Lip and tongue ties are common conditions present from birth that can impact oral functions. These anatomical variations involve restrictive tissue under the tongue or lip, affecting an individual’s ability to move these structures freely. When these ties interfere with daily activities, surgery is considered to alleviate restriction and improve oral mobility. This procedure aims to enhance feeding, speech, and overall oral health.
Understanding Lip and Tongue Ties
A frenulum is a small band of connective tissue joining two structures in the body. In the mouth, two primary types exist: the lingual frenulum, connecting the tongue to the floor of the mouth, and the labial frenulum, connecting the lips to the gums. When these frenulums are unusually short, thick, or tight, they are called tongue ties (ankyloglossia) or lip ties.
Tongue ties can be classified as anterior or posterior. An anterior tongue tie is visible closer to the tongue’s tip, often giving it a heart-shaped appearance when lifted. Posterior tongue ties are less visible, located further back under the tongue, and may feel like a tight band of tissue. A lip tie occurs when the labial frenulum, typically connecting the upper lip to the gums above the front teeth, is overly restrictive, limiting lip movement.
Why Surgery is Considered
When lip or tongue ties cause functional difficulties, surgery becomes a consideration. For infants, these ties can impair feeding, particularly breastfeeding. Babies may struggle with a shallow latch, leading to poor milk transfer, insufficient weight gain, and discomfort for the nursing parent. Infants might also exhibit clicking sounds during feeding or become gassy from excessive air intake.
In older children and adults, restrictive oral tissues can manifest in other ways. Speech impediments, where individuals have difficulty pronouncing certain sounds like “t,” “d,” “s,” “z,” “l,” and “r,” are common. Eating can also be affected, with individuals experiencing trouble clearing food or managing certain textures. Dental problems, such as gaps between the front teeth (diastemas), gum recession, and an increased risk of cavities due to cleaning difficulties, may also arise.
The Surgical Process
Surgical correction for lip and tongue ties is typically known as a frenotomy or frenectomy. While some sources use these terms interchangeably, a frenotomy generally involves a small incision to release the frenulum, whereas a frenectomy may imply complete removal or more extensive modification. The procedure is often quick, typically taking only a few minutes, and can be performed in an outpatient or office setting.
Various methods are employed, including surgical scissors, a scalpel, or a soft tissue laser. Laser procedures are increasingly common as they minimize bleeding and reduce infection risk by cauterizing tissues as they cut. Anesthesia varies with age; infants may receive a topical numbing gel or local anesthetic, while older children might require local anesthesia with sedation, or general anesthesia. Dentists, pediatric dentists, oral surgeons, and Ear, Nose, and Throat (ENT) specialists commonly perform these procedures.
Aftercare and Recovery
Following a frenotomy or frenectomy, immediate post-operative care focuses on managing discomfort. Over-the-counter pain relievers, as recommended by the healthcare provider, can alleviate soreness. The surgical site may appear whitish or yellowish during the initial healing phase, which is normal.
A crucial aspect of aftercare involves specific exercises, sometimes called “wound management exercises” or stretches. These exercises prevent reattachment of the frenulum and encourage proper healing and mobility of the newly released tissue. Adhering to these exercises is important for long-term success.
Recovery is relatively swift, with most discomfort subsiding within a few days and complete healing often occurring within two to four weeks, or faster with laser procedures. Follow-up appointments are usually scheduled to monitor healing progress and ensure optimal functional outcomes.