The tongue and lips are complex groups of muscles that are very important for all oral functions. Hidden under our tongue and lips are strong connective tissue bands called frenums or frenulums. These normal structures help the tongue and lips function properly. When these tissues are found to be unusually short, excessively thick, or attached in the wrong position then it is highly possible that the tongue and lip will function abnormally. A Tongue-Tie (TT) is a non-medical term for “ankyloglossia”, which is diagnosed as a frenum that did not develop ideally and now restricts the tongue from normal movement. The failure of the tongue to move freely  can cause complications with nursing, sometimes with speech, and occasionally with chewing and swallowing food.  Lip-Tie (LT) is also a non-medical term for an upper lip frenum that due to its abnormal development tethers the lip too tightly. A LT regularly prevents the lip from curling and moving in normal directions. Just as a TT can contribute to breastfeeding difficulties for a mother and baby, an upper LT is often a contributing factor to painful breastfeeding because the lip is not able to invert itself outward for proper latching. Upper LT also may increase the risk of cavities on front teeth, contribute to gaps between front teeth for children and adults, and lastly they are often at increase risk for injury when toddlers trip and fall.

Not everyone with an abnormal TT and LT requires treatment, but many infants and children experience significant benefits after having this problem corrected. Treatment of problematic TT and LT is not a "fad" treatment, but rather it has been recommended by the American Academy of Pediatrics (AAP) for many years. Current evidence based research completed by physicians, ENT specialists, and pediatric dentists has continued to further prove that the AAP recommendation is more correct than ever! When TT and LT treatment is the cause for complications with breastfeeding, speech, and/or swallowing then removal of pathologic TT and LT is best completed early as possible. This is especially true for breastfed infants and their mothers. Traditional treatments used to involve sedation, scissors and sutures, and were accompanied by post-operative bleeding. Advances in technology and training allow Dr. Hisaw to conservatively treat his patients with a soft-tissue CO2 laser. This safe and efficient technique is completed in the office and does not require sedation or sutures, and causes little to no bleeding.

If a baby has restricted movement of the tongue and lip due to tongue and LT, they may not be able to latch deep enough or seal on the nipple during feeding. This can lead to swallowing of air which is called “aerophagia”. This ingestion of air increases risk of causing colic symptoms, reflux and gas production for the baby. You may also hear clicking noises when the baby is feeding which is another sign that the child has not latched properly during feeding.

It is likely that your pediatrician and/or lactation specialist will have diagnosed this problem for you when your child was first born. The Anterior Tongue-Tie (ATT) is much easier to diagnose as the tongue is tethered to the floor of the mouth at the tip of the tongue. The Posterior Tongue-Tie (PTT) is more difficult to diagnose, and can often be “hidden” under the tongue due to its retracted position. Both PTT and the more visible ATT can cause the same problems with breast feeding. The ability of the tongue to elevate upward is essential to proper breastfeeding and swallowing. In the photos below you can see the difference in the sucessfully treated TT, because the tongue is now free to move upwards and function normally.  An infant or child with a PTT maybe able to move their tongue out but not up, and this is a common reason that PTT conditions remain overlooked.