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.
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.
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?
Inappropriate neurological reflex patterning
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
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.
Here is a short list of complexities in treatment sequencing with tongue tie release surgeries:
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.
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