I want to thank everyone for taking the time to respond to this question.
The answers were very interesting.  I would be interested to hear from
others who reccomend CST after clipping and how they perceive the results.
I have reccomended it but I do it something like this - there are other LCs
that reccomend that every baby have CST after frenotomy."  It is hard for me
to suggest to women to pay for one more thing especially something that I
don't understand at all - I know that there was a recent CST thread,
I haven't managed to read it yet.  They have already paid me - at least once
-  and the dentist who does the procedure.  One of the things that
encourages parents to choose frenotomy for their baby is that it is such a
quick simple procedure.  Maybe it shouldn't be so quick and simple to get
the  job done right.
Jennifer O'Quinn, did you read the response I got from Lisa Marasco.  It is
very interesting.
All the best to all of you,
Chayn in Israel IBCLC

On Wed, Nov 19, 2008 at 5:10 PM, Jennifer O'Quinn <[log in to unmask]>wrote:

> Cahyn,
> I was just looking through the archives and I don't know if anyone
> responded to your
> post.
>
> I posted awhile back about a son of mine who was tongue-tied who I could
> not find a
> provider 16 years ago willing to clip for breastfeeding, and then later for
> speech issues,
> who subsequently developed a large tongue, sleep apnea, and bed wetting.
>
> I believe the bed-wetting came from the sleep apnea which I believe was
> caused by the
> large tongue, and I think the large tongue developed as a result of having
> to work too
> hard to move because it was extremely anchored to the floor of the mouth.
>
> I came to this conclusion after watching a lecture by Brian Palmer DDS. I
> am not sure if
> Brian Palmer is as sure as I am about his own theory- of a large tongue
> developing as a
> result on extreme tongue-tie, but I have a large enough family that I
> believe if the large
> tongue was just the result of genetics somebody else would have one, and
> no-one else's
> tongue even comes close- the tongue is freakishly big.
>
> The only other family member with an extremely large tongue is not in our
> immediate
> family, and he too is extremely tongue-tied and has snoring and even
> snorting issues in
> the daytime from an obstructed airway.
>
> About 6 months ago I finally talked a provider into giving my son a
> frenectomy. My son
> was so tongue-tied he could not clean food out of his vestibules with his
> tongue like
> everyone else (the pockets between the cheek and gums) and he was also
> asking for a
> frenotomy because...well, because, he is a teenage boy....
>
> The oral surgeon was very skeptical that it needed to be done but once he
> got into the
> surgery he did a lot more lasering/cutting than he had planned, and he was
> positively
> gleeful in describing the surgery to me afterward because he knew it was
> going to change
> my son's life.
>
> My son had a frenectomy with a surgical revision but only a few stitches.
>
> My son did notice an immediate improvement in mobility- he described his
> tongue as
> feeling "light" before the anesthesia had even worn off...BUT the scar
> tissue he has
> developed overtime has lead to a regression.
>
> I think what he needs is a z-plasty...more of a surgical revision so that
> the tongue is
> lifted off the floor of the mouth further back and he is sutured
> extensively so that the
> improvement is permanent.
>
> This problem is vexing me professionally as well because I have a client
> with a 3 month
> old who has had a simply frenotomy with no improvement. The baby has an
> older sibling
> who had a swallowing disorder that was treated with a z-plasty.
>
> I think if moms see an immediate and permanent improvement with
> breastfeeding after a
> simple incision of the frenulum, or an small excision of the frenulum with
> modest
> revision- just a few stiches- their babies had mild to moderate tongue-tie
> and their babies
> got the surgery that matched their condition.
>
> I think in cases where there is obviously a tongue-tie but the simple
> frenotomy or
> frenectomy provides no relief to the mother or there is a regression, the
> baby is
> extremely tongue-tied and is really in need of a z-plasty.
>
> So my question is are z-plasties ever done on babies?
>
> Are there problems with breast refusal after the surgery?
> (my son said his surgery while not as extensive as z-plasty was extremely
> painful and he
> did not know how a younger child or baby could cope with it)
>
> If the baby is going to develop swallowing issues later does it make sense
> to take the risk
> with anesthesia and pain in the young baby with the hopes of improving
> breastfeeding
> because the baby is going to need the surgery in a matter of months anyway
> when solids
> are introduced?
>
> Anyway I am still in the information gathering stage of forming my opinions
> about the
> subject, and I have my leanings, but I would like to hear from other
> lactnetters about
> their personal and professional experiences with frenotomy, frenectomy and
> z-plasty,
> so I can help my client with the extremely tongue-tied baby.
>
> Jennifer O'Quinn IBCLC
>
>
>             ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: set
> lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome
>

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome