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Infant Laser Frenectomy
What is a tongue tie?
A tongue tie occurs when the thin membrane under the baby’s tongue (the lingual frenulum) restricts the movement of the tongue. Restricted tethered oral tissue can interfere with breastfeeding, speech and development, sleeping disorders, sinus and jaw growth, tooth alignment and eating function, to name a few. Also, infants with tongue ties can affect their ability to breastfeed and lead to poor latch, nipple pain and trauma, decreased milk intake and a decline in milk supply over time. The medical term for tongue tie is “ankyloglossia” and studies show the defect is likely hereditary.
What is a lip tie?
Many babies with a tongue tie also have an abnormally tight membrane attaching their upper lip to their upper gums (the labial frenulum). This is called a lip tie. Babies with a lip tie often have difficulty flanging their lips properly to feed and can’t create a proper seal at the breast. This can cause them to take in excess air during breastfeeding, which often makes these babies gassy and fussy.
The mobility of the tongue is very important during breastfeeding, both for the mother and the baby. A baby with a tied tongue may not be able to latch deeply onto the breast, past the nipple onto the areola. This compresses the nipple onto the hard palate in the baby’s mouth, leading to nipple pain and skin breakdown for the mother. A tongue tie often accompanies a high palate, which also decreases the suction and further reduces milk transfer.
Babies with ties may not maintain a latch for long enough to take in a full feeding, while others may remain attached to the breast for long periods of time without taking in enough milk. Some infants will feed only during the mother’s milk ejection reflex, or “let-down” when the milk ejects more freely, but won’t continue to draw milk out of the breast when this slows. Bottle feeding allows milk to drip into the mouth without effort, thus requiring less tongue muscle effort than is needed for breastfeeding.
An infant’s inability to breastfeed often results in the mother giving up breastfeeding entirely, while being told that the problem is her fault. In reality, the problems may actually result from restricted tongue and upper lip attachments – making normal function, mobility and breastfeeding difficult or impossible.
Feeding a Baby Comfortably and Efficiently is the Most Important Aspect of a Newborn’s Life and a Precious Experience for a New Mom.
A normal frenum is a connective band bringing two soft tissue pieces together. In some cases, if that band connects too low or tight it may result in a condition know as Restricted Tethered Oral Tissue (RTOT) or commonly known as a Tongue-Tie or a Lip-Tie. These conditions can jeopardize the beautiful nursing relationship between a mother and her newborn.
This tissue can be restrictive in nature, similar to how webbed fingers can become restricted with extra skin attaching to high. Imagine how a surgical release of webbed tissue allows fingers to be free and function well. A frenectomy procedure allows a baby to freely use their lip and tongue for an efficient, effective, and comfortable feeding experience.
Signs and Symptoms of Tongue and Lip Ties
Some babies with Restrictive Tethered Oral Tissues are able to attach to the breast and suck well though many of these infants struggle with other breastfeeding problems. However, it is important to note that these signs can be linked to other breastfeeding problems and are not solely related to ties.
Infants may exhibit:
- noisy suckling or clicking
- popping on and off the breast
- leaking on the sides of the mouth
- poor weight gain
- coughing or gagging
- lip blisters
- gas pain
- noisy breathing/snoring sounds when sleeping
- reflux or colic symptoms
Mothers may experience:
- flattened nipples after breastfeeding
- nipple pain and damage
- prolonged feedings
- poor breast drainage
- decreased milk production
How Are Tongue and Lip Ties Diagnosed?
Tongues and lips are only considered to be tied if their movement is restricted, impairing mobility. Correct examination of infants requires the infant be placed on the examiner’s lap with the infant’s head facing the same direction as the person evaluating the infant.
It is important to note that not all ties cause problems and require correction. Each case needs to be assessed by an educated and trained practitioner on an individual basis.
Tongue tie is a diagnosis based upon function, so what your baby’s tongue looks like can sometimes be less important than how it can move.
How are Tongue-Ties and Lip-Ties treated today?
Thanks to the great advances in laser technology, most technologically-savvy and up-to-date healthcare providers are educated on the laser’s properties and why they are highly favorable in soft tissue procedures. Dr. Lentfer’s expertise in using Solea CO2 laser allows her to provide desensitization and coagulation as it separates the tissue. The newborns we treat can feed immediately after the procedure for comfort. Moms report significant difference in personal comfort, baby’s consumption, and efficiency while nursing or bottle feeding.
Consequences of Untreated Lip and Tongue-Ties
Many children develop a high arch in their roof of the mouth (palate) as it does not get the benefit of proper shape and molding by the tongue. Many children struggle with transitioning from milk to purees or table foods. While some become picky eaters and have difficulty managing variable texture of table foods.
Many children develop air management and speech clarity or articulation problems due to limited range of motion and elevation of all parts of the tongue required to produce various sounds – l/th/d/n, st/sr/kh/gh, m/p/b and so on.
Children with lip or tongue tie are prone to developing cavities on the surfaces that do not get the benefit of natural cleansing from the soft tissue of the mouth. Cavities seen on the front part of the incisors or recession of gums near the midline are often attributable to lip ties. Cavities on the chewing surface of the molars are often seen in patients that have a tongue tie and never developed the reflex to clean out the sticky foods after snacks or meals.
Disordered Breathing and Sleep Apnea are often seen in children that cannot manage the proper posture and tone of the tongue muscle due to restrictions or ties. The tongue remains ‘down and back’ in the mouth which leads to restriction of the airway. Snoring, exhaustion, grinding of teeth, attention deficit disorders, behavioral issues are all now being connected back to sleep disordered breathing in the literature.
Team approach for long-term success
Mothers and babies experience maximum benefits when a frenectomy is combined with guidance from a knowledgeable lactation consultant or a feeding therapist. This is important in developing a new and improved breastfeeding relationship. They can help you tease out any maternal or infant related factors that may be interfering with your baby’s ability to feed.