Look at an anatomy text to see the location of the lingual arteries. 
They are paired and run lateral to the genioglossus muscle in the blade 
of the tongue. The grooved director was actually invented by Dr. Petit 
over 400 years ago to avoid accidentally snipping the lingual veins 
which are superficial to the arteries! It forms a shield over the area 
of vasculature. Anyway, the frenotomy is performed in midline, and the 
vasculature is lateral to the frenotomy site. Many docs make a small 
snip and use blunt dissection (enlarging the opening in the mucous 
membrane with their finger over a sterile gauze pad) to further avoid 
the risk of excessive bleeding. So, while there can always be an 
anatomical variant and more bleeding than is expected, the risk of 
excessive bleeding from a properly performed frenotomy is very very small.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 7/20/2011 10:23 AM, Katherine Lilleskov wrote:
> Just had a discussion with a pediatrician I respect who feels that it is dangerous to perform frenotomies on posterior tongue ties in the office due to the risk of severing the lingual artery and the possibility of hemmorhaging. She says that they should be done in the OR under general anesthesia so that if there was a complication it could be dealt with, since the bleeding could be fatal in an outpatient setting. Wanted to throw this out there for discussion. I have been sending many moms in to have the procedure done by a very competant local ENT in her office and feel a little shaken up by this conversation.
> Kathy Lilleskov RN IBCLC
>
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