TODDLER POST-OP
The first few days after tongue tie release can be stressful, especially for the parents! See below for answers to the most common questions after frenectomy, and for the latest protocols for wound management.
PAIN MANAGEMENT
HEALING
After the release, there will be a diamond-shaped wound under your child's tongue and/or lip. It takes about 2 weeks for the wound to heal (sometimes a bit longer). The healing will begin almost immediately after treatment, and the wound will often be larger than you would expect. The wound will be whitish yellow, or sometimes even neon yellowish green (common in babies with jaundice) and will look similar to pus. This is normal!!
At home you may notice that the upper lip is now freed into a new fuller position. This is due to the tension release of the previously underlying frenum. If there is any swelling, it will be slight and would be under the nose where the lip and nose meet. This will go away in a day or so. It should not be significant and never distort the lip. This newfound lip and tongue mobility may also be a little confusing to your baby as he/she adjusts to this improved muscle freedom. You may notice your baby sticking out their tongue or drooling more – this is normal!
A normal healing lingual (tongue) frenectomy
Source: Dr. Bobby Ghaheri
LIP EXERCISES
The upper lip is the easier of the two sites to stretch. If you must stretch both sites, I recommend that you start with the lip. 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) and hold for 2-3 seconds.
Then gently sweep from side to side, as if you were brushing invisible teeth, for about 5 seconds. Remember, 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.
The entire lip stretch should take less than 10 seconds to complete.
Here is Dr. Bobby Ghaheri's video that shows lip stretches (scroll down for the tongue stretch video)
TONGUE EXERCISES
Parents have the most trouble with the tongue stretches - if you are struggling, remember you are not alone!! The following stretches are from Dr. Ghaheri's website, www.drghaheri.com. Videos are available on his site to help with stretches.
To stretch the tongue, 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 – height, width, and depth – to minimize reattachment:
1. With clean hands, press down on the baby’s chin to gently open the mouth.
2. While the baby’s mouth is open, use one or two fingers from the other hand to tuck under the baby’s tongue and gently lift it upwards and back, exposing the healing diamond-shaped wound.
3. Hold this position for no more than 3 seconds.
4. You may gently massage the wound to make sure it feels soft and squishy. DO NOT RUB HARD!!!
Here is a video from Dr. Ghaheri that shows how to do the stretches:
Dr. Chelsea Pinto's "Bouncy Stretch" is often easier on both baby and parent! You can try this technique to see if it makes it easier to get under the lip and tongue - just make sure you are lifting the whole tongue!
If you are concerned that there is some adhesion in the wound, you can do a deeper stretch to loosen up the scab. This video from Dr. Richard Baxter (Alabama Tongue Tie Center) shows how to achieve this: