Many women choose to breastfeed their newborns, feeling that this is the best option for both them and their baby. However, what happens if this is unsuccessful due to the baby’s tongue-tie? Award-winning consultant head and neck / maxillofacial and oral surgeon – robotic and facial reconstructive surgeon Mr Konstantinos Karavidas explains how the condition can be diagnosed and resolved.
What are the common symptoms associated with tongue-tie and how can you diagnose this cognition?
Tongue-tie, or lingual frenulum, is a condition which is diagnosed immediately or in the first weeks after birth of a child.
The first diagnosis is usually made by midwives in the maternity units or by community health visitors. The most common symptom of tongue tie is difficulty in breastfeeding. Once this has been diagnosed, a referral will be made to a specialist surgeon in order to confirm the diagnosis and proceed with the treatment.
How is the diagnosis made?
The diagnosis is based on a thorough clinical examination, as well as on symptoms that the mother and baby may have during breastfeeding. There are several charts, scores and algorithms that can be used, but they are mainly used for communication between clinicians and in order to explain the problem and the diagnosis of the tongue tie to parents.
What are the surgical options available for treating tongue-tie and what are the factors that should be considered when selecting the appropriate procedure?
The main surgical option is a lingual frenectomy, which can be performed either with blunt scissors or with a laser. The laser is safe and minimises the risk of bleeding. It can allow the surgeon to be more invasive and achieve a much better result, avoiding any bleeding, recurrence or scarring under the tongue.
Before selecting the procedure, we must take into account the baby’s age, any comorbidities (other illnesses) that they may have or any known risk factors. The crucial fact is that the thickness of the frenulum can lead to a high risk of peri- or postoperative bleeding.
What are the potential risks and complications associated with a tongue-tie surgery? And how can you minimise this?
The most common risk of performing a tongue-tie release is bleeding, which can occur during the surgery or immediately after. I believe that it is important that the experienced surgeon can properly assess the risk before proceeding with the lingual frenectomy with a tongue-tie release, and they should utilise a laser during surgery, if possible.
If a laser is unavailable, they should use a cautery bipolar machine, which has the ability to stop and control bleeding during surgery. For this reason, an appropriate setting such as a hospital or a clinic, is preferable to any domiciliary visit or home setting, to perform the surgery.
How do you consult patients and their families on the expected outcomes of the surgery and what are some realistic expectations they should have?
Following tongue tie surgery, we hope to establish a rise in successful breastfeeding for the mother and baby. The success of breastfeeding post-posterior tongue-tie surgery normally rises to 80%. This is well established with audits that we've done in our department, where we treat 500 babies per year, 50% of whom have posterior ties.
With regards to the more anteriorly positioned tongue-ties, the outcome is usually very reasonably successful, rising higher than 90%.
What are some post-operative care measures that should be taken to ensure optimal healing and recovery?
If the surgery is successful and I have achieved the diamond-shaped defect under the tongue, I advise the mothers to try to successfully feed their babies, whether this is through the breast or through the bottle; that's all I feel that the babies need.
I'm not a strong believer in tongue exercises, as I feel that once the procedure is done properly, the incidence of scarring is extremely minimal
If you would like to book a consultation with Mr Karavidas you can do so via his Top Doctors profile today.