The Process
So now it’s time to talk with you about my tongue tie release journey. It’s post-release Week 10 now and I’m still feeling good, although quite tired. My tongue is stronger every day and therefore more able to do the work it was designed for. I’m told by my osteopath that there’s extra lymphatic fluid in my ankles and thumbs – that apparently indicates there is movement happening in the body. The muscle memory continues to be powerful, though – pulling me back into old positions – and I have to fight it, but generally I feel stronger and more able to maintain good posture and alignment
How Did I Get To My Tongue Tie Release?
But how did I get here? My TT process began about 9 months ago, when I was at my monthly osteopath appointment. I had been a client for a just over a year (with thanks to my brother for the referral!) and she was continually discussing possible causes for my constant muscle tightness, jaw headaches and digestive issues. One day during a session, she suddenly exclaimed, “Maybe you’re tongue tied!” Tongue tied? Whoever heard of such a thing? She went on to explain that there is evidence to show that a tongue that is anchored inappropriately can cause the jaw to be pulled forward and at a bad angle. That means that the muscles around the tongue aren’t allowed free movement and this can have repercussions for neck muscles, dental development and facial mandibular structure. And there seems to be some thinking out there that it affects digestion as well.
Hmmm. Someone finally was giving me an opinion on my issues that made sense! This really got my attention! Tongue –tie release surgeries are normally done by oral and maxillofacial surgeons, dentists with that specialty or ENTs (a.k.a. Otorhinolaryngologists). In my case, I was referred to a dentist with a great deal of experience in tongue tie.
So a few weeks later, I was sitting in Dr. Gambacorta’s waiting room filling in the eight pages or so of personal history that would form the basis of her investigation. After a brief discussion, she asked me to do some things with my tongue (like touch it to the tip of my nose…can anyone really do that?). When she did an oral examination, she said, “Wow! You ARE tongue tied!” She indicated that my lower incisors were too high compared to the rest of the teeth in the lower jaw, and that the lower jaw had never formed properly. I was suffering from UARS (Upper Airway Resistance Syndrome), a narrowing of the airway during sleep that can lead to sleep impairment. She explained that the nocturnal bruxism (grinding of the teeth at night), which I had experienced for eons, was the brain talking to the jaw and telling it to open up that airway. She noted that there wasn’t just resulting jaw and neck pain, but that I was carrying the right shoulder lower than the left, that my head was always tilted to the right and that this had implications for the upper spine. And she indicated that, as a bottle-fed baby, the roof of my mouth, or palate had not formed properly. Apparently breast feeding is a key in building life-long tongue strength and good posture.
Wow! That was a lot to take in! But everything she said resonated with me so intensely, that I knew there must be something to it. She explained the plan if I were to go forward. I would have 4 to 6 weeks of myofunctional therapy (i.e. daily tongue exercises to do at home) along with ‘closed mouth posture training’ (learning to breathe exclusively through the nose). And if all this was successful, and I developed the necessary tongue strength, she would go ahead and perform the tongue tie release surgery.
I’ve since learned that having this procedure without doing the pre- and post-release exercises for tongue tie, changes NOTHING. Here’s what Dr. Gambacorta has to say in that regard:
All of these dysfunctional compensatory functional patterns should get identified by a manual therapist and worked out before a tongue tie release procedure in order for the tongue to have the greatest range of motion after the release. If these compensations aren’t worked on before and after the tongue tie surgery, we cannot expect the forward head posture, neck and shoulder tension and pain that patients experience to resolve after the procedure. In essence, if we want to rehabilitate the tongue tied patient as a whole and want to help optimize the rehabilitation of the oromyofunctional dysfunction that exists, we have to address the compensatory muscular and joint tension through manual therapy before and after tongue tie surgery.
So clearly, if you want to see progress and changes in the body, you have to be prepared to put in the work to get there, just like with anything else. And it is a serious time commitment, but well worth it!
20 Weeks Before the Procedure
So there I was, then, a few weeks later, about 20 weeks before the procedure, back in her office, getting my first set of tongue tie exercises. As well as my personal favorites, ‘Monkey’, ‘Puffer Fish’ and ‘Waggle Flap’, there was a series of breathing exercises, designed to encourage mouth breathing and diaphragm strength. I also had to download ‘The Kids’ Breathe Well’ app and practise with it. All exercises were to be completed two to three times a day. But as the stunt commercials say, ‘Don’t try these at home!’ – all OMT exercises are designed for each individual, and without the proper exercise selection and professional guidance, serious damage could result.
At first, I was overwhelmed. Each exercise session was taking about 30 minutes! And I found it very tough to actually do them until my tongue strength began to increase. Over time, I developed strategies for getting them completed. I learned which ones I could do wherever when I had a minute of waiting time and which ones needed to be done at home in front of a mirror.
16 Weeks Before the Procedure
A month later I was back for a check-up, this time with the results of a CBCT scan (‘Cone Beam Computed Tomography’). Essentially, this scan is like a 3D x-ray of the jaw structure and teeth and provides information on the temporomandibular joints and the nasal airway. The scan showed that ‘Eagle’s Syndrome’ (named after the ENT who first described it, not after the bird of prey!) was present. It’s a condition in which the head is held in a forward pronation position, due to a badly formed styloid process (the piece of bone just below the ear), or in my case, due to a calcified stylohyoid ligament. (This is too much information, I know, but for the sake of accuracy, bear with me). I was easily able to identify with the symptoms – pain in the jaw, ears, neck or face, difficulty swallowing (a.k.a. dysphasia) or buzzing in the ears.
At that appointment Dr. Gambacorta said that my exercises should remain the same until the next visit. I also learned that I need to use some medical tape, ‘Micropore Tape’ by 3M to – you guessed it – tape my mouth closed sometimes during the day. The first time I tried it, I almost freaked out. I was getting so little air in through the nose that I became quite distressed. Clearly I wasn’t ready to be a nose breather yet! But I was learning that mouth breathing encourages improper tongue position, and can increase the tendency to have a poorly functioning upper airway passage.
12 Weeks Before the Procedure
Twelve weeks prior to the release at our regular appointment, she remarked that I was breathing more slowly and through the nose more and said she was impressed. Thank goodness! It was good to know that my efforts were paying off! She added a new exercise, called ‘Surprise Granny Face’ – trust me, this is one you don’t want to do in front of the mirror!
About this time, the osteopath reported that she could feel a lot of changes taking place in the cranial area and that I should expect a woozy, unsettled feeling. She noticed a change in my voice – apparently, I was making sounds more from the back of the tongue, as is natural, rather than from the front of the mouth, which was the way I had spoken all my life. It had resulted in some serious laryngitis as few years back, but more about that later.
You may well ask – was it really necessary to prepare for the release procedure for six months ? The answer is no, probably not. Six weeks of preparation might work for some people. But I wanted to go at my own pace and it was important to be ready, both physically and psychologically. Besides, I had other life obligations like family, work and Christmas to consider. And, had I had the required tongue strength earlier, I could have gone ahead sooner.
I have to laugh now when I think about how I wondered how my tongue would be held up during the procedure. Of course, that was partially what all the tongue strength was for!
10 Weeks Before the Procedure
Ten weeks to go before the release and I was back at Dr. Gambacorta’s office for a check-up. My tongue was still not strong enough and new exercises were assigned – one using a small piece of Thera band which I was to try to push my tongue through – ugh!! I also received tiny orthodontic elastics – about a centimetre in diameter – which I was to place on the end of my tongue and hold up against the palate for extended periods of time.
What is the proper tongue position, anyway? Mine had always rested on the floor of my mouth, with the lower incisors touching the ridge on the upper palate. Wrong! Apparently, about 50% of us carry our tongues incorrectly – with tons of negative health implications! The front of the tongue should sit up against the palate, about half an inch behind the teeth, inside that ridge. The balance of the tongue is also up against the soft palate, resting there while pressing against the roof of the mouth. Teeth are to be apart, with the jaw relaxed and the lips closed.
Easier said than done! How can the tongue be ‘resting’ and ‘pressing’ at the same time?
That was my question. But as it turns out, this is, of course, entirely possible and the best way to avoid dental and health problems. In fact, correct tongue position is essential to opening up the airway for normal nasal breathing – without it, we can face life-long health issues. (As an aside, evidently mouth breathing not only encourages improper tongue position, but is also a detriment to life-long health with possible implications like sleep disorders, chronic fatigue, anxiety, jaw and swallowing issues to name a few –definitely worth checking into!)
Next stop – an appointment with my TT physiotherapist, Carrie Dillman – and more exercises – yikes!! But there were only a few to add to my exercise list. It was so great to talk with her as she’d just had the procedure done the week before and she totally understood the aches and pains I’d always had. She reminded me to follow orders after the release and to have lots of soft foods on hand. She did some acupuncture as well – I felt amazingly loose in the neck and shoulders! Post-release physio really is a must – to teach the body the new muscle patterns that will make the entire process worthwhile.
I saw my TT dentist once more, at five weeks before the procedure. I had questions which she was happy to answer:
What are the risks with this treatment ?
A chance of nerve or saliva gland damage.
Would she be cutting muscle?
No, just fascia.
What was the recovery time?
Anywhere from 48 hours to a week.
What follow-up would there be ?
There would be a check-up at the two-week mark and some other appointments after that, along with more exercises to do (lucky me!)
Would I ‘talk funny’ when it was over ? (I had visions of having ‘too much tongue’ and talking with a speech defect)
No, not for long.
She then explained that I might need another release after the first one – not the best news I’ve ever had! And she indicated that once the release was completed, the hard work would START. Yikes!!