As the originators of the term posterior tongue tie, Betty Coryllos and 
I wanted to differentiate the thin web of frenulum that commonly is 
attached on or near the tip of the tongue from the subtler entity we 
were seeing in infants with breastfeeding problems and limited tongue 
mobility secondary to a restrictive frenulum that does not extend as far 
forward on the tongue. The term posterior denotes both that the frenulum 
is attached to the posterior tongue, and that it is often posterior to 
the oral mucosa (under the floor of the mouth). Posterior frenula are 
indeed often thicker and more vascular, but they can also be fibrous and 
inelastic.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 3/22/2013 5:16 PM, Loraine Hamm wrote:
> As regards the ENT's decision not to release the tongue tie, I have had the same experience with our ENT with whom
> we have built a good relationship. On the odd occasion he will say that the tongue tie is too thick and vascular to do a
> release in the office. I am happy to leave this decision to the person who has more knowledge than me as regards
> blood and nerve supply to the tongue. As the expert in that regard the ENT takes responsibility for the outcome of his procedure and he needs to be comfortable that it can be done safely.
>
> I had an interesting experience this week with an ENT telling me that we should not be talking about "posterior tongue ties", but call them "vascular" instead. I told her that I did not invent the terminology and in my frame of reference I understand why it is posterior as opposed to the more classic tongue tie, but she insisted that the tie is not posterior, but thick and vascular, so I wondered whether we were talking about the same thing?
>
>   I attended a meeting this week where a large group of surgeons,  orthodontists, ENT's and speech language therapists from NZ and Australia attended. A Paediatrician that presented  set the ball rolling referring to all the babies who now suddenly need tongue tie release and from the response to this I realized that tongue tie is still a hot topic and we do need to do everything in our effort to educate people about it because clearly Lactation Consultants need the procedure to be performed to support their patients. We have done the work around demonstrating why it is necessary and it is now acknowledged in the literature as best practice for breastfeeding issues.
>
> I think one thing that will be helpful in developing services for tongue tie would be for all referrals to ENT's to always be  accompanied by an assessment e.g. the Hazelbaker assessment. If we send a referral that substantiate clearly what the shortcomings are, we demonstrate that we have done more than just noticing a tongue tie and this will also  help to educate our ENT colleagues on why release is indicated and that what is in front of them is not "a normal tongue".
> Loraine Hamm
> SLT/IBCLC
> New Zealand
>
>
>   
>
>               ***********************************************
>
> 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