When Releasing a Tongue Tie with Laser Frenectomy Needs to Wait (Just a Little While)

While laser frenectomy is ideal for resolving issues with tongue- and lip-ties, there are some times when it’s not enough on its own.

Lately, in fact, we’ve been seeing more babies who exhibit extreme tightness and tension that makes it impossible for Dr. Evy to go in with the laser to release the tie. They clamp down hard, which is definitely not the norm.

Now, a tongue-tie itself can cause extraordinary tension. This is because the head follows the tongue. When there’s a tongue-tie, the head is naturally compelled to tilt forward and low. This greatly strains the nearby muscles, such as the sternocleidomastoids. These long muscles, one on each side, start from the top of the chest and continue up to the ears, behind the temporomandibular (jaw) joints (TMJ). They’re the muscles you use to turn your head or flex your neck.

Normally, releasing the tongue tie and following up with functional exercises can encourage proper realignment of the head on the spine. But if the tension and tightness have other sources, those issues may have to be addressed first for the frenectomy to be successful.

What sorts of factors might be at work in these cases, especially in infants? Here’s how board certified lactation consultant Dr. Leslie R Kowalski describes it,

In the early weeks/months, all babies need to “unwind” or “de-uterize” after pregnancy and birth (the uterus is a tight place and birth is a bumpy ride!). That means that sometimes oral tension is not from ties but from tight/asymmetric muscles or connective tissues, post-birth head molding, oral motion dysfunction, immature nervous system, and much more.

In such cases, some form of bodywork can help release the tension and loosen up the child enough so that the frenectomy can be done, allowing the child’s tongue to have its full range of motion, setting the stage for healthy orofacial and dental development. Myofunctional therapy – and, in some cases, continued bodywork – are crucial follow-ups for guiding this process along.

If there are ties along with the muscular tension, then relieving the muscular tension first and aiding overall oral range of motion is still the preferred first choice – because bodywork will “pre-loosen” the baby – aiding in the diagnosis, tie-release procedure, and healing from the procedure, as well as aiding the baby re-learning to use their newly freed tongue after the procedure. For this reason it’s important to not rush to a tongue-tie release – most babies (and their parents!) need some preparation prior to a release – we call this “optimal timing of release” and it gives you time to prepare the baby physically, neurologically, and time to prep you (the person who needs to help the baby) for this process too!

Here in Austin, we’re lucky to have a number of wonderful physical therapists who Dr. Evy refers parents to when tightness issues must be resolved so she can release the tie. Myofascial release, sacrocranial treatments, and both visceral and neural manipulation are just a few of the types of therapy that can be used to help our young mutual patients.

We’re grateful to have such skilled clinicians nearby who can see to our patients’ needs and help them on their way to getting the healthiest start possible.