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


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