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The following information is graciously provided by Dr. Ghaheri
There are two important concepts
to understand about oral wounds:
Any open oral wound likes to contract towards the center of that wound as it is healing (hence the need to keep it dilated open).
If you have two raw surfaces in the mouth in close proximity, they will reattach.
I feel that post-procedure stretches are key to getting an optimal result. These stretches are NOT meant to be forceful or prolonged. It's best to be quick and precise with your movements. I feel that getting an affordable LED headlight (like a camping headlight) allows you to get the best results.
You may use Tylenol, Ibuprofen (if 6 months of age or older), arnica, Rescue Remedy or other measures to help with pain control. Previously, we recommended the use of Hyland's Teething Gel or Orajel Naturals. As of October 2016, the FDA has requested that these gels no longer be used. A suitable replacement is an organic coconut oil, which can be safely used in the mouth following the procedure.
The main risk of a frenotomy is that the mouth heals so quickly that it may prematurely reattach at either the tongue site or the lip site, causing a new limitation in mobility and the persistence or return of symptoms. The exercises demonstrated below are best done with the baby placed in your lap (or lying on a bed) with the feet going away from you.
How to approach your child when doing stretches:
A small amount of spotting or bleeding is common after the procedure, especially in the first few days. Because a laser is being used, bleeding is minimized. Wash your hands well prior to your stretches (gloves aren't necessary). Apply a small amount of the coconut oil to your finger prior to your stretches.
TIMING: DO ONE STRETCH ON THE EVENING OF SURGERY. THEN, SKIP AHEAD TO THE NEXT MORNING. My recommendation is that stretches be done 5 times a day for 6 weeks. Diaper changes are a good time to do the stretches. The most important part about the stretch is the actual stretch... not just going through the motion! Make sure to elongate the diamond and hold it for a couple of seconds before repeating.
Constriction is a natural part of wound healing and by elongating the wound as it heals, we minimize the chance of a scar replacing they originally tight attachment, or “reattaching”.
NOTE: Courtesy of Dr. Shervin Yazdi. The wounds created are typically diamond-shaped. This diamond has 3 dimensions - height, width and depth. This is especially important for the tongue wound, which is much deeper than the lip wound. Maintaining these 3 dimensions is the key to successful healing.
Post-op Push, Scoop n' Stretch
Oral Exercises for Baby
Improper tongue stretch technique
This is an example of an improper stretch. Do you see how the fingers are away from the diamond? As these fingers lift up the tongue, too much of that force is directed at the sides of the tongue, and the middle portion is still pinned down. This will lead to reattachment.
Focus on getting your index fingers mentally glued together - this forces you to stay in the middle, right on top of the diamond. As you push into the diamond and then lift the tongue up, the top half of the diamond will ideally come away from the bottom half of the diamond. It is attention to separating the fold across the diamond that results in a successful post-operative stretching regimen.
It's important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. The following exercises are simple and can be done to improve suck quality. I would start these on the 3rd day following the procedure, and spend 30-45 seconds on each exercise prior to the wound stretches (no need to do these sucking exercises during your nighttime stretch).
1. Slowly rub the lower gumline from side to side and your baby's tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
2. Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
3. Let your child suck your finger and apply gentle pressure to the palate. Once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you. Listen for a seal break and then put your finger back up into the palate to re-stimulate sucking. Repeat as tolerated.
4. With one index finger inside the baby's cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.
Starting several days after the procedure, the wound(s) will look white and/or yellow and will look very similar to pus.
This is a completely normal inflammatory response. Do not let your child's regular doctor, lactation consultant, friend who thinks they're an expert, or anyone else make the determination for you. If you think an infection exists, give our office a call.
TO SCROLL THROUGH GALLERY
It is essential that you follow-up with your lactation consultant after the procedure to ensure optimal results.
Call our office for any of the following:
Refusal to nurse or take a bottle
Fever > 101.5