Frenuloplasty (Tongue Lengthening) Surgery Pre and Post-Operative Care Instructions
Your active participation is important to the post-operative success of your treatment. The following guidelines will help to optimize a successful surgical outcome.
Post Op Emergency Line (530) 334-6736
Frenectomy or frenuloplasty, is a relatively minor surgical procedure performed to loosen or remove overly large, tight, or poorly positioned band(s) of tissue that are present inside the mouth, connected to the lip, cheeks or floor of the mouth (frenum) – a condition commonly referred to as being “tongue-tied” or “ankyloglossia” – which can cause speech impediments and difficulties with chewing, swallowing and other aspects of oral function. In infants, this condition can impair feeding, and for some older children, teens and adults, cause daily discomfort/pain and lead to mouth breathing. Once the tissue has been removed, the wound will typically be sutured. Frenuloplasty is a quick procedure, generally taking less than one hour, and is often performed with just local anesthesia in adults.
The success of our practice is based on our ability to provide a complete and effective release of tethered oral tissues by incorporating a multidisciplinary protocol that integrates myofunctional therapy (and sometimes physical therapy) before, during, and after surgery.
Our tongue-tie release procedure is based on precision: releasing the appropriate extent of tissues for maximal relief; not too much, and not too little. The tongue is one of the most critical organs in our bodies as it has the ability to regulate and shape orofacial structure and musculature. The untethered mobility of the tongue is required for optimal speech, chewing, swallowing, oral hygiene, and breathing functions, as well as for development of the skeletal structures of the jaw and the airway. Because the tongue plays such an important role in so many functions, restricted mobility of the tongue may lead to compensatory behaviors that may negatively affect nasal breathing and cause snoring due to low tongue posture, or contribute to chronic stress on the other muscles of the head and neck. The tongue also has connections to the whole body through a system of connective tissue known as fascia, and a restrictive tongue may place tension on the fascia networks causing neck tension, pain, and postural dysfunction. Our functional frenuloplasty approach honors the changes that occur during a tongue-tie release and prepares the body for acceptance and optimal healing post-treatment.
Prior to surgery:
- MEDICATIONS: Prior to your procedure, it is okay to continue taking aspirin, aspirin containing, or aspirin-like medications such as ibuprofen, etc. Although these medications can cause a thinning of the blood, it will usually not cause a significant problem for frenuloplasty procedures.
- EATING: We encourage you to eat a full meal prior to your procedure. We also encourage getting a good night’s sleep the night before. Please refrain from consuming caffeine prior to the procedure.
- ARRIVAL TIME: Your prompt arrival is important in order to give our staff enough time to get you ready for your procedure/surgery. If you foresee a problem with arriving on time, please notify our office at (530) 222-1400.
Frenuloplasty Pre-Operative FAQ
Q: CAN YOU DESCRIBE THE TREATMENT FOR A PATIENT THAT IS TONGUE TIED? DOES IT HURT?: A frenuloplasty is a straightforward outpatient procedure that can be completed in office without the need for general anesthesia. If a release is recommended, the treatment takes less than an hour. Dr. Barnhart will apply an effective topical anesthetic gel on the frenular tissue underneath the tongue prior to treatment, followed by an injection of lidocaine, allowing for zero to minimal discomfort during the procedure. The anesthetic wears off approximately 30-45 minutes after the procedure is completed. For the first several days (occasionally up to 5 days) following surgery, pain is to be expected. This can usually be controlled with over-the-counter medication such as Tylenol or Ibuprofen.
Q: ARE ANTIBIOTICS ADMINISTERED?: No, antibiotics are not administered. We recommend rinsing with salt water and/or alcohol-free mouthwash several times a day to keep the wound clean and reduce the risk of infection.
Q: WHAT ARE THE POSSIBLE RISKS?: Complications of surgery are rare, but may include numbness, bleeding, pain, failure of procedure, infection, injury to adjacent structures, and scarring. It is crucial to follow the post-operative instructions to prevent scarring or re-attachment of the frenum. Pre- and post-operative myofunctional therapy is essential for optimal recovery after frenuloplasty.
Q: WHAT IS THE PROPER WAY TO ACTIVELY MANAGE THE WOUND POST-PROCEDURE? WHAT CAN I EXPECT TO SEE AFTER THE PROCEDURE?: We use absorbable sutures that will usually fall off or dissolve on their own within 3-5 days and sometimes anywhere from 1-10 days after surgery. As the sutures fall out, white tissue will fill the open wounds. This is normal and not an infection, rather, it is granulation healing tissue that will heal and disappear in approximately two weeks. You can use a soft toothbrush to remove any oral debris if necessary. Please refer to the attached post-operative instructions for more details regarding wound management.
After the surgery:
Patients should expect some mild swelling, pain, and/or discomfort as a normal process of wound healing. Pain is often controlled with over-the-counter pain medications, and other symptoms usually self-resolve over the course of 1-2 weeks with proper rest and myofunctional therapy. Possible (but very rare) complications of frenuloplasty may include bleeding, pain, numbness, failure of procedure, scarring, and injury to adjacent structures which may result in salivary gland dysfunction.
Immediately after the surgery:
- Wound Care and Bleeding: To alleviate discomfort, you can apply a small amount of topical analgesic gel to a piece of gauze, place it on the surgical site, and replace as needed every 1-2 hours, up to 4 times daily. It is normal to experience some bloody oozing during the first 1-2 days. If steady bleeding occurs, place gauze under the tongue to hold pressure and call Dr. Barnhart, or go to your local emergency department.
- Swelling and Inflammation: It is normal to experience some swelling and inflammation in the first 3-5 days after surgery. Your tongue may feel larger than usual and more painful to move. We recommend using Tylenol and Ibuprofen as needed for pain. We also recommend holistic options such as arnica, turmeric, ginger, and CBD oil. Patients who are more sensitive to pain may benefit from narcotic pain medications such as Tramadol.
- Oral Hygiene: Please continue brushing teeth as usual. We recommend rinsing with salt water and/or alcohol-free mouthwash several times a day to keep the wound clean and reduce the risk of infection.
- Food/Drink: During the first few days, you may find it helpful to have soft, cool foods. You may find it challenging to consume hot or spicy foods, or foods that require a lot of chewing.
- Sutures: We use absorbable sutures that will usually fall off or dissolve on their own within 3-5 days and sometimes anywhere from 1-10 days after surgery. As the sutures fall out, granulation healing tissue will fill the open wounds. If the granulation tissue overgrows the wound, we recommend brushing the surgical site with a soft brush to remove any oral debris. It is not necessary to completely remove the granulation tissue.
- PeriAcryl Glue: PeriAcryl glue may be applied to the wound site in place of or in addition to sutures. Over time, the glue can have a hard and rough texture, but try to refrain from picking at it. If the glue stays on past 1 week, we encourage gentle massage with Vitamin E oil, coconut oil, or mineral oil to dissolve and remove the material.
- Myofunctional Therapy Exercises: We recommend not doing any exercises the day of surgery. Give yourself the day to rest and then start doing gentle tongue movements the following day and for the first 3 days after your procedure, to focus on minimizing your pain. This may include light movements with your tongue by lifting it up to the front teeth with your mouth wide open, moving side to side inside the cheeks, tracing the tongue back and forth along the palate, and elevating the tongue in suction hold. Avoid sticking out your tongue during the first few days to prevent tearing the sutures. Contraction may occur by around day 5-7. It is extremely important to perform the stretches and exercises as prescribed by your therapist to obtain the most optimal results. We will go over these exercises at your 3 day post-operative appointment.
- Wound Stretches: Check in with your myofunctional therapist within a week after your procedure to assess the progress of your wound healing and determine whether wound stretches are indicated. Wound stretches involve wrapping the tongue in a paper towel or gauze, and pulling the tongue outwards, downwards, upwards, and to each side, to feel a stretch for at least 30 seconds or until there is a release of tension.
- Lip and Buccal Ties: We recommend that you take it easy for the first few days. Afterwards, run your tongue around the oral vestibule several times a day. We also recommend air puffs. After one week, you can stretch the lip outwards and perform manual intraoral massage.
- Bodywork/Physical Therapy: Many patients benefit from fascia physical therapy, craniosacral therapy, osteopathic manipulation, and other forms of bodywork pre and post-operatively depending on the clinical circumstance.
At any time, call our practice if you experience any of the following:
- Severe pain that does not improve with medication
- Brisk bleeding
- Severe swelling at the site of surgery
- Difficulty breathing
- Fever higher than 102 degrees F (~39 C)
For emergencies, please call 911 or proceed to your local emergency department. During office hours (8:00am -4:30pm, Monday-Thursday) call the office at (530) 222-1400. After 4:30pm, call the office first to leave a message, then call or text Dr. Barnhart directly at (530) 334-6736.
*Additional Resources (Dr. Barnhart has received this training through Dr. Zaghi and The Breathe Institute):
Cited Source The Breathe Institute – Dr. Soroush Zaghi, MD