An upper lip tie occurs when the maxillary labial frenulum, the tissue connecting the upper lip to the gum, is too tight, restricting lip movement. This restriction can interfere with an infant’s ability to flange the upper lip outward for an effective seal during feeding. The standard corrective procedure is a frenotomy, which is a simple release of this restrictive tissue. However, the body’s healing process sometimes leads to the two sides of the surgical wound reattaching, a complication often called recurrence. Monitoring the healing site closely for signs of reattachment is necessary following the initial procedure. This article focuses on identifying the specific physical and functional changes that suggest a reattachment has occurred.
Defining Lip Tie Reattachment
Reattachment is a consequence of the body’s natural wound contraction process. Following a frenotomy, the surgical site forms an open, diamond-shaped wound that must heal by secondary intention. The body attempts to close this open wound by generating new tissue, which can sometimes be overly aggressive.
This healing involves the formation of scar tissue, which pulls the two edges of the wound back toward each other. A true reattachment occurs when the scar tissue completely bridges the gap, restricting lip mobility once more. This complication typically manifests within the first two to four weeks following the release procedure. Consistent post-procedure stretching exercises are designed to disrupt this contraction and encourage the wound to heal openly.
Observable Physical Indicators
The most direct way to assess for reattachment is through gentle, visual examination of the released site. Parents should carefully lift the upper lip toward the nose to visualize the area where the frenulum was previously located.
The appearance of a tight, thickened band of tissue spanning the gap is a primary indicator of recurrence. This band may appear white, shiny, or dense, contrasting with the surrounding pink mucosa, sometimes feeling firm upon gentle palpation.
A significant sign is “blanching,” which occurs when the tissue turns white upon lifting the lip. This blanching indicates that the tissue is under excessive tension. After a successful frenotomy, the lip should be able to lift high without causing this noticeable tension or color change.
The ability of the upper lip to fully elevate is severely reduced if reattachment has occurred. Parents may notice that when they attempt to lift the lip, the tissue immediately snaps back down, indicating a lack of flexibility at the wound site.
Another key feature is the premature closure of the diamond-shaped wound created during the procedure. The wound site should remain relatively open and visible for several weeks as it heals. If the site has fused together, the diamond shape will appear significantly smaller or will have completely disappeared, replaced by the restrictive band. This visual evidence confirms that the new scar tissue is limiting the necessary range of motion.
Functional Signs in Feeding and Behavior
The functional consequences of a reattachment often become apparent during feeding. The return of difficulty maintaining a proper seal is one of the most common indicators. If the upper lip can no longer flange out effectively, the baby will struggle to create the necessary vacuum, causing them to slip off the breast or bottle frequently. This poor seal often results in the infant compensating by using their jaw and cheek muscles excessively, leading to fatigue.
A distinct clicking or popping sound during suckling is a strong functional clue that the seal is compromised. This noise indicates that air is rushing in as the vacuum is repeatedly broken during the feeding session. The resulting air intake can lead to an increase in gassiness, excessive hiccups, and frequent spitting up after meals.
For breastfeeding mothers, the return of pain during nursing that had previously resolved after the initial procedure is highly indicative of recurrence. The infant’s inability to achieve a deep, comfortable latch forces the mother’s nipple to absorb excessive friction and compression. This renewed pain signals that the mechanical issues causing a shallow latch have returned. The nipple may appear compressed, flattened, or lipstick-shaped upon removal from the baby’s mouth, reflecting the trauma of the shallow latch.
Continued slow or poor weight gain, or a plateau in growth, can also suggest that the infant is expending too much energy or not efficiently transferring milk. Behaviorally, the baby might exhibit increased frustration or fussiness during feeding attempts. For bottle-fed babies, difficulty maintaining suction on the bottle nipple may lead to milk dribbling out of the sides of the mouth.
Consultation and Management Steps
If any physical or functional signs suggest a reattachment, the immediate next step is to consult with the treating provider. This specialist, whether a pediatric dentist, an ENT, or a lactation consultant, will perform a professional visual and tactile examination. A professional needs to assess the degree of restriction and differentiate between minor scar tissue and a functionally significant reattachment.
Confirmation of a reattachment requires a collaborative management plan. The first approach often involves more aggressive stretching exercises, sometimes performed by the provider, to try and break the restrictive scar tissue. If this is unsuccessful or the restriction is severe, a revision procedure, which is a repeat of the frenotomy, may be recommended. This decision is based entirely on the functional impact the restriction is having on the infant’s feeding and comfort. Some management plans also incorporate bodywork, such as chiropractic or craniosacral therapy, to help release muscle tension.