Children – 6 months to 16 years

Our approach for this age group is slightly different from that of infants under six months of age. There are four stages to the pathway:

Initial Assessment

At the initial appointment, one of our physiotherapists will assess your child’s oral function followed by a medical consultation and examination of the mouth. Where appropriate, measurements and clinical photographs may be taken. Options of treatment will then be discussed with you.

Pre-operative Feeding Therapy/Myofunctional therapy

The therapy in the weeks leading up to surgery will be about improving strength and stamina in the muscles of the tongue, working on normalising movement patterns. A tongue tie causes a structural restriction which has functional consequences. We will work with you to come up with fun and functional ideas to help your child learn normal movement patterns to replace any compensatory adaptations they may have developed.

Functional frenuloplasty under conscious sedation

This step is the surgery for the Tongue/Lip/Buccal Tie.

For this, we use conscious sedation. This means that although your child will be breathing for themselves they will have no memory of the procedure. They are kept comfortable by numbing at the base of the tongue using local anaesthetic. Throughout the procedure and for a period of time after, we will have them monitored using an ICU-grade monitoring system. For a child-friendly approach, we use EMLA numbing cream applied to the skin 40 minutes ahead of inserting the cannula for IV access. Your child will only be taken to the procedure room following the administration of the first dose of sedation so they will not be aware of having been apart from you during the surgery.

As your child is conscious during surgery we are able to elicit tongue movements and assess tone, so we are able to more precisely gauge how much fibrous tissue needs to be released for optimal function whilst creating minimal inflammation during the healing process. Both doctor and physiotherapist work together in surgery ensuring all tension has been released under the tongue. This is what differentiates a functional frenuloplasty from a tongue tie release under general anaesthetic as then the patient is fully unconscious and muscles flaccid.

The surgical site is held together using absorbable sutures so that there is no need for any active wound management post-operatively, minimising inflammation and discomfort.

Post-op myofunctional/physiotherapy

The work you will have been doing pre-op is continued and monitored so that we obtain optimal healing of the surgical suture line.