Tongue-tie, Lip Tie & Structure Online Course(s) & Continuing Education

Institutions:  Department of Nursing, Laniado Hospital, Netanya, Israel, Halav-EM Breastfeeding Clinic
Background: As far as anterior tongue tie is concerned, there is a growing, vast body of knowledge that has been validated. As for posterior tongue tie, the scientific evidence is lacking and the assessment tools are not uniform among practitioners.
Medical diagnoses are not part of the scope of practice of Lactation Consultants. Hence, there is a lot of confusion among professionals (both Drs and Lactation Consultants), resulting in over diagnosis and over treatment on the one hand, and also under treatment on the other.
Aims: To present a unique perspective of an experienced Lactation Consultant who is also a dentist, experienced in diagnosing and treating various types of tongue ties.
Narrative: The discussion will focus on the clinical dilemmas regarding releasing posterior tongue ties and their implications for breastfeeding in newborns as well as in older babies.
Clinical cases of babies with posterior tongue ties will be shown to demonstrate how exclusive breastfeeding can be achieved in clinical cases with posterior tongue ties that were not released. Cases of anterior and posterior tongue ties that had been released although breastfeeding was going well will also be shown. In these cases, additional factors were taken into account, such as the palate structure and the additional consequences that Ankyloglossia may have later in life.
Conclusions: In some cases of posterior tongue ties, good breastfeeding counseling can make the action of releasing the tongue redundant. However, then we are left to consider conservatively what other effects Ankyloglossia may have on our body.

This session will focus on functional assessment and treatment of tethered oral tissue in the breastfeeding infant. Participants will understand the importance of task analysis of the motor skills to support sucking, prior to referring an infant for a release. Post op treatment has focused on active wound management (Ghaheri, B. 2017) rather than neuromuscular re-education. This approach multidisciplinary approach encourages lactation consultants to partner with body works specialists and speech pathologists to develop the underlying motor skills to support sucking.

This study aims to show a correlation between aerophagia in infants with tethered oral tissues (TOT’s) consisting of ankyloglossia and shortened maxillary labial frenula (tongue and lip-tie) and reflux. Currently there is little to no data on aerophagia as a possible cause of reflux in infants. Infants with tongue and possibly lip tie often have a poor latch in which there is often an inadequate seal around the breast and inefficient transfer of milk. As a result many of these infants swallow air during breastfeeding. Many of these infants suffer from symptoms of reflux. This study and results to demonstrate a correlation of ankyloglossia and shortened maxillary labial frenula with aerophagia and reflux.Treatment of these infants with a relatively simple frentomy procedure may reduce or eliminate reflux in this population.

Oral ties are often diagnosed and released during infancy to improve the breastfeeding relationship between mother and baby. But what happens if ties go undiagnosed? This course will review tethered oral tissues and their relationship in a breastfeeding dyad and the neurodevelopment of an infant and beyond. We will explore the implications of oral restrictions on the myofascial system throughout the body. Movement patterns, posture, and primitive reflex integration can all be affected by oral ties. Signs, symptoms, assessment tools, and strategies for co-management between IBCLC and bodyworkers will be discussed. Attendees will also learn neuro-biomechanical implications of TOTs beyond breastfeeding. Several case studies will be discussed and how successful management can be achieved with a team 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.

Trending in lactation consultants’ conversations are concerns of parents choosing not to release tethered oral tissues, declining structural realignment work, choosing frenotomy providers that are not on preferred consult lists, and experiencing less than desired outcomes or breastfeeding cessation. How can IBCLCs support families that might otherwise be ambivalent to body work, releasing restrictions, and follow up to ensure continuity of care and breastfeeding success? In this talk, we will explore the journey of holistic lactation care starting from a functional feeding assessment to helping parents reach a self-imposed goal of breastfeeding success with babies that have tethered oral tissues.

The management of tongue tie has many approaches. In this presentation we will explore the anatomy and physiology of normal tongue frenulae and that of ankyloglossia. How the structures affect function and how to manage them to optimise function. We will also discuss the problems that can be seen following incomplete release and reattachment. We will also cover complications during surgery and management options.

When it comes to addressing tongue-ties in medicine and dentistry, there is a large emphasis on treating infants in order to achieve optimal breastfeeding. But what happens to the babies who grow into children and adults without addressing their tethered oral tissues, and they end up as adults with tongue-ties? This presentation will discuss the challenges and symptoms that tongue-tied adults face later in life due to restricted lingual frenums. Knowledge of long-term implications is an important part of clinical teaching when explaining tongue-tie to caregivers or colleagues.

Anticipatory care plays an essential role in achieving desirable outcomes after the revision of tethered oral tissues. Tethered oral tissues are a common and underdiagnosed problem that impacts potentially 10% of the United States population. Lack of a universally accepted approach to diagnosis, treatment, and management creates confusion for the public and prohibits optimal care. This lecture dissects current research, trends, and information to present a deeper connection between oral function and anatomy during breastfeeding and tethered oral tissue revision management. Discover the interdisciplinary approach to restoring a functional and healthy breastfeeding relationship to the dyad and the critical importance of setting families up for success by providing adequate anticipatory care and guidance prior to revision.

Numerous symptoms may arise which prevent mother-infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments which positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality.

Surgical release of tongue/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1-week postoperatively) and continue to improve through 1-month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.