Tongue, Lip & Cheek Ties

Wound Management after Releases for Infants, Children and Adults Without Sutures

Summary

• Perform firm lifts of each site (lip, tongue, cheek) for 5 seconds at least every 8 hours (about 3 times daily) for a minimum of 3 weeks.
• Start lip and cheek lifts 8 hours after release; start tongue lifts 24 hours after release.
• Discontinue wound management when the wound’s diamond/oval area blends with surrounding tissue (same color and texture).
• Some spotting is normal; laser sites often appear white/yellow during healing—this is not an infection.
• Pain control as appropriate: homeopathic remedies (Arnica, Camilia, Hyland’s), acetaminophen (if directed by provider), ibuprofen/Advil/Motrin (>6 months and if directed by provider).
• Apply organic coconut oil after—not before—exercises; frozen breast milk chips can provide cooling/pain relief.
• If white lesion persists at 3 weeks, continue additional lifts until same color and texture of surrounding tissue.
• Serrapeptase can lessen the extent of the contracture phase of healing and prevent wound reattachment and is to be used around days 2–5 and weeks 2.5–3; consult your provider for this medication and instructions of use.
• Typical release locations and purchasing/usage notes are included below.
• Children and adults that are cooperative enough for sutures, do NOT do lifts, and can disregard these instructions. Myofunctional exercises will be prescribed instead, handout given at the time of the release.

How to Perform Lifts

Lip Lift

• Place two index fingers above the wound.
• Push the lip up to fully stretch it to the nose for 5 seconds, until you can fully see the diamond-shaped wound.

Cheek Lift

• Use one index finger in a hook shape to pull the cheek up as far as it will go for 5 seconds.

Tongue Lift

• Have child or infant’s head in your lap, looking up at you, for best visualization.
• Place two index fingers above the wound or use retraction devise from your provider.
• Push the tongue back and down to fully stretch it flat, so you can fully see the diamond-shaped wound, see picture above.

General Tips

• Lift the lip, tongue, and/or cheek until fully extended for 5 seconds.
• Do not be afraid—you cannot overstretch the wounds.
• Lifts are typically the sorest during the week following the procedure.
• Trim fingernails so nails do NOT touch the wound.
• Use smartphone reminders to ensure lifts occur at least every 8 hours, or more if directed by your provider.
• For infants, lifts can be done prior to feeding (but never less than once every 8 hours).

Schedule and Duration

• Start lip and cheek lifts 8 hours after the release.
• Wait 24 hours after the release to start tongue lifts.
• Perform lifts at least every 8 hours (about 3 times daily) for at least 3 weeks.
• Each lift should be firm and maintained for 5 seconds per site.

When to Stop Active Wound Management

• After 4 weeks, if you see only a vague outline of the diamond/oval wound and the skin inside appears the same color and texture as surrounding tissue, you may stop active wound management.
• Exception: If at 3 weeks you see any white inside the diamond/oval wound, add one more week of lifts—even if the next day no white remains.

What to Expect During Healing

Wound Appearance and Bleeding

• A diamond- to oval-shaped wound is expected at each release site.
• A small amount of spotting or bleeding—especially in the first week during lifts—is common.

Laser Release Notes

• Laser releases typically result in less bleeding and pain than other surgical treatments.
• A white to yellow colored wound is normal and will decrease in size while healing. This is not an infection.

Release Sites and Wound Shape

• Tongue-tie release: Located where the tongue and the floor of the mouth meet; it requires laser ablation to release fascia perpendicular to midline.
• Lip/cheek-tie release: Located at the insertion of the frenum to the attached gingiva (gums), extending toward the vestibule (where the lip and movable inner oral mucosa meet), until webbing/tension resolves.
• Release of all sites results in a diamond- to oval-shaped wounds.

Pain Control and Comfort Measures

Please use caution and consult with your provider for all medications.

Medications

• Homeopathic remedies such as Arnica, Camilia, Hyland’s, see below.
• Infant acetaminophen/Tylenol (3–6 months)
• Children’s ibuprofen/Advil/Motrin (over 6 months)

Optional Remedies

Arnica montana 30c pellets

• Available at Spokane Valley Fred Meyer’s on Sullivan and Rosauers grocery store on University.
• Place 2–3 pellets in a dropper bottle with 1 ounce of breast milk. Keep refrigerated and discard after one week.
• Place 1–2 drops on each wound every hour for the first few days or as needed for pain.

Boiron Camilia (oral liquid doses)

• Children 1 month and up: Administer one entire liquid dose; you may repeat every 15 minutes for 1–2 more doses. This repetition of 3 doses can be repeated 3 times a day for a total of 9 doses each day.

Hyland’s Naturals Baby Oral Pain Relief (dissolvable oral tablets)

• Children under 6 months: Dissolve 2 tablets on the tongue every hour up to 4 hours as needed. If symptoms persist, 2 tablets every 4 hours during the night until relieved.
• Note: For infants, consider dissolving the tablet with a drop of breast milk/water on a plate to create a paste you can wipe inside the mouth.
• Children 6 months to under 3 years: At onset of symptoms, dissolve 3 tablets on the tongue every hour up to 4 hours as needed. If symptoms persist, 3 tablets every 4 hours during the night until relieved.

Coconut Oil

• Organic coconut oil can be safely used in the mouth following the exercises to soothe and reduce friction.
• Do not use coconut oil before the exercises as it may inhibit full retraction (too slippery).
• Frozen coconut oil applied to the wound can help by providing cooling and comfort.

Serrapeptase

• Serrapeptase is recommended to all wounds during contracture phases—usually noted at 2–5 days following releases and again 2.5–3 weeks after releases.
• Release provider will supply the Serrapeptase for use, however if you wish to purchase please purchase from Arthur Andrew Medical – as it is without filler ingredients:  Serretia, Serrapeptase Formula for Muscle and Sinus Support
• Instructions with Serrapeptase capsules will be provided at the time of release.

Q&A

When should I start the lifts, how often should I do them, and for how long?

Short answer: Begin lip and cheek lifts 8 hours after the release and start tongue lifts 24 hours after the release, or more often if directed by your provider. Lift each site firmly for 5 seconds, at least every 8 hours (about 3 times daily), for a minimum of 3 weeks. For infants, lifts can be done before feeding (but never less than once every 8 hours). Trim nails so fingernails do not touch the wound, and use smartphone reminders if helpful. The lifts are usually the sorest during the first week, and you cannot overstretch the lip, cheek, or tongue when doing them correctly.

How do I know when to stop active wound management?

Short answer: After at least 3 weeks, when you can only see a faint outline of the diamond/oval wound and the skin inside looks the same color and texture as the surrounding tissue, you can stop. If you still see any white inside the diamond/oval at 3 weeks, add continue lifts for an addition week then reassess.

What should the wound look like while healing, and is some bleeding normal?

Short answer: A diamond- to oval-shaped wound is expected at each release site. After laser releases, the wound commonly looks white to yellow as it heals; this is normal and not an infection. A small amount of spotting or bleeding—especially in the first week during lifts—is also common. Tongue-tie releases are at the junction of the tongue and floor of the mouth (sometimes extended superficially at midline and sides), and lip/cheek releases are at the frenum where it inserts into the attached gums and vestibule.

What can I use for pain control, and how should I use coconut oil?

Short answer: Optional remedies include Arnica Montana 30c (prepared as drops applied to the wound), Boiron Camilia (single-dose liquids for children 1 month and up, with limited repeat dosing), and Hyland’s Naturals Baby Oral Pain Relief (age-specific dissolvable tablets; you can make a paste with a drop of breast milk/water for young infants). Organic coconut oil can be used in the mouth after the exercises to soothe and reduce friction; do not apply it before exercises because it can make the area too slippery for proper retraction. Frozen coconut oil applied to the wound can also help with cooling and comfort.  You may use acetaminophen (for infants 3–6 months) or children’s ibuprofen/Advil/Motrin (for children over 6 months). Please use caution and consult your pediatrician.

What is serrapeptase used for in this recovery, and when should it be given?

Short answer: Serrapeptase is recommended during the normal contracture phases of healing—typically days 2–5 after the releases and again around weeks 2.5–3. It helps resolve the tightened wound. It will be given to you by your provider at the time of the release with instructions.  It can be purchased online (e.g., Serretia by Arthur Andrew Medical).