Tongue and Lip Ties in Calgary
Tongue and lip ties, professionally known as restricted lingual and labial/buccal frenums (or ‘ankyloglossia in the case of a tongue tie), become a concern when they are causing restrictions in oral function. When restricted, they can interfere with the effective functioning of the mouth, which impacts speech, swallowing, eating, and breathing. While they are not always as obvious visually to an untrained eye, as is the case of what is known as a ‘submucosal tie’ or ‘posterior tie’ where the restriction is hidden under the base of the tongue, they can still require attention if the function is being impacted.
In infants, lip and tongue restrictions can have a significant impact on breastfeeding. Breastfeeding should be a pain free and enjoyable process, yet many mothers learn to adapt, either posturally or in additional ways, to deal with a lot of the issues that stem from the restrictions. Many may find these coping strategies to work initially, but when the transition from demand driving the supply of milk rather than the mother’s hormones happens, the strategies become less effective. Some of the signs and symptoms may include poor latch/inability to latch, sliding off the nipple, fatigue during feeds, sleepy feeds, irritability while feeding, poor weight gain, clicking during feeding, dribbling milk at the breast/bottle, digestive issues (increased gassiness, reflux, colic, vomiting, distended stomach), maternal nipple pain/damage (feels like the infant is compressing, chewing, gumming, pinching the nipple), increased maternal nipple/breast infection, compromised maternal milk supply. Often times, a well-trained lactation consultant will be able to help identify the issue, and we encourage working with one both before and after any treatment.
When restrictions are missed at an early age, or are not completely released, they still have many implications later on after breastfeeding, which can manifest through compensations made by the body to adapt to the restrictions in order to carry out functions. Signs and symptoms may include speech challenges, strong gag reflex, clenching or grinding of teeth, crowding of teeth, poor arch development, tongue thrusting, difficulty nose breathing, recurrent ear/nose/throat infections, history of bed wetting, extended pacifier use, thumb sucking, hair chewing, eyelash pulling, tiredness after speaking for extended periods, challenges with brushing upper front teeth, history of decayed posterior teeth, frequent bad breath, dislike of certain textures of food, difficulty swallowing food or tablets, difficulty clearing mouth of food, slow eater, digestive problems such as reflux or constipation, sleep apnea, noisy breathing/snoring, neck pain, back pain, head pain, migraines, TMJ pain or clicking.It is important to note that not everyone with restrictions may have all of the above issues and that there may be other causes for them. This is why a thorough history and exam is imperative to the process.
While it can often be easy to address the restrictions with a quick procedure in infants as it has been caught early, children and adults have had a longer period of time to compensate for the restrictions, and therefore have the oral dysfunctions more ingrained; the frenectomy procedure alone may not be a ‘cure-all’ or give an obvious major improvement immediately. As such, it can take a bit more effort through a multidisciplinary approach to help correct them and establish competent oral function, rather than compensatory. An oral myology program is key, as can be coordinated treatment with an orthodontist, chiropractor, physiotherapist, speech pathologist, nutritionist, or ENT if deemed necessary, on a per case basis. The fascial layer involved in restrictions and present in the tongue runs all the way down to the toes; it is all connected. For further insight into tongue and lip restrictions’ role in the ‘big picture’, please refer to the “Airway” section of the website. Also, please see the “Oral Myology” section for more information on what it is.
Q: How do you know it is a “tie” and not normal anatomy?
A: The more correct term would be “restriction”, and that is essentially how we know it is something that requires attention: it inhibits the normal functions of the mouth and face. It is not enough to judge based on how it looks alone, but we are taking into consideration the impact it may be having on overall oral function, based on various other signs and symptoms. This is why a thorough history and examination is key.
Q: How is a tongue or lip release done?
A: The release involves removing some of the tissue of the frenum, either with a laser or scissors/scalpel. Often a diamond shape of the tissue opening is achieved and either left as that (usually in the case of a laser), or stitched together (usually in the case where scissors/scalpel have been used). Which is done depends on operator preference, the specifics of the case, or other factors.
Q: Is it better to use a laser or scissors/scalpel?
A: The method used does not matter as much as the technique of the operator. The key is to perform an adequate release, which can be performed with either method. Even more critical, regardless of the method used, is being diligent with the oral myology exercises before and after; they are what can make or break the success of the procedure.
Q: Is the release procedure painful?
A: There may be mild discomfort as there is with any procedure in the mouth, but we utilize strategies to minimize it. In adults, youth, and most children, a strong topical anesthetic gel is applied, along with a small amount of local anesthetic as needed. In toddlers, usually, the strong topical anesthetic gel is sufficient. Sometimes, the actual local anesthetic delivery in this age group can be more cumbersome than the actual procedure itself, including just the taste and feel of the topical. As such, we tailor the experience on a per case basis. For infants, no anesthetic is required and this also allows us to have the baby breastfeed immediately after to determine whether an improvement has been made.
Q: What is the recovery phase like?
A: As with any procedure of this nature, some mild swelling, pain, and discomfort may be experienced as healing occurs, and as the exercises are performed in the first few days after. Regular over the counter pain medications are adequate to control any mild discomfort. Salt water rinses are also advised to keep the area clean. Mild bleeding is also normal. If sutures are used, they dissolve usually by one week. Infants may be irritable and we encourage skin to skin contact to help, and contacting your lactation consultant if concerns of not feeding or settling arise. Exercises are key, and for infants we advise performing them every 6 hours for up to 4 weeks after treatment. In adults and children, it is usually three times a day for up to 4 weeks after. Given the exercise regiment and active wound management involved, it is recommended to take it easy the first few days after, and refrain from swimming or other medical procedures for about a week or so after.
Q: How long does the release procedure take?
A: The actual procedure itself only takes a few minutes, but with children we may book more time as we get them going and set up for it. In adults and children, the appointment could be anywhere from a half hour to an hour. For infants, usually a consult is performed (approx. 30 minutes) with the procedure being done after (lasting anywhere from a few seconds to 5 minutes), and then the breastfeeding and post-op assessment phase varies depending on how much time you need to take (sometimes up to a half hour). For the oral myology exercise program set up with children and adult releases, please note that a separate myology assessment and schedule are required: initial assessment usually one hour, and then weekly visits for 4 weeks before and 4 weeks after (depending on progress and findings at initial assessment), usually a half hour each visit.
Q: Is the procedure covered by insurance?
A: It depends on your coverage. Some companies and plans do, some don’t. We encourage you to be familiar with your coverage, and our front-end staff can also help you with the process if needed.