I think it's important to differentiate between "frenectomy" and
"frenotomy".  Frenectomy (removal of the frenulum) is an ENT procedure,
done under anesthesia, in cases where there is muscular tissue in the
frenulum.  Frenotomy, or clipping, is a pretty minimal office
procedure.  I make a tiny snip at the insertion of the frenulum on the
anterior tongue then blunt dissect with my finger.  This way I can't get
into trouble by cutting something (like muscle) that I shouldn't and
generally get virtually no bleeding.  My criteria for doing the procedure
are: tongue can't get past the gum line AND functional effect on
nursing--poor latch or sore nipples AND frenulum anatomy that is clearly
mucous membrane only. I think it would be more painful for the baby to
inject lidocaine, although I have tried to use a tiny bit of topical
lidocaine--can't tell if it makes a difference, but makes me feel better.
Baby nurses right away--usually mom says with that first nursing that it
feels different.

--
Anne Montgomery, M.D.
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St.Peter Hospital Family Practice Residency
Olympia, WA