Frenuloplasty: Post-Operative Instructions

PRE-OP FREQUENTLY ASKED QUESTIONS

Your active participation is important to the post-operative success of your treatment. The following FAQ's will help you know what to expect in the days following surgery, and will help to optimize a successful surgical outcome. 

Q: CAN YOU DESCRIBE THE TREATMENT FOR A PATIENT THAT IS TONGUE TIED? DOES IT HURT?:

 

A frenuloplasty is a straightforward outpatient procedure that can be completed in office without the need for general anesthesia. If a release is recommended, the treatment takes less than an hour. Dr. Zaghi will apply an effective topical anesthetic gel on the frenular tissue underneath the tongue prior to treatment, followed by an injection of lidocaine, allowing for zero to minimal discomfort during the procedure. The anesthetic wears off approximately 30-45 minutes after the procedure is completed. For the first several days (occasionally up to 5 days) following surgery, pain is to be expected. This can usually be controlled with over-the-counter medication such as Tylenol or Ibuprofen.

Q: ARE THERE ANY PRE-OPERATIVE INSTRUCTIONS?:

 

We encourage you to eat a full meal prior to your procedure. We also encourage getting a good night's sleep the night before. Please refrain from consuming caffeine prior to the procedure.

Q: WHAT HAPPENS AFTER THE PROCEDURE?:

 

It is normal to experience some swelling and inflammation in the first 3-5 days after surgery. We recommend using Tylenol and Ibuprofen as needed for pain. During the first few days, you may find it helpful to have soft, cool foods. You may find it challenging to consume hot or spicy foods, or foods that require a lot of chewing. We will provide you with detailed post-operative instructions at the time of your procedure.

Q: ARE ANTIBIOTICS ADMINISTERED?:

No, antibiotics are not administered. We recommend rinsing with salt water and/or alcohol-free mouthwash several times a day to keep the wound clean and reduce the risk of infection.

Q: WHAT ARE THE POSSIBLE RISKS?:

Complications of surgery are rare, but may include numbness, bleeding, pain, failure of procedure, infection, injury to adjacent structures, and scarring. It is crucial to follow the post-operative instructions to prevent scarring or re-attachment of the frenum. Pre- and post-operative myofunctional therapy is essential for optimal recovery after frenuloplasty.

Q: WHAT IS THE PROPER WAY TO ACTIVELY MANAGE THE WOUND POST-PROCEDURE? WHAT CAN I EXPECT TO SEE AFTER THE PROCEDURE?:

We use absorbable sutures that will usually fall off or dissolve on their own within 3-5 days and sometimes anywhere from 1-10 days after surgery. As the sutures fall out, white tissue will fill the open wounds. This is normal and not an infection, rather, it is granulation healing tissue that will heal and disappear in approximately two weeks. You can use a soft toothbrush to remove any oral debris if necessary. Please refer to the post-operative instructions for more details regarding wound management.

POST-OP INSTRUCTIONS

After the surgery:

Patients should expect some mild swelling, pain, and/or discomfort as a normal process of wound healing. Pain is often controlled with over-the-counter pain medications, and other symptoms usually self-resolve over the course of 1-2 weeks with proper rest and myofunctional therapy. Possible (but very rare) complications of frenuloplasty may include bleeding, pain, numbness, failure of procedure, scarring, and injury to adjacent structures which may result in salivary gland dysfunction. 

Immediately after the surgery:

  1. Wound Care and Bleeding: To alleviate discomfort, you can apply a small amount of topical analgesic gel to a piece of gauze, place on the surgical site, and replace as needed every 1-2 hours, up to 4 times daily. It is normal to experience some bloody oozing during the first 1-2 days. If steady bleeding occurs, place gauze under the tongue to hold pressure and call Dr. Zaghi, or go to your local emergency department.

  2. Swelling and Inflammation: It is normal to experience some swelling and inflammation in the first 3-5 days after surgery. Your tongue may feel larger than usual and more painful to move. We recommend using Tylenol and Ibuprofen as needed for pain. We also recommend holistic options such as arnica, turmeric, ginger, and CBD oil. Patients who are more sensitive to pain may benefit from narcotic pain medications such as Tramadol. If you are already taking chronic pain medications, we have an outstanding in-house pharmacist who is available to take your questions and customize a pain control strategy.

  3. Oral Hygiene: Please continue brushing teeth as usual. We recommend rinsing with salt water and/or alcohol-free mouthwash several times a day to keep the wound clean and reduce the risk of infection.

  4. Food/Drink: During the first few days, you may find it helpful to have soft, cool foods. You may find it challenging to consume hot or spicy foods, or foods that require a lot of chewing.

  5. Sutures: We use absorbable sutures that will usually fall off on their own within 3-5 days and sometimes anywhere from 1-10 days after surgery. As the sutures fall out, granulation healing tissue will fill the open wounds. If the granulation tissue overgrows the wound, we recommend brushing the surgical site with a soft brush to remove any oral debris. It is not necessary to completely remove the granulation tissue.

  6. PeriAcryl Glue: PeriAcryl glue may be applied to the wound site in place of or in addition to sutures. Over time, the glue can have a hard and rough texture, but try to refrain from picking at it. If the glue stays on past 1 week, we encourage gentle massage with Vitamin E oil, coconut oil, or mineral oil to dissolve and remove the material.

  7. Myofunctional Therapy Exercises: We recommend gentle tongue movements for the first 3 days after your procedure and to focus on minimizing your pain. This may include light movements with your tongue by lifting it up to the front teeth with your mouth wide open, moving side to side inside the cheeks, tracing the tongue bath and forth along the palate, and elevating the tongue in suction hold. Avoid sticking out your tongue during the first few days to prevent tearing the sutures. Contraction may occur by around day 5-7. It is extremely important to perform the stretches and exercises as prescribed by your therapist to obtain the most optimal results.

  8. Wound Stretches: Check in with your myofunctional therapist within a week after your procedure to assess the progress of your wound healing and determine whether wound stretches are indicated. Wound stretches involve wrapping the tongue in a paper towel or gauze, and pulling the tongue outwards, downwards, upwards, and to each side, to feel a stretch for at least 30 seconds or until there is a release of tension. 

  9. Lip and Buccal Ties: We recommend that you take it easy for the first few days. Afterwards, run your tongue around the oral vestibule several times a day. We also recommend air puffs. After 1 week, you can do lift stretching and manual intra-oral massage.

  10. Bodywork/Physical Therapy: Many patients benefit from fascia physical therapy, craniosacral therapy, osteopathic manipulation, and other forms of bodywork post-operatively depending on the clinical circumstance.

Be gentle  with exercises  for the first 3—5 days.

 

Stretching  exercises  are better than strain.

At any time, call our practice if you experience any of the following:

Severe pain that does not improve with medication, Brisk bleeding,

Severe swelling at the site of surgery, Difficulty breathing,

Fever higher than 102 F

 

— For emergencies, please call or text Dr. Zaghi directly: 818—489—2444.

Video: Post-Operative Myofunctional Therapy Exercises - Achieving optimal healing after surgery by dissociating the tongue from the floor of mouth when doing tongue rehabilitation stretches and exercises. 
Video: Infant Lingual and Labial Frenectomy Post- Op Wound Stretches. Learn to set yourself up for success with this video by Dr. Chelsea Pinto.
Video: Sleeping Tongue Posture Hold. Useful pain-free tongue-lift activity for before and after frenectomy by Dr. Michelle Emanuel.
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