From the Guidelines
Lip and tongue tie release in school-aged children can be beneficial when these oral restrictions cause functional problems with speech, eating, or oral hygiene. The procedure, called a frenectomy or frenotomy, involves cutting or removing the restrictive tissue (frenum) that limits movement of the tongue or upper lip. For school-aged children, the procedure is typically performed under local anesthesia in a dental office, though more complex cases may require sedation. The actual procedure takes only minutes, with the dentist or oral surgeon using surgical scissors, a scalpel, or laser to release the tight tissue. Post-procedure, children usually experience mild discomfort for 1-2 days, manageable with children's acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) 1. Some key points to consider include:
- Stretching exercises are crucial for preventing reattachment, typically performed 4-6 times daily for 2-4 weeks.
- These exercises involve gently lifting the tongue or lip to stretch the wound area.
- Speech therapy is often recommended following the procedure to help children develop proper tongue movement patterns, especially if speech issues were present before the release.
- The decision to perform a tie release should be based on functional impairment rather than appearance alone, with a team approach involving dentists, speech pathologists, and sometimes lactation consultants providing the best outcomes. While the provided evidence does not directly address lip and tongue tie release, the principles of evidence-based practice and clinical guidelines can be applied to this topic, emphasizing the importance of functional assessment and multidisciplinary care 1. However, it's essential to note that the provided studies primarily focus on tonsillectomy in children, which is a different procedure, but the general principles of evidence-based practice and patient care can still be applied. In the context of lip and tongue tie release, the most recent and highest quality studies should be consulted to inform clinical decisions, but based on the available information, a functional approach to assessment and treatment, considering the impact on speech, eating, and oral hygiene, is recommended.
From the Research
Lip and Tongue Tie Release in School-Aged Children
- There is limited research on lip and tongue tie release in school-aged children, with most studies focusing on infants and young children.
- A study published in 2024 2 found that laser-assisted frenectomy combined with myofunctional exercises can be an effective treatment for pediatric tongue tie, resulting in improved tongue function and speech outcomes.
- However, a study published in 2020 3 found no significant difference in tongue mobility and speech production outcomes between children with and without tongue tie, suggesting that surgical intervention may not be necessary for speech production outcomes.
Treatment Options
- Laser-assisted frenectomy is a treatment option for tongue tie, which has shown promise in pediatric cases due to reduced bleeding, minimal discomfort, and faster recovery 2.
- Myofunctional exercises can be used in combination with laser-assisted frenectomy to improve tongue function and speech outcomes 2.
- Surgical release of tongue-tie and lip-tie has been shown to improve breastfeeding outcomes in infants 4, but its effectiveness in school-aged children is unclear.
Outcomes
- Improved tongue function and speech outcomes have been reported in children who underwent laser-assisted frenectomy and myofunctional exercises 2.
- No significant difference in tongue mobility and speech production outcomes were found between children with and without tongue tie 3.
- Surgical release of tongue-tie and lip-tie has been shown to improve breastfeeding outcomes, including increased breastmilk intake and reduced nipple pain 4.