I've been waiting to address this until I had a little time. I feel
crippled on Lactnet because I can't show photos and videos to go along
with my words! (You can find more explanation of posterior tongue ties
and some photos in the following article -
http://www.aap.org/advocacy/bf/8-27newsletter.pdf )
Posterior tongue tie is a short, restrictive lingual frenulum that does
not extend to the tip of the tongue. Dr. Griffiths classified tongue tie
by the extent of the frenulum under the tongue body - 100% to 0%. 0% was
still problematic if it was fibrous and tight! (personal communication,
the peer reviewers refused to have it included in the published
articles). Dr. Coryllos, who I work closely with, independantly
developed a four part classification system as well, and has also
treated 0% / type 4 tongue ties with good success. Mukai published a
classification system as well, with the attachment to the tongue as well
as the location of the frenulum on the floor of the mouth as variables.
Most physicians who divide frenula in infants snip the frenulum just
below the tongue, to avoid injuring the orifices of the salivary glands
on the floor of the mouth. Some divide frenula midway between the tongue
and the floor of the mouth. Dividing a posterior frenulum is very
similar to dividing an anterior (full tongue length one), just a little
farther back on the tongue. The exception is the type 4/ zero percent.
That just gets a tiny snip, again against the base of the tongue, and
opens up into quite a large opening that heals spontaneously.
Hope this answered your question. This is a complex issue, and we don't
have all the answers, though I have been following the sucking
compensations that each classification of tongue tie engenders...
Catherine Watson Genna, IBCLC NYC
Coryllos, E, Genna, CW, et al: "Congenital Tongue-tie and its Impact on
Breastfeeding" AAP Breastfeeding Section: Breastfeeding, Best for Baby
and Mother Summer, 2004
Griffiths, DM Do tongue ties affect breastfeeding?, J Hum Lact, 2004
Nov. 20(4):409-414
Hogan M, et al; Randomized, controlled trial of division of tongue-tie
in infants with feeding problems. J Paediatrics and Child Health
41:246-50, 2005 (also by Griffiths' group)
Mukai, S et al: “Ankyloglossia with deviation of the epiglottis and
larynx.” Ann Otol Rhinol Laryngol Suppl 153, 1991 May, p. 3-20.
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