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Tongue-Tie and Lip-Tie in Adults

Dr. Roca recently discovered that she herself lived for many years with a tongue-tie, and recently had her tongue-tie released using the same CO2 laser that she now uses in her practice. It was a painless procedure and finished within five minutes, she had no post-op pain, and she has been delighted with the results. She wishes she had it done years ago. She chose to release her tongue at the age of 51 because she was working hard on her oral myofunctional exercises and realized her tongue was tied down in the floor of her mouth, preventing her from keeping her tongue in the roof of her mouth 24/7. She realized that her posterior tongue-tie was making her severe sleep apnea worse.

“After my tongue was released, it was incredible how easy it was to keep my tongue in the roof of my mouth and I felt an immediate looseness in my neck and shoulders. I always thought my neck and shoulders were tight because of my job, but it must have been my tongue-tie since both my neck and back tension are now gone. But most of all, the last thing I expected was that the numbness in my fingers, present most of the day and night, would disappear. I was diagnosed with the beginnings of cervical stenosis, which was causing my numb fingers, and told that when my numbness was too much to handle on both hands I would need to have neck surgery. No one ever thought it could be my tongue-tie. After my tongue-tie was released, my numbness slowly started to go away, and by one week it was completely gone and has yet to return. And I don’t see it happening.”

Dr. Roca trained under Dr. Soroush Zaghi, renown Ear, Nose, and Throat Physician from California. He is the co-founder of The Breathe Institute. Dr. Roca is honored to be an ambassador of The Breathe Institute. Dr. Roca admires all the research Dr. Zaghi has published showing clear evidence and positive results for a functional frenectomy.

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Tongue-tie

We know that tongue-ties run in families, but because it is a dominant gene we are seeing more and more tongue-ties every day.

Your tongue should fill up the entire roof of your mouth. When it does, it provides an internal support structure for the upper jaw. If your tongue is in the right place, your teeth will grow in straighter and your face will develop properly. A tongue-tie keeps your tongue in the bottom of your mouth. People who are tongue-tied often mouth breathe, so they experience a variety of myofunctional problems and symptoms. Chronic jaw pain, facial pain, headaches, clenching and grinding, along with dental and orthodontic issues and quite often mouth breathing are common in people with tongue-ties.

Studies show that children who are tongue-tied are more likely to develop sleep apnea and airway issues. We also notice that patients that are tongue-tied swallow by pushing forward. We have noticed that this unnatural swallow pattern is what has led to many baby teeth not falling out naturally; we end up seeing permanent teeth often while the baby tooth is still present.

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Pre-Op Exercises

It’s critical to do myofunctional therapy exercises before the procedure for a successful outcome! We will prescribe a series of exercises to help strengthen and prepare the muscles of the tongue for the new range of motion it will experience post-surgery.

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Wound Care

The mouth is very good at healing after a surgery, which is why caring for the wound is an integral part of the process. If the wound is not managed properly, it’s possible the tongue will reattach the way it was before the frenectomy.

Myo-Therapy

The tongue and oral muscles will need to be retrained and strengthened after the frenum is released.

We perform laser frenectomies using the LightScalpel™ CO2 laser. We perform them on children of all ages – infants to adolescents – as well as adults. Because of the preciseness of the laser, we are able to gently remove the tissue causing restrictions without bleeding and with minimal post-op discomfort.

The area to be released is much better defined when muscles are toned. Therefore, myofunctional therapy is a must before release of the frenum. Once restriction is removed, post-frenectomy oromyofunctional therapy is also necessary in order to reestablish the swallowing, chewing, speaking, and breathing patterns acquired as a result of the tongue-tie[18]. Repetition of the pattern entrains behavior that helps to establish jaw stability. Length of time of therapy before and after the release is established by the myofunctional therapist depending on the overall goals of the patient. Without such therapy, the incorrect swallow, speech impediments, and compensatory posture and breathing habits remain, which can eventually lead to the relapse of obstructive sleep apnea and a return of pre-operative sleep-disordered breathing and other disorders. Understanding the continuous interaction between muscle activity of the tongue and other oral-facial muscles, as well as the development of normal anatomic structures supporting the upper airway, may lead to expansion of myofunctional reeducation as a therapeutic tool.[19]

18. Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol. 2013; 22;3:184. doi: 10.3389/fneur. 2012.00184. eCollection 2012.

19. Guilleminault C, Sullivan SS. Towards restoration of continuous nasal breathing as the ultimate treatment goal in pediatric obstructive sleep apnea. Pediatr Neonatol Biol. 2014;1(1). Accessed February 19, 2016.

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Yes. Any wound can have scar tissue. The precision of the laser and the lack of collateral damage because of focused energy is thought to minimize that scar tissue. Regardless of the technique used, however, if the entire tongue-tie is released (including the posterior portion), then there is a higher chance of scar tissue because the wound is deeper and the opposing edges of the release site are closer together, increasing the chances of scarring. Often, to reduce scar tissue Dr. Roca can add sutures that will dissolve on their own, but she has found positives and negatives from the suture approach.
Stretches are necessary to prevent reattachment for the lip and a released posterior tongue-tie. The opposing raw edges of the wounds in a lip-tie or posterior tongue-tie are too close and will stick together to some degree without stretching.
No. It’s all about preparation. When Dr. Roca does the laser treatment, she just injects a small amount of numbing medicine that contains adrenalin. There’s minimal bleeding, and the release can be done easily in the office.
If the release is done absolutely perfectly and the stitches are placed precisely, then theoretically reattachment would be difficult. That being said, Dr. Roca’s experience is that placing stitches with the CO2 laser is not necessary since the bleeding, if any, is minimal and will stop on its own. Plus, she always sees the patient one week post-op to stretch open the wound in case reattachment has started.
The surgical goals of tongue-tie release are different for infant and adult. Infant lingual frenectomy[14,20] pursues proper eating/breastfeeding and nasal breathing. Adult needs are much more diverse. Constant, repetitive, and incorrect use leads to deformation and damage done to orofacial structures that needs to be corrected. Therefore, the release is more extensive than for the infant, and it also involves the mandatory pre- and post-frenectomy myofunctional therapy. Authors’ technique for the adult tongue-tie functional release includes the following steps:

  1. Pre-surgical OMT exercises to prepare and re-pattern tongue function once released.
  2. SuperPulse CO2 laser frenectomy, preferably under topical anesthesia and combined with Tongue Movement Assessment for ideal release to achieve optimal function.
  3. Post-surgical OMT exercise program to ensure long-lasting functional results.

14 Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: a comparison of carbon dioxide laser and scalpel techniques. J Periodontol. 2006;77(11):1815-9.

20. Kaplan M, Hazelbaker AK, Vitruk P. Infant frenectomy with 10.6 micrometers dental CO2 laser. WAGD Newsletter. 2015 Apr;34:10-12.

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Photos courtesy of Dr. Soroush Zaghi at The Breathe Institute
Dr. Zaghi’s most recent article of myofunctional and tongue tie release reducing sleep apnea by 50%.

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Below a testimonial of patient a few days after posterior release.
Below testimonial after her anterior tie release.
Below Dr. Roca teaching patient via video how to suction tongue flat against roof of mouth to pass test ready for release.
Below Dr. Roca teaching patient over video how to do tongue clicks and suction flat.
Below patient has sent a video to Dr. Roca showing she can keep her tongue flat on roof of her mouth without any vibration or movement for at least 30 seconds. This means tongue is strong and conditioned enough to be released.
Below is a video of patient bloopers trying to keep her tongue flat for 30 seconds.
No one needs to live with the difficulties of tongue-ties and lip-ties. Call (703) 237-7622 now to schedule a visit to see how we can help you or your child.