Does clipping for a tongue-tie really require general anesthesia?
March 23, 2009 12:05 PM   Subscribe

Our 21 day old daughter is tongue-tied (ankyloglossia). The doctor wants to do the clip (lingual frenectomy) under general anesthesia by default, and we're uncomfortable with that. Is general anesthesia appropriate by default for this? Should we be concerned?
posted by NortonDC to Health & Fitness (27 answers total)
If you want a second opinion, ask another doctor, not the internet. This is a medical question with complexity that makes it unsuited to answers from laypersons.
posted by Inspector.Gadget at 12:11 PM on March 23, 2009 [4 favorites]

A general anaesthetic sounds like serious overkill. Our son had the same thing; it's a very simple procedure which took about fifteen seconds to perform. I'm not certain exactly what anaesthetic was used, but it was definitely a local.

I'd find a different doctor and get a second opinion at least. (Our hospital took us to the dental wing and had an oral surgeon do the job, but that may just have been because we were already there for other reasons.)
posted by ook at 12:12 PM on March 23, 2009 [1 favorite]

Answer from layperson: we had our son's tongue clipped: no anesthesia at all, the doctor used special scissors, it took two seconds, he cried for two seconds, and then was completely happy. It really helped with nursing, too. Of course, we did this when our son was about a week old, so maybe more nerves develop by three weeks.
posted by faustessa at 12:15 PM on March 23, 2009 [1 favorite]

Anecdotal evidence here again, but my short guy had his tongue clipped at the age of 5 days with no anesthesia and he cried for all of 3 seconds. Perhaps age changes things.

So, as stated above, get a second opinion from a doctor.
posted by Seamus at 12:24 PM on March 23, 2009 [1 favorite]

Our son had an undiagnosed tongue-tie. It seriously reduced his ability to breastfeed, but two and a half years later (with tongue-tie intact) he eats and talks with no problem at all. Poor bugger can't poke his tongue out very far, but it'll eventually stretch. So there's a third option for you.

If you're serious about breastfeeding, snipping it will probably help immensely. We were told by our health visitor (when we eventually spotted the tie) that it's sometimes done with a local anesthetic, but generally with none at all. You should probably ask this doctor why they're recommending general anesthesia, or get a second opinion.
posted by le morte de bea arthur at 12:26 PM on March 23, 2009 [1 favorite]

I have only ever heard of this procedure being performed in-office with a perfectly alert baby, as fautessa describes.

But you really need to talk to your doctor (or another doctor) about this. Your daughter's situation may be quite different and there are a lot of variables we just can't determine via the internet.
posted by kate blank at 12:27 PM on March 23, 2009 [1 favorite]

ditto abouve experience: our daughter had it done in roughly the same time frame; no anesthesia, a simple clip in the doctor's office. kid cried for about 10 seconds.

now she's always sticking her tounge out at us.
posted by lester at 12:37 PM on March 23, 2009 [1 favorite]

This is sort-of unrelated and you should talk to a doctor about whether tongue-cutting is necessary... but I had my tongue pierced when I was 20 and it hurt less than having my earlobes pierced. I barely felt anything other than pressure. From my understanding, this is a common experience.
posted by cranberrymonger at 12:41 PM on March 23, 2009

NortonDC, check your MeMail. In short, no, it shouldn't require general anesthesia unless there's something specific that your kiddo's ENT is concerned about... but without knowing more, it's hard to say anything specific. But if you're in DC, as your nickname suggests, I have a recommendation for you.
posted by delfuego at 12:49 PM on March 23, 2009 [1 favorite]

Response by poster: The doctor (who is highly recommended) said he prefers knowing the child won't be moving during the procedure, giving him more confidence on avoiding complications. This answer was given when we immediately expressed our surprise at his requiring general anesthesia. Nothing he said was specific to our daughter, who remained asleep during the entire exam.

We're working on asking other doctors, but correlating the list of in-plan doctors with the list of recommended doctors takes time.

As far as necessity, a lactation consultant, a pediatrician and an this guy, the otorhinolaryngologist (ENT doc) all recommended the procedure. The only variation was in the degree of urgency, and even there no one has deemed it an emergency.

You folks are being really great and we'll share any info we get from other doctors.
posted by NortonDC at 12:53 PM on March 23, 2009

People in the body-mod subculture often do this with only local anesthetic. And sometimes with no anesthetic.

This really doesn't sound like the sort of thing that requires general anesthetic. It should take about five minutes, and shouldn't be traumatic or even especially painful.
posted by Netzapper at 12:56 PM on March 23, 2009

Oh, 21 day old not 21 year old.

I can see the doctor's point about making sure she doesn't move around during the procedure. But, if you're uncomfortable with general anesthetic, then you should find a different doctor.

That said, the sorts of drugs used in anesthesia for most minor surgery these days are fairly low risk.
posted by Netzapper at 12:59 PM on March 23, 2009

Ditto what's been said above. Had son's tongue clipped at 14 days old, about a month ago, in the doctor's office with no anesthesia (this was at Boston Children's Hospital, fwiw, with an ENT recommended by a lactation consultant). When we asked about anesthesia , the doc said there are few if any nerve endings there, it would hurt less than a vacc shot, and for less time. He said they only use anesthesia if they have to with an older kid and then for ease of access (that is, to get past a bigger kid's swinging arms as he tries to keep the doctor/scissors away), and not because of pain.

My first child did have general anesthesia as a newborn for a different reason, and I know we got a big talk (again at Children's) about how they only use general with infants when doing the procedure clearly outweighs the very real risks associated with general anesthesia. Standard policy was to keep the baby overnight for observation for possible complications from anesthesia, not from the procedure itself.
posted by cocoagirl at 1:02 PM on March 23, 2009 [1 favorite]

Consult another doctor as stated above. But that said, midwives would do this with a (pinky) fingernail and a simple mouth swipe to allow the child to latch on better.
posted by Verdant at 1:03 PM on March 23, 2009 [1 favorite]

As a follow up to your note, my son was moving around quite a bit. We held his arms, doc held his head at the mouth/chin area and just calmly waited for good access every few times the baby cried (I have one of those babies that cries even when not being restrained). Then snip, wait, look, snip, wait, look, done. Baby stopped crying as soon as I picked him up.
posted by cocoagirl at 1:14 PM on March 23, 2009 [1 favorite]

Mr. Llama's was taken care of by his doctor right after birth, quite casually, via his fingernails--if Mr. Llama's mother remembers correctly. (She wasn't expecting this and is still, 35 years later, a little freaked out by how casual it was.) Certainly no general anesthesia.

It kind of sounds like the guy didn't even wash his hands. Sheesh.
posted by A Terrible Llama at 1:27 PM on March 23, 2009 [1 favorite]

hal_c_on, do you even have the faintest idea what a frenectomy is?
posted by ook at 2:01 PM on March 23, 2009 [7 favorites]

Whoa, this sounds like the tonsillectomy of the 2000s. If my baby was gaining weight at a normal pace I would not have this done to my child. I would be suspicious of any doctor that wanted to use general anesthesia this frivolously.

On a lighter note, it is extremely unlikely anything bad will happen if you decide to go ahead with this (didn't want to add bad juju to this situation).

I was told I was tongue-tied but I've never been clipped, my sister was clipped (the dentist told her she would give better bj's if she were clipped - she was 16). There doesn't seem to be a difference between us now. We both talk normally. Although I don't know if ours was as severe as your child's.

Additionally, if I were to do this I would take the child to a pediatric dentist instead of a pediatrician. Because I think they would have much more experience doing this. It would also help to call around to pediatric dentists and ask if they use anesthesia for this procedure. It's not too early to start looking for a dentist anyway.
posted by cda at 2:10 PM on March 23, 2009

More anecdotal experience here. I had this procedure done when I was about 4 or 5 and it was in the doctor's office with no anesthetic. The doctor told me: "Lift up your tongue." I did and he reached in with some scissors and cut the frenulum. It was horrible. It is actually one of my first memories of childhood.

I have 3 children and 2 of my 3 children had this same condition. With my oldest daughter our pediatrician recommended waiting until she was 1 to see if it would resolve itself. It did not resolve itself and so she had the operation under general anesthetic. There was noticeable post-op pain and it took 4-5 days to recover.

With my son, we decided not to wait and we did it while we were still in the hospital with just a local anesthetic. The recovery time was almost nothing and there was no noticeable pain when feeding. This was the first time the pediatric surgeon we used had performed this procedure, and afterward, she was so pleasantly surprised by how minor it was that she changed her opinion about what she would recommend in the future.

Also, at the time our daughter was born I did as much research as I could on this condition and I was unable to find very little actual medical knowledge. There are almost no real studies of various treatment options (at least as far as I could find). I had a similar experience when I would talk with doctors. Each doctor had a definite opinion about how we should proceed, but when I would question the doctor more closely I found that in general this opinion was based on their experience (which was usually more limited than my own) and very little hard evidence.

So, I agree that you should talk to your doctor, but I also think you should probe more deeply about the doctor's reasoning behind any potential recommended treatment options. Is his/her opinion based on medical evidence, or anecdotal evidence?

Also, the reasons why my mom had this done on me, and why I had this done on my two children were because it affected my eating and not my speech. Before I had my tongue clipped I could not physically lick an ice cream cone, and I was a very messy eater because I could not use my tongue to lick around my mouth. It never affected my speech, and it did not affect the speech of my daughter (who was 1 and could definitely talk some by then).
posted by bove at 2:19 PM on March 23, 2009 [1 favorite]

Daughter has this and we were given the choice to do it or NOT do it. She is now 16 years old and other than not being able to stick her tongue out very far absolutely no disability. Get a second and third opinion. Sounds like a source of revenue rather than a needed procedure.
posted by Muirwylde at 4:21 PM on March 23, 2009

My daughter had this and it resolved itself at some point. (But, DANG, breastfeeding hurt for a few weeks.) Also, my husband is still a bit tongue tied and it doesn't affect him in the least.

Regarding anesthesia, my son had general anesthesia at one year old so a tube could be put in his tear duct. (Same as you, if this had been on an adult, the doc would have said, "Keep still" and just done it. The Anesthesia was just to keep him still.) The surgery was done in just a few minutes, it took about an hour for him to really wake up (but he was GROUCHY for about half an hour) and then he was home and eating lunch like nothing had ever happened an hour after that. Your baby's really little though, so I might be more worried. I am just saying this to give you a vague idea of what it will be like if you do go the anesthesia route. Also, the tube that was supposed to fall out of the tear duct did NOT, so we got to do it all again at 2 years old.
posted by artychoke at 4:35 PM on March 23, 2009 [1 favorite]

I'm a dentist, and i do this procedure periodically in my office, on small squirmy children sometimes, with no ill effects. 21 days seems awfully young to me, unless there is a serious worry about the child's ability to feed.
the biggest concerns, as have been stated above, are with speech, and you've got years before that's an issue.
My advice would be to wait, or seek someone confident to do it without GA. it's not going to be a harder procedure later on.
posted by OHenryPacey at 5:08 PM on March 23, 2009 [1 favorite]

hal_c_on, a frenulectomy (or frenotomy, or frenulotomy, as it's variously called) isn't what you think it is (or I have no idea what you're talking about). Yes, a tight frenulum might correct itself, but the evidence suggests that it does so after most mothers give up the idea of breastfeeding because it's just too painful -- which is the main side-effect of a tight frenulum. Nearly all pediatric ENT docs I've spoken with actually agree on the fact that tight frenulums correct themselves; the one thing that separates those who recommend frenulectomies from those who don't is that those who recommend them also are reasonably strong advocates for breastfeeding (or at least having the choice to do so), and those who don't aren't. (As a sidenote, I'm not sure I've met a female pediatric ENT who recommends waiting, but that's likely selection bias, since I've only met two or three.)

bove, that stinks that your pediatrician or ENT didn't point you in the right direction, because there's actually quite a bit of evidence out there to support doing frenulectomies. Ricke et al (Journal of American Board of Family Practice 2005; 18:1-7) found that tongue-tied infants were significantly more likely to be exclusively bottle-fed by one week of age than non-tongue-tied infants. Ballard et al (Pediatrics 110; 5:e63) found that significant ankyloglossia (the medical term for a tight frenulum) was frequently associated with poor latch and severe nipple pain for the breastfeeding mother. Dollberg et al (Journal of Pediatric Surgery 2006; 41:1598-1600) performed a randomized prospective study that demonstrated immediate relief of breastfeeding pain after the frenulectomy. Hogan et al (Journal of Paediatrics and Child Health 2005; 41:246-150) performed another randomized trial comparing frenulectomy to intensive lactation consultation and support and found significantly-improved feeding in the frenulectomy arm. Finally, Geddes et al (Pediatrics 2008; 122:e188-194) did imaging and milk delivery kinetics studies and showed that babies who underwent frenulectomy attached better, compressed the nipple more effectively, delivered more milk, and caused less maternal pain than pre-frenulectomy.

I'm obviously in the pro-frenulectomy camp, both because of the evidence and because it helped my daughter and wife immensely when it was done at 6 days of life. My wife is 100% certain that she would have given up breastfeeding within days (if not hours) had it not been done.
posted by delfuego at 5:58 PM on March 23, 2009 [3 favorites]

Hal_c_on: you don't know what you are talking about. Again.

Sheesh. Close mouth, my friend; open ears.
posted by BadMiker at 6:42 PM on March 23, 2009

delfuego, those are great cites. My daughter was born in 2002, so maybe the better research is just more recent. My doctors weren't bad, but like many doctors when asked they gave their opinion as if it was fact.

Also, I didn't mention it above, but in both cases the frenulectomies really helped make breastfeeding more comfortable for my wife. Also, I am happy to report that both of my kids can happily lick an ice cream cone.
posted by bove at 7:30 PM on March 23, 2009 [1 favorite]

Both of my children were tongue-tied. We the snip done within the first week or so, and there was no general anesthesia, nor was there any crying. It took literally 1 second, and then they were back to nursing.
posted by tom_g at 3:41 AM on March 24, 2009 [1 favorite]

Response by poster: All that fuss for such a blip of a procedure! We went to a doctor in a super-highly regarded local practice because they could take us this morning and they indicated over the phone that they don't normally use general anesthesia (and they're in our plan). The doctor inspired a lot of confidence and our daughter cried more from the doc getting her fingers in her mouth than from the snip. There was nothing to it, just a swab of local anesthetic before the snip, and she was done crying within a few seconds.

When we mentioned that another doctor wanted to use general anesthesia, she gave a "whatever" kind of look and said they only might use it for significantly older and toothier children where biting the doctor became a concern.

Onlyconnect reports an immediate reduction in latching pain, our girl has been pretty serene ever since, and we feel good about our decision to switch to a doctor that eschewed general anesthesia. Yay!

Oh, and if I recall the numbers correctly, Onlyconnect's calls to other doctors came back as five out of six against general anesthesia by default.
posted by NortonDC at 11:03 AM on March 24, 2009

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