Author:  Dr. Juancho de Quixano, odontologist at FreLac

It is well known that surgeries may involve some risks. As with any surgical procedure, it is very important to know how to perform it in the best possible way to minimize those risks. An intervention on the lingual frenulum is considered a surgery.

Today, there is still controversy about how to classify frenectomy within surgical concepts. In theory, it is considered a minor surgery, which would allow professionals from different healthcare specialties to perform this procedure. Whether it is a basic or advanced minor surgery has not yet been established, and more importantly, the difference between frenotomy and frenectomy has not yet been clarified in legal terms. However, we can conclude that it is a surgical procedure, and as such, it will require a series of precautions, control measures, and damage limitation protocols in case something does not go as expected.

Frenectomy or frenotomy?

When referring to tongue-tie release surgery, the concepts of frenotomy and frenectomy have certain technical differences, one of which is the depth of the incision. This aspect can help us to prevent a series of potentially negative consequences of this procedure.

The main objective is to make an incision as subtle as possible so you can later release the tissue most appropriately by disconnecting it. When this cut goes deeper than what is anatomically ideal, you can reach into tissues with a greater vascular supply, such as muscle, glands, or even the sublingual veins. When damaged, these structures will generally present more profuse bleeding.

Emergency care after frenectomy

When faced with abnormal bleeding, the body will naturally look for a way to cut off the blood flow through what is known as coagulation. When coagulation is not impacted, the body has a number of factors to stop the bleeding, but this will mainly depend on the depth, extent, and severity of the injury. When the body fails to stop the bleeding, a hemorrhage occurs.

If this happens, a protocol for surgical emergencies must be activated that has been prepared in advance. At the LactApp-FreLac tongue-tie release clinic in LactApp Barcelona, we have developed our own protocol to minimize risks and guarantee the safety of the babies being treated.

The main thing is to know this surgical technique and the anatomy well on which you are going to work. Even more important is to be aware of the possible risks and negative consequences so you can be prepared for them.

Suppose that, for whatever reason, such as human error, coagulation problems, technical error, and so on, you are faced with a bleeding situation that you cannot control. The first thing you would do is compress the bleeding point with sterile gauze for 5 to 10 minutes by exerting pressure on it. After that time, reevaluate. If the bleeding has stopped, there is normal coagulation.

If, on the other hand, the bleeding reoccurs or has not stopped, repeat the procedure, but this time with a gauze impregnated with tranexamic acid (Amchafibrin®). The purpose of this is to accelerate and facilitate coagulation by acting directly on the bloodstream. Again, if, after those minutes, the bleeding is resolved, then the problem is solved.

However, if nothing is working for you and the bleeding continues, we always work with a diode laser prepared to seal any profuse bleeding vessel that fails to stop the flow of blood on its own. With this procedure, in most cases, the problem should be resolved. If this is not the case, then opt for the last resort, which is an emergency transfer of the patient to a specialized referral center, by giving prior notice of the arrival. In this situation, the professional who has performed the intervention is in charge of coming with the infant and family and assisting in whatever they may need until stabilization is ensured by the hospital medical team.

Fortunately, all these are hypothetical cases, but you need to be prepared for what should never happen. Ignoring a possible reality, however remote it may be, would prevent you from working with peace of mind and safety.

In light of all these considerations, the best prevention will always be good training that is continuous and of high quality, a correct use of common sense, knowing your own limitations and teamwork that always keeps in mind your patients.