Type 2 Lingual Frenulums
Fig 7-9: The frenulum can barely be seen in the middle image, but when the tongue is manually elevated, the frenulum and Eiffel Tower appearance becomes more evident.
Fig 1-3: Notice the variation in thickness and vertical length between these two frenulums.
Type 4 Lingual Frenulums
Fig 4-6: The frenulum is no longer connected to the tip of the tongue, but still restricts elevation and free movement of the tongue.
Fig 10-12: This depicts the submucosal frenulum that is typically a dense band of tissue that feels like a guitar string or piano wire when it is pressed on. The middle and right image are of the same patient and this thick band restricts the tongue from elevating and can lead to negative compensatory actions when the infant nurses.
Tongue Tie Appearances:
The frenulum or connective piece of tissue under the tongue can appear in many different, shapes and sizes. The frenulum can vary in vertical height, thickness, and where the two pieces on the frenulum connect. The frenulum can act to restrict the range of motion of the tongue in the various directions it needs to move (upwards, downwards, extension, retraction and a combination of these movements). The pictures outlined below will give two viewpionts for how the frenulum may appear. The tongue also varies in it's size, muscle mass and ability to coordinate movement. Appearance alone is a small portion of determining the root cause(s) for nursing issues and the function of the tongue is of primary concern.
Type 1 Lingual Frenulums
Once the revision is complete, all of the frenulum is revised to the genioglossus muscle of the tongue. Some healing and a subtle frenulum may reappear as the tongue moves and the head, neck and jaw grow. A fully revised tongue will no longer be restricted or held in place. The tongue will need to relearn how to use the muscles, recoordinate movements, improve muscle mass (if needed) and unlearn prior movements and mechanics it may have used leading up to the revision.