Following the release of your infant or toddler’s (and even older adult or child) oral restriction one important factor that appears to contribute to the success of the release procedure is the component of stretching the release sites. . This practice is also known as Active Wound Management (AWM). There is currently no ‘best practice’ studies to show what exactly is the best post-release care after a frenectomy, however from clinical experience and an understanding of wound healing it appears that AWM is an integral part of achieving the best results.  You can read more about the puzzle surrounding post release care here.

Following a complete release of oral restrictions – there should be a diamond shape wound present (whether that is under the lip, tongue or buccal area).  It is common knowledge that the mouth is an excellent healing spot for the body and a simple bite on the cheek or ulcer usually heals within 24-48 hours – this usually means that there is little risk of infection following a release procedure. If left untreated the release sites will very quickly heal back to where they started via primary wound healing principles and the wound will ‘reattach’ creating a loss of function again.

What we want to implement is for the diamond shape wound to remain open and heal vertically (along the blue line) where point C to D will eventually come together instead of point A to B.  This is where AWM kicks in – by doing the stretches frequently enough you are essentially slowing down the healing process and encouraging the release site to heal vertically and create a new unrestricted frenum.

For active wound management to be successful these stretches should be performed frequently for the following weeks post procedure.  Ideal time frames include stretching 5-6 times in a 24 hour period (essentially every 4 hours) for 21 days followed by a week or so of 3-4 times in 24 hours.  Leaving the stretches for greater than 4-6 hours will increase the risk of reattachment and loss of function.  Stretches do need to be performed around the clock and not left overnight.  The stretches should only take a short amount of time (10-15 seconds).  Some parents even report that their infants sleep through the stretches.

To perform the stretches:

Lip

• With two fingers elevate the lip so that you can see the diamond shape completely open and hold the diamond shape open for 3 seconds
• If your baby has had their buccal (cheek) ties releases you can place your finger in the space between the cheek and the gumline and lift the cheek up and away from the release site.

Tongue:

There are two different methods that seem to be successful in preventing primary reattachment.

Method one:

Insert two fingers either side of the tongue and place your fingers at the edge of the side of the diamond (Point C and D) and lift the tongue upwards to open the diamond.  You should be able to visualise the diamond once this exercise is performed.

Method two:

Insert one finger under the tip of the tongue (Point A) and place another finger on the bottom gum or jaw and gently push both of those areas apart to encourage a vertical stretch of the diamond.

You can watch a video demonstration of stretching technique here.

When performing the stretches on your infant or toddler a couple of tips that may help include:

 

• Swaddle the infant to stabilise his/her body
• For an older infant/toddler you may find it easier to sit on the floor with legs out straight and place your child in between your legs.
• For easy access – position the baby so their feet are away from  you
• Make sure you have washed your hands and cut/filed your nails short
• Approach the stretches in a calm and efficient manner (making it into a game can be helpful – pulling silly faces/singing a song etc).  Babies are highly attuned to their parents emotions so its essential to remain as calm as possible.
• Use pain relief options as required
• Try feeding your infant a little bit of milk first, then perform the stretch and continue on the feed
• Avoid using any oils such as vit E that can promote healing

The diamond shape wound should slowly get smaller and smaller over the first three weeks post release and the fourth week of stretches is to ensure movement remains within the tissue. It can be beneficial to continue the stretches even after the wound has closed properly (2-3 times a day) to keep the tissue supple as further healing will continue underneath the surface. During this time of healing the release site may vary in colour (from pink/red, white, yellow and sometimes even green).

When the upper lip is healed you will see a new attachment to the gumline – this is normal and supposed to be there.  As long as you can continue to see improved function there is usually no need for concern. Under the tongue you may also see the presence of a new frenulum – once again unless there is loss of function this will be considered normal.

Between 2-4 weeks post release you may be able to feel some tension under the tongue frenum which is a normal part of healing.  This is as the fibers of the frenulum are knitting together and the frenum will feel tight and then release again when normal function is returned.  This is why continuing to perform the stretches is vital as if left at this point can result in a loss of function.

Please follow up with your revision provider or IBCLC if you are having concerns regarding the healing phase for your infant.

 

Tamika Newman

RN, RM, IBCLC