BackTable / ENT / Podcast / Episode #8
with Dr. Felicity Lenes-Voit
Dr. Felicity Lenes-Voit from Dallas Children's Health discusses her approach to diagnosis and treatment of Tongue-Tie, or Ankyloglossia, in the infant.
BackTable, LLC (Producer). (2020, October 20). Ep. 8 – Treating Tongue-Tie [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Felicity Lenes-Voit
Dr. Felicity Lenes-Voit is a practicing ENT and an Assistant Professor in the Department of Otolaryngology at UT Southwestern Medical Center in Dallas ,TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. Felicity Lenes-Voit joins our hosts Dr. Gopi Shah and Dr. Ashley Again to speak about Tongue-Tie, or Ankyloglossia, and its comprehensive management.
Dr. Lenes-Voit starts the discussion by describing what Tongue-Tie is and how to conduct an initial evaluation and workup. She describes the importance of lactation consultation and the effects tongue-tie can have on both mother and baby. The discussion then continues to discuss physical examination as an important aspect of the workup and how best to determine the extent of the ankyloglossia, while also factoring in the weight of the child as a key aspect of workup.
Next, Dr. Lenes-Voit and our hosts discuss points to keep in mind when considering frenectomy as a correcting procedure, which include conducting a thorough lactation evaluation prior to making that decision. Speech impairments are also a potential worry from parents and, as a controversial topic in frenectomy evaluations, should be clarified with families. Other risks and benefits are further discussed such as timing of intervention and the use of general anesthesia at certain ages. This portion of the discussion ends with Dr. Lenes-Voit talking about the different operative techniques that can be employed as well as tips for smooth procedures.
Lastly, the discussion concludes with Dr. Lenes-Voit speaking to the importance of counseling and a multidisciplinary approach with mothers of tongue-tie patients. The team effort between ENT’s, pediatricians, and lactation and breastfeeding consultants is key in the comprehensive management for both mother and baby. Setting realistic goals and expectations, especially for new mothers, will be beneficial and something to incorporate with each patient.
[Felicity Lene-Voit MD]
When I do the physical exam, I look visually to see if there's a tie. But to me, what matters a lot more is the functional exam. And tell me how you all do this, but I use a gloved finger and I stick it on in there and kind of tickle the palate to try and stimulate the suckle response. And then I feel the tongue move and I try to see how good of a hole baby has on my finger as kind of a surrogate for how much suction they're able to generate. But then also there's that what's as important as the suction is actually the massaging movement from posteriorly to anteriorly of the tongue, sort of coaxing milk out of those duct tools. And so if I don't feel that tongue kind of undulating in a coordinated fashion from posterior to anterior, I don't know that I think that cutting the frenulum is going to help a ton.
Of course, I look to see if they can stick their tongue out of their mouth past their gums, but that hasn't been shown to be a totally helpful parameter in all cases. And so I honestly don't know how much weight to put to that. I always document it, but I feel like the sort of functional assessment is a little more reassuring for me if I'm going to recommend the procedure. There are some situations where baby seems to have torticollis, their jaw seems really stiff, or they're having other symptoms that might need worrying about swallowing or make me worried they have a laryngeal cleft or something like that. And if I'm getting any sort of antenna signals that they had tone issues or mom says anything that makes me think, "Oh, maybe they have sleep apnea," I really am very reluctant especially the first time I meet them to do a procedure.
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