Nurse’s Notes: What to do Pre and Post Frenotomy

Posted: September 5, 2016 in Nurse
Tags: , , , , ,

I got a chance to assist an oral surgery today. And I’m thrilled to share it’s nursing management.

Frenotomy, Frenectomy

Screenshot from NIH.gov

Our one month old male patient had ankyloglossia or tongue- tie. His mother noticed him to elicit difficulty during breastfeeding. He cannot latch well to his mother’s nipples. To correct and prevent the child from further harm in the future, our pedia doctor and orthodontic surgeon performed frenotomy.

Background on Frenotomy

Frenotomy is  procedure done to cortect  pediatric disorder called ankyloglossia. It is usually the choice for neonates as it is less invasive and can be done in a dental clinic setting.

The infant may not be given local anaesthetic spray prior to the procedure since infant’s pain is slight. Bleeding is also neglible. Frenotomy improves feeding immediately.

The baby is placed supine with the elbows held flexed securely close to the face. The tongue is lifted gently with gloved finger and thumb so as to expose the frenulum. With sterile scissors, the frenulum is released by approximately 2 to 3 mm at its thinnest portion, between the tongue and the alveolar ridge, into the sulcus just proximal to the genioglossus muscle. Care is taken not to incise any vascular tissue (the base of the tongue, the genioglossus muscle, or the gingival mucosa). There should be minimal blood loss, i.e., no more than a drop or 2, collected on sterile gauze (Ballard et al 2002).

Nursing Management for Frenotomy

As a nurse assigned to an orthodontic surgeon, you have the duties before, during and after the procedure. The following are the nursing management for frenectomy and frenotomy.

Before

1. Ensure that the patient’s guardian or parents are informed by the doctor about their child’s case, and the procedure to be performed.

2. Prepare the needed equipments (e.i. gloves, sterile gauze, Normal Saline, suture kit, surgical scissor, hemostat) for the procedure.

3. Prepare a sterile or aseptic area where you will perform.

During

1. During the procedure always maintain sterility or asepsis.

2. Hold the baby, especially in the head, firmly.

3. To remove blood from the baby’s mouth, press two- ply wet sterile gauze.

4. Hand over surgical instruments to the surgeon properly.

After

1. Clean the baby or your patient’s mouth and face.

2. The infant should be returned immediately to the mother for feeding. Reassessment of nipple pain and infant latch should occur post release.

3. Inform the parents about the follow- up check- up.

Reassessment, evaluation and continuing care must be provided to the patient following the procedure. Frenotomy in neonates or babies up to 4 months old can have a recurrence later.

You must remember that each patient is unique, so let this post be your guide.

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