After Care Instructions The success of tongue tie or lip tie laser surgery is dependent upon post-procedure stretching. The mouth is an amazing organ that heals very quickly. This can become a problem because reattachment of the frenum can occur if adequate stretching exercises are not completed. "Intentional", quick and precise stretching creates the best results, stretches need not be forceful.
How to do the stretches: 1. Wash your hands well and apply a small amount of organic coconut oil to your index fingers. (Do not use any gel that contains benzocaine for children under 2 years of age or when there is an open wound. Do not use regular Orajel or Ambesol.) Be sure to read the label of ingredients. 2. Lay your infant on your lap or on the bed with their feet facing away from your body. The Upper Lip is the easier of the 2 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. 3. To stretch the upper lip: Place your finger under the lip to the place you meet resistance. Then gently move your finger from side to side for 1-2 seconds then roll from the gums up into the lip with your finger. It is appropriate that you touch the open wound as the reason you are stretching is to make sure the two healing edges remain apart. The stretch under 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). - Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby's mouth). Hold it there for 1-2 seconds and then relax. The goal is to completely unfold the diamond so that it's almost flat in orientation (remember, the fold of the diamond across the middle is the first place it will reattach). The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up. Picture how a forklift works: If you don't get the forklift tynes completely under the pallet, lifting the pallet up will cause it to tip backwards. If you get the tynes completely under the pallet, you can lift the pallet straight up. Push your index fingers together to prevent them from separating, then push at the top of the diamond into the tongue (in the direction of the tonsils). Once you are under the tongue, then lift the tongue so that the middle of the tongue comes up with you. If your fingers separate and go on either side of the diamond, your lifting pressure will be directed at the sides of the tongue and not at the diamond itself. - With one finger propping up the tongue, place your other finger in the middle of the diamond and turn your finger sideways and use a lifting motion from low to high to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across that diamond. Make sure your finger starts within the diamond when doing this stretch. This stretch should be done with “intention” but not be rough within the wound. - Massage on either side of the diamond (outside the diamond) on the floor of the mouth to relax and loosen up the musculature.
4. The first stretching exercise should occur the evening after surgery is performed. A small amount of spotting or bleeding is considered normal, especially during the first few days after surgery. Then beginning the following morning, stretches need to be done every 3-4 hours (at least 6 times each day) for the first 21 days. No more than 4 hours should elapse between stretching exercises. After 21 days, gradually taper off exercises, doing one less session a day, so that by day 28 you are finished. For pain relief you may use Tylenol, arnica or Rescue Remedy. For children over 6 months of age, Ibuprofen (as recommended) may be used.
Your infant will also benefit from sucking exercises. 1. Rub gently side to side the lower gum line. Your child’s tongue should follow the movement. 2. Allow your infant to suck on your finger. Gently pull your finger back – a gentle tug-of-war movement. This will improve the strength of their tongue. 3. While your child is sucking on your finger, apply gentle pressure to both the roof of their mouth (palate) and down onto the top of the tongue.
Your lactation consultant is an amazing resource and is also vital to your success. Please follow up with a lactation coach after the laser procedure(s) are completed.
Call our office if: 1. There is uncontrolled bleeding 2. Your infant refused to nurse or bottle feed 3. Has a fever of greater than 101.5