Lip Tie Information

What is a lip tie?   

Just like a tongue tie, everyone has a lip tie.  The vast majority of lip ties also have a tongue tie. The question we should be asking is if the lip tie is restricting the function of the lip muscle.  The tie itself is a small band of tissue (a frenulum) that connects the lip to the upper gumline. It is made of collagenous fiber that does NOT stretch.  The tissues and muscles around the tie may stretch to accommodate the ties, but the actual tie does NOT stretch.  It should be located in the middle of the upper gumline and connect to the lip close to the bony part of the gum line.  When the lip is flipped up to the nose using your index finger and thumb to hold on either side of the tie, the tie itself and the gum line attachments should stay pink and not turn white which is called blanching.  This should also not be painful.   If the attachment is short and tight or inserted near the middle or edge of the lip border then the lip cannot function properly. In breastfeeding or bottle feeding, lips are just meant to rest and create a soft seal to prevent air from entering.  Babies should not have an upper lip muscle which can form if the baby has been trying to use the lip to compensate for lack of tongue function.  We often see babies grabbing onto the breast or bottle with the lip muscle and actually trying or move the lip in the wave-like rhythmic motion instead of using the tongue muscle.  This develops a stronger attachment and thicker lip tie and also encourages abnormal development of cheek or buccal ties, discussed in the next section. Normally, a thin lip muscle will develop with use of a spoon for eating solids and is used for some letters in speech like P and B.  Lips should be horizontal and symmetrical resting flat with the soft pink parts up, not curled under.  A tight lip tie will cause the upper lip to pull up in the center and look more like a triangle.  When looking at a profile, the upper lip should come straight down from the nose and meet the lower lip and be in line with the forehead and lower jaw angle.  The abnormal triangle upper lip shape causes the mouth to rest open and makes it difficult to use the lip to form the letters or eat solids. The younger this attachment is released, the more normal the lip forms and develops over time.  It is always easier to look for a lip tie so trained professionals tend to start there.

 

What are problems or symptoms that a lip tie can cause?

Lip ties can cause problems with breastfeeding because when the lip is restricted it can prevent the mouth from opening fully to the 180 degree angle which allows the tongue to feed correctly.  It can cause nipple pain for Mom, lip blistering for baby, and persistent shallow latch problems. If the lips are not correctly sealed on the breast or bottle, baby will swallow lots of air which causes excessive gas or colic issues.  If babies or children continue to use their lips incorrectly, they will also develop a lower lip tie which is NOT a normal tie.  A lower lip tie will develop to balance out the of the tongue tie pull from the inner gum line or from using the lower lip muscle to abnormally suck.  Different problems may also occur later in life, such as eating problems, speech problems, and dental issues.  A lower lip tie causes gum recession with aging.  Once the gum has receded then the options for treatment are gum grafting with is costly and painful. Research shows that a lip tie procedure is a safe and effective treatment and helps improve air swallowing and reflux issues related to this.

 

How are lip ties treated?

The procedure to cut a lip tie is called a labial frenotomy.  When scissors or a scalpel are used to cut a lip tie, it always bleeds because there is a thin layer of tissue over the tie.  It is also difficult to remove all of the tie with scissors and it often reattaches and forms a thicker, stronger tie.  A revision of a scared lip tie is much more challenging and painful, and frequently has more bleeding. Sometimes you will hear misinformed people say, " Just wait for it to tear on its own." This will never fix a lip tie.  When a lip tie tears as a result of an accident or injury, the overlying tissue covering the thick collagenous fiber tears and most of the lip tie is still present. This is horrible medical advice and we never recommend to injure yourself and allow the body to fix itself after an injury without appropriate medical evaluation and treatment.  When the tissue rips under pressure, it is very painful and bloody, often requiring an Emergency Room visit.   It is much safer to release the tie in a controlled environment with a laser.  The laser procedure to remove a lip tie is called a labial frenectomy.  In our office we perform this procedure with a CO2 laser which is safer, less painful, and more complete than clipping with scissors, or heating and destroying the tissue with a diode laser.  The CO2 laser frenectomy is  done in our laser safe procedure room in our office. We apply a topical anesthetic, then use a cold laser to anesthetize the area. The cold laser is painless and helps control pain and aid in healing. The procedure itself is takes a few seconds and your baby can go straight to the breast afterwards.  Remember, your baby does not need a lip to breastfeed but will be a bit confused with a numb lip while latching.  Many mothers feel less nipple pain and a better latch almost immediately.  After the procedure, some infants may feel pain for 1-3 days which can be managed. Although it is a minor procedure, as with any surgical intervention, it does have some risks, including but not limited to bleeding, pain, allergic reactions, temporary numbness, injury to the mouth, scarring, or reattachment.