Tongue-Tie and Lip-Tie

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Tongue-Tie and Lip-Tie Assessment at any age: Infants discussed in detail here.

The initial assessment of your infant requires only a few minutes.  We begin by discussing your symptoms and your infant’s symptoms.  Dr. Gunsaulis will examine your infant in the same position we recommend active wound management after the revision of an upper lip-tie, cheek-tie and/or tongue-tie:  the person doing the examination will hold the infant’s head in his or her lap with the infant’s feet toward the examiner’s knees.  In this way, the examiner is looking straight down into the infant's mouth.

Releasing the Tongue-Tie and Lip-Tie

If a frenum is contributing to functional deficits and scores high enough on appearance and functional examination, it is tie; and a frenectomy will be recommended to release the tie.  Releasing the lip, cheek and tongue does NOT require any general anesthetics and is safely, quickly and easily completed in the dental office using a CO2 laser for infants to adults.

Surgical release of an infant’s tie takes less than 30 seconds and requires NO numbing, restrictive sutures or other drugs.

Active wound management after the release of a tongue-tie, lip-tie, and/or cheek-tie  is necessary to prevent reattachment of the tie and to retrain the now-free muscles to function efficiently to form the mouth correctly through growth and development.  For an infant, this means achieving an efficient feed.  For children or adults this may mean achieving coherent speech, or a restful nights sleep without pain/headaches the following day. 

As Michelle Price Emanuel has said, “Releasing the tie is a big part of improving latch and nursing, but there is also a need to do intentional therapy and exercises to help bring on healthier oral function.  Somethings will improve spontaneously, but most oral function needs intentional activities to promote optimal function.”  This is also true of older children and adults.

 

 

Active Wound Management

Active wound management after the release of a tie, also known as tethered tissue, is critical to prevent reattachment.  Wash your hands well before and after lifts (gloves are not necessary)  Lift the tongue by pushing up with your two index fingers on both sides of the wound to stretch the tongue fully back and up off the floor of the mouth as far back as it will go so you can see the diamond shaped wound for 5 seconds.  Lift the lip or cheek by pushing up with your two index fingers on both sides of the wound to fully stretch the lip up to touch the nose, so you can see the diamond shaped wound.

Lift the lip, tongue and/or cheek until fully moved free from the wound for 5 seconds.  Do this 4 times a day, every 6 hours, for 3 weeks. Trim nails as finger nails should NOT touch the wound. Use Smart Phone Alerts to make sure lifts are occurring once every 6 hours.  Start 6 hours after the release for all ties, however, Dr. Gunsaulis may recommend waiting to do the tongue lift till the next morning for some infants.

A small amount of spotting or bleeding is common after the procedure, especially in the first week when doing the lifts. You may use Tylenol, Ibuprofen (if 6 months of age or older), Arnica, Rescue Remedy or other measures to help with pain control. As of October 2016, the FDA has requested that teething gels no longer be used. A suitable replacement is organic coconut oil, which can be safely used in the mouth following the exercises.  Do not use coconut oil before the exercises as it may inhibit full retraction.  Frozen coconut oil to wound further helps with pain control, cooling the wound.

Tongue-tie release is always located where the tongue and the floor of the mouth meet, it often requires a horizontal, superficial extension to release fascia on either side of the tongue, sometimes more on one side than another, in response to the tie and its effect on the growth.  The lip/cheek-tie release is always located at the insertion of the frenum to the attached gingiva, gums) extending to the depth of the vestibule, where the lip and and movable inner oral mucosa  meet.  Release of all sites results in a diamond to oval shaped wound.

Keep in mind that laser release of ties results in less bleeding following the release than with other surgical treatments and a white to yellow colored wound will be seen and decrease in size while healing and resolve upon full healing.  This is not an infection; it is normal wound healing and because it is free from sutures, heals with less restriction and pain.

Laser

Dr. Gunsaulis prefers to use lasers to release ties because it is the most state-of-the art method and because it is her preference and what she has been trained to use.  However, Dr. Gunsaulis knows this procedure can be successfully done in many manners and is quick to point this out to parents and patients seeking her services. 

Regardless of the surgical technique used, ensuring full release of all oral tethered tissue is critical to the patient's growth and development of optimal feeding, chewing, swallowing, breathing, speech, tooth and jaw positions and preventing oral diseases.

It Takes A Community

After a frenectomy, or tie-release, it is necessary to retrain your infant to suckle correctly.  This can be done by massaging the front half of his or her roof of mouth.  Use your finger to do this and if you feel your infant is uncomfortable dissolve a teaspoon of sugar in one cup of water and dip your finger in this solution.  Your infant should be able to suck on the area between the first and second knuckle.  Do this at least 3 times a day for 3 weeks following the frenectomy.

If you don’t have a lactation consultant already we will give you the name of one of the many IBCLC in our community that can help you achieve the best possible outcome.  We also routinely refer our post-operative frenectomy patients to other professionals experienced in treating infants, children and adults  that can further evaluate and/or provide treatment to enhance growth and development, such as Myofunctional Therapists, Cranial Sacral Therapists and Chiropractors.

We encourage parents to engage their infants in tummy time and provide gentle body massage to aid in healing, regain balance and provide comfort.

Please feel free to contact Dr. Gunsaulis with questions/photos via e-mail anytime: Molly@GrowSmileShine.com