If the frenulum is posterior to the floor of the mouth (submucosal), the 
doctor only has to make a small snip through the oral mucosa to get to 
the frenulum, and then divides the frenulum. If you lift the tongue, the 
frenulum will press on the mucosa and cause it to tent out. It can also 
be felt if one puts a finger under the tongue against the base of the 
genioglossus muscle on one side and sweeps a finger across. If the 
submucosal frenulum is very tight, it will be difficult to get a finger 
under the tongue at all.

The oral mucosa bleeds more than the frenulum generally does, so a 
minute or two of pressure is usually applied at the incision site with a 
sterile gauze pad to stop the bleeding. The snip usually opens up into a 
diamond shaped incision that heals open (lifting the tongue 5-8 times a 
day with clean fingers or a tongue depressor for a week or so after the 
procedure helps ensure it heals open), improving tongue mobility in 
every direction.

If there truly is NO lingual frenulum, this is associated with 
connective tissue disorders such as Ehlers-Danlos syndrome.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 5/7/2011 4:55 PM, Sonya Shaver wrote:
> 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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