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From:
Joanna Koch <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 13 Aug 2006 10:23:20 -0700
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Responding to Pamela's questions re frenotomies - I am fortunate to work in
an area where frenotomies are performed with minimal hesitation.  Many are
done before discharge.  Many more in the next 2 weeks.  It's a rare month
for me not to meet several babies who've had frenotomies (I'm going to meet
that population because there may still be latch/efficiency problems).
Neither the highly-regarded ents at the local hospital nor within the clinic
where I work have ever expressed a concern that a frenulum could grow back.
Only negative mentioned was that perhaps scarring could constrict "but
infant still would be better off than before".  And I've never seen this.

Note that we're talking about frenotomies (incision of frenulum) - not
frenectomies (excision of frenulum).  A frenuloplasty requires stitches and
anesthesia (frenulum thickens with age so this is a procedure an older child
might face - another reason to snip 'em early).  Hope I got my terms right
here.  Suspect the ent who worries about frenulums growing back is involved
in the the latter surgical procedures?  And is not talking about the very
simple frenotomies most of us are familiar with.

I've worked in same clinic for 10 years.  If frenotomies caused trouble I
would have heard without a doubt, either from the ent who performs the
trickier (thicker, more vascular frenulums) frenotomies, or from the
pediatrician facing the negative sequela! 

Only one ped uses cautery to incise the frenulum.  3 zaps and she's done.
Zero bleeding tho nasty burning smell. Seems like great approach to those
rare frenulums that look a little meaty. 

There is no recovery time in any event whether snipped or cauterized.  

Cheers,
Joanna Koch, IBCLC

Date:    Sat, 12 Aug 2006 16:31:38 EDT
From:    Pamela Mazzella Di Bosco <[log in to unmask]>
Subject: frenotomies again

Okay, if the research is showing they grow back, then that is definitely
going to impact them getting done at all, and most certainly impact a
mother's decision to have it done.  It's one thing to think of a painless
procedure  and another to see it as something that requires stitches.  So,
my question  is do we see this in only certain types of tongue tie?  Or in
all tongue  ties?  
Is there research that supports 60% with a problem of scarring and  growing
back?  If this research is there, and if the procedure being done  on a
number of babies by several doctors in my area is in fact 60% ineffective
and can do more harm than good, I would want to see that research.  I am
not saying the ENT was not right about this baby, I am thinking in general
because most of what I am reading talks about the procedure as something
simple  and does not require stitching for simple tongue tie in the newborn.

 
Like I said, this is not an ENT who routinely clips and actually, I find he
only does so in the most severe instances, so of course I trust what he saw
and  did.  Is this 60% a number specific to a type of procedure?  I have
not seen thousands of babies with tongue tie, but I have never seen one have
it grow back.  I am thinking if it were 60% we would be discussing this on
Lactnet .....
 
Thanks Cathy Genna-Watson for letting  me know it has happened  before.  
Seems so odd to me that it would happen.  Does the same thing  happen with
cauterization?  Is that another reason why ENT's prefer to  cauterize?
Which do you think gives the best recovery time for the  baby?  

Thanks,
Pam MazzellaDiBosco, IBCLC, RLC

             

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