What instrument to use is also a hotly debated issue. According to the AAOHNS consensus statement, “There is insufficient evidence to support claims that one technique of frenotomy, such as laser, is superior to other techniques.”
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April 2023“The main difference is that some providers use sharp instruments like scissors, and others use in-office lasers. The level of pain that the child experiences after the procedure may be very different depending on the instrument used,” said Dr. Truong. For example, histologic studies that compared a CO2 laser to a scalpel on a bovine tongue found that the laser created a deeper injury as compared with the scalpel (Head Neck Surg. 1997;116:379–385).
Dr. Ghaheri agreed. “You absolutely do not need a laser to perform a posterior tongue tie release. You just need to know how to do it safely.” Dr. Ghaheri prefers to use the laser to do these procedures because of the volume of cases he performs. “Probably 90% of my practice is performing frenotomies.”
Although Dr. Truong is trained in laser use and does use them for other procedures, she chooses not to use them for frenotomies. “I do respect, however, that every surgeon has their preferred tool that they feel works best for them.”
Post-Procedure Care
There’s also debate regarding the need for post-procedure care after frenotomy. Although some clinicians prescribe a regimen of stretches and a massage technique after the procedure, the AAO-HNS consensus statement found no evidence to support post-procedure care regimens (i.e., stretching, massaging, manual elevation of the tongue by parents).
Massage and stretching regimens can be onerous for parents, Dr. Messner noted. “Many parents are told they need to do this every four hours for three to six weeks, depending on the particular practice,” she said. In a recent study by Bhandarkar and his colleagues, the authors retrospectively compared breastfeeding or recurrence rates between infants who had post-frenotomy massage and those who did not (Matern Child Health J. 2022;26:1727–1731). The authors found that the overall recurrence rate was 0.66%, with no statistically significant difference between the two groups. Breastfeeding rates were also similar between the massage and non-massage groups, but only 43.5% of those advised to massage adhered to the regimen.
“The consensus statement recommends no aftercare because the overwhelming majority of otolaryngologists perform only anterior releases, where there is no wound [and therefore no need to perform stretches],” Dr. Ghaheri said. “If a full release is done, however, a diamond-shaped wound develops, and appropriate wound aftercare optimizes tongue mobility and improves tongue elevation through stretches and exercises.”