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REFLUX IN THE PATIENT WITH TONGUE AND LIP TIE

Dr. Scott Siegel, DDS, MD, FACS, FICS, Diplomate American Board of Oral and Maxillofacial Surgery, Clinical Assistant Professor, Oral and Maxillofacial Surgery SUNY Stony Brook School of Medicine and School of Dental Medicine

It was providential that I sat beside Dr. Scott Siegel on the first day for lunch. We were able to have interesting dialogue on how his practice is comprised of 50% tongue and lip ties. He focuses on airway and reflux issues as well.

Reflux is defined when stomach acid backs up into the esophagus/ mouth. Aerophagia , “air-eating”, is an excessive swallowing of air. Some is thought to be psychologic, some is thought to be anatomic.

Aerophagic baby gets stomach distension, belching, cholic and pain.

GER-gastroesophageal Reflux—immature lower esophageal sphincter in infants, stomach contents reflux into esophageal and oral/ nasal cavity

GERD when LES (lower esophageal sphincter) becomes weak or relaxes when it should not.

No one is looking at the lips and/ or the tongue. Dr. Siegel is interested in studying lip and tongue involvement on the above. How can we objectively quantify these things? How much air is coming in during breastfeeding? Is there a correlation between aerophagia and reflux? IF there is a correlation, and there is, then we should correct with a frenotomy and possibly get baby off Prevacid and Zantac. (proton pump inhibitors and—doesn’t have a reduction of reflux, it reduces the acidity. Effectively treating the limited mobility of the lip and or tongue is addressing the cause of reflux/ aerophagia. Babies are on occasion put on PPIs when fussy. They are taken off breast, put on bottle and prescribed medicine). He has treated over 10,000 babies successfully and is working toward collaborative efforts with colleagues and utilizing data from his patients.

Can GERD precipitate aerophagia or vice versa? There is contradictory research. Important to follow pediatrician’s orders and not discontinue meds unless told to do so by pediatrician.

What is the significance of changes of oral airway pressure? Current research studies esophageal pressure and does not look at oral pressure. We need to look at oral pressures because this is where much of the problems stem from.

Is there a correlation between tongue and lip tie in adults. Aerophagia is understudied functional gastrointestinal disorder. A review of the literature looks BEYOND the tongue and lips. Digestion starts in the mouth and we need to start there. We need to start looking at the oral cavity. Dr. Larry Kotlow is currently studying GI distress, aerophagia and reflux in correlation to lip and tongue dysmotility . An early diagnosis of aerophagia will save family members from resources and frustration when searching for appropriate treatment for their child.

It will also save the child from unnecessary discomfort and from the risks associated with extensive and invasive testing. We need to look at the lips and tongue.

Comments from crowd: An adult attendee from the meeting had frenectomy and two days later ate an avocado that was refrigerated. She felt for the first time cold on her palate and her GI symptoms improved dramatically

Stopped taking prescription antacid

No longer had Dysphagia (difficulty swallowing) had to have her husband slap her back to help her stimulate to swallow, all foods previously had to be pureed.

Vagal nerve affected when swallow, stimulated vagal nerve and helps peristalsis all throughout intestinal tract.

Now she barely has any reflux

Tongue plays a bigger role than just, also plays a neurological role

One IBLCL has all of her babies get released. Most of them improve, but some of the babies that don’t improve. Don’t just look at babies swallowing air. Have to look at mom’s diet. Mom’s diet is reviewed and they are taken off gluten and dairy. We need to ensure that their zinc is not depleted from the medicines they are taking and the babies are getting body work.

Biomechanical role that can be complicated by tongue tie; Suboccipital such tight suboccipital muscles so tight, as child grows and muscles elongate, hypertonicity of iliopsoas muscles elongate, the restrictions moved into the torso, the child stopped vomiting.

She saw a 4 year old that has been vomiting since discharged from 5 months old from the NICU.

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If diaphragm is too tight, could cause tightening on esophagus, release musculature.

Isabella Knox, gag reflux may play a role, can trigger gag reflux because a tethered tongue is unable to properly reach the palate and close the

Initiate factor is elevated the hyoid upward and forward. The UES is not opening up and staying up

Gummy smile from over active orbicularis oris and levator muscles, no concern with maxillary labial frenotomy. Only may notice lift in central portion of upper lip.

Dr. Robyn Abramczyk and Michelle Emanuel

(Michelle Emanuel has over 17 years’ experience as a neonatal / pediatric occupational therapist, which includes neonatal intensive care unit, pediatric critical care, outpatient and a private practice, with a specialty in using soft tissue manual therapy techniques. Michelle has a wide variety of skills that includes newborn/infant development, pre and perinatal psychology, autonomic nervous system regulation, infant sensory processing, baby massage/craniosacral therapy and other forms of bodywork. Michelle developed and began teaching TummyTime!TM classes six years ago. Michelle is licensed and registered as an occupational therapist, a national board certified Reflexologist and 200hour Registered Yoga Teacher. She is also certified in CranioSacral Therapy, Divine SleepTM Yoga Nidra, Reflexology, Infant Massage, Baby’s First Massage, Butterfly Touch Massage, Neonatal Oral Motor Assessment Scale (NOMAS) and the Infant Behavioral Assessment.)

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