I gave a talk at the ILCA conference in Atlanta in 1994 on tongue-tie and
showed a clinical vignette from my practice.  (Actually, the patient had
been in the day before I left for Atlanta!) A lot of people were eager to
get a copy of the video right then and there and wrote to me later.  I felt
that though the video went well with my talk it needed to include more
background information in order to stand alone.  In response to all these
requests I recently completed a 20 minute video on infant tongue-tie and
breastfeeding.

In my practice I find that a tight frenulum restricting tongue  movement
has a definite impact on breastfeeding and I have seen  babies with failure
to thrive, slow weight gain, mothers with very sore nipples, and babies who
are unable or unwilling to try latching at all.  When a full assessment is
done of the baby and the mother and the breastfeeding situation and when
ONE IS ABSOLUTELY CERTAIN that there is no significant blood supply or
muscle tissue in the frenulum, that is, that it is very thin and
translucent with a pen light or otoscope shone through it, it is often
desireable to release the frenulum to allow better tongue movement.  I have
had very good results with improved breastfeeding immediately after or in
some cases several days after frenotomy.  I have never seen a case of
infection, scarring, continued bleeding or continued pain.  A caution
though, some frenula are thick and meaty and contain abberant blood supply
or abberant genioglossal muscle.  I would NEVER touch these in the office.
I would consult an oral surgeon who would do a much more complex operation
with a general anesthetic in the operating room.  It is very important to
distinuish between frenotomy, which is a simple clipping of a simple,
almost bloodless, skin-like structure, and frenectomy, which is a major
surgical procedure.  And it's also very important to be quite conservative
in clipping the frenulum to ensure that there is little or no blood loss.

Being aware of tongue-tie as an impediment to breastfeeding and arranging a
frenotomy in selected cases with good follow-up to ensure resolution of the
problems can make all the difference in the world in promoting
breastfeeding success for these mothers and babies.

Evelyn Jain, MD, CCFP, IBCLC
Director, Lakeview Breastfeeding Clinic
fax: (403)246-7076
email: c/o: [log in to unmask]