Ties are remnants of connective tissue that failed to fully disappear during development in utero. Most all of us are born with these attachments to some extent. Look in a mirror and lift up your upper lip. See that little string? That string is a frenum and so is the thin string under many people’s tongues.
So if most all of us have them why are they a problem? Because not everyone has a tongue or lip frenum that attaches to the same area or are the same size or as flexible. Sometimes in babies their upper lip frenum will attach to the crest of the gummy ridge where their teeth will eventually come in. This often prevents babies from being able to flange their upper lip to create the needed seal that is the first part in allowing an infant to achieve a good latch on mom for breastfeeding.
Tongue ties can be anterior or posterior and oftentimes both are present. The best analogy I've heard is to think of a mast on a sailboat and the sail itself. The sail is equivalent to the anterior tie. The posterior tie is analogous to a mast. Every sailboat has a mast, but they don’t always have their sails visible. The posterior tie is hidden beneath the base of the tongue and can prevent proper elevation of the tongue. In tongue ties and for breast or bottle feeding, UP is the far more important motion rather than OUT. Parents will often not even consider the possibility of their little one having a tongue tie since they see them sticking their tongue past their lips. The tongue must be able to touch the roof of the mouth while the jaw is open in order to go through a necessary wavelike motion to draw milk from the mother's nipple. Failure to elevate properly leads to the little one holding onto the nipple as tightly as possible with their lips. This often leads to severe pain to mom and often what are called suckling blisters on the baby, seen in the midline of the upper lip and sometimes the entire lower lip.
Refer to this table to see a more extensive though not comprehensive list of possible symptoms of baby, mom, young children and adults with ties.
If you or baby is experiencing any signs or symptoms listed in that table please give us a call. If you’re first able to see an IBCLC (International Board Certified Lactation Consultant)-even better. Sometimes there aren’t restrictions and a change in hold or position suffices. Laser revisions can often help improve/prolong a breastfeeding relationship which has countless benefits to mom and baby; health, immunity, a strong & loving bond for the dyad.
Note the obvious tongue restriction and the upper lip blister indicative of a baby holding on tightly rather than flanging and relaxed.
In the right hands a frenectomy is a simple procedure whereby the connective tissue remnant that failed to completely disappear during development is revised to allow for more natural movement of the lip and tongue.
There are many ways to perform a frenectomy: scissors, electrosurge and what is becoming the method with the least postoperative discomfort and minimal collateral tissue damage: laser frenectomy.
With our state-of-the-art diode laser we can revise tongue ties and lip ties in a minute or less typically. The laser has a microscopic tip that causes very little collateral tissue damage. This is largely why laser tongue and lip ties releases tend to have less if any bleeding, reduced inflammation and often lower postoperative pain following the procedure.
The image on the left is immediately after the revision of the tongue seen above and the relaxed position of the tongue is obvious as is the diamond-shaped wound beneath the tongue. The image on the right is a few days later with mom lifting the baby’s upper lip to both show how easily it flanges to the nostrils now and to visualize the typical wet scab appearance of the wound seen for a week or two following the procedure.