Lingual Frenectomy

Anesthesia Implications

Position: Supine, arms tucked
Time: 5-30 min (very short)
Blood Loss: Zero
Post-op Pain: Zero
Maintenance Paralytic: No

PEDs – The vast majority of these procedures are done on pediatric patients usually under 2 years of age.

Quick procedure – The patient is usually given a small amount of fentanyl at induction and then maintained by mask ventilation. Once the patient is adequately sedated, the mask is pulled away and the frenulum is cut. The cut itself only takes approximately 30-60 seconds.

No IV – If you don’t have an IV in place (very common for these procedures), intranasal Fentanyl 1.5 mcg/kg before incision is recommended. Half of the dose in each nostril. Occlude contralateral nostril on administration of each dose

Multitasking – The difficulty of these procedures is balancing charting with the anesthesia/mask ventilation. In some cases, another provider will be in the room and can help with one or the other. If you’re by yourself, anticipate this challenge!

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

This surgery is essentially to ‘release the tongue’. The frenulum extends too far towards the end of the tongue, which greatly restricts newborn/early feeding.