Take note of what the incisions look like immediately after the procedure (Taking a photo after the first stretching session is a great way to do this.) Watch for any changes to the shape. The edges of the diamond should stay sharp. If it begins to look muddled or “tucked in”, or you see tissue protruding from the base, there may be some reattachment starting. If you are concerned it has reattached be sure to pay extra attention to that area, using a slightly firmer pressure during the stretching session. You will likely be able to release it yourself with your fingers. (It might bleed a little, that's okay, sucking or ice will stop bleeding). A small amount of reattachment is expected but we want to minimize as much as we can.
Remember, often the appearance of healing tissue may look like reattachment. However, if there is an improvement in function, the objective of doing the procedure has been delivered and your child may not need further intervention.
Checking for Reattachment with Every Set of Exercises
You should notice the wound is a diamond shape after the release. It is important that you maintain the diamond shape until it is completely healed. We want the wound to heal as open and soft as possible. Look at the diamond each time you stretch. The diamond is composed of an upper triangle and a lower one that is upside-down. We want the lower half to be as open as the upper half and we want the entire diamond to be away from the gumline. The new frenulum that forms with time should be mid tongue attached to the middle of the floor of the mouth. If the diamond is shrunken or not even from one side compared to the other, there may be reattachment happening. Try to open it back up with a firm push down on the area. Remember to use topically applied benadryl or Tylenol for pain if you need to do a firmer exercise to open it up. Please let us know and make a recheck appointment so we can check the healing again.
What to Expect
Some patients can get frustrated after the procedure. Remember that you are learning to use their tongue in a new way. This can get overwhelming and just takes time and patience. You and your baby/child may be using muscles that were restricted or not even developed and definitely not used before. It is just like any other muscle. When you finally start to use them, they are weak before they become strong. So the first week your child may become frustrated with this process until their muscles become strong and they figure out how to use them. The most important thing is keeping calm and continuing to be encouraging to keep working at it.
Time for success varies although we do see some immediate success after the procedure, most patients take 2-3 weeks before seeing more significant results. We have also found some patients can take up to 6-8 weeks to show improvement. Continuing with therapy (lactation and/or bodywork) may speed up this process. Please keep in mind that some patients require multiple sessions after the release of tethered oral tissues. Remember, if there is also muscular tension in the floor of the mouth, jaw, neck, shoulders or back then it is important to seek out an experienced Bodyworker to help with relaxation and avoid reattachment. If your baby or child continues to have weak muscular issues then we would recommend an in-office evaluation by our Occupational Therapist, Ora Duben. Please let us know if you feel this would be helpful. We will also assess the need for this service at the 2 week follow-up visit.
It is normal to see a small amount of bleeding, especially if there is some reattachment that releases with the stretching and massage exercises. Sucking/Breastfeeding your baby will help any of the bleeding to stop. Children and adults can apply pressure to the wound with a clean wet cloth or wet gauze for several minutes, use an ice cube or cold wet tea bag on the site for 20 seconds to stop bleeding. Please let us know that this is happening so we can further assist in the healing process.
Following up with a lactation consultant 2-5 days after the procedure will make a big difference. Even if your child is bottle fed, a lactation consultant can still help with feeding. We also have Occupational Therapy as an option. Your lactation consultant is the person to contact if there are any issues with latch, pain, frustration at the breast, oral aversion, and any other feeding related issues. We all work as a team so you and your child can have a successful experience with feeding.
Team Tongue Tie specializes in releasing all ties in the mouth and can help you with pain management, aftercare, and supporting you and your child after the procedure. Please reach out to us as needed.