Do you or your baby have a problem of tongue tie? Tongue tie is characterized by difficult breastfeeding and speech. In this post, we have insights on the symptoms of posterior tongue tie in babies and adults. You will also learn how to treat this tongue condition using surgery and exercise.
Posterior Tongue Tie Baby Symptoms
Posterior tongue tie is also known as ankyloglossia. It is the shortening of the tissues that connect the tongue to the floor of the mouth known as frenulum.
This results to limiting of the tongue mobility. Shortening of under tongue frenulum is a birth defect that some of the newborn babies may have.
Ankyloglossia can be detected earlier by physically examining the under tongue frenulum and other tissues. However, you can notice most of the symptoms from your baby. They include the following:
- Troubled Sucking and Swallowing
An approximate of 5% of all babies born across the world have a tongue tie problem. Among them, 25% to 60% have trouble breastfeeding. This may not be a problem to the child alone but to the mother too since the nipple may become painful or inflamed due to poor latching or may suffer from mastitis.
The child may also suffer poor milk supply that results to neonatal dehydration and unstable weight gain. This may force the mother to start premature weaning. The child may not even shallow food properly during the weaning period.
- Speech Problem
Difficulties or problems in speech are also associated with tongue tie. It can cause errors in join words and affect the expression of alveolar-lingual and dental-lingual. Alphabetical letter like t, d, l, n, and r may remain constant since their pronunciation requires opposition of the tongue against the palate 
Most of the joint word mistakes are made by people who have a problem with the mobility of the tongue. Fortunately, speech problems can be correct by speech therapy.
- Irregular Tongue Movement
The affected baby cannot move the tongue freely since it may be anchored. For instance, the tongue does not move systematically when the baby is crying.
Children with ankyloglossia are characterized by tongue clicks. This is because the tongue cannot make a grip well. The sounds are produced especially when sucking on something.
- Mechanical problems
A mechanical problem with the movement of the tongue is associated to a tongue tie. The tongue movement limited in a way that there is the inability of the tongue to perform inside mouth self-cleaning and licking of the lips.
Retrognathia is a condition whereby the lower jaw from the top is shorter. Although it is physiological in infants and normally changes with growth but those with a tongue tie usually have an obvious retrognathia. When a tongue tie is released earlier, this condition can disappear as the baby grow.
Posterior Tongue Tie infant
Newborn tongue tie causes disturbances when sucking during breastfeeding. It can also cause speech defects, the problem with swallowing and miss-alignment of the lower teeth in older children or even adults. Ankyloglossia occurs in four different types that include:
- Short and thin frenulum with little blood vessel [type i]
This type occurs when frenulum insertion happens at the tip of the tongue. It is characterized by a heart-shaped appearance when the baby cries. It occurs when the bridle pulls back the tip of the tongue into the mouth.
- Short and thick frenulum or bridle with large blood vessel [type ii]
It occurs when the frenulum insertion appears few millimeters from the tip of the tongue as compared to the first type. This type of tongue tie causes the tip of the tongue to fall down when the baby cries. It does not necessarily affect the speech.
- Thickening of the Sub-mucosal brake [type iii]
This is a rare type of tongue tie, it can be described as a combination of type 1 and 2. It is characterized by the little visible membrane at the back of the tongue and submucosal anchor. It is therefore not enough to sever the membrane to release the tongue onto the floor of the mouth. This type of tongue tie is not visible to the eyes but you can notice it by running a finger from side to side under the tongue.
In this type, the tongue may have a normal appearance and move with ease but it results in a small depression at the center of the tongue. It is also difficult for the baby to touch the roof of the mouth with tongue while the mouth is open.
- Sub-mucosal brake that restricts movement at the base of the tongue [type iv]
In this case, the bridle is not visible as it is hidden under the layer of mucosal tissues. It is characterized by almost total restriction of the tongue mobility. The tongue is anchored to the floor of the mouth which presents a compact appearance.
Tongue tie simply means that the tongue is anchored. It is used to describe those babies that are born with too short frenulum for the tongue.
Posterior Tongue Tie in adults
The problems of untreated tongue-tie do not reduce in maturity or in adults, instead, the challenges increase as the time passes. There are various problems that adults may experience when having a tongue tie. This can affect their self-esteem, dental health, domestic situations and even social interaction with friends or other people. Some of the challenges an adult is likely to face when having a tongue tie include:
- Always worried and having a watch at their speech when addressing a gathering or expressing themselves.
- An anchored tongue affects the speech and eating habits. An adult victim cannot be able to open the mouth widely.
- Producing clicks with jaws.
- Frequent dental problems like inflamed jaws, tooth extractions, and increases need for filling.
- Misalignment of the lower teeth and protruding of the jaws
- Various effects in work environment
- It affects the social life like of having meals with friends, kissing, and relationships
- A severe headache or a migraine
- Difficult to speak even after taking moderate amount of alcohol
- Sensitive to personal appearance
- Inability to speak fast, loud or even soft
- It also makes it difficult to wear dentures
Tongue tie can also have an effect on the cosmetic appearance of a person. The appearance of the tongue look small, rounded with a heart-shaped appearance. The movement of the tongue is also restricted since it is anchored on the floor of the mouth.
It may also cause salivary profusion due to poor coordination of swallowing when making a speech. The appearance of the tongue and the tie becomes more conspicuous and even ugly in the adulthood.
Posterior Tongue Tie Breastfeeding
Breastfeeding provides a great opportunity for the baby to interact with the mother and to develop a strong bond between the two. However, an interrupted breastfeeding due to the tongue tie can delay interaction and bonding between the two.
When a baby tries to suck the breast unsuccessfully, he or she will fall asleep without fully satisfying the hunger. This will cause the baby to wake up several times during the night to feed. This can also result in sleep deprivation for the mother and the baby.
The inability of the baby to breastfeed properly due to a tongue tie can result in a number of challenges to him or her, the mother, and the whole family. Some of the challenges a baby may experience include:
- Low milk supply
- Termination of breastfeeding
- Premature weaning of the baby
- Problem with introducing solid foods
- Poor sleeping habits
- Interrupted bonding between baby and the mother
The mother may also not be at peace when having a baby that is suffering from a tongue tie. The mother is likely to experience the following challenges:
- Nipple pain, damage, bleeding, and distortion
- Having a severe pain when having or losing latch
- Having inadequate sleep due to being stressful and unsettled
- Breast infections such mastitis
- Stress or even depression due to having a sense of failure to attend well to the baby.
However, it is important to know that tongue tie is a condition that can be corrected using a simple surgery. Therefore, parents who blame this condition for baby’s feeding problems or speech may be fooling themselves. There are many pediatric surgeons who can perform a tongue tie release to avoid complications.
Posterior Tongue Tie Speech
Individuals with a tongue tie always have a poor sense of the geography of their mouth. This can result in speech problems or under-development or oral kinaesthesia. Speech problems occur since the victim cannot be able to memorize the correct movement of speech due to an anchored tongue.
Adults and children with a tongue tie may often try to pronounce or speak with small oral aperture. This cause a problem to acquire the lingual contacts needed for pronouncing consonants. Tongue tied individuals may try to speak softly, slowly or loudly but still have to experience the problem of clarity.
Posterior Tongue Tie Release
Both posterior and anterior tongue tie can be released using either laser or scissor technique. There are several factors to consider before choosing the best technique to release a tongue tie. Some of the factors the doctor will have to consider include:
- The thickness or the depth of the tongue tie.
- The amount of bleeding that is anticipated.
- The risk and benefits of each method as compared to each other.
- The quickness or the amount of time that the procedure is supposed to be done through.
Both laser and scissor technique are effective methods of releasing a tongue tie. Regardless of which method is used, both of them has the following similarities:
- The end result of the procedure is the same. The healing duration remains the same
- Both laser and scissor technique can be used without sedation depending on how the affected victim cooperates.
- Both of the methods can be used to perform the procedure relatively quickly.
- When using any of the techniques, an injection of local anesthesia is used.
- Both laser and scissor method can be used to perform the surgical procedure on both infants and adults with equal results.
- Both methods result in the minimal pain that can be alleviated with teething gel or painkillers.
- The factors above determines which method is better to use.
Regardless of the doctor’s technique preference, the final decision on which method to use is determined by the patient or the family members of the victim to undergo the procedure. There is no problem on choosing on either of the two techniques since the results are the same.
Most of the doctors prefer to use the scissor method since it is much faster as compared to laser. It is important to perform the procedure of tongue tie release faster especially when the baby or infant is uncooperative. Therefore, anything that can be done to minimize the duration of the procedure is preferred.
On the other hand, laser technique is preferred in a case whereby bleeding is anticipated. The laser works best for both cutting and stopping bleeding at the same time. When using scissors to perform a tongue release, bleeding may take between 8 to 10 minutes to stop especially when performing tongue tie release. This is because the lower part of the tongue is thick.
The table below summarizes the similarities and differences between laser and scissor technique:
|Comparisons||Laser Method||Scissor Method|
|Duration of the procedure||Within 5 minutes||Within 30 seconds|
|Bleeding anticipated||Low bleeding||Medium to high bleeding|
|Complications of the method||Blindness or facial burns||High bleeding|
|The type of situation used||Tongue tie especially posterior||Anterior tongue tie|
|Afterward pain||Minimal pain||Minimal pain|
|Require sedation||No sedation under normal circumstances||No sedation under normal circumstances|
|Use of anesthesia||Yes||Yes|
|Parent being with baby during the procedure||No||Yes|
|Improvement noticed||Within 2 days||Within 2 days|
It is important to note that the method to be used may depend on the clinic. Some of the clinics only specialize in using the scissor method while others specialize in the use of a laser. The doctor may also advise you on the method to use, although both of the two methods are effective.
Posterior Tongue Tie Exercise
After tongue tie release, there are a number of exercises that can be done to reduce re-attachment. Some of the exercises include the following:
- Stretching the Tongue
Stretching the tongue exercise after tongue tie release is very important as it helps to reduce the risk of reattachment and other complications that may require further procedures. However, it is important to wash your hands thoroughly with an antibacterial soap before starting the exercise.
You should also trim your nails to prevent scratching or injuring the affected area when performing the stretching exercise. This is how to perform the exercise:
- Position your baby on the back with the head facing you and feet pointing away from you.
- Using the index finger, get under your babies tongue and elevate it to expose the wound or the area that was releases.
- Hold the stretch for 5 seconds before releasing the tongue.
- Place two fingers on the sides where the incision was made and pull them apart for 3 seconds to stretch the affected area horizontally.
It is recommended to start the stretching exercise at the second feeding after the surgical procedure. Stretching exercise is supposed to be done at least 6 times a day with 1 done during the night. You can also in cooperate a gentle massage of the wound after 24 hours. This should be done for 5 seconds for the day for the first 4 weeks after the procedure. It is important to note that:
- All babies require stretching exercise to prevent re-attachment or formation of a scar.
- Stretching exercise does not necessarily prevent every baby from re-attaching, it only limits the probability of re-attachment.
- Stretching exercise should be done 6 times a day for a month to prevent other complications.
- Second tongue tie release can be done for the babies that re-attach
- Regular Breastfeeding
Regular breastfeeding is also the best exercise that promotes healing after tongue tie release. Breastfeeding causes the baby to stick out the tongue under the breast. Sucking also causes the tongue muscles to rise up and down. The contraction and relaxation of tongue muscles help to stretch the tongue.
Breastfeeding the baby immediately after tongue tie surgery helps to control the pain as well as preventing adhesion.
Posterior Tongue Tie Surgery
The incidences of tongue tie among newborn babies have increased across the world. Professional health care providers are diagnosing this tongue condition and recommend surgically cutting the tie through a procedure known as frenotomy.
Tongue tie surgical treatment procedure is fairly straightforward although posterior is more involving as compared to anterior tongue tie. The procedure can be performed only under the use of local anesthesia when the affected baby is below the age of 1 year.
However, if the baby is between the ages of 1 to 2 years, sedation is required since the baby is usually uncooperative. The baby is supposed to open the mouth wide and keep the tongue still in order to perform a successful surgery. Sedation may not be required when the baby is cooperative.
The surgery can be performed using laser or scissor technique to perform infant tongue tie release. Here are steps used to perform the procedure:
The surgeon assembles all the necessary tools, medicines and other items that will be used throughout the procedure. The surgery table is set and all the tools are sterilized before proceeding.
Local anesthesia is applied to the affected area. A health professional uses a tiny needle to inject 1% lidocaine with epinephrine to the affected area. Sedation may be given or not depending on the age of the baby or how he or she cooperates.
A black line is drawn is drawn over the affected area where an incision is made using a scalpel or scissors. A laser procedure may also be used to release the tongue tie. Many people prefer laser than scissor technique although the results are the same.
An incision is made through the mucosa, into the tie and finally down to the tongue musculature. A diamond-shaped wound is left behind after the procedure. A fast- absorbing suture is placed over the incision. The stitch slowly dissolves away after 7 days and does not require to be removed.
Although the incision is done in a horizontal position, the suture is placed in a vertical position to strengthen the tip of the tongue.
The surgical procedure is finalized and double checked to ensure that everything is okay. The tongue should be able to heal within a period of two weeks.
Posterior Tongue Tie Surgery after Care
Caring for your baby after tongue tie release is important. It helps to control the pain and soothe the baby, prevents bleeding, and encourages the proper feeding of the baby and proper healing of the wound.
Controlling Pain and Soothing the Baby
The baby will be uncomfortable or upset especially on the first day after the procedure. The baby may not be able to feed properly until several hours after the procedure. The baby should be able to improve from day to day after the procedure.
If the baby is three months and above, you can give him painkiller syrup like Calpol or Nurofen to alleviate the pain and other discomforts. The baby can also be given the first dose of analgesic before the procedure to minimize the discomfort.
Cuddling the baby and skin to skin contact can help to soothe the baby. Ensure that the baby is not hungry by giving him or her small feeds frequently. Breastfeeding the baby after the surgery is very important. Mother’s milk contains sugars that are effective pain relievers.
Most babies will be unsettled for the first several days after the procedure. The tongue may swell 1 to 2 days after the procedure. It is important to be patient with your baby and be there always to provide the necessary assistance your baby may require.
If the baby is too young for medication, then cuddling the baby may be the only option you have. Skin to skin contact with the mother and frequent breastfeeding may be the only thing your baby needs in order to calm after tongue tie release procedure.
It is normal for the baby to bleed slightly after tongue tie release. The scissor technique may cause slight bleeding as compared to laser. However, bleeding does not last for long. Bleeding can happen days after the procedure when the baby accidentally scratches the affected area.
Bleeding can be controlled by applying firm pressure on the wound for several minutes using a clean tissue paper. However, don’t hesitate to visit a healthcare professional if bleeding is severe. You can prevent the baby from scratching the wound by placing mitten or socks on his or her hands for several days.
Feeding the Baby
Some babies will have full movement of the tongue and lips immediately after tie release procedure while others may take some hours or days to gain full movement of their tongue. This means that some babies feed right away after the procedure while others may take some hours before resuming back to feeding.
It is normal for the tongue to swell and pain for some days after the procedure. This may interfere with your baby’s routine feeding. However, it is important to give your baby small feed frequently until when the pain and swelling come down.
Sources and References:
- Tongue Tie and Its Treatment: https://www.fauquierent.net/posteriortonguetie.htm
- Tell Me About Tongue Ties! https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties
- What to Expect After Tongue-tie and Lip-tie Release: http://nurturedchild.ca/index.php/breastfeeding/challenges/what-to-expect-after-tongue-tie-and-lip-tie-release/
- Laser vs. Scissor Technique for Tongue/lip Tie Release: https://fauquierent.blogspot.co.ke/2015/06/laser-vs-scissor-technique-for.html
- Consequences of Untreated Tongue Tie: http://tonguetie.net/consequences/
- Tongue Tie and Lip Tie FAQ: http://www.drghaheri.com/blog/2014/10/2/tongue-tie-and-lip-tie-faq
- Posterior Tongue Tie Causes and Treatment: http://www.posteriortonguetie.com/
- Care Post Laser Tongue Tie Release: http://www.tonguetie.ie/service/laser-tongue-tie-release-after-care/
- Tongue Tie Aftercare: http://tonguetieclinic.ie/aftercare/
- Tongue Tie: https://www.nhs.uk/conditions/tongue-tie/Pages/Introduction.aspx