Tongue Tie - Myofunctional Therapy - Frenectomy

Imagine that the giraffe above couldn’t stick its tongue out like it is in the photo. It would have so much difficulty grabbing food in hard to reach places, drinking water, or eating and swallowing. Imagine the tension that would be caused from the strain of trying to perform certain functional daily tasks. Of course it would adapt to the best of its abilities, but it would be hindered throughout life. This circumstance would be similar if a person was limited in that way; this tongue restriction is called a tongue tie.

Trained in tongue tie releases and protocols, Dr. Cortés has been performing tongue tie procedures, for newborns and up, for over 25 years.

Tongue tie:

Tongue tie is when the tissue underneath the tongue is tethered to the floor of the mouth and can be present in different variations (as seen in the pictures to the right). This attachment can cause a multitude of compensations such as:

Jaw, neck, and back discomfort and/or pain
Constricted lower jaw
- This can cause the lower jaw to be held back, infringing on the the airway and/or causing pain for individuals with TMJ issues.
- Retrognathic lower jaw (where the chin protrudes backwards towards the neck). This is also called a receding chin.
Difficulty speaking
Improper and/or hindered eating and swallowing functions
Forward head posture
- This can cause cervical compression - which can cause headaches, and other complications
Limited range of motion in the lower jaw
Relapse of orthodontic treatment

These are only a few of the issues that tongue tie may cause; however, there is a simple procedure that allows this tethered tissue to be released, but it requires some prior work in order to have it done.

Photo of patient before Tongue Tie Release. Image of patient's mouth open showing oral tissue tie under the tongue with their tongue touching the roof of their mouth — **Before Tongue Tie Release**

Photo of patient after their tongue tied release procedure and healed. Images shows patient's mouth fully open with tongue touch the roof of their mouth — **After Tongue Tie Release**

Oral Myofunctional Therapy:

We rarely consider this, but the tongue is a muscle and a strong one to boot. Like any muscle, it needs to be trained, toned and strengthened so it can perform its daily functions properly. When tongue tie is present, the full range of muscles that make up the tongue are not fully used, and become weak. In addition, because of the restrictions, the body begins to utilize other facial and neck muscles to compensate, thus causing tension.

Girl doing remote myofunctional therapy and speech work

Oral myofunctional therapy trains, tones and strengthens the tongue for proper function, movement, and placement, as well as strengthens and teaches the lips to maintain and have a closed mouth posture. Studies often show that myofunctional therapy may provide improvement in sleep, and release tension in the facial, neck, shoulders and back muscles. It also teaches the individual not to use the facial and neck muscles they have been using to compensate for any restrictions, as a result releasing unwanted tension. The therapy establishes a remapping within the brain, almost like a soft rewiring, so that proper function and placement becomes unconscious.

In order to prepare oneself for their tongue tie release, myofunctional therapy, with a certified myologist, is necessary. When the tongue is released, the muscles that haven’t been in full use have acquired some strength and muscle memory in order to perform their rejuvenated function. But that’s not the end, myofunctional therapy is also necessary after the next procedure(s), that we are about to discuss.

Frenectomy:

A frenectomy is a simple surgical procedure to release tongue tie. Performed with either a laser, scalpel, or scissors, a trained practitioner skillfully cuts the tissue restraining the tongue. With local anesthetic administered to the site, this procedure is typically short and painless.

Frenuloplasty:

Sometimes a regular frenectomy isn’t enough to establish a proper release. In fact, the tongue can have posterior (in the back) and anterior (in the front) ties, and so a more in depth tongue tie release, called a frenuloplasty, is necessary. In this procedure, the tongue is cut laterally, opened, and the practitioner releases the posterior and anterior ties within allowing a proper release.

Buccal Tie & Lip tie Release:

Buccal ties, and most importantly lip ties, are tissues tethering the upper and/or lower lips to the gums. These ties can cause oral and facial tension, prohibit proper lip seal and suction, and cause complication with oral development (especially babies, for whom it may also complicate breast feeding), among others.

This procedure is similar to that of a frenectomy, but instead, the tethered tissue of the lips to the gums are cut and released.

Infants & Children

tongue Tie and lip ties:

Little is it known but tongue tie and lips ties can greatly impact your infant / child. Some of the impacts can include:

Upper and lower jaw development
- This also involves palate development which will lead to improper room for the growth of deciduous (baby) and permanent (adult) teeth
Airway development
Speech / Phonetics
Lip posture - open mouth posture and mouth breathing as opposed to a proper close mouth posture and nasal breathing
Eating and swallowing function - leading to dysfunctions such as a reverse swallowing pattern, messy eating and tongue thrusting

Tongue tie and lip/buccal ties can affect a newborn’s further development, in addition to their ability to breast feed, which plays an important part in the development of a baby’s oral and airway development and health.

There are multiple signs of a tongue tie or lip tie, some of them include:

Open mouth posture
Trouble nursing and/or latching on to the breast

Image showing a tongue tie present under an infants tongue — **The thin lighter pink line of tissue under the tongue is a tongue tie**

Image of a infants upper lips being pulled up to show a labial tie or lip tie — **The thicker line in the middle of the upper lip, which is extending down through the gum, is a lip tie**

Oral Myofunctional Therapy:

Tongue position/posture, function and habits, as well as the lips resting position (open or closed), can greatly impact your infant / child’s physical development. In fact, because these two components also impact the development of the airway and proper breathing/function, an infant / child’s cognitive development can be impacted as well. Though the age can vary, a pediatric oral myofunctional therapist can assist in the correction and training as early as 4 years-old.

Tongue Tie and lip tie Release:

A pediatric tongue or lip tie release is a quick and simple procedure, usually done with a special laser. Sometimes a physician will do the procedure if a tongue tie is noticed at birth, but it can sometimes require a revision, otherwise a dentist with pediatric and laser experience can perform the procedure. The area is numbed with very little anesthetic and the laser cuts the tie(s). You can find more information on laser frenectomies here. Post procedure your myofunctional therapist will show you specific stretching and massaging techniques so that the site does not reattach, and any scar tissue is broken down.