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The Dreaded Reattachment

You may have heard it suggested that the return of the appearance of a frenulum, or the recurrence of symptoms following release means that reattachment has occurred. Yikes. You've just spent your valuable resources (money and time!) on having ties released, and now it's all for naught?! Read on for more about the dreaded reattachment.

What is reattachment?

“Reattachment” is a very common, very valid, concern of parents and patients following frenectomy procedure. However, I propose that it is a concept that is not well understood by the public (for good reason), and a term which often leads to more confusion and misinformation.

First, it is important to acknowledge that a frenulum is a normal part of anatomy. We all have them, but some are more restrictive than others, and when they limit mobility and function, they are referred to as a “tie” or “tethered oral tissue”. It is important to also know that following a release procedure, eventually a new frenulum will form. (It is ideal if this new frenulum is afforded optimal length and mobility via active wound management, as will be discussed below.) Therefore the reappearance of a frenulum following release does not alone constitute reattachment (*collective sigh of relief*)!

Second, there is a difference between the physical restriction of a tie, and the dysfunctional movements that it can cause. One can exist without the other, therefore, it is important to have a functional assessment done by a trained provider to ascertain whether ties are truly present, or if symptoms are caused by oral motor dysfunction in the absence of ties, or both! More on that here. Third, it is possible that following procedure, symptoms will abate, and then reappear after some time. This alone also does not constitute “reattachment”, but it definitely warrants a closer look at function, if one is not already working with a provider in this regard!

So, what is reattachment? Simply put, it is the reappearance of a restrictive band of tissue following surgical release of a previous tissue. Several sources purport that reattachment occurs in approximately 4% of patients, however there is limited research to conclude this definitively.

Why does it happen?

Following surgery, the body immediately starts working to heal the wound. In the mouth, wound healing occurs slightly differently than other areas, such as the skin. The mouth is a wonderful environment for healing to occur because it is moist! So, mouth wounds tend to heal quickly, which is good if you’ve got a canker sore, but not when you are actively trying to guide wound healing and prevent contraction (closure) of the wound in a specific way,

such as post-frenectomy.

This mama diligently performs active wound management on her post-frenectomy infant.

In addition to normal healing properties of mouth wounds, there are other factors to consider with respect to risk of reattachment, such as: the type of procedure and skill level of provider (more tissue damage = more inflammation), wound management (provision of aftercare or “stretches”), and inherent tendencies of scarring within the individual, which is sometimes genetic.

What can be done to prevent reattachment?

In some cases, very little, but in most cases, very much! Your release provider will prescribe active wound management, sometimes referred to as “stretches” following the procedure. Adhere to the protocol, communicate any difficulties or questions to your provider (not the internet), and do your best to keep your stress levels low. It is a LOT to manage, and usually you have already been through a lot to get to the point of release. Deep breaths!

It is also wise to pursue therapy. Movement, hands-on therapy, restoration of function (including oral!) can be a wonderful complement to care from other team members such as IBCLC, following release. I am a proponent of PT, obviously, but it is highly dependent on the individual issues, as well as the provider’s education and training which discipline is best suited to treat you/your child.

Read more about who is typically involved in treating individuals pre-/post-release, and what we do!

Pictured is the Beckman Tri-chew - one of my favorite tools for young babies for oral skills! See my Product Recs page for more!

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