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Health Matters

Infant Tongue-Ties and lip-ties

January 1st, 2014

By: Dr. Kelly Brooke

Tongue-ties and lip-ties are conditions that occur in three to four per cent of infants, and can pose significant problems to the developmental and nutritional requirements of newborn babies. Tongue-ties are caused by a band of soft tissue that attaches the underside of the tongue to the floor of the mouth. This band of tissue is referred to as a lingual frenum . All new born babies have lingual frena; however when these structures hinder movement of the tongue, the condition is know as ankyloglossia.
Numerous factors are associated with ankyloglossia, for both infant and mother; 

Infant Factors To Consider 
A. No ability to latch on to breast 
B. Unsustained latch 
C. Slides off nipple
D. Prolonged feeding 
E. Unsatisfied after prolonged feeds 
F. Falls asleep easily while feeding 
G. Gumming or chewing on the nipple 
H. Poor weight gain or failure to thrive 
I. Unable to hold pacifier
Maternal Factors To Consider
A. Creased, flattened or blanched nipples after feeding
B. Cracked, bruised or blistered nipples
C. Bleeding nipples
D. Severe pain with latch of infant draining breast
E. Incomplete breast drainage
F. Infected nipples
G. Plugged ducts
H. Mastitis & nipple thrush
I. Reduction in milk flow

Mothers are encouraged by healthcare providers to nurse their infant(s) due to nutritional and protective benefits provided by breast milk. Ankyloglossia primarily interferes with the infant’s ability to extend their tongue; preventing an adequate latch (Figure 2 pictured). Unfortunately, a combination of infant failure, maternal frustration and discomfort, often result in the mother giving up nursing, placing her infant on an alternative milk source such as formula.

Lip-ties in infants are caused by soft tissue bands that extend from the inside of the lips to the gum pads. These tissue bands are referred to as labial frena. These frena can occur singularly on either upper or lower lip, and/or in combination. Akin to the hindrance of the tongue by lingual frena, labial frena prevent the lip(s) from rolling outward during feeding. This interferes with the infant’s ability to create and sustain an adequate latch. In situations where upper labial frena are pronounced, the frena may extend past the gum pad to a midline structure called the incisive papilla. This small bulbous structure is highly innervated (sensitive), thus pain is often elicited during feeding from the tension created by the tissue pull from the lip.

Fortunately, these conditions can be easily treated with a procedure called a frenectomy. In the past, frenectomies were performed using scissors without any anesthetic. However, with the advent of modern laser and pharmaceutical technology, this procedure is simple, brief and virtually devoid of complications. The preferred method for performing a frenectomy is with a topical gel anesthetic and an Erbium Laser. The anesthetic is applied for one to two minutes and provides complete local anesthesia for 30 minutes. Rather than cut the frena, the Erbium Laser ablates (vaporizes) the tissue while simultaneously sterilizing the tissue attachment areas. Likewise, due to the therapeutic properties of the laser; postoperative swelling and inflammation are virtually eliminated. Healing time following this procedure is usually within five to seven days, as compared with two to three weeks with the former "scissor-snip" procedure.

On rare occasions, small soft tissue adhesions (areas of reattachment) can occur. In order to counter this, simple tongue and lip movement exercises can be undertaken during the healing phase. Most often, mothers’ report significant improvement in the infants nursing ability, immediate relief from nipple pain and discomfort, extended nursing duration and improved infant sleeping. All of which occur within approximately 24 hours.

Dr. Kelly Brooke is a certified specialist in orthodontics and dentofacial orthopaedics; he maintains an orthodontic clinic in Fort McMurray.
Questions regarding the subject of tongue-ties and lip-ties, can be directed towards Dr. Brooke: #212, 9914 Morrison Street, Fort McMurray,
AB T9H 4A4, phone: 791-9663.

Tags: Babies, health, Moms

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