SLP Corner: The Posterior Tongue Tie and Feeding Challenges
by Melanie Potock
In a March 2015 post titled Just Flip the Lip, we explored how the band of tissue or “frenum” that attaches the upper lip to gum tissue can affect feeding development if the frenum is too restrictive. Today, we’ll focus on the lingual frenal attachment that is the easiest to miss: The posterior tongue tie (sometimes referred to as a submucosal tongue tie), a form of ankyloglossia.
Consider that the normal lingual frenum inserts at about midline, just under the tongue and down to the floor of the mouth allowing free range of movement and oral motor skill development. While many pediatric professionals are familiar with a tongue-tie when the frenum attaches closer to the tongue tip (where it’s visible when the tip is gently lifted), the posterior tongue tie requires a specific technique to view. According to Bobby Ghaheri, an ENT surgeon who specializes in treating ankyloglossia, whether anterior or posterior terminology is used, the focus should be on function. As he describes in this article, many anterior ties also include a posterior restriction and releasing just the thin membrane is not always adequate for full tongue function necessary for feeding. The frenum, if visible at all, may appear short and thick, but is often buried in the in the mucosal covering of the tongue.
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