Oral Ties: A Pic is Worth 1000 Words

There's a lot of information about tongue & lip ties, and it can be hard to feel like you have a good understanding of the subject. I don't have an issue saying that as both a lactation professional and parent, it's a confusing topic. Hell, the leading experts on tongue tie seem to be in an ongoing online feud regarding everything from how to identify ties to the best way to treat them.

But if you take a close look into the literature and listen to hundreds of parents about their tongue tie experiences, the tongue tie "picture" becomes more clear. It becomes easier to understand how any restricted oral tissue can impact feeding, sleep, and facial development.

I will make a post (or few) that digs deeper into the topic at a later date because, despite the confusion, there is A LOT of information out there. For today I just wanted to share with you a couple of pictures that I think may help provide a bit of insight for you as parents on the impact oral of and movement.

Restricted Labial Tissues

It's nearly impossible to be able to identify a lip tie from pictures because a significant part of assessing oral tissue depends on feeling how elastic the frenula are. The frenulum is the band of tissue that connects the lip to gum line or tongue to the bottom of the mouth. The elasticity of oral tissues, or lack thereof, affects function.

The one caveat to this is when there is notching in the gum line. If your baby has a notch in their gum line, where the gum ridge is misshapen, there is a near 100% chance that it's caused by tension due to oral restriction. As Dr. Ghaheri puts it " in the battle between muscle and bone, muscle always wins."

If you're not already following his Facebook page, you totally should. Oh, and Dr. Newman too.

For this baby, who had a revision done at seven weeks against the recommendation of the pediatrician and providers managing her care, it's undeniable that there is remodeling of bone due to a tight labial frenulum.

Here is the same baby five weeks later. You can see the improved lift and length of the labial frenulum, the reduced tension on the actual lip when lifted and miraculously, the notching is gone. Who would have thought?

Restricted Lingual Tissues

There are some that feel if there is a lip tie present then the majority of the time, there will be a tongue tie present as well. For this sweet babe this unfortunately rings true for her.

It's hard to imagine what the proper lift of a tongue should be until it's compared to the height that same tongue is capable of lifting when its free to move. The difference between these two pictures is one day and a tongue tie revision.

Like lip ties, tongue ties CANNOT be determined through pictures alone, and there are many reasons for that. But you can see characteristics of oral restriction or tension in photos when you know what to look for.

Generally speaking, tongues should be able to lift *at least* half way up the oral cavity, which means roughly past the crease of the mouth. But that gets tricky because oral tension can cause the creases of the mouth (where the lips come together) to be in a different spot, often times lower, than they usually would if there was no tension. So there can be a restriction with a tongue that appears to lift half way.

So when looking at tongue lift, you have to see how wide the mouth can open, if it can stay wide, and how the lips and tongue move while their mouths are open. And when you have done that assessment, you still have to look at a baby during a feed because none of the above details will explain how well a baby can do those things during a feeding session.

For this baby, the overall shape of their mouth is different post revision. It can be hard to see, but here's are a few visuals that might help.

That little bit of improvement may not look like much, but for a baby who physically can't open wide or lift their tongue to maintain a seal, those millimeters matter. The extra lift matters. The reduced tension matters.

So why make a blog post about this?

I wanted to make a post because I find oral function highly fascinating and it's impossible to appreciate oral function without geeking out at images that clearly show the impact tethered oral tissues has on anatomy.

When we know what we're looking for, we can better identify babies who are struggling.

The conversation is much larger than this one blog post but one I hope you'll join in on! Do you have some crazy before and after pictures of how bodywork and or revision improved oral function? If so I'd love to see them.