What is Frenotomy?
Frenotomy (a.k.a. frenulotomy or frenulectomy) is the procedure in which the lingual frenulum is cut. It is done when the frenulum seems unusually short or tight (anklyoglossia or "tongue-tie"). In the newborn nursery, frenotomy is indicated when the abnormal frenulum is impairing the infant's ability to breastfeed.
The procedure involves holding the tongue up towards the roof of the mouth to make the frenulum taut, then cutting through the white, fascia-like tissue along a line parallel with, and fairly close to, the tongue. The cut is made in a single motion in less than a second. Anesthesia is not necessary. The only risk is excessive bleeding. Normally, there is only a drop of blood or less.
A specialized frenotomy kit with a tongue elevator makes the procedure easy, but the tongue may also be lifted with the index and middle fingers on either side of the frenulum, and the frenulum clipped with sterile scissors from a suture removal kit.
What Does the Tongue Look Like After the Procedure?
Here are photos of the same newborn before and immediately after frenotomy. One can easily see how the tight frenulum has been cut, permitting much more movement of the tongue. There is no bleeding, and breastfeeding was significantly improved as a result of the procedure.
This procedure dates back to the 18th century, when it was a rather common practice for midwives to divide the frenulum with a sharp fingernail. Medical authors of that time also began recommending it for infants with breastfeeding difficulties.
There is still controversy regarding when frenotomy is indicated, but it seems reasonable that physicians caring for newborns all be skilled in performing this simple procedure. When indicated, frenotomy in the newborn period can quickly improve a "poor latch" on the breast, and prolong the mother's ability and willingness to breastfeed.