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Tongue-Tied Adults

Lingual Frenuloplasty

Ankyloglossia is also known as a tongue-tie. This condition restricts the range of motion of the tongue due to the frenulum. The frenulum is a thin membrane seen under the center of the tongue; It is either too short or too tight if you are tongue-tied. In the early stages of life, a mother may experience trouble nursing if her infant has a tongue-tie. If not noticed in infancy, young children with tongue-ties may have difficulties when transitioning to solid foods or have speech pronunciation problems. An adult with a tongue-tie may experience neck and shoulder pain, snore and/or have sleep apnea.

Treating Tongue-tie

Research has found that there is a link between the tongue and sleep disorders. Dr. Smith has spent hundreds of hours studying the tongue; has become an Ambassador in adult tongue-tie release surgeries with The Breathe Institute under Soroush Zaghi. MD and has trained in pediatric & infant tongue-tie release surgeries with Matthew Rowe, DDS. Dr. Smith is also a Diplomate in dental sleep medicine and a Fellow of the American Academy of Craniofacial Pain.

The tongue accounts for approximately 40% of the issue when it comes to snoring and sleep apnea. When you are awake and asleep your tongue should always rest at the top of your mouth. Some people can get the tip of the tongue to the roof of the mouth, but the frenulum holds the remaining portion of the tongue to the floor of the mouth. Therefore, the back of the tongue cannot rest at the roof of the mouth. During sleep for a non-tongue-tied individual, the tongue forms a strong suction to the roof of the mouth. For a tongue-tied individual, at best, only the tip of the tongue is touching the roof and suction does not occur. As one falls asleep, your muscles begin to relax causing the tongue and soft tissues to collapse, blocking the airway partially or completely causing snoring and sleep apnea.

tongue suction1.jpg

In addition to contributing to a sleep disorder, it is common for a tongue-tie to cause craniofacial pain. The human body consists of fascia. Fascia is bands or sheets of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscles and our internal organs. Your fascia starts in your mouth at your frenulum! When dissected the fascia in your tongue has been found to be connected all the way down to your toes! The muscles in the head and neck are not able to function properly and must compensate in their restricted movements because of a tongue-tie. This compensation causes tension through your entire body, but especially in the head and neck. The tension not only causes stiffness and pain but may cause headaches.

The procedure

Treating tongue-tie is a team effort. Our team includes a myofunctional therapist; a psychologist; and our dentist with a specialty in orthodontics, a fellow in craniofacial pain, diplomate status in dental sleep medicine, and advanced infant and adult training in tongue-tie treatment.

To start your treatment Dr. Smith and his team will perform an IOPI test to measure the strength of your tongue. You will then schedule an evaluation of your orofacial function by our myofunctional therapist. Myofunctional therapy consists of approximately   15-30 weeks of therapy to train your mouth, lips, and tongue to work normally and to eliminate the compensation that you have developed over the course of your life. The myofunctional therapist will work with you to reverse those habits and get your muscles moving the correct way to prepare you for your tongue-tie release.

The relatively minor surgical procedure is done in office. You will be awake; However, Dr. Smith will use an injection of a topical and local anesthetic to numb the tongue. The procedure is generally quick taking about 45 minutes.  A frequently asked question is whether we perform the procedure with laser or scissors. Our technique is based on precision: releasing the appropriate extent of tissues for maximal relief -not too much and not too little. Scissors causes no thermal tissue damage as compared to lasers. Lasers limit how deep you can go which often results in an incomplete release that does not effectively address submucosal posterior

tongue-tie, causing excessive scarring that results in worsening tongue mobility. Throughout the procedure, Dr. Smith will have you perform some of the myofunctional exercises to monitor tongue mobility. When the procedure is complete Dr. Smith will suture the underside of the tongue.

Following the procedure, you will be given a numbing gel to help alleviate any discomfort. After the procedure, you will be expected to perform light tongue exercises. One week post up you will begin the post-op myofunctional therapy.

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Tongue-tie is diagnosed in 4 grades. Grades 1 and 2 are thought to be posterior whereas grade 3 and 4 are anterior. The grade however does not technically determine the severity.
Grade 1
The lingual frenulum does not tribute to any major mobility restrictions. 
The lingual frenulum is not seen. This is the most commonly missed tongue-tie. The sides and tip of the tongue are able to elevate however the middle of the tongue is tied to the floor of the mouth.
Grade 2
The lingual frenulum connects to the tongue just below the tip of the tongue. The heart shape is not present however the tie is still very clear.
Grade 3
The lingual frenulum connects at the tip of the tongue and when the tongue is raised shows the classic heart shape. This is usually the only tongue tie that is caught by medical professionals that are not familiar with tongue-ties.
Grade 4
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