We Performed Lip Tie ve Tongue Tie Release Surgery (Frenectomy)

Frenectomy With Thermal Welding Device

lip tie surgery, tongue tie operation, frenectomy

We detected type 4 upper lip tie and type 2 tongue tie in a baby with breastfeeding problems, split teeth and walking problems. The operation was started under sedation anesthesia, and after local anesthetic infiltration, we marked the incision areas with the help of a clamp. Triangular tissue was removed from both lip tie and tongue tie. Thermal welding device was used and cuts were made only in "cutting mode". In this way, the possibility of heat damage to the incision area is reduced. Especially in tongue tie operations, when cautery, electrocautery, some laser types and radiofrequency devices are used, which can cause heat damage, it is thought that the sensory nerves in neighboring areas may also be damaged. After the procedure, mucosal sutures were made with self-absorbable suture materials. The opeasron time done here is about 10 minutes. The patient can eat and discharge from the hospital 1.5 to 2 hours after the procedure. I hope these operations we have performed will prevent negative anatomic effects on the jaw structure, swallowing problems, dental problems and other permanent anatomic changes for the future.

How A Tongue Tie Can Affect Babies

A tongue tie can have various effects on babies. A few of these are:
  • Nervousness and crying: If your child is always hungry and disappointed, he may get angry and cry a lot. He may also have trouble sleeping.
  • Breast rejection: Some babies refuse to breast if the nurse is irritated and not getting enough breast milk.
  • Poor weight gain: If your child cannot latch on and suck well, he or she will not be getting enough breast milk to grow and gain weight at a consistent rate.
  • Other issues: As the baby grows, eating a short frenulum can cause problems with swallowing and speech.

Tongue Tie Symptoms in Adults

There are difficulties with speech, social conditions, self-esteem, working environment and dental health problems due to restricted language mobility in adults due to language ties.

The following symptoms may occur in adults with a short and tight tongue tie:
  • Restriction on mouth opening and tongue lifting (may affect speaking and eating habits)
  • Difficulty in clarity or difficulty in speaking quickly and speaking words containing hard consonants
  • Sharpness deterioration when talking fast / loud / soft
  • Difficulty speaking after drinking moderate amounts of alcohol
  • Clicky jaws when opening and closing
  • Jaw pain
  • Migraine
  • Protrusion of the lower jaws (prognathism)
  • Concentration problems in the workplace
  • Social situations, eating out, kissing, effects on relationships
  • Dental health, tendency to inflammation of the gums and an increase in the need for dental filling and tooth extraction
  • Sensitivity about personal appearance
  • Emotional factors that increase stress
  • In the elderly, the tongue tie often makes it difficult to keep the denture in place.

The Effects of Tongue Ties on Mothers

A tongue tie can also have some negative effects on mothers.

Nipple sore If your newborn only holds on to your nipple or chews while trying to suck, it can lead to painful, cracked, damaged nipples.

Painful breast problems: When the baby is not able to breastfeed well, the breast milk cannot empty the breasts. The accumulation of breast milk in breasts can lead to breast enlargement, blocked milk ducts and mastitis.
A low source of breast milk: A poor latch and ineffective removal of breast milk can rapidly reduce breast milk supply.
Emotional stress: Breastfeeding difficulties can lead to frustration and lack of confidence in breastfeeding.6 If the baby is not getting enough milk, it can be frightening or cause sadness and guilt.
Early weaning: Painful breastfeeding, low breast milk supply, and dealing with an irritable, hungry baby gaining weight very slowly can all lead to premature weaning.

As the tongue ties symptoms are clarified with scientific studies, the symptoms that may appear in infancy and adulthood are gradually published in guide sources. Other interesting information I saw on the above book and other websites:

- Adult and tongue-tied patients tend to speak to their own speech more than usual, as their own speech may seem strange to them.
- The difficulty of adult patients who have tongue ties during rapid, loud or soft speech
- Protrusion of the lower jaw forward (jaw pain and neck pain!)
- Adult patients with tongue ties are affected faster when they drink alcohol
- Switching to a bottle earlier than expected (due to lack of vacuuming), reduced milk intake with wrong sucking movements, reduction in growth rate.
- Early transition to formula instead of breast milk, decreased immunity and increased frequency of infection in the baby.
- Difficulty vacuuming the bottle in babies who are fed with tongue tie and bottle
- Adult patients with tongue ties have a feeling of inadequacy, withdrawal and sensitivity about their external appearance.

Jaw Pain and Neck Pain Added to Tongue Tie Symptoms!

The movement of the tongue in childhood has a great influence on the placement and development of teeth and the structure of the jaw. When the tongue is tied, the tongue cannot move smoothly and this often results in a smaller mouth, jaw, and palate. Moving the lower jaw forward more than normal during the movement of the tongue can cause pain in the temporomandibular joint that connects the mandible to the skull. Likewise, the use of auxiliary neck muscles in jaw movement can cause neck pain. Temporomandibular joint pain and neck pain can be seen more in tight and short tongue ties.

Lip Tie Symptoms in Infants

If the lip tie in babies is tight and tense, usually the upper lips of babies are fixed towards the gums, the baby's inability to turn the upper lip outwards and upwards enough during breastfeeding, and the following symptoms and signs related to this may occur (during breastfeeding, you may see a few signs that the baby may have a lip tie) :

Lip tie symptoms and findings in babies can be summarized as follows:
  • Weak latch during breastfeeding is often the leading symptom of the lip tie because the baby's lips cannot be fixed by inserting the skin around the nipple into the mouth.
  • The baby cannot maintain suction at the nipple and come out earlier than it should
  • Baby may make rattling noises due to weak latching that causes air to pass through the lips
  • More air intake causes the baby to swallow gas (gas swallowing and reflux are more pronounced in those with tongue ties)
  • The baby can become fussy. This is due to constant hunger and frustration at not being able to maintain a latch.
  • When the frenulum is too tight, the baby's upper lip curves inward
  • Poor weight and height gain due to insufficient breast milk intake can slow the baby's physical growth
  • Other common symptoms that can be seen in babies with lip tie are frequent breathing and falling asleep while breastfeeding.

What does a lip tie do?

Lip tie restricts the forward and upward movement of the upper lip. It acts as a fixing band between the gum and the inner surface of the lips. Although the tongue tie have the task of fixing the tongue to the base of the mouth in case of loss of consciousness or coma, the lip ties do not seem to have a very important role in terms of vital and health.

Symptoms that can be seen in mothers of babies with lip tie

Mothers of babies with a tight and short upper lip frenulum may develop the following symptoms:
  • Nipple pain: Improper latching can cause nipple discomfort and pain. Baby may also try to bite for nipple attachment, causing more pain.
  • Flattened nipples: Fixed false latch can distort the nipples (take the shape of a lipstick).
  • Swelling of breasts and mastitis: The milk stays in the breast because the baby is not fed properly. It can lead to breast enlargement, which can lead to problems such as mastitis and infection of the milk ducts.
If you think that your baby cannot sustain the latching movement for a long time while breastfeeding and cannot protect it by moving towards the nipple, you can check the lip tie.

Gently lift the baby's upper lip to see a thin layer of frenulum tissue underneath. If it is attached to the back of the upper gums or goes beyond, the baby probably has a lip tie. If you notice other symptoms or are unsure whether it is a lip tie, be sure to have your baby examined by a doctor.

We had appointments for an intense revision and primary rhinoplasty operation this week. In this way, I perform the operations of our angel patients in between.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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