A Retruded Mandible
A skilled IBCLC referred a ten-week-old boy for evaluation and possible treatment. She noticed a tongue tie and, before she mentioned surgery to mom, she wanted my opinion on his condition.
The baby presented with oral motor issues with difficulty nursing. Since he was gassy, mom assumed he was taking in air from a poor latch. Reflux was also a problem. Clinically, his mandible was retruded, or pushed back towards his neck.
There was definitely a tongue tie, but was that the sole causative issue? He was presenting with left TMJ strain. I also felt a bilateral fascial strain pulling on his mandible from his posterior neck and cranial tissues.
The left TMJ strain cleared nicely on the first visit, but this often-overlooked fascial strain pulling his jaw back was still fierce at the second visit. That restriction was probably the root cause of his oral issues.
But until that strain clears, I do not really know if that is the sole cause. Maybe the tongue tie will still be a problem that will require surgery. As a therapist, my role is to just create a strain-free baby and let the skilled IBCLC determine further care.
As a former periodontist who did many frenectomies without fascial awareness, I am the first person to say oral ties can be an important factor in wellness. But I am also saying that health-care providers need to avoid make my mistakes from the 1970s and look at the entire oral and full body fascial web.
All too often, I see infants post surgery still presenting to me with issues. Even worse, they have failed revision(s). Providers need to look at the many fascial web possibilities for a more complete assessment.
I also wonder if this can be the cause of a child growing up with a retruded mandible that requires jaw surgery along with extensive orthodontic correction. Maybe this scenario can be prevented at birth.
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