Our approach for this age group is different from that of infants under six months of age. There are four stages to the management:
This is a medical consultation and clinical evaluation of the mouth following a review of your child’s history. Where appropriate, measurements and clinical photographs may be taken. Options of treatment will then be discussed with you.
At the initial therapy appointment, we will assess your child’s oral function in order to make a therapy plan for the weeks leading up to surgery. A structural restriction will have a functional consequence so 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.
This plan can then be monitored through in-clinic visits, Zoom-type consultations or video and email reviews as best suit the family and child.
This step is the surgery for the Tongue/Lip Tie.
For this, we use conscious sedation using IV Midazolam. This means that although your child will be breathing for themselves, unlike when using a General Anaesthetic, they will be unaware of what is going on and have no memory of the procedure. They are kept comfortable using local anaesthetic. Throughout the procedure and for the period following, 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 for the healing process. Both doctor and physiotherapist work together in surgery ensuring all tension has been released under the tongue which is what differentiates a functional frenuloplasty from a tongue tie release under GA when 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, meaning there is less inflammation and a more comfortable patient.
The work you will have been doing pre-op is continued and monitored so that we obtain optimal healing of the surgical suture line. Again this can be done through a combination of clinic visits or Zoom-type consultations.