TONGUE TIE OR ANKYLOGLOSSIA
It is very common for a baby to be born with restricted tongue movement, commonly called a “Tongue Tie”.
WHAT IS A TONGUE TIE ?
This is a congenital anomaly characterised by an abnormally short lingual frenulum, ( a piece of skin connects the tongue to the floor of your mouth and restricts tongue movement) the tip of the tongue cannot be protruded beyond the lower incisor teeth. It varies in severity between individuals.
WHAT IS A LIP TIE ?
Most babies who present with a tongue tie will also have a lip tie. This is an attachment from the upper lip to the bone of the upper jaw. This prevents the upper lip everting during sucking. (baby cannot turn their lip up and out “to pout ” )This prevents a good latch and allows air to be swallowed while suckling. The release of a lip tie often has more of an effect than the release of a tongue tie.
HOW COMMON IS TONGUE TIE ?
Reports on its frequency vary from between one in every 10 babies born to one in every 20 babies born. It appears to be more common in boys and there also appears to be a hereditary element with several members of any family suffering from the condition. It has been suggested that Tongue-Tie and Lip-Tie are part of a greater family of mid line deformities, but there is little evidence to support this.
TONGUE-TIE SYMPTOMS and LIP-TIE SYMPTOMS
The extent of the restriction varies with every infant from very minor and insignificant to a restriction so severe it will interfere with suckling and feeding and as the child develops further it may affect speech development, however there are differing opinions on this. Teenagers and young adults who have not had their tongue tie corrected are usually more worried about the restrictions it poses on kissing as the movement of the tongue is restricted.
Common Reported Symptoms of Tongue-Tie and Lip-Tie in babies include
- Painful feeding for mum
- Bleeding nipples
- Ulcerated nipples
- Shallow or poor latching on resulting in baby becoming frustrated
- Frantic feeding with a lot of very quick biting movements instead of a slow rhythm to feeding
- Prolonged feeding, with the baby remaining hungry and irritable
- Baby is exhausted by feeding, sleeps immediately on finishing feeding to wake hungry
- Excessive dribbling (opinions differ on this point)
- Clicking sounds
- Swallowing excessive amounts of wind (opinions differ on this point)
- Most tongue ties do not appear to affect speech, but each case must be individually assessed by an appropriate professional
The links bellow will bring you to the UK’s National Institute for Health and Care Excellence ( NICE) information web site on Tongue tie. Please read the information on these sites before considering the release of a tongue tie.
ANTERIOR TONGUE TIE
In simple terms an anterior Tongue Tie is when there is a band of tissue connecting the tip of the tongue (or an area near the tip of the tongue) with the floor of the mouth. When the mouth is opened and the tongue raised the piece of skin is obvious. It divides the area below the tongue in to 2 compartments, either side of the band of tissue.
POSTERIOR TONGUE TIE
In simple terms the band of tissue connecting the tongue with the floor of the mouth is set back into the tongue. You may not see the band of tissue when you look below the tongue, but if you push your finger int0 the undersurface of the tongue you will feel a tight band in the tongue.
TONGUE TIE INFO SHEET
SHOULD YOUR BABY HAVE A TONGUE TIE RELEASE or Lip Tie RELEASE?
A tongue tie release is a small and simple surgical procedure, however like all surgical procedures especially on infants they should be avoided if possible. Every attempt to find a non surgical resolution should be attempted before considering a tongue tie release. You should consult a lactation consultant, or GP for advice on breast feeding difficulties before considering this procedure.
Dr Murnane insists that all babies are referred for this procedure. A referral from a lactation consultant or GP is required.
For the best results you should also see your lactation consultant after the procedure so help in adjusting breast feeding is given.
SPEECH AND TONGUE TIE SYMPTOMS
It is possible for a Tongue Tie to affect speech. It is not possible to predict if a particular child will have their speech affected by a Tongue Tie as all children adapt differently. Each case must be assessed individually and the opinion of a speech and language therapist must be sought. But in general terms any sound which requires you to place the tip of your tongue behind your front may be difficult to articulate and if individuals speak quickly they may literally trip over their words. Tongue-tie release may have a role in these situations but the input of a speech therapist should be sought first.
DENTAL PROBLEMS with TONGUE-TIE and LIP-TIE
It has been reported that a restrictive lip tie will result in milk or other liquids the baby is fed pooling under the lip against the baby teeth when they erupt resulting in decay in the deciduous teeth. This would not be a common complaint.
A tongue-tie which is attached to the rim of bone on the palate may result in a gap developing between the two front adult teeth as they erupt in later life. The removal of this tissue is a commonly performed procedure in teenagers who are having orthodontic treatment to close such gaps.
If the tongue-tie or lip-tie attach close to the gums (the pink soft tissue immediately around your teeth), the tie can pull the gum off the teeth. This can compromise the health and appearance of the front teeth and in severe cases result in the loss of a front tooth.
LASER SCALPEL TONGUE-TIE RELEASE or LIP-TIE RELEASE
also referred to as a FRENECTOMY or LABIAL FRENECTOMY
A Soft Tissue Laser, which has transformed The Release of Tongue Tie and dramatically reduced the amount of post operative pain and swelling.
Dr Murnane uses a laser scalpel. There is NO BEAM, the laser evaporates, cauterises and sterilizes the tissue it touches and allows the procedure to be carried out while the child is awake without the need for a general anaesthetic. If the traditional method of snipping with a scissors is used it is not possible to release the lip as the lip tie is fleshy, requires some anaesthetic, will bleed if cut or snipped and would require sutures. No infant would be able to tolerate this amount of treatment so a general anaesthetic would be required
A small amount of anaesthetic is given in the lip tie and under the tongue in the Tongue Tie .
The lip is held up and if the baby will remain still the upper lip is released in a minute or so.
Then either 2 fingers are placed into the mouth under the tongue or a tongue retractor is placed under the tongue. Most infants will cry while you do this and this facilitates the procedure as the mouth is opened for crying.
A tongue tie is released at this stage. It is expected that the child/infant will cry during this as they do not like having their mouth interfered with. This allows better access.
TONGUE-TIE OPERATION / FRENECTOMY
Baby is swaddled in a blanket and held firmly and snugly by mum or dad on their lap. Dr Murnane sits opposite mum/dad knee to knee, babies head on Dr Murnane’s lap, baby looking at mum/dad.
The upper lip is held up and the lip is released. This is a very simple procedure as access is easy. The release of an upper lip will take a minute or two. Baby will cry during the procedure but will normally stop crying once the procedure is completed.
The release of the tongue tie is more difficult as access to the underside of the tongue is restricted. Some tongue ties are easier to access and other ties are more difficult to access. The length of the procedure depends on how easy it is to access the tongue tie and how still the baby is. But the release of a tongue tie will take between one and four minutes or so. Again baby will cry during the procedure and would be expected to stop crying once the procedure is completed.
It is best to allow an infant to suckle or to drink from a bottle immediately for comfort.
WILL THE RELEASE OF A TONGUE TIE OR LIP TIE HELP MY BABY FEED ?
There is no guarantee that the release of a lip tie and or tongue tie will offer any improvement in feeding for any child. However most babies do improve the efficiency and speed of feeding, swallow less air and latch in a less painful manner. It is however not possible to predict these results for any individual child.
It can be quite difficult to watch your little baby have a tongue and lip tie released. Baby will cry, their face may go red and their may be baby tears. If you do not think you can cope with this then you should consider carefully if this procedure is appropriate for you and your baby.
HOW WILL BABY BE AFTER THE PROCEDURE?
- About half of all babies will settle quickly and feed very normally after the procedure and show little or no side effects.
- About half of all baby will be a little “out of sorts” for a period of time. Reluctance to feed for about 8 hours is often reported and possibly a bit grumpy and unhappy the following day. But most will be feeding normally within 24-36 hours.
- Rarely a mother will report that baby is unhappy/upset and slow to feed for several days. Feeding by syringe for several days up to one week as baby will not suckle has been reported. If a baby is very sore after the procedure and will not feed the only treatment available is comfort, analgesics, slow feeding by syringe and letting nature and time resolve the issues. If in doubt it is best to consult your gp/ public health nurse or lactation consultant. It is important that fluid intake and nutrient intake is maintained.
Most babies will show an improvement in breast feeding immediately. However many babies will need to re-learn breast feeding or mum may need to be shown new techniques of feeding and as they do and as the surgical wounds heal a more gradual improvement in feeding will also occur over 7 – 10 days.You should seek advise and follow up from from your Lactation Consultant or PHN after the tongue tie release. The release of the Tongue-Tie and or Lip-Tie is not a quick fix but part of a process which includes proper follow up care and advise from a Lactation Consultant or PHN.
APPEARANCE OF THE LIP AND TONGUE AFTER RELEASE OF LIP-TIE AND TONGUE-TIE
Initially the areas under the lip and tongue which has been operated on will have a grey / black almost charred appearance. This will turn into an ulcer over several days (a whitish area with a greenish surround). The area will heal completely and look pink and normal within 10 to 14 days.
POST OPERATIVE CARE
A little minor swelling in the upper lip is to be expected and this should resolve in several days.
The baby may be upset for several days and reluctant to feed due to pain in the lip and or tongue. Regular breast feeding will provide skin to skin contact which is reassuring and breast milk has an analgesic effect for baby. If your baby is old enough they can be given calpol.
It is advised to clean under the lip with cotton wool soaked in warm salty water several times a day if baby will tolerate this. If baby will not tolerate cleaning its best not to persist.
It is often impossible to clean under the tongue with salty water but if it is possible it should be done.
Exercises are recommended after the procedure and the best exercise is regular breast feeding as this will splay the upper lip and exercise the tongue. If baby is not feeding properly mum may have to exercise the lip and tongue and these exercises will be demonstrated in clinic.
You should see your Lactation Consultant or PHN in the days after the procedure for breast feeding advice.
You should contact your public health nurse or GP if you have any worries about your babies not feeding sufficiently.
Many mothers travel a considerable distance to have this procedure carried out and returning for a review appointment is difficult. Dr Murnane will phone you in the days after the procedure to enquire as to how things are going. You will have Dr Murnane’s mobile number should you wish to talk to him, and you can return to see Dr Murnane if you wish to at any time.
If you wish for a review appointment, it will be organised on the day. There is no charge for a review appointment.
Reattachment or regrowth of tongue tie does not happen. However in about 4% of babies scar tissue develops in the surgical wound and this scar tissue can glue either side of the wound together. As the scar tissue matures it tightens and restricts movement once again. It is not common, it is not predictable but it is probably preventable. Exercises are advised to prevent scar tissue formation. The best exercises are regular breast feeding with a good technique as this will splay out the lips and exercise the tongue. Formal and simple exercises will be demonstrated in clinic if the baby is unable to breast feed properly. Tongue exercises such as sticking your tongue out to the maximum during the healing period may be of some help. However this may only work in an adult as it would distress a baby to have its tongue pulled it this manner. Re attachment if it happens is more likely to happen slowly over a period of several months.
If you do get re attachment Dr Murnane will release the tongue once more if requested. There is no charge for this. If a tongue re attaches a second time it is probably futile to attempt a third release of a tongue tie.
ARE TONGUE EXERCISED NEEDED AFTER TONGUE TIE RELEASE?
The benefit of tongue exercises after the release of a tongue and lip tie is unproven and opinions differ on the issue. However everting the lip for several seconds about 3 times a day will help prevent re attachment, it will upset baby but will do no harm. However the benefit of doing this is unproven.
Tongue exercises, where you put your fingers under the tongue and raise the tongue to the roof of the mouth about 3 times a day are also generally advised.
Exercises will upset your baby and should be done just before feeding. The benefit of tongue and lip exercises are unproven but their use is generally accepted.
BENEFITS OF LASER SCALPEL TONGUE-TIE RELEASE SURGERY
- General Anaesthetic is not needed.
- A steel scalpel is not used so the tissue is not cut in the traditional fashion.
- There are no stitches
- There is no bleeding
- There is very little post operative swelling, usually a little in the upper lip.
- There is little or no post operative pain for MOST babies.
- Instant (or within several days) improvement in tongue function and feeding for many babies.
- The procedure is very quick.
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LASER SAFETY NOTE
THE LASER USED BY DR MURNANE, IS A LASER SCALPEL, THERE IS NO LASER BEAM.
IT WILL ONLY EVAPORATE, STERILIZE AND CAUTERISE WHAT IT TOUCHES. THE LASER SCALPEL, UNLIKE OTHER TYPES OF LASER POSES NO RISK OF DAMAGE TO EYES.
PEOPLE VERY CLOSE WEAR PROTECTIVE GLASSES TO PROTECT FROM GLARE ONLY.
IT IS NOT NECESSARY TO WEAR GLASSES IF YOU ARE SEVERAL FEET AWAY.
The 2 most common lasers used in Ireland are
DIODE LASER (LASER SCALPEL)
Dr Murnane uses a Diode Laser, which is effectively a laser scalpel. It cuts only what it touches, cauterises and sterilises as it cuts. A diode laser is not very powerful. its effects are limited to the laser tip, There is no beam which can travel through the air. If you touch the laser tip with your finger it feels like a vague touch of a pin tip.
The Waterlase is a YSGG laser. A powerful laser used for cutting teeth and bone and soft tissue. The Waterlase is an excellent and powerful laser. It produces a laser beam which poses a risk of damage to eyes and safety glasses are compulsory.
There is no such devise as a “Water Laser” ie a laser which uses water to cut. The water used in a Waterlase is for cooling and rehydrating the cut surface as tremendous amounts of energy are produced by the laser and transferred to the tissue during treatment.
The fee for this procedure is normally €350
If you have health insurance the fee is €250.
The insurance code for “Labial Frenectomy” is 2980 For “Tongue Tie ” is 1170
If you have any queries on this procedure please contact Dr Murnane via the contact page on this web site.