I've only seen/heard about tongue-lip adhesion surgery being needed a few times over the past year at our hospital.  It's usually done when there is life-threatening obstruction, sometimes occurring when the babies are wide awake, and often the kid's anatomy causes extreme difficulty in accessing the airway in an emergency.

The last time I was involved, it was for a kiddo with Pierre-Robin Sequence and cleft palate who was initially nearly unintubatable as a newborn -- certainly requiring the expertise of multiple anesthesiologists and ENTs, along with the airway devices/medications/and general good luck gleaned by doing elective airway evaluations during daylight hours in the operating room.  For that little one, if she had required emergent intubation in the middle of the night in the NICU, it very likely would have been disastrous.  But when she had her direct laryngoscopy/bronchoscopy performed in the OR, it was found that when her tongue was adhered to her lip, there was no difficult in visualizing her airway (she had a "grade 1 view" instead of a "grade 4 view" of her larynx).  Later surgery to fix the cleft and divide the adhesion went well.

I've also seen a couple of urgent/emergent tracheostomies performed even after successful intubation with an endotracheal tube, just because of concerns for future upper airway obstruction and difficulty in intubation; it seems like the tongue-lip adhesion procedure, which is usually needed for less than a year until future jaw growth occurs, can be an elective temporizing measure in selective cases where there is retro- or micrognathia and the tongue itself is causing obstruction.

Jodie, feel free to contact me offlist if you want to discuss further -- I'm off work right now gestating full-time but can maybe shed some light as to why particular surgeons at our institution are making certain surgical decisions about this...

-Sarah Reece-Stremtan M.D. (peds anesthesiologist in Washington DC, who still enjoys wrestling with a good difficult airway as long as there is extra help around...)

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