We know that it can be difficult to find the right health professional to provide release of a tongue and lip tie, particularly for young children, adolescents and adults. Our focus is for children aged 3 and up, including adults.
For infants and younger children, we recommend that you seek the advice first from your child’s other healthcare providers such as their GP or Paediatric Physician, Lactation consultant, or Speech Pathologist. We welcome referrals from these providers, and we also welcome direct booking requests from parents and caregivers should you prefer to deal with us directly. The Royal Melbourne Children’s Hospital has an excellent guide for parents about tongue ties available for parents who breastfeed.
What is a Tongue and Lip Tie?
Tongue and lip ties are a developmentally unique feature of your child where a band of soft tissue has formed in a way that for some, restricts free movement of the lip or tongue or cheek. Normal anatomy comes in a wide range of variations and these differences should not be mistaken for “problems”. For most people, these anatomical features have no practical impact on daily life or on their general health. For some however, they may be a significant problem for speech, eating or undertaking certain mouth, tongue or lip movements or for the effective performance of oral hygiene.
There is substantial evidence that for some, their tongue and lip ties will “fix” themselves with normal growth and development. With growth, the tie may “move” away from the ridge of the alveolus and no longer interfere with certain activities and movements. Because of this, we will always assess the unique condition of the patient and make a clinical judgement as to benefit, risks and necessity of the procedure. We find only a small percentage of cases presenting to our clinic meet our criteria for surgical intervention.
Please be aware, we view the treatment of Lip, Tongue and Cheek ties from an evidence based medical therapeutic context.
Assessment of the Child and the Tongue and Lip Tie
We are not experts in breastfeeding and do not claim to be. It is recommended that you are comprehensively assessed to ensure that treatable breastfeeding issues for the dyad are dealt with first. We recommend speaking with your GP, community health clinic or IBCLC as appropriate. If you need further assistance, in Brisbane we recommend Possums Clinic for comprehensive, evidence based, expert assessment (https://possumsonline.com/ tel: 07 3177 2000)
One of the most important considerations for us is the psychological impact of the procedure on the child. All procedures undertaken by us will be performed with a local anaesthetic, usually requiring two small injections into the surgical site. The procedure will require the patient to remain still and compliant for approximately 20-30 minutes and permit us to gently touch their face, lips and tongue during that time while we perform the procedure. We are able to offer nitrous oxide inhalation sedation for suitable cases, but not all children may be suited for this approach and may be better suited to treatment under intravenous sedation in a hospital as a day-surgery case. We can make the necessary arrangements for this if required. The child’s interests come first with us – if it is thought that the case would be best treated by a Maxillofacial Surgeon or Ear Nose and Throat Surgeon, a referral for consultation will be offered.
It is our policy that we will not perform this procedure on the same day as the consultation. We wish you to provide proper consideration of the risks and benefits of surgery prior to consenting to the procedure.
The Procedure
There are two basic types of procedure – frenectomy and frenotomy. In lay terms there is not much difference. What is more important than the label is the outcome. Surgical division of the tie to promote improved function and to minimise scarring and pain are the real objectives. For children aged 3 and up, the procedure is more complex than a simple “snip” with a pair of scissors. We perform conventional (scalpel) and more commonly, electrosurgical procedures. Electrosurgical procedures produce similar results to those achieved by laser by providing precise cutting of tissue and minimising bleeding. Across the world, only a minority of frenectomy procedures are performed by laser due to the high cost of the purchase and operation of surgical lasers. Electrosurgery is a widely used technique used in all forms of surgery performed in hospital with safe and predictable results. The practice by some providers of simple tissue cutting by laser or scissors can leave a large wound – this is painful, is prone to healing back onto itself (necessitating painful exercises) and is also prone to scarring and contracture in some cases which contributes to an unfavourable outcome.
We ensure all procedures are undertaken with due consideration to minimise scarring and discomfort. The complexity of the tie will determine our surgical approach. Some ties may require stitches to be placed, some may not. Simple ties will heal rapidly, with minor discomfort for only a few days, while more complex procedures may cause a degree of bruising and swelling, need sutures and have slightly longer healing. We will discuss our approach with you during the consultation so you are clear. Due to the surgical techniques we utilise, we do not recommend any particular “exercises” or movements after the procedure and recommend that the tissues be allowed to heal naturally. Once the soft tissue healing is complete, we encourage an early return to the Speech Pathologist to continue with their therapy.
Postoperatively, we may recommend the use of conventionally trained Speech Pathologists and Occupational Therapists as necessary. Please note that it is our professional view that there is no proper regulation of the workers calling themselves “oral myofunctional therapists” and their training and experience varies widely – we are uncertain as to the quality of the scientific basis of their practices and do not encourage their use. We also do not refer to or recommend the use of chiropractors or osteopaths for the post-operative therapy due to philosophical differences in treatment approaches.
Most procedures are complete in 20-30 minutes, including local anaesthetic and discharge advice but we will discuss your specific circumstances at the consultation.
From the practical perspective, it is required that a competent adult caregiver be with the child for the whole day of the procedure (before and after) to attend to their social and support needs.
Fees
We are committed to excellence in clinical care. Our fees reflect the investment in equipment, materials and staff needed to achieve this. For these procedures, we have an experienced surgical Registered Nurse attend to provide clinical assistance to the Dentist during the procedure.
Medicare Child Dental Benefits may be payable for the consultation (if eligible) but no Medicare benefit is available for the procedure.
Some health insurers may pay a benefit for the procedure though the amount covered will vary by policy. We recommend you discuss your rebate directly with your health insurer as this is not within our control.
Most treatments would occur over several visits, with dental items:
- 014 – Comprehensive examination or Consultation. $52.65. (Note: This fee is specific for tongue and lip consultations in this practice.)
- 391 – Frenectomy. $280 for the first procedure at the surgery appointment. Subsequent procedures performed at the same appointment will have their fee to be detailed at consultation based on complexity.
- 943 – Sedation – inhalation – per 30 minutes or part thereof. $98. (Nitrous Oxide laughing gas – if required).
Procedure 391 includes routine post-operative care without charge, usually with one or two short followup visits as indicated.
Bookings
We welcome your enquiry or booking. We also offer a no-cost familiarisation visit so that the child can meet us as real people in our workplace so that they have less anxiety at the consultation and procedure visits.