Tongue Tie Release Before or After Expansion?

Should a tongue tie release (frenectomy) be done first, before any palatal expansion? Or should it be done at the end of treatment, once palatal expansion is complete?
In this video I argue that tongue tie release should be done at the end of treatment, because the additional oral volume will help you do the exercises that will allow your tongue to heal into a maximally elongated position.
I also mention that upper lip tie release is not something you should just add on as part of your tongue tie release, because if the lip tie release is not done perfectly there is a risk it will give you an uneven smile.
I end with a brief discussion of how nasal surgeries should also be done last, after any maxillary expansion.
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[@grimartificial]

This is an important question, but I have to disagree completely. Tongue tie release with a laser is far, far inferior to doing it with scissors, like Dr. Zaghi of The Breathe Institute (who has a KZbin channel) has pioneered. The tissue that's released should be cutting the inappropriate bands of fascia inside of the frenulum and sometimes muscle deep within the tongue (which are speculated to be developmental scaffolding not reabsorbed before birth), not just ablating the entire frenulum. The difference in healing is huge: laser requires you to stretch your tongue around the clock for weeks to ensure that the enormous hole created heals in as elongated as a position as possible, whereas scissors merely create a hole in the frenulum and fascia is removed often just by crimping the bands, if enough strength has been built up by OFM therapy. Once that's done, the very small hole in the front is sutured and there's almost no stretching required. I've had both, laser first, and there's just no comparison. It's also generally not possible for the scissors method to cause you to heal into a more restrictive position than before, because the wound is sutured into the correct position as the procedure is wrapping up. Another important difference is that laser is often a very incomplete release, whereas this scissors method is as thorough as it needs to be, which may include dissecting deeper into the tongue than can be safely done with the laser. I think that the order you do release and expansion isn't very important, but if you had to pick, I would guess that release first would be better, because there's a tremendous amount of tension in the entire body that results from a tied tongue, and removing all of that first will make osteopathic treatment much more effective and permanent, which in turn is almost certainly likely to make expansion easier. Additionally, Dr. Zaghi's research has shown that those with very tied tongues and those with completely untied tongues have similar orofacial habits, because having a very tied tongue makes it completely impossible to develop maladaptive habits that would contribute to craniofacial dystrophy, because the tongue simply can't move very much, so saying that tongue tie and CFD are a chicken-or-egg situation isn't fully accurate.

[@grimartificial]

Same thing with the lip tie release. Doing it with a laser is a complete misunderstanding of what causes lip tie and the scissors-and-Qtip approach pretty much guarantees you can't "overdo" it or end up with something uneven.

[@JawHacks]

Thanks for sharing this great information. I've got a lot to learn about frenectomy. I'm thinking someday perhaps I will go to Dr. Zaghi so I can have a second release done his way. I've been telling people for years, from all over the world, to go see Zaghi for frenectomy. I've always known he was the best, but never really knew precisely why. Now we know!

[@theradicalaxe553]

Yeah, I got my tongue tie release about a week ago and it was lasered. My tongue is much larger now, but I can tell that the people that went the scissors route have less restriction. The people I went through gave me a free lip release with it all and I am grateful for it. I like it personally. I'll probably end up asking them if they can laser it again though. That or I need to stretch it to oblivion.

[@stevenmclarssen6608]

@@theradicalaxe553 I got laser done too, to be honest I feel the doctor that did mine didn't do the full release and I'm looking to see if I can do a 2nd one. Still a massive benefit though I got from the first operation.

[@grimartificial]

I would highly recommend getting it taken care of all the way! I think the biggest benefit comes from releasing the deepest fascia, speaking from personal experience doing laser and then scissors much later

[@danielsalvador8232]

I had the frenectomy without maxillary expansion, and now I feel that the lower jaw has moved forward, giving a class 3 appearance.

[@JawHacks]

Thanks for sharing your observation.

[@theradicalaxe553]

Got my mse expansion and just got my tongue tie release + lip tie releases 4 days ago, still gotta get my invisalign. I'm hoping the invisalign creates more expansion, tongue is still much larger now. Not sure if I got the full tongue though after healing, I may of needed the invisalign.

[@JawHacks]

Thanks for sharing your experience. All data is good data.

[@rickrobinson8417]

Does youtube and a bathroom mirror not make a myofunctional therapist a waste of money? I've got mewing down by myself with the help of youtube videos, all while being tongue tied and recessed.

[@alizapya]

Depends on if you plan on doing a tongue tie release surgery and what your goals are. Do you want the best possible results and to be functioning well without compensation? Compensation is something that needs to be addressed and won’t be unless you are well aware of what your compensations for the tongue restriction are.

[@LittleHarryBrother1]

Thank you for weighing in on this topic, Ronald. I would love if you could clarify one thing for me: After watching the video, it is still not clear exactly how would oral volume allows for more stretching of the soft tissue beneath the tongue. Of all the exercises myofunctional therapists recommend for this purpose, I have never come across one that requires ample oral volume. Most exercises are performed by stretching the tongue outside of the mouth, so oral volume won't be an issue during these exercises. Sure, tongue clicks are usually recommended, but the focus here is stretching the tongue away from the floor of the mouth(as well as strengthening the tongue). Oral volume shouldn't really be of any concern here either. Best regards

[@JawHacks]

Tongue clicks and Mewing at rest during down periods between formal exercises. For example, when I was healing from my frenectomy, I was back to work the very next day. Rather than having my tongue out in front of coworkers, I resorted to exercises and stretches I could do with my mouth closed, such as clicks. Occasionally when alone I would do stretches that involved bringing the tongue out of the mouth.

[@LittleHarryBrother1]

@@JawHacks Okay, then I see where you are coming from. In that case, would you agree that although helpful, it may not necessary to have ample oral volume, provided one performs formal exercises to a sufficient degree?

[@fangbite]

should i get a lower lip tie release? i feel like i kind of pulls my chin inwards creatjng like a fold

[@jacobzamorano8483]

I love you. You provide so much useful information on your channel.

[@Ojj2002]

i got rhinoplasty a few weeks ago 😬😬😬im 19

[@bumba8154]

Nice, how did it go?

[@Ojj2002]

@@bumba8154 its great results look natural and aesthetic pretty boy look

[@bumba8154]

@@Ojj2002 nice, glad it went well

[@user-ig1ew2kb8t]

Imo tongue tie is the cause of underdevelopment and not the other way around. I think breastfeeding is meant to train the tongue to swallow properly which would prevent a functional tie from forming. Curious to know your thoughts.

[@JawHacks]

Agreed.

[@minney124]

Hi Ronald, thanks for the great video! I was wondering, what are the supposed benefits of a lip tie release?

[@JawHacks]

That's a really good question. It's not very straightforward, is it? Always a red flag when something doesn't seem to make common sense. I think the idea is that a tied upper lip restricts, well, lip movement I suppose? So lip sealing, speaking, etc. I've also heard one dentist claim that a tied upper lip can prevent the maxilla from "growing" or being expanded forward. Not sure if any of these assertions are true.

[@alizapya]

A lip tie release is recommended if the tie is causing a diastema (gap) between the front teeth or if it is so tight that if restricts lip closure. In baby’s it can prevent proper latch to the breast which can prevent a baby from being able to feed well. Another reason for lip tie release could be if it is pulling on the gum and adding to or causing gum recession in that area. Buccal and lip ties may also be addressed if they cause issues such as facial tension or gum issues.

[@stevenmclarssen6608]

@@JawHacks Yeah a doctor told me that lip and buccal ties can slightly restrict maxillary growth but it's not too significant. Still why not do it if you can if it'll improve the odds of less restricted expansion especially if older.

[@cavemandude257]

I believe that the tongue tie keeps the chin up when mewing and holding the lower jaw in place. I

[@d4nm4n91]

The dumbest thing I've done was getting a release before getting my deep bite fixed

[@JawHacks]

Why what has been your experience?

[@d4nm4n91]

@@JawHacks it's terrible man after the surgery I did only 1 week of exercises because the snoring already got worse from the big tongue and small mouth and had no energy or focus.i got very disassociated because every breath even while awake was a snore.now I finally got these braces and it's easier on my brain since I'm not in that wierd position with My bite and 4 months in I'm finally getting a real myo therapist. I got the surgery 10 months ago so I've been dealing with this since Oct 2021.im so glad it's finally coming to and end

[@d4nm4n91]

@@JawHacks what's worse is she was personally trained by zhagi making her tongue tie release really deep. So she got out the posterior and anterior.but my face was the face of someone who had a posterior and anterior tongue tie for 20 years so it really had no benefit.now I just got this really long tongue waiting to be exercised up hahaha

[@sosathegreat]

so your tongue being bigger but your jaws still be at the same size made your breathing more difficult? is that what happened?

[@SecretMountainTroll]

I am 25 with a posterior tonge tie lol rip

[@JawHacks]

Lol ain't nothin that cain't be fixed bra

[@SecretMountainTroll]

@@JawHacks very true

[@ZuZu66667]

Is it a good idea to put on MSE and after 2 weeks go under rhinoplasty surgery for deviated septum ? Will it affect my nose and my healing process negatively?

[@LittleHarryBrother1]

Think you should wait until the MSE expansion is done.

[@LittleHarryBrother1]

@@ZuZu66667 Are you asking if braces will affect the nose in any way? If so, not in any way that I am aware of.

[@JawHacks]

Soft tissue nasal surgery last.

[@ZuZu66667]

@@JawHacks even after a double jaw surgery? I heard it makes it wide and pointy

[@bumba8154]

@@ZuZu66667 depending on the type of movement you’d get in bimax, your nose could change from the surgery and take time to settle into a new shape

[@mistertrumpet5856]

Unrelated but I noticed that really nice icon of Christ the Shepherd in the background. Very good!

[@JawHacks]

Thank you, I bought it at St. Basil's Cathedral in Moscow last October

[@mistertrumpet5856]

​@@JawHacks Wow! I wish to visit it myself one day

[@chappi5939]

Hi Ron, one question I have which I forgot to mention in my consult is that while lightly pressing my tongue onto the surface behind my front teeth I can feel multiple slight pops under and around my teeth. Any idea what this is? It is also very slightly audible if I wiggle my front teeth slightly. Thank you!

[@JawHacks]

Perhaps you are putting too much pressure on your teeth. You could tip or otherwise harm them over time. Similar to the effect creating by tongue thrusting. Sounds like you may need some forward expansion to get those teeth out of the way of your tongue.

[@chappi5939]

@@JawHacks That would make sense, hopefully MSE would provide enough expansion in that case, cheers