I have been wondering about similar situations.  What does it mean if they
can't visualize a lingual frenulum?  How can they cut if there isn't
anything to clearly cut?  Exactly what happens surgically in a revision of a
posterior tongue tie?

I posted this week about my client whose baby has a maxillary frenum.  I
contacted the ENT who told me she couldn't do it, because it is a dental
issue, and we'd have to call a dentist.  So I called a pediatric dentist
that I know, but he said most dentists just don't do that anymore, that they
used to do it but now they don't, etc, but he was very open to reading the
newest literature.  So I have sent him some links and articles.  He said he
might be able to refer her to an oral surgeon who uses lasers.  However, I
am thinking she'd rather see someone who is familiar with this procedure.  I
am waiting to hear back from him on his comments of what I have sent to him.

So, I am kind of just waiting on Monday to come around.  In the meantime,
the mom is using a nipple shield, but baby doesn't really like it, and she
is concerned about him getting enough.  She is also getting repeated lumps
on that side of her breasts, where the upper lip just can't get over the
breast enough.

How do we do case studies on these so that we can begin to document more and
more the best treatments and outcomes in these instances?  I want to know
what I should be writing down.  Should I take pictures?  This baby has a
class IV maxillary frenum, according to the articles we looked at on
Kotlow's website.

This mom was told by her pediatrician that we don't do anything about
maxillary frenums because it bleeds too much and because if he uses a nipple
shield for a few weeks it will stretch.

Thanks for the continued discussion on this topic.

Sonya Shaver, BS, CHES, IBCLC

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