Why I Opted To Do The Frenectomy
I decided to consider a frenectomy for a tongue tie (ankyloglossia) after doing it for my daughter, Viviana, when she was 2 months old. Seeing how the shape of her face immediately changed, how she was immediately able to open her mouth wider, how she was finally able to bottle feed pumped breast milk for the first time, and she was able to breastfeed more efficiently instantly, I began to wonder if this would be helpful for an adult. It is generally thought that once one is fully grown that the structure can no longer adapt. Understanding the human body is a dynamic, I felt there could be a huge benefit for adults. It was after her procedure, that I realized that I had a tongue tie as well.
You see, my wife had pointed out the tongue tie in Viviana, but it is generally not recommended to do anything unless there is an inability to gain weight. Well, our daughter was quite a large baby so it was not recommended. However when my wife went back to work, Viviana was unable to drink from a bottle so my mom was having to feed her with a dropper. “That is like trying to feed an elephant with a dropper,” commented a family member.
That was the moment when we decided to pursue the frenectomy for Viviana. The research we had done suggested that her tongue tie could be the real problem preventing her from being able to use her tongue to bottle feed. We took her to an ENT named Linda Dahl, M.D. who has become a leader with this for infants. The results were immediate and although it was a few days afterwards that we tried bottle feeding for the first time, she no longer had a difficulty with it to our relief.
I tried researching to see if there was benefit for doing a frenectomy in an adult. The general consensus was “no.” There was great information for infants and children. If the child or adult appear to be doing well and are growing, there is no reason to do a frenectomy. There were some accounts I came across of adults who opted to do a frenectomy, but they did not notice any changes other than stating they could stick their tongue out further.
Because of the line of work I am in, I have not bought into the idea that once an adult is fully grown, there is no point in addressing these problems because we are no longer growing. The tension produced by the tongue tie could still be present wreaking havoc in adults. Specifically, I wanted to know if this could help with pain relief to see if this was something I should be paying attention to for my patients. I also tried to understand anatomically how releasing the tongue would allow one to open their mouth wider in which I did a great amount of research for.
Once I decided to do the frenectomy to correct the tongue tie, I did a search and found a dentist near me who performs them with a laser. Using a laser has many benefits including faster healing time, no stitches, and less pain after the procedure. In the meantime, I met with an Orofacial Myofunctional Therapist, Dana Hockenbury, SLP, who evaluated Viviana but also confirmed that I did have a tongue tie. Orofacial Myofunctional Therapy (OMT) deals with teaching proper swallowing and proper use of the muscles of the mouth. She was excited to hear that I had elected to do the procedure.
She had me open my mouth as far as I could with the tip of my tongue on the roof of my mouth. She took a measurement and also swept a finger across. She said tongue ties feel like a “guitar string” when she moved her finger back and forth across the structure called the frenum. Then she had me open my mouth as far as I could and measured the difference. So it was confirmed. The next step was doing the procedure.
The Procedure
A few weeks later I went to see Robert Convissar, D.D.S. who would do the frenectomy. I did not have any major indications. I did not have considerable speech problems except for being told I mumbled a lot most of my life and I would lose my voice in a crowded room within 20 minutes the last couple years. The tongue tie did not appear to cause any other problems. I did not mention that I was there to do a self experiment.
The procedure was very quick. I was at Dr. Convissar’s office a total of 30 minutes. When we were done, he told me that my tongue was more mobile but not sure if it would help my other problems. My mouth was numb but I know if there are going to be changes, many will be instant. Right away as I walked out I could feel my wind pipe felt more “open.” I felt this would be a success but the results were incredible.
The Results
As I was on my way out, I stuck my tongue out and saw with my camera that it deviated to the right. My first concern was that there was a nerve issue. 
However, I looked under my tongue and could see that the correction was more complete on the left side and there was still a small amount of tissue on the right that was anchoring the tongue down a little on the right. (Dr. Convissar later told me he tends to under-correct because that can always be revised, but over-correction is irreversible which is perfectly reasonable).
The interesting thing about this is that it made it so that I could compare right and left sides. I will plan on going in for a revision soon and will write another post to demonstrate the changes. Having said all this, the changes were nothing short of remarkable. I will attempt to explain things anatomically in another post. However, I believe osteopaths, orofacial myofunctional therapists, and dentists should be checking for this and having patients corrected, including adults.
Here’s The Changes Noticed:
- Tongue is much more relaxed
-Left side feels completely relaxed whereas right side is more hypertonic and sensitive
-Floor of mouth relaxed and less sensitive on left side
-Tongue visually wider and more relaxed on left than right
- Trachea felt more open and vocal cords felt relaxed
-Trachea glides better to the right than to the left
- Hyoid bone dropped and more side to side motion
-Hyoid bone glides better to the right than to the left
- Less tension in the front of the neck down to rib cage
-Longus colli muscles are not sensitive on left but hypertonic and sensitive on right
-Vertebrae on the left deeper and more mobile than right
- Back of upper neck feels more relaxed and more ease during range of motion
-Subocciptal muscles more relaxed – more hypertonic and sensitive on right
-Occiput has moved posteriorly on atlas more on left than on the right
- Hump at base of neck straightened dramatically (diminished exaggerated kyphosis)
- Structural changes in the head and face
-Left side of head in more pronounced flexion (osteopathic term)
-Hypertonicity in facial muscles such as buccinator, levator labii superioris and zygomaticus minor no longer present on left but still palpable on right
- Swallowing very different
-Tongue able to rest comfortably on roof of mouth while drinking a cup of water without having to lower it completely with each gulp (my wife said I was quieter drinking from a cup)
-Swallowing much less effort
- Low back tension released with sacrum feeling softer and more mobile
-Psoas muscles more relaxed
-Pain at L5-S1 relieved
-Greater ease with forward bending and during range of motion
Conclusion
The implications that tongue and lip ties produce in adults has yet to be studied. This is the most powerful release I have experienced to date. Based on this experience, it feels like the frenulum, even mostly corrected, acts like a “fascial vortex” that binds the tongue or lip and many seemingly unrelated structures. It can affect development in children and have orthodontic implications and can affect the shape of the skull in an adult. I believe an unresolved tongue and lip tie in adults also has profound implications not just in the tongue but throughout the body. This should become a consideration for anyone coming for osteopathic treatment. This will be evaluating and referring for when appropriate in the future. In another post or posts, I will go through the anatomy in detail to explain the related changes as well as post an update and comparison after the revision.
Frenectomies are not without potential complications. If the frenectomy is under-corrected, the full benefit may not be realized and would require more revisions. An over-correction, although rare, can have irreversible implications or longer term complications. The same is true if damage is done to the salivary glands, which lie at the floor of the mouth
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I think your self study is both remarkable and yet perfectly identifiable with rational findings, in hindsight from reading your article. Thank you so much for sharing! I look forward to both sharing and discussing this further with my colleague’s! Having an open mind to conditions once considered simply as “variants” of normal, as possible life altering conditions, once many related variables have been identified, is what it is all about! I remember identifying a patient’s tongue thrusting, macroglossia, and mouth breathing as a respiratory/airway related problem/issue. I encouraged the parents of the patient to seek further guidance from an ENT. The next time I saw the patient, it was like a different person! Just the difference in posture alone was amazing! The parents were thrilled with the resolve of so many other issues and I remember being somewhat awed as this had been ignored by many for far too long. I became much more proactive in recognizing airway compromise and related dental and maxilofacial development markers. So thanks! Excited to learn more, so please keep sharing in this experience and others! (I see ankyloglossia and high frenum connectivity, literally every day.)
Respectfully,
Dawnne Donovan CDA, RDH, BHS
Thanks for the great input. I’m realizing the problems from intact frenulums, even those that appear to have not impact, can have huge implications in the overall body structure. That being the case, problems with frenulums are highly undiagnosed and treated. I’ve been learning a lot about this recently and will certainly be writing more about it.
Thanks,
Dr. Lopez
Hello Doctor quick question, I fear that if I get a frenectomy (because sharp teeth cut it a lot) I will swallow my tongue at night and die, will that be a possible outcome or am I safe from that ever happening?
Hi, that is not possible anatomically. Your tongue is anchored to the floor of your mouth. The frenulum is not the reason you cannot swallow your own tongue. I hope that helps.
-Dr. Lopez
Hi Dr. Lopez,
I am also a physician working with Dana Hockenbury and just had a frenectomy three days on her recommendation with the excellent Dr. Paul Calat. Your post in fascinating and I hope you post further on your observations!
Joanne
Hi Joanne,
Thanks for your message. I will have a lot more information coming up as I am doing a lot of research. Hope to have some things out soon.
Daniel
Hi Daniel,
Great to hear you discuss and sharing your benefits of your procedure.
Can you post pictures of before your procedure.
That would be great!
Look forward to reading about your continued benefits from the procedure.
Respectively,
Loree Christianson, RDH
Orofacial Myofunctional Therapist
Breathing Educator – RBBE
We have been recommending revision of all tongue ties from Grade 1 upwards. Lots of research has been done on babies (lactation / feeding problems) and children with speech problems. Unfortunately not enough data /research has been correlated on the benefits of adult TTie release.
It is imperative from a dento-facial growth aspect that the tongue function is optimised, and nothing inhibits its unique action, particularly its “resting posture”.in any way.
We have seen all our patients have improved tongue function post frenectomy, but many (approx 40%) who have benefited positively in other ways including neck, shoulder, and back pain relief, postural improvements, airway enhancement, reduction or resolution of bruxing and clenching, gag reflex resolved, improved sleep etc. etc
We should really be putting our findings together to help advance research and make the benefits and importance of frenectomy known to all.
Keep up the great work.
Hi David, Great work and thanks for sharing. I have a particular interest because you describe similar symptoms to me and i have a poor head posture and posture in general has got worse. Do you do and release of the muscles around/under the tongue? digastrics etc? If so do you find this affective? I find also the tongue affects my shoulder girdle and upper thoracic spine. After reading your post and releasing my own digastrics and doing some simple neuromuscular inner core and postural exercises i generally feel much better and my posture has improved and as you say… quickly. Any thoughts on release work before going to frenulum? i don’t wasnt the scar as i find they also can cause problems with motor control. Thanks
Dear Doctor Lopez, I’ve also recently realised that I too have a tongue tie and am considering a revision. Can I ask did you snore before the procedure was done and did the procedure reduce snoring/ apnea? Secondly, did you have excessive saliva prior to the procedure and has this reduced post operationhttp://www.unicef.org.uk/BabyFriendly/Parents/Problems/Tongue-Tie/Locations-where-tongue-tie-can-be-divided/? Lastly, Do you have a high palette and do you have overcrowded teeth?
Looking forward to you replies and also reading your research.
Kind Regards
Liz May
Hi Liz, thanks for your questions. I did not snore and I actually did not have any particular symptoms like you describe. The first thing I noticed getting off the chair was how “open” my wind pipe felt. It felt easier to breathe. I do not have a high palette and some overcrowded teeth on the bottom. My tongue tie was considered mild and I really did not know what to expect. My reason for trying it was to see what effects it could have on my head, neck, and body in addition to swallowing. Post operation, I have had an easier time swallowing and far less pain. I hope that helps.
Hi Liz May, i’m also tongue tied and have problems with excessive saliva.
Did you have a frenectomy? Did it help with your excessive saliva production problem?Thanks!
Very interesting and informative article! I am having my tongue tie revised on 1st December and I’m very excited to feel the results.
Thanks so much for sharing your experience. Personal accounts of adult frenectomies are hard to come by. I am in my 40s and am considering the procedure. However, like you, my current symptoms are mild/manageable. What risks do you know of regarding the laser frenectomy procedure? Is there ever prohibitive scar tissue or worsening of symptoms or new symptoms post-op? Would you be able to provide an update and/or before/after pictures? Your account is especially compelling because you are also a healthcare expert. Would love to hear how things are going for you now. Thanks again.
Hi sorry for taking so long to respond. As far as I know laser frenectomies have low risks but probably the main one would result from overcorrecting the frenulum. Scar tissue will form and I generally still stretch my tongue on a regular basis to help prevent the contraction. I haven’t had worsening of symptoms and none of my patients having undergone it have either other than scar tissue tightening. I’m sorry I haven’t written an update but have had too much on my plate and writing has been put on the back burner. Unfortunately I was unable to find a good quality before picture so I haven’t posted. At this point, I have still felt the frenectomy was helpful. Eventually things that felt great normalized so they don’y feel “amazing” anymore but I don’t have pain and tension and that’s what matters. I hope that’s helpful for now.
I thought the rule of thumb was to stop when you see the diamond shape in the mouth. Did you have a diamond upon revision? I have been reading a lot online (like Dr. Ghaheri’s blog) and bouncing questions off of periodontists and dentists (which I have found don’t all see eye-to-eye on the subject). I am curious about the posture as I wonder if it would help mine. Mostly I am considering the procedure for myself to deal with jaw issues/clenching, grinding. Not sure if the headaches I get sometimes are related or not but they may be.
Did your daughter have any other before/after symptoms like reflux, gas? We are researching the matter as I would like to get my daughter’s lip and tongue tie corrected for multiple reasons.
Hi, thanks for your comment. I did have a diamond. I found the frenectomy helped my posture quite a bit and same with my mother. Others haven’t had the same experience so it would be impossible for me to say. The procedure may help with jaw issues, but there may be other factors involved. I would consider if you haven’t to see an osteopathic physician that does cranial work (www.cranialacademy.org) to make sure your temporal bones, jaw, and other cranial structures are working properly.
My daughter did not have reflux but she did have some gas which improved once her latch improved. Good luck with the whole process and I hope it helps you.
We don’t have a lot of osteopaths around here from what I can tell. I got zero matches for both my zip code and my parents’ (who live in another part of the same state) using a search of a 300 mile radius. But, my father sees a CST that I may see next time I go visit. Thanks for all the feedback.
Firstly, I want to thank you for the insight, the observation to impact on whole body is often dismissed.
I have similar problems as you had; however, I’ve always expected that it was due to the uneven bite and alignment of my jaw. I had many difficulties around neck and shoulders, and received osteopathic manipulation often to correct the problems. Recently, I found out that I have TMJ as well. I’m starting to wonder if the tongue tie could have promoted TMJ. I am hoping this small surgery will help diminish all of these problems.
after reading this, I am looking forward to my upcoming operation.
Thanks again
Thanks for commenting. From my experience, I did find the tongue tie was having an effect on how my TM joint worked so it’s possible. I wish you the best of luck and hope it goes well for you.
Dr Lopez, I see you haven’t blog on this in a year. How are your feeling from this tongue tie surgery? I only ask b/c i’m thinking myself in doing it. But I’ve heard the results are only temporary and any relief goes away in about 3 months.
Hi, sorry for the delayed response. With a baby, it’s been harder to write regularly. Anyway, I have felt good from the tongue tie surgery. I have continued to work to stretch my tongue since having the procedure. It has not necessarily been my experience that the results are temporary, but eventually the feelings of relief wear off as they just become the new normal.
I am an adult who just had a frenectomy. Today is day 5 since my surgery. I am experiencing a lot of pain at the site and on the tip of my tongue. When I do my stretching exercises and after, my tongue feels like it has a wire running to its tip that is very tight. My tongue tip bothers me more than the surgery site. Today I also feel more saliva in my mouth. Are either of these conditions abnormal? I would really appreciate your thoughts.
Hi Heather, this is not normal as far as I know. You may want to contact the person who did it and discuss it with them. It sounds like a nerve may have been affected.
Sir
interesting article. I am a dentist of 35 years experience and in the 80s I use to refer all patients with high lingual Frenum attachments to periodontist or oral surgeons for frenectomy and I use to see a lot of gradeschool children with speech difficulties referred to me by speech pathologists for the same issue ….but insurance company’s got involved and someone figured it was an elective procedure so now it’s not nearly done as often not as it should be. With the new lasers and electrosurge units out now it’s even easier to do the procedure, almost bloodless and without sutures. Its really easy to do when patients are sedated and having their third molars extracted. I still see patients monthly that need the procedure so I still refer them ….an idea to ponder…does adults with ankyloglossia snore or have lower incidence of sleep apnea since the tongue is more securely attached to the anterior part of the mandible ???? I have treated nearly over 100 patients whom snore or have some type of obstructive sleep apnea and I don’t recall any with ankyloglossia. …..More to come on this subject I am sure….
Hi Don,
Thanks for the comment. Sorry for the delayed response. I’ll be curious to hear what you find regarding the sleep apnea. Keep up the good work.
Hi Daniel,
For someone who has a tongue tie and forward head posture with a bony bump at the base of the neck, would you recommend a frenectomy? A sedentary lifestyle may have contributed to the forward head posture and the bump, but then again many people have a sedentary lifestyle without having these problems.
Many thanks,
Flora
Hi Flora,
It’s very possible a frenectomy would help. It just depends on whether or not it’s a reason for your forward head posture. It very well could be.
Thanks,
Daniel
Dr. Lopez,
Very nice post and thread. I just had an adult frenectomy performed yesterday the old fashioned way (laser was not available for me) for a very different reason that may affect a few other people. I am a professional musician and have been playing saxophones, clarinet, and flute for about 27 years. Each instrument requires several different tonguing positions. Sometimes the tongue needs to get out of the way and sit on the roof of the mouth to allow the air to more directly flow into the instrument. I have always had a labored tongue for doing fast exercises so when I went in for a wisdom tooth extraction I finally had this done. I was nervous for some of the reasons you have pointed out, possible nerve damage or a worse ability to move the tongue. Obviously, I still have soreness now but my first observation was that I can move my mouth much wider now. 2nd observation is how tired my tongue is with the newfound extension. I will wait a few days and then try to play my instruments. Hope this might aid other musicians thinking about this procedure. So far so good.
Awesome! I hope it helps you take your abilities to the next level.
-Dr. Lopez
What a great article! And your responses to your commenters are amazing, I just want to give you kudos for not only going forward with the work you did, but also sharing it with your audience!
As an oral health coach I am always seeking out practitioners willing to think outside of the box and engage with their clientele. It’s a breath of fresh air when I find them! I just recorded a podcast with an OMT/RDH therapist on my podcast. Please let me know if you’d like to listen and offer feedback.
Looking forward to keeping up with what you are doing. Thanks for writing a great article. I’ve shared it on my professional fb page!
Thank you so much. I would love to listen to the podcast. Keep up the great work.
Hi,
Thanks for sharing this! I have a tongue tie and just diagnosed with significant scoliosis. I am wondering if they might be partially linked. I am 38 yrs old. I’m considering a frenotomy. I appreciate any of your thoughts regarding a link between scoliosis and tongue tie.
Thanks,
Gillian
Hi Gillian, It’s possible that a tongue tie could be related to scoliosis, but there’s a lot of factors in my opinion that can be involved with scoliosis so I would not be able to say for certain if it would help at all. The best I can do is say that it could be possible. Best of luck.
Sincerely,
Dr. Lopez
Dr I just did a tongue tie relief surgery,but have been told that my voice is still not clear,having been using TAB ORELOX 200mg