The tongue attaches to the floor of the mouth with a web of tissue called the lingual frenulum. Tongue-tie, or ankyloglossia, is an congenital variation in this structure whereby it may be shortened, thickened or it may tether the tongue too close to the tip. All of these variations can restrict mobility of the tongue.
It is important to know that tongue tie is not the only cause of breastfeeding difficulties. It is being diagnosed more now that breastfeeding is becoming more commonplace, but it is far more common for babies not to have a tongue tie than to have one. And even if a tongue tie is present, tongue tie surgery may not improve breastfeeding. If a tongue tie is deemed by a lactation consultant and/or a pediatrician to be contributing to breastfeeding difficulty, treatment may be appropriate. This is often determined after several days of breastfeeding when the baby is discharged home with parents.
Frenotomy (a.k.a. frenulotomy or frenulectomy) is the procedure in which the lingual frenulum is cut. 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 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 bleeding, and usually there is only a drop of blood or less. Most babies can feed immediately afterward.
At times the frenulum is too thick or located too posteriorly to be clipped by a pediatrician, in which case a referral to ENT will be made. Thankfully, almost all babies can bottle-feed, so while working to determine the causes of and addressing breastfeeding difficulty, it is may be recommended that you pump and bottle-feed. It is not necessary to provide any specific post-procedure care for babies after a frenotomy, including stretches or massage. Please discuss whether or not your baby may be a candidate for this procedure with your pediatrician before seeking care from non-MD providers such as dentists.