A tongue tie release is a very simple and uncomplicated procedure. The release is only the first step in the tongue tie treatment process though. Following the release, bodywork, IBCLC consultations, aftercare and more, must be performed and attended for the next 6 weeks.
The topic filled with most conversation and controversy, is aftercare. This makes perfect sense, as it can be both hard and stressful to perform aftercare, especially as the baby often resists to the exercises. As such, parents often fear that they do not perform the exercises as they are intended, and that the wound reattaches as a result thereof.
To clear up unnecessary confusion and to assist parents to assess if the tongue tie has indeed reattached, we have decided to go through the basics.
What does reattachment mean?
There is some confusion on what is meant by reattachment. We are often contacted by parents where the doctor didn’t prescribe aftercare at all. These parents are scared that because they didn’t perform aftercare, the wound has reattached. In these cases, it is almost always the case that it was only the anterior frenulum that was nicked. If the anterior frenulum is nicked, there will not be a wound under the tongue and therefore there is nothing that can reattach. Aftercare is only required where a full tongue tie release is performed.
A full release is required for aftercare to be relevant
In the case where a full tongue tie release is performed, there will be a wound between the bottom of the tongue and the bottom of the mouth. Here aftercare is necessary, both to ensure flexibility, but also to prevent that the wound closes (reattaches). The tissue inside the mouth is one of the fastest healing tissues in the entire body, and as such scar tissue can form fast.
Once an open wound is created in the mouth, the body will try to close it. The result is that the tongue will try to stick back down to the bottom of mouth. The trick to achieving optimal results is to try and guide the tissue, through proper aftercare, to heal in a way that maximizes vertical movement. This vertical movement is important for upward movement of the tongue towards the palate to form the seal necessary for vacuum generation.
Reattachment usually occur within the first three weeks. After this time, symptoms of reattachment can be found, but this is not because the wound reattaches, but because mobility is impaired.
What are the signs of reattachment?
Full reattachment, where the entire tongue reattaches to the bottom of the mouth, never occurs if the procedure was deep enough to begin with. As such, most patients that experience reattachment only has a small part of the tongue reattach, usually at the base of the wound. If you see a band under the tongue at the conclusion of aftercare, this is not a sign of reattachment, but a sign of attachment. The tongue needs to attach somewhere.
When diagnosing a tongue tie the most important parameter to consider is which symptoms you and your baby experiences.
This is also true when assessing if the wound has reattached. Look at the list of symptoms and try to assess what you are experiencing now, compared to what symptoms you experienced before the release. If you experience many of the same symptoms as before the release, be sure that this is not caused by restricted mobility, as this can yield the same symptoms as reattachment.
As aftercare generates tensions you should have regular bodywork done to your baby. Ask your bodyworker if mobility is restricted, and what to do if this is the case. Reduced mobility around the wound is by far the most common cause of worsening symptoms, most often as a result of inadequate bodywork and/or aftercare.
Symptoms and aftercare aside, it is very important to keep good track of how the wound looks. A successful release will create a diamond shaped wound, which will go through a normal healing process. During this process the wound will change color, which is perfectly natural. What to look out for, is that the wound continues to look like a diamond, and that it is possible to stretch vertically. If the diamond starts to change shape or become more horizontal than vertical, you need to ensure that you perform aftercare sufficiently, specifically that you lift the entire tongue upwards and not just the sides.
If the wound no longer looks like a diamond and symptoms have returned, you should consult your local practitioner.
It reattached. Should you get a new release?
It depends. It is never guaranteed that performing the release a second time will yield better results than the first time. The more releases you get, the more scar tissue you risk generating and the harder it is to soften the tissue. As such, it is important that you consider if the symptoms are causing so much discomfort that you want to risk going through the entire procedure again without the guarantee of a better result.
You should also keep in mind, that the scar tissue around the wound will tighten around week 2 and 3 and then soften afterwards. It might take several months before the tissue is fully loosened, during which mobility will increase and symptoms decrease. In all cases, the wound should get at least 6 weeks of rest before performing a second release, so no matter what, you should wait 6 weeks before a second release. This will also ensure that you give the tissue time enough to loosen to fully see the effects of the procedure.
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