WHAT EXACTLY IS A TONGUE-TIE AND LIP-TIE?

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia. Lip-tie is a condition where the upper lip has restricted mobility and function. As we develop in the womb, a tight string of tissue called a frenum is supposed to recede and thin under the tongue and lip. The frenum is visible and easily felt if you look in the mirror under your tongue and lip. Everyone has a frenum, but in some people, the frenum fails to recede and is too tight, thick, or short and causes mobility problems.

The tongue and lip are very complex group of muscles and are important for all oral functions. For this reason, having a tongue-tie can lead to nursing, bottle feeding, dental, speech, sleep, and solid feeding issues.

Infants with Feeding Difficulties

A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have poor weight gain. If they cannot make a good deal on the nipple, they may swallow air causing gas, colic, and reflux or spitting up. You may hear clicking noises when the baby is taking the breast or a bottle. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue and lip-tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in the mother and inability to hold a pacifier.

Sometimes a tongue-tie can be "hidden" or "posterior" and can be difficult to diagnose but still cause the same issues as a more visible to-the-tip tie. A tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child's weight gain but lead many others to abandon breastfeeding altogether. Many times, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch. The symptoms of reflux, gassiness, and colic may also disappear and weight gain may occur rapidly.

INFANT ISSUES

  • Poor Latch

  • Poor weight gain

  • Reflux or spitting up often

  • Clicking or smacking noises

  • Gassy or fussy often

MOTHER’S ISSUES:

  • Painful nursing

  • Creased or flattened nipples

  • Blistered or cut nipples

  • Incomplete breast drainage

  • Plugged ducts

  • Using a nipple shield

 

Tongue-ties come in all different varieties. Some are more obvious and to-the-tip while others are more hidden or posterior. More important than the appearance is the mother's and baby's symptoms.

 

THE RELEASE PROCEDURE

Tongue-tie and lip-tie release is a simple procedure with minimal complications when using a laser with good technique. Dr. Nehal has been trained by Dr. Richard Baxter, a board-certified laser surgeon, and performs more tongue-tie releases than anyone in the state and lectures nationally on tongue-ties.

The laser allows for excellent visualization and precision during the procedure to achieve a full release of all the fibers, which typically does not happen with scissors.

The procedure may be performed as early as a couple of days after birth and can be performed into adulthood. Typically, once a problem with a tongue-tie or lip-tie has been discovered, the sooner it is addressed the better the procedure will work and the less issues the child will have.

The procedure can be performed in our office with numbing jelly. Dr. Nehal uses the highest quality, state-of-the-art CO2 laser to perform the release. Older children who understand the procedure receive some numbing medicine and laughing gas, and often report no pain at all during the procedure. Younger children and babies usually cry more due to us working in their mouth rather than the pain.

The laser gently removes the tight tissue with typically minimal bleeding, no stitches, and no sedation or general anesthesia. Most of the time the release only takes about 20 seconds or less. The baby is allowed to nurse immediately after the procedure, and older children often notice an immediate difference in mobility of the tongue. Often speech is improved within a few minutes to a few weeks, but speech therapy is required to achieve optimal results.