Frenectomy at the age of 28

Written by Reica Aprilyana, MD

 

Tongue-tie or also known as ankyloglossia may have been heard recently in Indonesia, especially in pregnant women or breastfeeding women. Tongue-tie might disturb the baby’s ability to suckle to the mother’s breast, which results in less breastmilk intake.

While nursing difficulties may appear as the result of tongue-tie in baby, it also affects an adult’s quality of life. Further problems in adulthood, for example, are difficulty in feeding (eating), picky eater, long duration in feeding due to chewing difficulty, less oral hygiene, struggle in pronunciation and spelling, neck pain and back pain. Moreover, the asymmetrical postureproblem might exist in relation to tongue-tie.

The tongue is a complex organ composed of 8 muscles that are involved in feeding, breathing, speaking, sleep, posture, and many other essential functions. The ideal tongue function and muscle rest postures also provide a mold for proper growth and development of dental arches and facial/airway development.2

A tongue-tie exists as the results of failure in lower tongue tissue development to completely resorb during development. This process is known as apoptosis (programmed cell death) that take place  around the 12thweek in utero. The frenum formed when the tongue moves posteriorly (backward) from the primitive jawbone, and it holds the tongue in the correct position. At a later stage, it is then supposed to disappear. A common example of apoptosis is the gradual disappearance of the ‘tadpole-like tail’ that occurs as the human embryo develops. A fault in the apoptotic process may leave a string under the tongue, which commonly attached too high on the gum or under the tongue. Another variation of faulty apoptosis occurs when the string has mostly disappeared, but the tissue is tighter or less elastic than it should be. This more restrictive tissue can lead problems similar to those of the classic tongue-tie. The example above of webbed fingers is also known as syndactyl, which also resulted from a failure tissue apoptosis.2

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Case

I am a medical doctor and a mother from a daughter (14 months) who lived with tongue-tie for 28 years. I decided to undergo a frenectomy because I had a problem in chewing some foods. I could only chew foods on the left side of my mouth and could not use the right side. Therefore, eating was a tiring activity for me and the duration was also too long. It took around a minimal 30 minutes and might even last longer. Furthermore, I often bit my tongue and the cheek mucosa, which then leads to thrush formation. I always had gingivitis because I could not clean the gum with my tongue. Moreover, due to my difficulties in chewing some foods, I ate less often which then resulted in lower BMI (underweight). During speaking some words were not clear especially in pronouncing R and L. Other activity that I found to be frustrating was driving a car. I often felt neck pain and it radiated to my shoulder. I also could not sleep well because every time I woke up, I felt the neck pain and dry throat due to mouth opening during sleep (mouth breath).

Fig 1. Pre-Frenectomy

Prior to frenectomy, an examination was done by a oral surgeon and the result was that my tongue was already in atrophy stage. The oral surgeon then did the frenectomy. The simple frenectomy was done on the dentist chair without operation room. Before the procedure, the local anesthesia was given to the tongue and frenulum via lidocaine injection. The tongue was cut by a scalpel and then the wound was stitched by silk and needle. Overall it took 7 stitches and the Gengi gel, that composed of Hyaluronic Acid, was applied to the wound. At the end the surgeon suggested me to eat some ice creams, move my tongue frequently, and prescribed analgesic and Aloclair gel. The surgeon told me that the stitching wound would be removed on the 8thday.

Fig. 2 First day post frenectomy

On the 1stday after the frenectomy, I could eat as usual, however the tongue movement was restricted due to the pain after the operation. Sadly the anesthesia wound became a thrush. Nonetheless, the first thing after frenectomy that I could immediately feel was my tongue ability to touch the palate as my mouth in closed position. Moreover, as I woke up my neck pain was gone. I felt more relaxed than before. In the meantime, I often applied Aloclair and exercised my tongue up, left to right, sticking out the tongue to the front, singing, pronounce the alphabets, reading the Holy Qur’an and eating ice cream.

Fig. 3. Two weeks post frenectomy

On the 8thday, the stitching wound was removed. At this stage, the tongue movement was more flexure and my duration of eating was faster than before. The surgeon also prescribed me a gargle for the thrush.

Two weeks after the procedure, I felt well rested as my sleep was in higher quality. I could eat faster, and while I was eating, I never bite the tongue and the mucosa anymore. This happened because I could move my tongue well and my jaw never felt sore or pain.

Fig.4. One month post frenectomy

In addition to my case, my brother had also felt the same. He was 24 and also did the frenectomy by the same surgeon. My brother had an anterior type of tongue-tie with the complication of asymmetrical jaw and disorder temporomandibular joint (TMJ).

My daughter was born with an anterior type of tongue-tie. There was a breastfeeding difficulty, which resulted in crack nipple. Fortunately, she got frenotomy when she was 1 day old.  I succeeded to breastfeed my daughter up until now (14 months).  I am grateful that her growth and development are normal.

Fig 5. Lip-Tie grade 4 and Anterior Tongue-Tie

 

Case Discussion

Tongue-tie’s symptoms would not only be observed in baby, usually the mother who breastfeeds their child with tongue tie had a crack nipple, pain while breastfeeding, less effective in emptying the breast, and breast infection. Tongue-tie’s symptoms also directly affecting the baby such as, poor weight gain, falling asleep while nursing (because the babies with tongue-tie have to exert much effort in breastfeeding attempt compared to normal babies which resulted in fatigue), poor quality of latch, reflux and colic, gumming or chewing the nipple, lip blisters, short sleep episodes. 1

Tongue-tie will affect the quality of life until adulthood. This occurs commonly as the child starts to eat, and they will have difficulties in chewing some foods. To make things even worse, the parent often labeled their child as a picky eater. Tongue-tie also affects speech, such as speech delay. Some alphabets were more difficult to pronounce such as T, D, N, L, R, S, Z.

Neck pain occurred because a restrictive tongue pulls the hyoid bone in the neck upward and puts tension on all of the connective tissue or fascia in the neck, which is connected throughout the whole body. Neck tension, pain and range of motion often improve significantly after a tongue tie release.2

In the end, as a mother who breastfed a baby with tongue-tie and as a former tongue-tie patient, all these experiences could be regarded as valuable life experiences. Although the tiny string under the tongue looks insignificant, to me it is very important. This tiny string might disturb the quality of life as we grow up. When the baby nurse to the mother, the breastfeeding will never feel comfortable to the mother and resulted in poor weight gain. This will directly affect the baby and unfortunately, the mother will also go through a stressful experience. Furthermore, a higher chance to fail in breastfeeding for 2 years period will be likely to happen. As the baby enters the feeding stage, they might have difficulty in chewing some foods, and it will likely to stay until adulthood. I feel so bless and so lucky because I had my daughter’s tongue tie release (frenotomy) immediately on the first day of her life.

“It’s Never Too Late to Have A Tongue Tie Released” – Richard Baxter

References :

  1. https://www.drghaheri.com/blog/2014/2/20/a-babys-weight-gain-is-not-the-only-marker-of-successful-breastfeeding

Baxter, Richard. 2018. Tongue Tied – How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding and More. A

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