Tongue-Ties or Lip-Ties
Dr. Taiym and Dr. Kamali are experienced in the diagnoses and treatment of mild to severe tongue-tie and/or lip-tie.
The procedure is called a frenectomy. Dr. Taiym and Dr. Kamali have been performing frenectomy procedures for over 13 years.
We do a full examination on each patient and determine that patient’s individual needs before
giving the option of treatment. If treatment is recommended, we can perform the procedure the
same day in most cases, especially because many of our patients drive from several hours away.
We would be honored to care for your child and help you through understanding more about this
Infants with Nursing Problems
A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have
poor weight gain. If they cannot make a good seal on the nipple, they may swallow air
causing gas, colic, and reflux or spitting up. You may hear clicking noises when the baby
is taking the breast or a bottle. Nursing mothers who experience significant pain while
nursing or whose baby has trouble latching on should have their child evaluated for tongue
and lip tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in
the mother and inability to hold a pacifier. The mother often reports it’s a “full time job”
just to feed them because they are constantly hungry, not getting enough milk, and spitting
up what they do get.
Although it is often overlooked or dismissed by other medical professionals, a tongue and
lip-tie can very often be an underlying cause of feeding problems that not only affect a
child’s weight gain, but lead many mothers to abandon breastfeeding altogether.
Very often, after releasing the tongue and/or lip, mothers report immediate
relief of pain and a deeper latch. The symptoms of reflux and colic almost
disappear and weight gain occurs rapidly. The sooner the tongue-tie is
addressed the better the child will learn to use his or her tongue correctly.
Upper lip tie is when the upper lip is tethered to the upper gum. Though most infants
have some degree of upper lip tie, when it becomes large and tight enough, it may
prevent the upper lip from flaring out or curling up which is essential for breast-feeding
in order to create an adequate seal with the breast. Also, some infants with upper lip tie
will exhibit an upper lip crease with the skin turning pale in an attempt to flare up during
If the upper lip tie is tight enough, an infant may have trouble feeding even from a bottle.
Tongue tie (otherwise known as ankyloglossia) is when the tip of the tongue is anchored to
the floor of the mouth. Tongue tie may extend all the way to the tip or it may extend
partially to the tip resulting in a partial tongue tie. There is also a condition called
posterior tongue tie in which the tongue tie is hidden under the tongue lining.
Regardless whether dealing with a newborn or an, the treatment is the same. But when it
comes to newborns, tongue tie can lead to feeding problems which can be quite distressing
to both child and mother.
With tongue tie, the tip of the tongue is unable to help the infant draw the nipple into the
mouth. It also prevents the tongue from being normally positioned between the nipple and
lower gumline leading the infant to chew on the nipple. Ouch!
What to Expect During the Visit
In general, the procedure is very well-tolerated by children. We take every measure
to ensure that pain and stress during the procedure is minimized.
1) General anesthesia is not utilized in the office and is almost never
needed to perform the procedure.
2) The actual time of lasering is 1-2 minutes.
3) For babies under the age of 12 months, a topical numbing cream is applied to
the area(s) that will be treated. This medication works very quickly.
4) For children 12 months of age or older, numbing cream is applied. In some
instances, an injected local anesthetic may be applied for additional anesthesia.
5) Crying and fussing are common during and after the procedure. In older children,
we have the option of giving an oral dose of Versed (midazolam), which is a relaxing medicine
similar to Valium. It is very safe in children and begins working in 20-30 minutes.
It helps alleviate separation anxiety in addition to providing an amnesia-like effect during
the procedure. It lasts about 90-120 minutes.
6) You may breastfeed, bottle-feed, or soothe your baby in any manner you'd like following
the procedure. You may stay as long as necessary.
Aftercare Stretch Exercises
The main risk of a frenectomy is that the mouth heals so quickly that it may prematurely
reattach at either the tongue site or the lip site, causing a new limitation in mobility
and the persistence or return of symptoms. The exercises are best done
with the baby placed in your lap (or lying on a bed) with the feet going away from you.
A small amount of spotting or bleeding is common after the procedure, especially in the
first few days. Because a laser is being used, bleeding is minimized. Wash your hands
well prior to your stretches (gloves aren't necessary). apply a small amount of the
teething gel to your finger prior to your stretches. The area of the surgery will have
a diamond shape. Initially it will be pink to red in color, but will eventually turn white.
Do one stretch on the evening of surgery. Then, skip ahead to the next morning
(keep in mind that this is the only time that you should skip the overnight stretch).
Our recommendation is that stretches be done:
6x/day for the first 3 weeks, and then
spending the 4th week quickly tapering from 6 to 5 to 4 to 3 to 2 to 1 per day
before quitting completely at the end of the 4th week. We find it's easiest for
parents to do 5 of the stretches during their waking hours and one of those stretches
in the middle of the night, taking care to not go more than 6 hours between stretches.
Diaper changes are a good time to do the exercises.
Upper Lip Stretches
The Upper Lip is the easier of the 2 sites to stretch. If you must stretch both sites,
We recommend that you start with the lip. Typically, babies don't like either of the
stretches and may cry, so starting with the lip allows you to get under the tongue
easier once the baby starts to cry. For the upper lip, simply place your finger under
the lip and move it up as high as it will go (until it bumps into resistance).
Then gently sweep from side to side for 1-2 seconds. Remember, the main goal of
this procedure is to insert your finger between the raw, opposing surfaces of
the lip and the gum so they can't stick together.
The Tongue should be your next area to stretch. Insert both index fingers into the mouth
(insert one in the mouth and go towards the cheek to stretch out the mouth, making room
for your other index finger). Then use both index fingers to dive under the tongue and
pick it up, towards the roof of baby's mouth. Once you are under the tongue, try to pick
the tongue up as high as it will go (towards the roof of the baby's mouth). Hold it there
for 1-2 seconds and then relax. Massage on either side of the diamond (outside the diamond)
to loosen up the musculature of the remainder of the floor of mouth. You can use more
pressure when doing these stretches because you aren't in the wound at this point.
Post Frenectomy Exercises