I wonder if the second frenotomy has healed/scarred back down? If so, 
and it's only a few weeks, moms might be able to lift the tongue with 
clean fingers and break the attachment. The very experienced docs are 
starting to recommend lifting the tongue after posterior frenotomy for 3 
seconds 5-8 times a day for a week or more to prevent re-adhesion, which 
seems to be more likely with a posterior than an anterior frenotomy 
according to a recent study, see abstract below:

  Defining ankyloglossia: A case series of anterior and posterior tongue 
ties.
Paul Hong, Denise Lago, Judi Seargeant, Lauren Pellman, Anthony E Magit 
and Seth M Pransky
Abstract
INTRODUCTION: Ankyloglossia is a congenital condition in which tongue 
mobility is limited due to an abnormality of the lingual frenulum. The 
impact of ankyloglossia on breastfeeding is poorly understood but there 
is a recent trend toward more recognition of this condition and early 
intervention when needed. Currently, there lacks clear definition of 
ankyloglossia and different subtypes have been proposed with no clinical 
correlation. OBJECTIVE: To determine the prevalence of anterior versus 
posterior ankyloglossia in a large series of consecutive patients and to 
assess clinical outcomes after frenotomy. METHODS: Retrospective chart 
review of patients from July 2007 to July 2009 who were diagnosed with 
ankyloglossia and underwent office frenotomy. Baseline characteristics, 
specific feeding issues, type of ankyloglossia, and clinical outcomes 
after frenotomy were reviewed. RESULTS: Of the 341 total patients, 322 
(94%) had anterior ankyloglossia and 19 (6%) had posterior 
ankyloglossia. Median age at presentation was 2.7 weeks (range 1 day of 
life to 24 weeks); 227 were males and 114 were females. Revision 
frenotomy rates were significantly higher for the posterior 
ankyloglossia group (3.7% anterior and 21.1% posterior, p=0.008). 
CONCLUSION: Anterior ankyloglossia is much more common and readily 
managed when compared to posterior ankyloglossia. Posterior 
ankyloglossia is a poorly recognized condition that may contribute to 
breastfeeding difficulties. The diagnosis is difficult due to the subtle 
clinical findings but relevant health care providers should be aware of 
this condition. Frenotomy is a simple, safe, and effective intervention 
for ankyloglossia which improves breastfeeding. Copyright © 2010 
Elsevier Ireland Ltd. All rights reserved. | PMID: 20557951

Catherine Watson Genna, BS, IBCLC  NYC

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