My son had a frenulectomy (termed "tongue reconstruction" on our bill --
yikes!) at 7 months old.  The surgeon who did it was recommended to me by a
couple ENT residents because she is fairly "old school" and does an
extensive dissection.  The peds anesthesiologist also told me that she does
the most generous and meticulous work, which necessitated my little guy
having an endotracheal tube for the procedure -- they can usually just use
intermittent masked general anesthesia for these cases.

That being said, it was not a z-plasty, but rather large vertical and
horizontal incisions that she brought together in the midline with several
stitches.  She warned me that they end up having to hospitalize many
babies/kids overnight because of refusal to feed afterwards, but we didn't
have that problem.  His tongue was *hobbled* by this for a few days, and it
was a good 2 weeks before we were even back to where we were before the
surgery, and another 1 week until I was able to say that there was some
improvement in my pain level and his distress in feeding.  We did not do CST
afterwards, maybe should have, but he'd had many sessions of it in the prior
months and the practitioner did not think his tongue was a problem.

We went into this not knowing if it would help at all.  His type 3 tt was
definitively identified by Catherine Genna Watson at 5 months, and she
initially did not think that clipping would be worthwhile -- his
suck-swallow-breathe coordination was still not fully developed and he also
had some stridor that we attributed to laryngomalacia (never confirmed, but
the ENT agreed).  He also was having a ridiculously protracted problem with
apnea/bradycardic events that were thought to be triggered by reflux causing
laryngospasm with a pronounced vagal response, likely a combination of food
sensitivities and his difficulties eating.  When his problems dealing with
milk flow both by breast and bottle persisted, we decided to pursue the
clipping.  The ENT did not want to do it, as little guy's weight gain was
okay and he appeared to have great range of motion with his tongue (could
stick it out about 1cm!) but she finally agreed.

Now at 12 months he still has difficulties drinking out of a cup or with a
straw (appears to start to aspirate, but he loves it), but he hasn't had any
trouble with breast or bottlefeeding since the initial recovery after the
frenulectomy.  He also put on 7 lbs since he was 7 months old and his
nickname is "Fatty." :)  So the surgery helped him tremendously but was not
the complete magic cure we'd hoped for.  Though I am so happy we did it if
only because we can now nurse lying down and I am able to scrape together a
few hours of sleep each night that I'm home.

-Sarah Reece-Stremtan M.D. (anesthesia resident in Washington DC)

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