Tongue Tie/Lip Ties/Buccal (cheek) Ties

The International Affiliation of Tongue-Tie Professionals (IATP) definition of tongue tie (lingual frenum restriction), is “an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement.” In layman terms this means it is a tight string of tissue under the tongue that can prevent the tongue from functioning properly. If the tongue appears tied, it is important to assess what function has been impacted. The lingual frenum can vary in length, thickness, position, and elasticity. Some ties are hidden underneath the outer mucosal layer and are not readily visible (Baxter, R. Tongue Tied, 2018, 1-4).  There are additional frenums including an upper labial frenum and lower labial frenum as well as 4 buccal frenums (cheek frenums one on each of the upper cheeks and one on each side of the lower cheeks). These frenums can also vary in length, thickness, position and elasticity.  When function is impacted by  lips and cheeks the ability to close the lips can be impacted, breast feeding can be challenging due to a poor latch, or it can be difficult to acquire lip closure for bilabial sounds such as /p/, /b/, /m/.  

The estimated prevalence of tongue-tie (restricted lingual frenum) is estimated to be between 4% and 10% of the population. A tongue tie will often promote a low tongue resting posture which can interfere with a child’s development of their upper jaw contributing to a narrowing of the roof of mouth and can also promote the lower jaw to be more protrusive (crossbite) due to the tongue living low in the mouth. The tongue is supposed to rest on the top of the mouth which promotes proper growth of the maxilla (upper jaw). A tongue tie can also make it difficult for the tongue to move separately from the lower jaw and can contribute to multiple speech sound errors. For example, the tongue tip may not be able to elevate up to the alveolar ridge to properly produce a /t/, /d/, /n/ or /l/ and instead compensates by using the mid portion of the tongue to elevate which leads to a distortion of these sounds. Elevating the back of the tongue to produce /k/ or /g/ or elevating the lateral posterior tongue borders for oral stability required to produce /s/, /z/, /ch/, /sh/, /j/, /r/ can also be impaired. These impairments often lead to compensations of the lip/jaw/facial muscles to over work due to inefficient tongue mobility. A tongue-tie also promotes an abnormal swallow pattern because the tongue cannot elevate completely up to the roof of the mouth or chewing may be difficult because the tongue cannot move freely in the oral cavity to manipulate the food particles. These children are often labeled as “picky eaters”. It is important to have your child evaluated by a speech-language pathologist that is trained in orofacial myology to conduct a functional assessment to determine if oral function is affected by a lingual frenum restriction. 

With my adult patients that have a history of temporal mandibular joint disorder such as popping, clicking of the jaw, jaw sliding when speaking, chronic headaches, shoulder and neck pain, teeth bruxism and clenching and complaints of a “different swallow” such as making loud gulping noises I have often discovered those patients also had restricted lingual frenums.  I had a former patient who began as just the mother accompanying her child to speech therapy when I discovered that she had definite functional limitations and after working through myofunctional therapy and having a lingual frenum release procedure she no longer had any of the above symptoms.  She became an incredible happy person without pain.   It is important that if there appears to be restricted lingual, labial or buccal frenums that the functional impact is fully assessed to determine if the restriction is impacting proper speech, feeding, oral resting posture and swallowing.  Following a thorough evaluation with Nancy Magar we will then generate a plan of care that is unique to each individual. 

Orofacial myofunctional therapy is essential to the success of a lingual frenum release before and after the release to improve oral motor patterns and teach the child or adult how to correctly produce speech sounds without compensations and to incorporate proper orofacial myofunctional patterns to prevent reattachment of the released tissues. This clinic works closely with release providers to provide the best care for each patient.  

Nancy Magar can help with your pre and post tongue tie treatments and correct abnormal muscle patterns that resulted from the restriction(s).  Call us today for a functional assessment if a tongue lip or cheek tie is suspected.