What to Expect When You're Treating Tongue, Lip, and/or Buccal Ties

Congratulations for scheduling your child’s oral function assessment! You’ve already made it further than the majority of parents, and in doing so, have taken an enormous step forward in addressing your child’s struggles with oral and facial function. There are a lot of misconceptions online about the “best” way to treat tethered oral tissues in infants. The following is what we have found to work through years of rigorous academic research, professional education initiatives and years of shared interdisciplinary experiences. It is important to note that the below process is for infants only- that treatment protocols for those who have aged beyond infancy will vary from the process below, and referral to different providers may be made in order to address issues that do not come up in infancy.

​We break it down into three phases: Pre-release (1-3 weeks), the release itself (1 day), and post-release (4-8 weeks is the average range of time to full functional ability- the timing may vary depending on a variety of variables). 

 The first phase of treatment involves addressing tension in the fascia. Under each tether, the fascia (connective tissue which links all our muscles together) is bunched up, resulting in limited mobility for the surrounding muscles. When the fascia is bunched up around the tethered frenum, the revision provider may have difficulty releasing the entire tether because it may not be fully visible. Smoothing this tissue out is the best way to ensure that the revision is a success, and it also will help prepare the tissue for the procedure and reduce your child’s risk of developing restrictive scar tissue afterwards. You may be tempted to skip this step and go straight to the release, but we cannot stress enough that this is not in your child’s best interest in all but the most extreme circumstances (and if you fall into that category, we’ll have that discussion together). During this first phase, as your child begins to have a little bit more muscular mobility (due to the release of fascia tension), your baby will have the ability to move their tongue, lips or cheeks with a wider range of motion than they had previously. This means they can now begin to develop strength and coordination in these muscles, and as such we will be beginning a rigorous exercise regime to help them develop functional ability in these areas. This work will help to support optimal function both before and after the revision. Once the tether(s) is/are released, these muscles will be able to move in ways they’ve never moved before, and they will never have had the opportunity to develop strength to support the proper use of them. Our exercises will ensure that when the release does happen, the auxiliary muscles will be in a better place to support the newly released ones with more optimal function, helping to ensure that your baby has a symptom reduction as quickly as possible. Phase one can last anywhere from 1-3 weeks, depending on the severity of your baby's challenges and the impact of those challenges on the feeding dynamic.

The second phase is the release itself. You have been provided with information about the most effective frenectomy providers in the region. You will find that there are plenty of providers who offer releases, but we are only going to refer you to those whose work we believe in, as they have demonstrated time and again that their practices are indeed evidence-based and they have a thorough understanding of optimal oral function, and how their work can support your child’s ability to achieve that optimal function.

​The third phase is the oral habilitation. This phase may last from 4-8 weeks after the release. During this time you will continue doing various exercises prescribed by your lactation consultant in order to support optimal healing, growth and development of function, and also to better manage any challenges faced while feeding. It is important to finish your habilitative treatment completely, or your child will be at risk of sub-optimal healing and, subsequently, recurrence of symptoms or the development of new symptoms over time. You’ve put in so much work- stay the course and your child will reap the benefits! 

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