Tongue and lip ties, though often overlooked in adults, can significantly affect an individual’s oral and overall health. Tongue and lip tie release may answer many unresolved problems that no medical professional has been able to solve fully.
From speech difficulties and swallowing challenges to dental issues and altered facial appearance, to TMJ and digestive issues these tethered oral tissues (TOTs) can lead to various problems, particularly if left untreated.
Fortunately, modern medicine offers an effective solution: tongue and lip tie release. Actually, the release of a tongue or lip tie dates back well before modern medicine.
Tongue and Lip Tie Release: An Age Old Problem
Many references to releasing tongue ties exist in history, including these notations utilized in the article cited below.
“Almost 2000 years ago, Cornelius Celsus, a Roman encyclopaedist at the time of Christ, described the condition known as tongue-tie, and accurately noted the dangers of frenulotomy to release the tongue.1 In the Bible, Moses complained, “I am slow of speech and of tongue” (King James version, Exodus 4:10), and St Mark wrote, “The string of his tongue was loosed, and he spake plain” (King James version, Mark 7: 35).”
“The midwives at the time of Fabrizio d’Aquapendente (a 16th century anatomist and surgeon, known in medical science as the “Father of Embryology”) kept a fingernail sharp to strip the tongue of all new-born babies,1 and the practice was also noted in John Theobald’s A Young Wife’s Guide to the Management of Her Children (London, 1764).1 In the early 1900s, tongue-ties were routinely divided but, as formula milk gained popularity and infants could bottle feed, the practice fell out of favour.2”
pr K. Ganesan, S. Girgis, S. Mitchell,
Lingual frenotomy in neonates: past, present, and future,
British Journal of Oral and Maxillofacial Surgery, Volume 57, Issue 3, 2019, Pages 207-213,
ISSN 0266-4356, https://doi.org/10.1016/j.bjoms.2019.03.004.
https://www.sciencedirect.com/science/article/abs/pii/S0266435619300683
Today many people reach adulthood with tongue and lip ties intact since the act of releasing them as infants fell out of favor.
This blog will explore the entire process, from diagnosis to the essential role of myofunctional therapy and the various professionals involved in the surgical release.
We’ll also discuss the critical role of post-release therapy in ensuring long-term success.
The Importance of Myofunctional Therapy Before and After Tongue and Lip Tie Release
Before diving into the specifics of the surgical procedure, it’s essential to understand why myofunctional therapy is a critical component of successful tongue and lip tie treatment.
Myofunctional therapy involves exercises designed to strengthen the muscles of the mouth, tongue, jaw, and face, improving oral function.
These exercises are critical for individuals undergoing tongue or lip tie release, as they help retrain the body to use these muscles properly both before and after the surgical release.
What professional performs myofunctional therapy for a tongue and lip tie release?
Speech Therapists, Occupational Therapists, Physical Therapists, RDH (Registered dental hygienist), and Dentists may all select a specialty in oral facial myofunctional therapy intervention.
You can begin your search here by state.
But not every practitioner is created equal. Do your due diligence by reading reviews and getting second and third opinions. Sometimes personalities don’t mesh and that’s ok, find a provider you are comfortable with and confident in their skills!
A speech Therapist is uniquely qualified to assess patterns of disorganization in feeding and swallowing as well as speech production and breathing.
Part of preparing for a surgical release is Identifying compensations utilized to perform the desired function and correcting those movement patterns.
Why Is Myofunctional Therapy Necessary for a Tongue and Lip Tie Release?
A tongue or lip tie restricts the natural range of motion of the tongue or lips, making it difficult for the individual to perform essential tasks such as chewing, swallowing, speaking, and even breathing properly.
Over time, compensatory behaviors develop, leading to improper oral habits that can be challenging to break even after the release procedure.
Myofunctional therapy helps individuals:
Strengthen and retrain muscles: This therapy prepares the oral muscles to function optimally after release by teaching correct tongue placement, swallowing techniques, breathing patterns, and increasing range of motion in the muscles.
- Improve speech: A tongue or lip tie can cause speech impediments due to imprecise or compensatory placements of the tongue that break down over time. Creating excess saliva and air escape and a general feeling of fatigue in the mouth.
Oral facial myofunctional techniques teach correct placements as well as strengthening the muscles and reducing tension in the fascia of the muscle.
- Improve Swallowing: the tongue needs to form a bowl, to cup and hold liquid and food as it enters the mouth. It then needs to elevate up to the palate to propel the food down the throat.
These simple alternating patterns of sinking to create a tongue bowl and elevating to propel food can be non-existent or very weak in tongue and lip tie individuals. Resulting in limiting diets and digestive issues from air being swallowed with the food.
Myofunctional therapy will train the movements for swallowing hence improving diets and digestive issues.
- Provide the best environment for surgical release: When we speak about increasing range of motion and reducing tension for performing speech and swallowing, we are also providing the surgeon the best view of that frenulum.
Unlocking it from bound muscle and fascia and opening the area to allow for the best possible visualization and surgical release. Often creating a more complete release than could otherwise be performed.
- Support long-term success: After the release procedure, the body needs to adapt to the newfound freedom of the tongue and lips. Without myofunctional therapy, the risk of reattachment increases, and reverting to old compensatory habits.
Team approach
As mentioned several professionals are trained in myofunctional therapy, including:
Speech-language pathologists (SLPs): These experts are trained in diagnosing and treating speech and swallowing disorders, making them well-suited to work with individuals who need oral motor therapy.
Occupational therapists (OTs): Some OTs specialize in feeding and oral motor function, helping individuals develop better control over oral structures and addressing sensory needs.
Registered dental hygienists (RDHs) with myofunctional training: Many dental hygienists have pursued additional certification in orofacial myofunctional therapy to help patients improve oral function after a tongue or lip tie release.
Intervention and collaboration with a myofunctional therapist are critical to ensuring that the patient’s oral and facial muscles are ready to adapt to the changes post-surgery.
Therapy is typically initiated weeks or months before the surgical release and continues for several months afterward to ensure optimal recovery.
A team approach can often be necessary. A speech therapist may refer to a dentist and RDH specialist due to concerns of misalignment, over-bites, under-bites, or tooth grinding.
After years of living with tethered oral tissues a referral to a PT with pelvic floor training, myofascial release training, or cranial sacral training may be necessary. Or to a chiropractor for addressing the cervical spine as the head has been pulled forward by the ties causing neck strain.
As the mouth corrects, so does the body’s need to correct, and allowing for a team approach to address all facets of recovery will yield the best outcomes.
Types of Professionals Who Perform Surgical Tongue and Lip Tie Releases
The surgical release of a tongue or lip tie, also known as a frenectomy or frenotomy, is a straightforward procedure, but it requires the expertise of trained medical professionals.
Various healthcare providers, including ENT (Ear, Nose, and Throat) specialists, dentists, and Oral & Maxillofacial surgeons, are qualified to perform this surgery.
1. Ear, Nose, and Throat (ENT) Specialists
ENT specialists, also known as otolaryngologists, are medical doctors who treat conditions related to the ear, nose, and throat.
These professionals have extensive knowledge of the head and neck region, making them highly qualified to perform tongue and lip tie releases.
One should be cautious when selecting an ENT as many do not believe in releasing a frenulum. Always look for a preferred provider list to begin your search.
2. Dentists
Many dentists, particularly pediatric dentists, orthodontists, or oral surgeons, have the training to perform frenectomies.
They often use advanced laser technology, which can result in minimal discomfort and faster recovery times.
Dentists and oral maxillary surgeons who specialize in treating tongue and lip ties often work closely with myofunctional therapists to ensure patients receive comprehensive care before and after the release.
Surgical Techniques for Tongue and Lip Tie Release
When it comes to performing a tongue or lip tie release, there are two primary surgical techniques: using a laser or traditional scissors.
Both methods aim to cut the frenum, the tissue restricting the movement of the tongue or lips.
Laser Frenectomy
Laser technology has revolutionized how professionals perform tongue and lip tie releases. In a laser frenectomy, the practitioner uses a specialized dental or medical laser to cut through the restrictive tissue. This method offers several advantages:
Precision and control: Lasers allow for precise cutting, reducing the risk of damage to surrounding tissues.
Reduced bleeding and swelling: Lasers cauterize the tissue as they cut, minimizing bleeding and reducing the need for stitches.
Faster recovery: Patients who undergo laser frenectomies often experience quicker healing times and less postoperative discomfort.
The laser sterilizes the area as it works, reducing the risk of infection
Professionals typically perform laser frenectomies in a dental or medical office, usually completing the procedure in just a few minutes. Local anesthesia or topical numbing agents are often sufficient to manage discomfort during the procedure.
In this study titled: Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review the authors examined various laser techniques.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031639
They concluded:
“The use of lasers for the surgical treatment of ankyloglossia seems to be an effective and promising method for children and adults. The employment of lasers offers several benefits, including shorter procedural time, reduced use of general and local anesthesia and suturing, a reduced need for the administration of analgesic and/or anti-inflammatory drugs, favorable postoperative healing, and a reduction in postoperative bleeding and complications (in the form of inflammation or hematoma).”
Scissor Frenectomy
A scissor frenectomy was the more traditional approach to releasing a tongue or lip tie. In this method, the practitioner uses sterilized scissors to cut the restrictive frenum.
While this method is still effective, it may involve slightly more bleeding and a longer recovery period compared to a laser frenectomy. Doctors may require stitches to control bleeding.
However, it remains a widely used and reliable technique, particularly when lasers are not available.
The choice between a laser and scissor frenectomy will depend on the healthcare provider’s expertise, the patient’s condition, and the available technology.
Both procedures are safe and effective, and the patient should decide based on their specific needs and preferences.
What it may look like after release:
The above picture shows before the release and the bottom picture is what it may look like after surgical releases. This area may look like a wide open circle. Within a few days, it will turn into a white patch and have more of a diamond shape.
Post-Surgical Care and the Need for Follow-Up Therapy
While the tongue or lip tie release itself is a significant step toward improved oral function, the journey doesn’t end after the surgery.
In fact, one of the most critical phases of treatment comes after the release: post-surgical myofunctional therapy.
The Healing Process
After a frenectomy, the body begins to heal almost immediately. However, because the tongue or lips have been restricted for so long, the muscles may struggle to function properly in their new, unrestricted state.
Without proper care and therapy, there’s a risk that the frenum will reattach, leading to the need for another release.
The healing process typically involves:
Postoperative stretches and exercises: Immediately after surgery, the patient will be instructed to perform specific stretches and exercises to prevent the tissue from reattaching.
These exercises are explained immediately following the surgery by the staff and usually guided by the myofunctional therapist thereafter. Patients should do these consistently for several weeks.
Monitoring wound healing: The practitioner will follow up with the patient to ensure proper healing of the surgical site. Regular check-ups allow for early detection of any complications, such as reattachment or infection.
Addressing discomfort: While the procedure itself is relatively quick and minimally invasive, some patients may experience discomfort, swelling, or soreness after the release.
Pain management strategies, such as over-the-counter pain relievers or cold compresses, can help alleviate these symptoms.
We often recommend keeping cold ice pops on hand to enjoy during the healing phase.
Typically, two weeks after the surgical release, patients are free of pain, and the wounds have healed enough that reattachment is no longer a concern.
The Role of Follow-Up Myofunctional Therapy
Once the initial healing phase is complete, it’s essential to continue working with a myofunctional therapist.
Therapy continues after surgery to retrain the muscles for optimal function. This is particularly important for patients who have developed improper oral habits due to their restricted tongue or lip mobility.
Follow-up myofunctional therapy helps with:
Tongue mobility and strength: Patients learn how to properly use their tongue for functions such as speaking, swallowing, and breathing. This is crucial for individuals who may have been compensating with incorrect muscle movements for years.
Improving speech and feeding: Myofunctional therapy plays a significant role in correcting speech impediments or feeding difficulties that may have developed due to the tongue or lip tie. With the help of the therapist, patients can develop new, healthy oral habits.
Breathing and airway support: Many individuals with tongue ties experience breathing difficulties due to poor tongue posture.
Post-release therapy focuses on improving nasal breathing and ensuring that the tongue rests properly against the roof of the mouth, which can even help alleviate issues such as sleep apnea or snoring.
The length of time a patient will need follow-up therapy varies depending on the severity of the original tie, how long the tie was present, and the patient’s overall oral function.
However, in most cases, patients will continue working with their myofunctional therapist for several months to ensure long-term success.
Final Thoughts
Tongue and lip tie releases are transformative procedures that can significantly improve an individual’s quality of life. However, surgery alone is not a complete solution.
Skilled professionals—including ENTs, dentists, oral surgeons, speech-language pathologists, occupational therapists, physical therapists, and registered dental hygienists trained in myofunctional therapy—collaborate to achieve optimal outcomes.
Myofunctional therapy before and after surgery prepares the patient’s oral muscles for release and retrains them afterward to ensure that the newfound freedom of movement is maintained
By understanding the complete process, from the surgical techniques used to the importance of ongoing therapy, patients and caregivers can approach tongue and lip tie treatment with confidence and achieve amazing outcomes!
Please check out our other blogs on tethered oral tissues at https://lynnstiedtogetherhub.com/blog/