Fit 2B Tied
The Tongue...
It is the 2nd strongest muscle in the body.
Has has 3 neurological inputs (general sensory, taste, motor).
It is powered by 5 cranial nerves.
It is surrounded by the pretty white teeth that drive the millions of dollars that influence the dental and orthodontic industries
Yet is has the interesting and powerful position of holding the title of “no man’s land”
with so much that we think that we know with so much yet to learn.
Oral Restriction vs Tongue Tie
What is a tongue tie?
Why is it often incredibly frustrating to find a simple answer and one treatment that is effective for a such a common condition?
Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease the mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth.
https://en.wikipedia.org/wiki/Ankyloglossia
The Titanic was not sunk by part of the iceberg that could be easily seen.
The additional layers of restrictive tissues under the tongue that are being referred to as the "posterior tongue tie" are often deeper, more broad, follow no distinct pattern and are much less obvious than the popular and visible "anterior tongue tie".
If not addressed, these tissues remain and often result in less than optimal results of tongue release procedures.
According to one of the thought leaders in the tongue tie community:
"A posterior tongue tie is the presence of abnormal collagen fibers in a submucosal location surrounded by abnormally tight mucous membranes under the front of the tongue" - Bobby Ghaheri, MD
But what if there is even more to consider?
What if the submucosal fibers implicated in the posterior tongue tie involve the fascial system of the tongue...and therefore the entire body?
How about the impact of the reflexive system (especially the startle reflex known as the Moro Reflex) on the fascia?
Why would anyone think that treating the lower jaw, neck and hyoid bones wasn't just as important as treating the tongue muscle itself?
What if the nerves that make the tongue work aren't actually working well?
And what about how the brain interprets all of this?
There are many types of tongue and oral restrictions
Other types of tongue restrictions
Inappropriate neurological reflex patterning
Suck/Swallow/Breathe
FPR/Moro
Root
Gag
Lateralization
Phasic bite
Palmar grasp
Hyaluronic acid crystallization/decreased viscosity secondary to fascial restrictions
Unresolved cranial and upper cervical spine rotations/strains secondary to intrauterine molding and birth trauma
Restrictive /inelastic lingual and labial frenulae
Cause for concern
An "incomplete release" is usually blamed on the surgeon who didn't "cut deep enough" when in reality, the restriction that was released was most likely appropriate, it just was not the restriction that was creating the problem with tongue function.
Complex Considerations
It's more than a snip...
Here is a short list of complexities in treatment sequencing with tongue tie release surgeries:
- Cranial nerve dysfunction
- Unresolved birth trauma
- Cervical compression and rotations
- Aerophagia/gassiness
- Unintegrated and retained primitive reflex patterning
- Low-tone babies (Autonomic nervous system dysregulation)
- High tone babies (Autonomic nervous system dysregulation)
- Torticollis
- Cranial molding and craniosynostosis
- Cleft lip and palate
- Non-integrated suck swallow breathe reflex patterning
- Insufficient buccal fat pad development
- High palatal vault development
- Maternal challenges with dysregulation
- Maternal breastfeeding challenges (nipple size, over or under supply, nipple soreness, lack of professional support for efficient nursing, etc)
- Insufficient functional oral volume (mouth is too small)
- Mandibular recruitment (abnormal and hyperactive muscles pulling the lower jaw back and mouth open)
- Underdeveloped/insufficient airway/mouth breathing
- Enlarged tonsil and/or adenoid tissue
- Presence or oral habits
- And many more
Who and what should we believe? It's all so confusing.
Good question.
Keep asking questions and looking for answers. Find professionals that you trust in your local area who are licensed and experienced in situations like yours.
Please be careful in taking the advice from Facebook groups. Even though some of the members are well intentioned, they are not your doctor and cannot diagnose anything with a picture taken with your phone. (especially if a surgical release is "complete")
Do not rush to treatment and find acceptable alternatives to infant feeding until you feel comfortable with the decision to choose a surgical intervention.