GOLD Learning Tongue-Tie Online Symposium 2022 - Day 1 Fundamental Skills

What are tethered oral tissues and what is the role of fascia? Fascia is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. How is the fascial system connected to TOTS? The condition of tongue-tie and lip-tie exists on a continuum with variable visibility and symptoms differently across the body through different age groups. Some restrictions, mainly anterior or “classic” tongue tie, are highly visible and easier to detect. However, “posterior” or submucosal tongue-ties are often more challenging to diagnose. Through this session, we will explore a detailed dissection of what is fascia and how the concept of tongue ties has evolved and changed with the role of fascia and its impacts with TOTS. It takes a village of specialists to treat this challenging problem. We will learn how we can help prevent a vicious circle of problems if treated early with a holistic integrative approach.

Ankyloglossia is an embryologic variation of the lingual frenulum, which causes a significant restriction in the mobility of the tongue. As such, an altered lingual function is always an essential consideration when faced with breastfeeding challenges. On some occasions however, other anatomic or functional alterations in the babies’ orofacial region can cause breastfeeding problems, similar to those seen in tongue-tie babies. They can be the root of latch difficulties, nipple trauma and/or suction and deglutition issues. In these cases, frenotomy does not solve those problems and therefore, the misdiagnosis and posterior surgical treatment can frustrate parents. From a pediatric dentist perspective, retrognathia (recessed chin) and hypotonia are two common differential diagnosis of tongue tie, which can affect a babies’ suction at the breast. The aim of this talk is to present normal and abnormal orofacial structures so as to differentiate ankyloglossia from two problems that can be part of a “faux tie”, in order to aid breastfeeding consultants, and broaden their perspective on breastfeeding difficulties.

A suspected or diagnosed tongue-tie can throw a breastfeeding journey into immediate peril, with concerns over the baby's well-being most often discussed and debated. However, without an appropriate and intentional strategy for supporting the mother, the breastfeeding journey risks meeting an untimely, unplanned, and/or unsatisfactory end. The mental and emotional toll such a complex lactation situation can take on parents is wide-ranging in its effects, and it is critical to provide personalized and comprehensive counseling to restore a sense of empowerment and control to the mother as she makes continual decisions on how and whether to proceed with lactation and breastfeeding. Additionally, it is vital that indications of postpartum mood disorders are recognized and addressed as early as they appear. Lactation care providers can benefit from a clear framework for their fundamental responsibility to safeguard both the mother and child in a breastfeeding dyad. In this presentation we will explore ideas and themes that can guide the lactation care provider to ask the right questions at the right times in the specific context of tongue-tie so that they can offer effective counseling and care.

Frenectomy has become an increasingly more common procedure since the resurgence of interest in breastfeeding. Patient selection and anticipatory guidance provided to the family are key to success in reaching their goals. An honest discussion about the indications for doing the procedure and providing them with resources preemptively help in establishing trust and the future success of the procedure. After the procedure the care of the baby and the site are very intimidating to families and support at that time is vital to the success of the procedure. The post procedure experience can vary widely and to an extent depends on the family’s readiness. It is very important that post procedure be discussed before the procedure and support given after the procedure. Ultimately, the pre and post procedure interventions make the experience wholesome and conducive to successful breastfeeding.

Tongue movements are essential for milk extraction during breastfeeding. It is therefore very important that professionals are able to reliably identify anatomical variations in the lingual frenulum that may impact infant feeding. Learn more about how to use the Lingual Frenulum Assessment Protocol for Infants. This tool allows assessment of changes in the lingual frenulum and limitation of tongue movements, which can compromise the functions of sucking, swallowing, chewing, breathing and speaking.