A maxillary lip tie occurs when the maxillary labial frenulum, the piece of tissue connecting the upper lip to the gum above the front teeth, is unusually short, thick, or tight. While everyone has this tissue, a “tie” refers to a restriction that limits the upper lip’s normal range of motion, impacting various oral functions.
Signs of a Restrictive Lip Tie
Infant Signs
A restrictive maxillary lip tie can present with several observable signs in infants, often related to feeding difficulties. Babies may struggle to achieve a deep latch during breastfeeding or bottle-feeding, as the tightened frenulum prevents the upper lip from flanging outward effectively. This can lead to a shallow latch, where the baby primarily sucks on the nipple rather than the wider breast tissue. Clicking or smacking sounds during feeds are common indicators, suggesting the baby is losing suction due to the restricted lip movement.
Infants might also exhibit poor weight gain despite frequent or prolonged feeding sessions, as inefficient milk transfer means they are not receiving enough nourishment. Feeding can become exhausting for these babies, causing them to fall asleep at the breast or bottle shortly after starting, only to wake up hungry again soon after. Swallowing excessive air due to an improper seal can lead to increased fussiness, gas, or symptoms often associated with colic.
Maternal Signs
Nursing mothers whose infants have a restrictive lip tie often experience their own set of challenges and discomfort. Nipple pain during or after feeding is a common complaint, resulting from the baby’s shallow or improper latch. This can manifest as creased, cracked, or bleeding nipples, indicating trauma from ineffective sucking mechanics.
Nipples may appear flattened or compressed after nursing, a sign that the baby is not adequately opening their mouth or creating a proper seal. Inefficient milk removal can impact the mother’s milk supply, potentially leading to engorgement, plugged milk ducts, or recurrent mastitis. The constant discomfort and feeding struggles can also contribute to maternal fatigue and frustration.
How a Lip Tie Is Diagnosed
The diagnosis of a maxillary lip tie involves a comprehensive assessment that combines a physical examination with a functional evaluation. Healthcare professionals, including pediatricians, pediatric dentists, or International Board Certified Lactation Consultants (IBCLCs), perform this assessment.
During the physical examination, the practitioner visually inspects the maxillary labial frenulum to observe its appearance, including its thickness and attachment point on the gum. They may also gently palpate the tissue to assess its elasticity and the extent to which it limits the upper lip’s elevation and movement. A functional assessment involves observing the infant during a feeding session to evaluate their latch, the efficiency of milk transfer, and any signs of discomfort for either the baby or the mother.
Maxillary lip ties are sometimes categorized using grading systems, such as the Kotlow classification, which describes the frenulum’s attachment point. However, intervention is primarily guided by the presence and severity of functional symptoms, not solely by the anatomical grade. A visible frenulum without associated difficulties may not require intervention.
Corrective Procedures and Management
Not all maxillary lip ties necessitate intervention; some may not cause any functional issues or symptoms. When a restrictive lip tie is confirmed to be causing difficulties, particularly with feeding, various management strategies are considered, ranging from non-surgical methods to surgical procedures.
The primary surgical treatment for a restrictive maxillary lip tie is a frenectomy, a quick procedure often performed in an office setting. Two common methods are utilized: laser and sterile scissors. Laser frenectomies vaporize the restrictive tissue with minimal bleeding and a reduced risk of infection. This method can lead to less post-procedure discomfort and a lower chance of tissue reattachment compared to traditional methods.
Alternatively, a frenectomy can be performed using sterile scissors. This method is also quick and effective, though it may involve more immediate bleeding and potentially a higher risk of reattachment if the raw surfaces come into contact during healing. Regardless of the method, post-procedure care is important for optimal results. Gentle stretching exercises of the upper lip are recommended for several weeks to prevent the released tissue from reattaching as it heals.
Beyond surgical intervention, non-surgical management plays an important role, often as a first step or in conjunction with a frenectomy. Working with an International Board Certified Lactation Consultant (IBCLC) can help improve feeding mechanics through optimized positioning and latch techniques. These strategies aim to maximize the baby’s ability to feed effectively and can sometimes alleviate symptoms without the need for a procedure.