to be continued based on your child’s specific needs. Be sure to thoroughly wash your hands or wear gloves. Also be sure that your fingernails are short prior to the stretches. If both the lip and tongue were revised, we recommend you start with the lip each time you stretch since it is the easiest of the sites to stretch.
The wounds created are typically diamond shaped. This diamond has 3 dimensions (height, width, and depth). This is especially important for the tongue wound which is much deeper than the lip or cheek wounds. Maintaining these 3 dimensions is the key to successful healing.
For the upper lip, simply place your index fingers under the lip next to the diamond and pull it out and up towards the nose as high as it will go (until it bumps into resistance) then hold for 5 seconds. It is helpful to have the lower jaw partially closed to allow for maximum range of motion of the lip when stretching. Then gently sweep your finger over the wound from side to side for 1-2 seconds. Use your right index finger for the left side and your left index finger for the right side. Windshield wiper strokes inside of the cheeks are also recommended when cheek muscles are tight and before and after buccal frenums are released. Lip and cheek puffs may also be done to stretch and strengthen the orofacial muscles.
For the lower lip, the stretches are the same with the exception of pulling the lip out and down instead of up towards the nose.
If sutures were placed at the revision site under the tongue, finger stretches typically are not needed to prevent reattachment in the first week following the procedure unless you have been instructed to work to keep the “Eiffel Tower” area incision open. To stretch the “Eiffel Tower” incision, apply pressure with your pointer finger down into the floor of mouth for 5 seconds as you see the “Eiffel Tower” incision open. Repeat 3 times. Take care not to poke directly at the sutured area of the main sublingual incision (if applicable). It is encouraged to check the sutured sites daily in the first week to be sure that stitches are intact and dissolving symmetrically. If not, please contact our office immediately for further advice.
Exercises that encourage elevation, lateralization, and extension of the tongue in conjunction with stretches will commence after the 1 week post op. Examples include licking a popsicle or lollipop, clucking, and practicing /L/ sounds.
Follow up with your child’s therapist is recommended within 3-10 days post revision as well as post op appointments with AIPD at 1 and 4 weeks.
Sucking Exercises for infants may also be introduced pre and postoperatively to help disorganized feeders or those with incorrect or weak sucking patterns. We recommend these to be done before or after stretches and/or before feeds.
Feeding patterns may be different in the days following the procedure. Your baby has a new mouth to get used to. Occasionally, they know just what to do with it, but usually it takes time and practice. On the day of the procedure and sometimes the day after, your baby may not eat as much as usual and may even skip some feedings or have feedings that seem shorter or longer than usual. Focus on responding to your baby’s cues and be flexible as things are changing. Always ensure baby is getting enough milk by counting wet and dirty diapers, but do not worry. If primarily breastfeeding, please don’t hesitate to use bottles or syringes if needed to ensure that your baby is adequately hydrated. These temporary changes are expected. Remember, it is a marathon, not a sprint!
It is expected to need more support in helping your child become as effective as he or she can post revision. This will be new to you both as you are learning the proper feeding techniques and addressing any problematic issues. In order to gather both information and support, we suggest that you request to join the Louisiana Tongue Tie Support Group Facebook Page where our doctors are listed as preferred providers. We strongly recommend that you seek out further support beyond our care within 48-72 hours of the procedure and anytime it should be needed thereafter. At the time of your child’s lactation or speech and feeding evaluation, their therapist would have set goals that should be met to ensure that the best results are achieved.