Lip & Tongue-Tie Release

• Many babies have nursing difficulties that do not resolve.
• Speech issues with R, L, S, TH, speech delay, mumbling, “baby talk”.
• Airway issues because palate and nasal cavity are too narrow.
• Snoring and Sleep Disordered Breathing in kids and adults.
• Feeding issues like difficulty transitioning to solids, swallowing food, slow eating, picky eating, and reflux.
• Dental issues in the future (cavities, gap, narrow palate, braces).
• Mouth breathing leading to ear infections and enlarged tonsils and adenoids is common.

• Difficulty with sounds that require tongue elevation: “S, Z, T, D, L, R”.
• Difficulty with sounds from the posterior aspect: “G, K, N, J”.
• Difficulty with speaking clearly or speaking quickly – “Baby Talk”.
• Stuttering, lisping, or slurring words.
• Speech delay can occur if child has impaired tongue mobility.

• Very Picky eating  - especially with textures (mashed potatoes, meat, etc.)
• Slow eating – difficulty swallowing leads to slow eating and getting distracted while eating. Possible trouble gaining weight.
• Packing food in the cheeks.
• Spitting out food.
• Swallowing food whole with very little chewing.
• Reflux and constipation.
• Gagging on foods.
• Unable to eat age-appropriate diet.

• Sleep disordered breathing /sleep apnea
• Restless sleeping / thrashing around
• Snoring
• Waking up not feeling refreshed
• Waking often during sleep
• Bedwetting
• Tooth grinding
• Mouth breathing
• Sleeping in strange positions

• Minimal to no bleeding
• Less post-treatment pain than using scissors or a scalpel
• Better visualization during surgery
• Extremely precise
• Virtually no risk of infection
• No need for general anesthesia or sedation
• Very effective
• Excellent healing and less scarring compared to scissors
• We use the highest quality surgical CO2 laser available that vaporizes the tissue instead of burning it like electrocautery or diode lasers.
• Local anesthesia with topical numbing jelly or injected lidocaine are often sufficient to prevent pain during the procedure.

Learn more about the LightScalpel Laser

• We follow all laser safety protocols and use protective eyewear for everyone in the room, including the child.
• We swaddle the infant in a soft wrap to prevent movement that could make the procedure more difficult and ensure the baby’s safety.
• Parents wait in the consult room during the procedure so we can fully focus on your baby and parents watch a short video about post-treatment  stretches. We bring your baby back immediately after the procedure is complete to nurse or feed.
• It takes a few minutes to position your baby then approximately 20 seconds for the lip, 10 seconds for the tongue.  You baby is back with you in about five minutes. We take before and after photos of the mouth only.  These photos does not show your child’s face.  They are for medical record and insurance purposes only.

• We want a baby to nurse or feed right away
• Oral wound healing is rapid
• The scab will turn a white or yellow color after a day or two
• It can look like an infection or pus (but it is not)
• Increased drooling is normal
• Tylenol (any age) and Motrin (if >6mo) for pain – dosed by weight
  • A suppository can be used if needed (Feverall).
• Nursing, bottles, nipple shield, pacifiers, sippy cups can be used. Do what you normally would to keep your baby comfortable and eating well.  Some parents also work with a lactation consultant or feeding specialist if needed. Try not to change too much else for the baby’s sake right away.
• Soreness typically lasts for 1-3 days.

• Done to prevent re-attachment and strengthen the tongue muscles
• 3 weeks, 6x a day. Plan to coordinate stretches with feedings and diaper changes for babies. 
• Keep it as playful as possible with funny noises and faces if baby is older.
• Play with baby’s mouth and tongue when you are not doing exercises to prevent an oral aversion.
• Keep the actual stretching of the wound to just 5-10 seconds for lip, and 5-10 seconds for tongue.
• Use a camping headlight, or have someone hold a flashlight to see the diamond.
• First lift the upper lip high to the nose so the diamond is fully opened, then use a gentle massage on the wound to ensure it does not grow back together.
• For the tongue, come from behind, use one or two fingers to lift the tongue as far up and back as possible to put tension on the wound and ensure the diamond is open.
• Gently massage the wound backward using the same rolling massage motion to encourage the wound to elongate.

• Sample exercises to help with healing are described below and should be performed 3 times a day or more often if desired.
• Stick tongue out all the way to a point (not flat) by scraping edge of top teeth and pull back and lick top of palate 20x.
• Stick tongue out to the left all the way, right all the way, and touch palate- 10x.
• Push tongue into cheek on R side like a gumball, 10 sec, into L cheek 10 sec.
• Stick tongue out down the chin as far as possible- hold 10 sec.
• Suction the tongue to the palate and open widely and hold for 10 sec.

• Reattachment is simply the natural healing process. Just like a cut on the hand will heal back together, the special cut under the lip or tongue will try to contract and heal together as well. We are trying to “trick” it to stay open.
• Can happen easily if stretches aren’t performed routinely and with enough pressure or tension. 
• Make sure to stretch often with sufficient pressure and look at the site with a light. If it looks or feels tight, do a stronger or deeper stretch to open the scab again.
• If symptoms begin to return after they disappeared, then this is the likely reason.

• Performing exercises is required for best results. 
• We make our diagnosis based upon functional issues for the child and related symptoms the child may be experiencing combined with the clinical exam and amount of restriction present under the tongue or lip.
• We do our best to achieve a “full” release.
• We use the latest technology, protocols, and most current methods to provide our patients with the best results and experience possible.
• We educate parents to ensure the child has the best chance of a good outcome, and we often partner with our colleagues like speech therapists, occupational therapists, and myofunctional therapists to facilitate the rehabilitation and help the child achieve normal function.

• We will call later in the afternoon to check on you and your baby/child in case there are any concerns.
• If you have any questions, please call the office.
• Remember, this is a process! It will likely be better in the office, but could get more difficult for a few days, then get progressively better over a few weeks. Expect one better feed a day in infants.