Keeping up with post-surgery exercises (also known as Active Wound Care or AWC) is one of the most important aspects of a tongue or lip tie release. These exercises are required for approximately six weeks after treatment, and they will ensure that the released tissue doesn’t reattach during the rapid healing process. Reattachment can cause new limitations in mobility and the return of tongue or lip tie symptoms.
1) Any open oral wound will contract towards the center of the wound as it is healing (hence the need to keep it dilated and open).
2) If two raw surfaces in the mouth are in close proximity, they will reattach.
Post-surgery exercises (AWC) are the key to an optimal result. The main risk of a frenectomy is that the mouth will heal very quickly and the tissue may prematurely reattach at either the tongue or lip site, causing a new limitation in mobility and the persistence or return of symptoms.
This is the easier of the two sites to stretch. We recommend that you start with the lip. Babies may cry during the stretches, and starting with the lip allows you to get under the tongue more easily if and when this happens. Simply place your index finger under the lip, lift up towards the nostrils (until it bumps into resistance). Then, gently hold for 5 seconds. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can't stick together.
This should be the last area you stretch. Coming from behind, insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers on wound where floor of mouth and tongue meet. Then pull straight back until you feel a little stretch, hold this for 5 seconds. Do this 5 times per day. Minimal bleeding is totally normal for the first few days.
The tongue needs three separate stretching motions:
1) Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the mouth). Hold it there for 5 seconds and then relax. The goal is to completely unfold the diamond so that it's almost flat in orientation. Remember, the fold of the diamond across the middle is the first place it will reattach. The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up.
Picture how a forklift works: If you don't get the forklift tynes completely under the pallet, lifting it up will just cause the pallet to tip backwards. If you get the tynes completely under the pallet, you can lift the pallet straight up.
We recommend pushing your index fingers together to prevent them from separating, then pushing at the top of the diamond into the tongue (in the direction of the tonsils). Once you are under the tongue, lift so that the middle of the tongue comes up with you. If your fingers separate and go on either side of the diamond, your lifting pressure will be directed at the sides of the tongue and not at the diamond itself.
2) With one finger propping up the tongue, place your other finger in the middle of the diamond,turn your finger sideways and use a lifting motion from low to high to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across that diamond. Make sure your finger starts within the diamond when doing this stretch. This stretch should not be forceful or rough within the wound.
3) Massage outside of the diamond on either side to loosen up the remainder of the musculature on the floor of mouth. You can use more pressure when doing these stretches because you aren't touching the wound itself, only the areas surrounding it.
It is important to show your child that not everything you are going to do to their mouth is associated with pain. Additionally, babies with disorganized or weak sucking patterns can benefit from these exercises. Start these exercises on the third day following the procedure, and spend 30-45 seconds on each one prior to the wound stretches:
1) Slowly rub the lower gum line from side to side and your baby's tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
2) Let your child suck on your finger and do a tug-of-war, Slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
3) With one index finger inside the baby's cheek, use your thumb on the outside of the cheek to massage on either side. This helps lessen the tension.
Starting several days after the procedure, the wound(s) will look white and/or yellow and will look very similar to pus. This is a completely normal inflammatory response. View the images below to get an idea of what to expect, but don’t hesitate to give us a call if you think that an infection is present.
Call our office immediately at (720) 507-0077 if you notice any of the following:
If you have any questions regarding tongue or lip tie release treatments, post-surgery exercises, or the healing process, don’t hesitate to reach out! Our knowledgeable team will answer any questions you may have and explain any of the stretches or exercises. You can also stop by our office at 4704 Harlan Street, Denver, CO 80212.