Monday, February 8, 2016

Tongue Tie and the SLP

Mild tongue tie restriction with a
client working on /r/ targets.

Small notch at tongue tip

Over the last year, I have learned more about tongue tie (ankyloglossia) thanks to social networking. Having spent much of my speech career in the early intervention and school settings, I was never the first to identify a tongue tie, but things are very different in the private practice world.  This past year, I referred a toddler and high school-aged client to ENTs for suspected tongue ties and both were later diagnosed with this condition.  While the toddler had an immediate release performed, the high school client is pending medical intervention at this time as a release may be completed along with another procedure in the near future.  The toddler had immediate, notable improvements in both speech sound productions and feeding.  We continue working on oral motor skills and sequencing sounds. Caregivers commented that just days after a laser procedure, this youngster began chewing and eating chicken, which she had not done while she had a tongue tie.

Please note that I used the word, "identify" in the previous paragraph, not "diagnose."  As SLPs, we can relay our suspicions about tongue tie, but only a physician can diagnose this condition.  For those of you in private practice, you cannot code on insurance claims for tongue tie under the new guidelines of ICD-10 without a physician's diagnosis, even if you are 110% certain that your client has a tongue tie.

Recently, I stumbled upon a closed Facebook group about the SLP and tongue tie and I am so relieved that I joined this network of experienced professionals!  Like most social networks, you can collaborate and consult with people from around the world.  In order to protect patient privacy, we refrain from using names and other identifying information in our discussions.  I also obtain signed consent from my private practice families prior to taking pictures, even if the photos are for my own records.  Being part of this Facebook group allows you access to files and documents pertaining to tongue tie that can help us become better at identifying it.  While exploring one document about experienced experts that perform tongue tie surgeries, it occurred to me that I should google someone near my location in Naperville, Illinois.  The first name that appeared at the top of the list was Dr. Robert Pick.  When I clicked the link for Frenectomy I was delighted to read this:

"Dr. Pick helped pioneer the use of lasers in dental surgery and his team at Northwestern in 1983 were the first ever in the world to do the carbon dioxide Laser Frenectomy technique and publish on it. Dr. Pick co-wrote the first textbook on the subject Lasers In Dentistry."

As it turns out, Dr Pick has been practicing this procedure with pediatrics for over 30 years at his office that is a mere eight minute drive from my home office.  I called the office as soon as I finished exploring his website, which incidentally is a fabulous resource for tongue tie with great visuals, and within a few weeks, I was invited to observe a procedure.

In order to protect confidentiality, I cannot use the patient's name or any identifying information, but I can provide some details about the procedure itself.  From start to finish, the frenectomy took about 30 minutes with much of that time spent waiting to ensure that the numbing agent had taken full effect.  The patient was wide awake throughout, relatively calm, and well informed about every step of the procedure.  Dr Pick had forewarned us that he told terrible jokes and he did not disappoint at all!  His bedside manner was delightful and one could clearly and immediately recognize that Dr Pick has a calling and he has made and continues making a tremendous difference in his work.  Within seconds of the laser surgery, the patient could exclaim, "I can finally stick my tongue out of my mouth!"  The muscle vanished before my eyes and the tongue found freedom.  Five minutes later, the procedure was complete and the patient was heading out the door to a lunch date with mom.

The surgery was exactly as it is described on Progressive Periodontics website: 

"Dr. Pick uses the carbon dioxide laser to remove frenum attachments.  The laser is fabulous for this as with the laser there is no bleeding during and/or after the procedure, no suturing needed, minimal to absent swelling and scarring, almost no chance for recurrence and a decreased to complete absence of pain post-surgically! In addition due to the use of the laser surgical time is dramatically reduced."

Whether you are in private practice like me or working in another setting, I highly recommend taking an opportunity to find a specialist in your area who performs tongue tie release surgery.  According to Dr Pick, he has not had to perform a second release on any patient that he has seen over the last few decades; however, he does refer post operative patients to their speech pathologists and/or myofunctional therapists to teach the tongue new placements at rest and during speech productions.  Below are some links and resources that you may find helpful in identifying red flags and performing post operative exercises.

Frenectomy exercises with an infant

Diagnosing and Understanding the Maxillary Lip Tie

The Significance of Tongue and Lip Tie and Why You Should Consider Correcting Them

List of Published Articles Concerning Tongue and Lip Tie

Frenectomy and After Care

Treatments forAnkyloglossiaand AnkyloglossiaWith ConcomitantLip-Tie

International Association of Orofacial Myology

I found many of these resources through collaborating with other professionals in my area and through discussions on Facebook.  If you have a resource that you use that isn't listed above, then please provide details in the comments section below.  I'm so appreciative that Dr Pick allowed me an opportunity to tour his office and observe a tongue tie release and feel even more knowledgeable on this subject following that visit.


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