Dr. Agarwal at Agave Pediatrics has performed thousands of tie release procedures for tongue (lingual frenectomy) and lip (labial frenectomy) ties over the years. On the day of the procedure, Dr. Agarwal will assess your child once again and discuss the procedure and any possible complications with you. The procedure involves little to no pain for the child and has improved feeding and speech for many children.
● Tie release is a brief and minor procedure done in a treatment room in our office (at either Chandler or Glendale location).
● The child is given a local anesthetic injection to numb the site.
● A laser is used to release and cauterize the tissue under the tongue or lip. As the tissue is being released, it is continually checked for any bleeding, as well as for appropriate range of motion such as lift and extension.
● After the procedure Dr. Agarwal will show you the results.
● Exercises and wound care will be reviewed with you
● Pain management will be reviewed with you.
● If you are breastfeeding or bottle feeding, we will encourage you to complete a full feeding cycle while in the office so that both infant and you are as comfortable as possible for your trip home.
After the Procedure
Immediately after the procedure, our staff IBCLC will guide you to a lactation room and assist you in latching your infant. If you are working with a lactation consultant, you will be referred back to your IBCLC for follow-up approximately 3 to 5 days post-procedure.
You will be encouraged to complete a full feeding while in the office so that both mother and infant are as comfortable as possible for the trip home.
Please take note of what the incision looks like immediately after the procedure. Take a photo of the white diamond shaped wound that becomes visible under the tongue in the first 24 hours after the procedure. The white diamond should remain the same size; it should not get smaller or disappear.
With every set of exercises, check for re-attachment by noting the size and shape of the white diamond. The white diamond should remain the same shape with distinct, straight edges. It should be even from side to side: the edges should not look muddled or “tucked in.” You should not see tissue protruding from the base.
If you detect re-attachment, please call the office for further instruction. Some reattachment is expected, but minimizing it is important for over-all improvement.
At times, the exercise sessions can cause a small amount of bleeding. If this occurs apply firm pressure to the wound with a clean cloth or cotton ball. Breastfeeding your infant will also help bleeding to stop. If bleeding does not stop, the child needs to be evaluated immediately.
If you have questions,
check out our FAQs,
contact us, or visit the tongue tie support clinic.*
*The in-person tongue tie support clinic is currently on hold due to COVID-19 precautions, but we offer support via text, email, or phone. With a lactation consultation, you can bring your infant for in-person guidance, support, and discussion with our IBCLCs.
Proactive pain management is very important. For most children, the first 72 hours are the hardest. The use of Tylenol or Ibuprofen based on your child’s age and weight and Arnica 30 C, (a homeopathic remedy) will be helpful.
Dosage information is included in the packet you received at your consult, as well as in the email that was sent to you.
● Initially, your child’s mouth will be numb at the site of the procedure. This will last for approximately 2 hours.
● Please prepare to ease your child’s discomfort by having pain medication on hand before procedure day.
● If you have traveled a distance of a couple of hours, please bring Tylenol or Ibuprofen so that you can give a first dose before traveling home.
● If your child is uncomfortable with the exercises, be sure that their pain is being managed.
Initially, post-procedure exercises can be the hardest on parents and children; however, they are necessary and helpful in the long term. We are here to teach you firm but gentle (not forceful) methods so that your child may tolerate them as well as possible. You will be shown the post-procedure exercises immediately after the procedure is done. There are also
videos of the exercises in the email you received regarding the procedure.
The goal of the exercises is to keep the healing tissue open and separate. This area needs to heal without the released tissue re-attaching back together. Within 24 hours or so of the procedure, a white diamond shape will be seen at the wound site. PLEASE do the exercises consistently, 6 times per day until your two week follow-up appointment.
After that appointment, exercises may continue for up to another 4 weeks to decrease the chance of re-attachment and continue to help muscles of the mouth. If you are working with an IBCLC or Speech Pathologist, they can guide you through the specific and unique needs of your child's oral-motor patterns.
● Please start these exercises 6-8 hours after the procedure, unless given different instructions by Dr. Agarwal.
● Build on the skills you developed by doing the pre-procedure exercises. Remember to start with clean, well-rinsed hands. If you are doing these while the child is awake, try to make this a playful routine so that YOU are effectively stretching the tissue and the child's discomfort is kept to a minimum. These exercises do not take a long time to do; however, they should be done consistently to avoid re-attachment.
● Position your child on a stable surface such as your lap or a changing table so that you can see into their mouth. If helpful, place a rolled up hand towel or receiving blanket behind their neck to help their head flex back, making it easier to see the inside of their mouth.
● You can start with the gentle facial massages and stimulating their philtrum to open their mouth. Once you are allowed inside their mouth start with “Follow the Finger”. Doing these first helps baby become familiar with your fingers in their mouth (again) and exercises lateralization of the tongue (moving it from left to right).