Dr. Palmer,

I was glad to see your note from the 21 of April that you had seen the
video, Tongue-tie: Impact on Breastfeeding, and enjoyed it.  I certainly
hope that it will be helpful to everyone involved in breastfeeding.  I also
read your previous post of 16 of March which was very good.  I have
certainly seen a great many babies who's mothers have worked very hard to
breastfeed them who
ve had failure to thrive or marginal weight gain.  Sometimes the mothers
have been feeding for ours an dnot getting very far except exhausted and
frustrated and not really knowing why.  Of course, we all se the terrible
traumatized mipples from tongue-tie as well.  When I exam  a baby and find
that the tongue will not protrude over the lower gum and feel the grating
on the back of my finger, I certainly can feel for these mothers who are
struggling with their tongie-tied babies.  I have done a number of
tongue-tie releases in the office after assessing the problem and the
tongue movement, the tickness of the frenulum and the impact of the
tongue-tie on the breastfeeding, and provided that the frenulum is thin and
doesn't contain any muscle or blood vessels, I find it a very low risk
procedure.  I have never had any bleeding more than the merest semar of
blood, a drop or less.  I've combed the literature for any evidence of scar
tissue or infection and not found anything.

Interestinly, 2 dads have watched their child have a frenotomy at my clinic
and asked me if I would release theirs.  In one case the man said that his
frenulum would get caught between his middle lower teeth if he protruded
his tongue and the other man said that everyone laughed when he tried to
eat an ice cream cone!  It was interesting for me to release these 2
frenula.  The men were quite grateful and they reported that they had no
pain as I snipped.  Pain occured a couple of seconds afterwards and lasted
30 - 4- seconds, a stinging feeling, but certainly nothing dramatic.  The
two had very little bleeding but a bit more than a newborn would have.
Also, as those of us who work in this field will have observed there is a
very strong tendency to a family history of tongue-tie and quite a large
number of the parents, more so the fathers, I think, have had a tongue-tie
released in infancy as prevention (especially if they were born in England
or in the country) or have had it done in childhood because of speech
problems.  I have always looked under their tongues and I've never seen any
sign of scar tissue in these cases.  That seems to be one of the worries
some people have but I see no reason for concern in this area.

During the past 6 years I've had 2 cases requiring a complete FRENECTOMY in
newborns and unfortunately the breastfeeding outcome was not good because
of severe restriction of the tongue before and to some extent even after
the procedure but these were done under general anesthetic aat the
Children's Hospital by a helpful oral surgeon.  They had significant
geneoglossal muscle crossing over the frenulum so I wouldn't touch them in
the office.  I think some of the confusion that we here about may be due to
people not making a distiction between simple frenotomy and surgical
frenectomy.

I'm excited to see you discussing the significance of breastfeeding to the
development of the oral cavity and airway at the ILCA conference this year
and if I'm not able to attend the conference will certainly be looking for
a tape of your talk.

Now that I have just dipped my toe into the world of internet I'll be
looking forward to seeing your future contributions.

Evelyn Jain, MD, CCFP, IBCLC
Director Lakeview Breastfeeding Clinic
6628 Crowchild Trail SW
Calgary, AB  T3E 5R8
tel/fax:  (403)246-7076

PS  Thank you for recommending our video to Australia.  It is quite
exciting to see this information take flight.