Older children & adults are reporting significant pain post frenectomy

Q: I have a clinical question that I would love your opinion on.  In adult patients with TT, do you find less pain in the post frenectomy rehabilitation phase when a period of pre habilitation is undertaken, in essence conditioning the musculature as much as possible? A number of older children & adults are reporting significant pain post op, not at the wound site but in the body of the tongue as the muscles work anew. Thank you so much, I hope you don’t mind my asking!

A: I am so glad you asked this question.  It has not come up before although I touch upon it during my courses.

• Here are my comments:  Since there is obvious restriction pre-frenectomy, we would not be addressing the necessary musculature and excursions, etc. if we offered pre-muscle training.  Everything is modified post release, so it would make sense only to offer treatment with the “newly, released” lingual musculature and altered oral space within the oral cavity.
• I fear doing so pre surgery as we might be contributing to a difficulty later; for one example, if our exercises happen to focus on the glossopharyngeal, we are not doing anything to train the patient to shape and move the tongue as it will have to do once released. In fact, we might very well be aggravating the post frenectomy situation.
• Now, if you are also asking if in some cases, we might want to provide treatment before making the decision to refer for lingual frenum division, there are some rare instances where that might reasonably come into play.  For example: someone who is borderline when assessed with the Quick Tongue Tie Assessment and is likewise borderline with the TAP (Tongue tie Assessment Protocol by Carmen Fernando).  However, as the therapist becomes more experienced with determining a restricted lingual frenum, there should be very few instances where she/he cannot make the determination upon examining the patient the first time.
• In reference to the patients’ experiencing a lot of discomfort when they begin orofacial myology treatment, that does concern me somewhat.  My questions would be the following:

o Are the ones experiencing discomfort all being seen by the same medical professional for the release?

o Are they waiting too long to be seen by you or other orofacial myologist after having had the release?  I think that 3 days post frenectomy should be the maximum amount of time to wait to initiate treatment under most circumstances.

I hope I helped answer your questions.  Please let me know your thoughts and if I missed anything. I look forward to seeing you at the upcoming conference, and I am pleased you are keeping in touch and helping to keep my thinking cap on!!