A cheek tie, also known as a buccal tie, refers to a condition where a band of tissue restricts the normal movement of the cheeks or lips. This restriction can influence various oral functions. Understanding this condition involves recognizing its anatomical basis and the effects it can have on daily activities.
Defining Cheek Ties
The mouth contains small folds of connective tissue called frena (plural of frenum), which secure the motion of various oral structures. These frena include the labial frenum, connecting the lips to the gums, and the buccal frenum, which links the cheeks to the gums. A “tie” occurs when one of these frena is unusually tight, thick, or short, thereby limiting the natural range of motion for the associated lip or cheek.
The labial frenum is located in the front of the mouth, both between the upper lip and gum and the lower lip and gum. Buccal frena are found on the sides of the mouth, typically near the premolar teeth, connecting the inside of each cheek to the gums.
Common Indicators
Recognizing the signs of a cheek tie often depends on the individual’s age, as symptoms can manifest differently in infants compared to older children and adults.
In babies, a cheek tie might present as difficulty achieving a proper latch during breastfeeding or bottle feeding, sometimes leading to clicking sounds during feeds. Other indicators in infants include milk leaking from the corners of the mouth, excessive drooling, or signs of discomfort and fussiness during feeding sessions. Poor weight gain despite frequent feeds can also suggest an issue with milk transfer efficiency due to restricted cheek movement.
For older children and adults, a cheek tie can contribute to challenges with maintaining oral hygiene, such as difficulty effectively brushing teeth due to limited access. Food might frequently get pocketed in the cheeks, leading to discomfort or potential dental issues. Speech articulation problems, particularly with sounds requiring full lip or cheek movement (e.g., “p,” “b,” “m” sounds), can also be a noticeable sign. Individuals may experience general discomfort or pain while eating or speaking.
How Cheek Ties Can Affect Oral Function
For infants, the inability to form a proper seal due to limited cheek mobility can hinder effective suction during feeding. This often results in inefficient milk transfer, prolonged feeding sessions, and can contribute to inadequate weight gain. Poor suction may also cause the baby to swallow excessive air, leading to gassiness, reflux-like symptoms, or colic.
Limited lip and cheek mobility can impede proper speech development. Certain speech sounds, especially bilabial sounds like “p,” “b,” and “m,” or sounds requiring lip rounding, depend on coordinated lip and cheek movements. A tight frenum can make it challenging to articulate these sounds clearly, potentially leading to speech delays or unclear speech.
Oral hygiene and dental health can also be compromised by cheek ties. Restricted access to certain areas of the mouth due to limited cheek movement can make effective brushing and flossing difficult. This difficulty in cleaning can increase the risk of plaque buildup, cavities, and gum issues, especially in areas near the restricted frenum. A tight labial frenum might pull on the gum tissue, potentially leading to gum recession or a gap between the front teeth.
Diagnosis and Management
Diagnosing a cheek tie involves a comprehensive evaluation by various healthcare professionals, including pediatricians, lactation consultants, dentists, or ear, nose, and throat (ENT) specialists. The diagnostic process includes a visual inspection of the oral frena and a functional assessment to observe how the restriction impacts daily activities like feeding and speech. The diagnosis relies on the functional limitations observed, rather than solely on the appearance of the frenum.
Management options for cheek ties can range from conservative approaches to surgical intervention, depending on the severity of the restriction and its functional impact. Conservative measures may involve oral motor exercises and stretches, guided by a professional, to improve mobility. If the restriction significantly affects oral function, a frenectomy may be recommended.
This surgical procedure involves releasing the tight frenum using methods such as a scalpel, surgical scissors, or a laser. Frenectomies are quick procedures, often performed with local anesthesia. Post-procedure care includes specific exercises to prevent reattachment of the tissue and to encourage proper healing and muscle retraining. Speech therapy or orofacial myofunctional therapy may also be recommended after a frenectomy to help retrain oral muscles and improve overall oral function.