TETHERED ORAL TISSUES
Tongue-tie, Lip tie, TOTs, Tethered Oral Tissues, Ankyloglossia…
These are all very “hot” topics in the Breastfeeding world and are being talked about more and more within all of the supporting professions. The subject as a whole is also surprisingly controversial. In April of 2021, the Academy of Breastfeeding Medicine released an official statement questioning the validity of current diagnosis standards, opposing the diagnosis of a posterior tongue tie at all, and urging caution about surgical intervention.
While I’m absolutely not saying that research and caution are not positive actions, this statement unleashed some unfortunate consequences for breastfeeding families.Much of the allopathic world (covered through health insurance) used this information to refuse to diagnose or address tethered oral tissues in the clinical setting.I have been told by my personal friends who are hospital-based Lactation Consultants that they have been formally forbidden from evaluating an infant for tongue ties or from referring parents to outside sources for more help.Receiving the needed care to address subluxation causing tethered oral tissues and, if needed, having a surgical release of actual Ankyloglossia is often the difference between breastfeeding and not breastfeeding.
So… what are the key points in question?
The Over-Diagnosis of Ankyloglossia
True Ankyloglossia is defined as a condition in which an unusually short, thick, or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth.
Why does this happen? There are numerous studies emerging that suggest that the rise in prevalence of such defects seen in recent years may be linked to such factors as increased environmental toxins, excess unprocessed folate in the pregnant parent’s diet, and an abnormality in a gene called MTHFR- Methylenetetrahydrofolate Reductase. This mutation may cause this mid-line deformity in the developing embryo.
In contrast to true Ankyloglossia, another possibility for the appearance and functional pathology of a “tongue-tie” is the structural imbalance of the baby’s spine and cranium causing abnormal tethering of the tongue muscles at their attachment sites.
All muscles of the tongue originate on various points in the cranium (mainly the styloid process of the Temporal bone and the interior of the Mandible). Most of them insert onto the Hyoid bone in the anterior upper neck. Imbalance in these areas, caused mainly by birth trauma, traction these muscles and can mimic a tongue tie.
Recent studies have also called into question the diagnostic standards of Ankyloglossia; suggesting that there are more variations of normal frenulum tissue than there are truly abnormal tethered tissues.
The Possible Harmful Side Effects of Surgical Release (frenotomy)
The ABM statement and other recent studies caution against unnecessary surgical releases mostly due to the possibility of damaging the lingual nerve during the procedure.
What’s the lingual nerve?
The lingual nerve has branches that pass toward the midline immediately beneath the fascia on the ventral surface of the tongue, with smaller branches continuing onto the lingual frenulum. It has also been found that there are many variations of patterns of these terminal branches of the lingual nerve on the ventral surface of the tongue; making it difficult to predict their location.
The risk of temporary or permanent neural injury is higher when the incision is deep, is performed with any tool that utilizes thermal energy (a laser) which is absorbed into underlying tissues, and/or any procedure where the incision extends widely from the midline (a posterior tongue tie).
Should I be Worried?
Despite the negative consequences from these new viewpoints of possibly under-diagnosing Ankyloglossia and therefore denying truly needed care; there is a silver lining!
Several research articles outlined hesitations surrounding the frenotomy and encourage a holistic approach first. Surprising, the traditional medical establishment is actually advocating for a gentler, non-surgical approach before resorting to surgery.
What does that sound like?
Now… the accepted statements are most certainly NOT clarifying exactly what that “holistic” approach is. They are NOT specifically sending patients to the Chiropractor or the CST therapist or any other non-medical provider. Wouldn’t THAT be something???
However, what they do say (written between the lines) is that there is validity to the “structure/function” viewpoint; meaning that imbalanced underlying structure contributes to abnormal function.
*This is GREAT for all of us dedicated Chiropractors who have been working for years to communicate the efficacy and value of our care.*
So… what’s the bottom line?
What is the actual effect of this on the people that are affected the most- the babies suffering from birth trauma and neurological damage and their parents trying to feed them?
It appears to me that the door is opening a little wider leading to the inclusion of Chiropractic and Cranial therapy in the accepted model of care for Ankyloglossia and tethered oral tissues.
In my own social and professional circles, I am asked more and more about my advice and services in this arena. Other Chiropractors are contacting me, asking for help with their knowledge and skills because they are getting questions and referrals. Parents are talking about us on social media. Lactation consultants and Pediatric dentists are including us in their care plans for their clients. The word is getting out that we are getting results and helping babies to breastfeed!
The time is ripe to take our place in the accepted care team for breastfeeding support and the tethered oral tissue arena.
While this happens, be aware that the medical world will be watching.
More studies will be conducted.
Outcomes will be measured.
The time is also ripe for us to increase our skills and knowledge so that we can ensure the increased inclusion and access to our care. As more chiropractors become highly knowledgeable and skilled in very specific infant cranial work, then the medical community as a whole can recommend our care confidently.
More babies can receive the care needed.
More children will be breastfed for longer
More children will grow up healthier, physically, and emotionally, with less long-term neurological impairments.
Does that sound worth the work to teach and study and practice?
I think so.
To learn more about breastfeeding and the anatomy involved in infants and how it affects breastfeeding, real-life case studies with breastfeeding patients, a host of interviews with lactation consultants, diagrams, demonstrations, and visual examples to teach the global subluxation pattern – The Anatomy of Breastfeeding. This new, updated, accredited continuing education course is for Chiropractors who are looking to improve their careers, learn from leaders and experts in their industry, and looking for new opportunities! The course is approved for 10 L-CERP hours.