149: Tongue-Tied: Unraveling the Evidence Base for Assessment & Treatment of Ankyloglossia [Podcourse]

TRANSCRIPTION

Venita Litvack: Today. I'm joined by Kayla FAO, a speech language pathologist, and [00:02:00] I a O M certified oral facial biologists.

Kayla founded flower mound speech and therapy center in 2015 because she saw a need to provide in depth personalized services for her clients. Before we get started, we do have some information to share for the agenda today. We're gonna talk about tongue tie, release the controversy around them, what it's like running a private practice for this population and other factors that you should consider in the oral mechanism.

And I do have some financial relationships to disclose. I am the owner of FII side up and task learning, LLC. And I receive royalties from the Lu knows what todo book series and my non-financial relationship to disclose is that I am a member of ASHA's special interest group 12, and I will let Kayla come on and share her

Kayla Fontenot: financial disclosures as well.

my financial disclosures financially, I am the owner of flower, Mount speech and therapy and receive compensation [00:03:00] for treating patients privately. I'm a paid member mentor for the myo membership, a paid speaker for talk tools. And my non-financial disclosures is I am a member of the IM.

Venita Litvack: Great now that we've got all that covered.

Let's get started. Kayla, thank you so much for coming

Kayla Fontenot: today. Thank you so much for having me. This is really exciting.

Venita Litvack: It really is. Can you tell the listeners a little bit about yourself and what you're currently working on before we get into

Kayla Fontenot: our topics and questions? Absolutely. So I am a speech language pathologist, um, since 2011 and.

Started in private practice back then and began specializing in oral motor and myofunctional type disorders. Um, back in 2015, 16, and became a certified oral facial, my and have a private practice, um, in flower Mount, Texas.

Venita Litvack: Great. Yeah, I'm really curious, like [00:04:00] how you just kind of found your way into this specialty area, but I'm sure we'll get into that.

 my 10, almost 10 month old. Now she actually had a tongue tie release at about the two and a half week mark and. It was such a relief when she got it done. I wish she had got it done sooner. But of course, like as a first time, mom, you're just wondering like, is there anything else that we can do beforehand?

But I think when you're a speech language pathologist and you're trained to look for those things, like I knew at the hospital that, that it was an issue that she had, you know, a short tongue time. She also got the lip released as well. But what are some signs and symptoms that practitioners should be aware of and families should be aware

Kayla Fontenot: of.

absolutely. So if we're talking about tongue ties, there are different signs and symptoms across the lifespan that we're looking for. So in babies specifically, um, one of the most common things that we get approached, um, with, for tongue tie or painful latch [00:05:00] are just a difficult breastfeeding journey.

Um, there are other things like reduced weight gain clicking on the breast or bottle. Heart shaped tongue. So the baby sticks their tongue out and there's a little groove at the end. Um, babies with reflux that they can't seem to solve the problem with reflux, um, that can be from swallowing too much air, which can be the results of a tongue tie.

Um, in an older infant difficulty transitioning to solid foods because they have a hard time mobilizing the tongue in the mouth or, um, maintaining control of the foods and then babies that aren't able to take a pacifier that oftentimes, um, when we do a functional assessment, we find that there's a tie and then, um, babies that are unable to breathe with their mouth closed, or they're often open mouth breathing.

Can be a, um, can be an indicator of tie or could be an indicator of, um, an airway issue or an allergy. So we really like to look at the whole picture and not just say everything's a tie because you have [00:06:00] something, um, you know, on this list, it doesn't mean you have a tie. It just means, Hey, let's look a little bit, a little bit more closely at the whole picture.

So you said your daughter had her release done at two weeks old?

Venita Litvack: Yeah. Two and a half. And she had everything that you described the I B CLC that we worked with the lactation consultant. Mm-hmm she wanted to wait, like she wanted to look into the, the clicking look into the latching issues and, um, major like GI issues we had going on as well.

Uh, so. We were trying to do like a process of elimination. She didn't want me to do the elimination diet because she wanted me to, I had a major oversupply as well. Mm-hmm so we were doing like one sided, uh, nursing and that helped, but it didn't help enough. And I had spoken to another I B, C, L, C, and she was like, what I find is that parents sometimes just wait too long.

Mm-hmm and. She was [00:07:00] right. So like shortly after that, we got, uh, an appointment with the pediatric dentist and he was very upfront. He was like, I can't guarantee that all of the things that are going on, like with GI and all of that is contributing to, or is attributed to the tongue and the lip tie, but I can see it's extremely restricting and.

I think it was part of the puzzle because mm-hmm what did immediately get better was the latch and nursing immediately. Like that day got better. Um, which, you know, we could have like probably, uh, Bottle fed. And would've been okay with that. But like you were describing, I was really concerned about her feeding in the future.

Mm-hmm like how, if we're having like these issues now and you can, you could clearly see how restrictive it, it was. I just was thinking there's just so much more that's involved and, um, It's probably better to get it done now rather than later. And it was, I [00:08:00] mean, she's a great eater now. I'm super grateful for that.

Cause I know it's not always the case and she we're still nursing at 10 months. Um, so it was very, we actually had to get it re-released which was horrible.

Kayla Fontenot: Um, no. So you had a second, you had a revision done then how, what age, when did that happen?

Venita Litvack: Um, it was within like the checkup. Face. Okay. So I can't remember how many weeks after it was, but we were going in every two weeks and we were doing all the exercise.

Actually, my husband was doing the exercises. I couldn't stomach it. I was like there for moral support mm-hmm but I ended up doing them after she got it revised. And I haven't looked down there in a while. Like sometimes she'll like cry and I can see a little bit, and I see like the. Underneath mm-hmm but I'm curious to see, like, you know, I'm sure some of it reattached a little bit, it seems like some babies like can go without even doing the exercises and it doesn't attach.

I don't know why some have the propensity to [00:09:00] like reattach and then some don't, but. Thought that was

Kayla Fontenot: interesting. I think that's a really good point. And you brought up another good point too earlier about, um, oversupply and undersupply, and that's often commonly overlooked when, um, a tie is involved, but the oversupply could be the result of a tie baby, just, um, going vigorously at the breast and produc and mom is over producing.

Um, and then under supply, same thing. So it's like really hard sometimes to discern. Is this from a tie or not, and is a release going to help this one particular symptom or not. So you mentioned the tie immediately helped with latch, but then there were still some other things that you had to figure out.

Right? So I think that's a really, really good point to bring up. Yeah, thanks for

Venita Litvack: pointing that out. Yeah, it was just a, like I said, a piece of the puzzle, there was a lot going on. There was, uh, intolerance issues, which are seeming to resolve themselves yet now. Yay. Besides, um, [00:10:00] the dairy and wheat, but I think we'll get there.

Mm-hmm um, but it's nice that I had like a, that support team and I wish that other parents did as well. So I'm really grateful that you are coming on to talk about this because. I know everybody has like, there's a lot of different opinions out there. So I would love to talk about like the controversy around tongue ties and how that impacts like getting

Kayla Fontenot: proper treatment.

Absolutely. Absolutely. Um, I'll tell you a little bit about my story with, um, with my kids with tongue ties. Um, Because I think it's, I think it's important. I'm giving a, um, a presentation later this week for talk tools about it. I it's called responsive releases when to wait on getting a release and it has a lot to do with, um, maternal response and mental health surrounding, um, when it's appropriate for an infant to get a tie based on the way the mother responds to the infant and that [00:11:00] connection with the child.

Um, because as you mentioned earlier, It's hard to stomach some of the aftercare, right? Like you're, you've got a little baby crying and. You're not wanting to go in and do the stretches or, or cause the baby any kind of distress or anything like that. So, um, I'm excited to be talking about that really soon, but I'll tell you a little bit about my story with, um, my two kids.

I have, um, an almost five year old and an almost three year old and, um, They're, they were both tied as infant. And with my first, um, he came out, I checked him the minute he came out and I go, okay, pretty sure he is tied. Breastfeeding's not going so well. Um, I was newer to tongue ties back then. They weren't as, um, Commonly treated in our area and I was doing my best to learn everything I could about them.

And I decided to wait on him. I just wasn't quite ready. I needed to find the perfect provider, the perfect scenario. And I waited till he was about 13 months old to have him released. [00:12:00] And of course, After the fact and, and looking back, I go, okay, I should have done that, you know, day, one, day two, or somewhere in that very beginning, um, timeframe.

But I, I talk about this because I like to illustrate the hesitancy that even as a professional, knowing what needs to be done and knowing what's happening, it doesn't make it any easier. Um, so imagining a parent or lay person coming in and going, okay, you need to get a tongue tie release, you know, and they're going, I need to do what

It, luckily it's being talked about more and more people have had them done and had success with them. And, you know, there are a lot of support groups and things like that for people that are going through the process. Um, so that's really great love that there's so much support out there. Um, my daughter.

Um, when she was born again, I immediately checked her and she was like a little Piana and I went, okay. I mean, she's not even an hour old. And it's like, the first thing I do, you know, is check her mouth and I go, okay, she's really tired. She's like a Piana, breastfeeding was [00:13:00] going, it was dismal, it was painful.

It was awful. Um, but I had a traumatic birth experience with her and I had difficulty, um, Regulating my emotions after she was born, because it was a traumatic birth. And because of that, I felt that, um, I felt very protective over her. And so I know that even though it was, it's a very low invasive procedure, I thought, well, you know, I do this all day at work with other babies, but I'm not ready to do it on my own.

And it took me about three months to get there with her and to be in that mental space where I go, okay, I'm ready. This it's time. We can do this now. Um, I feel like I'm out of the woods and we can focus on this now. So we did her release at about three months and, um, she had a very interesting release.

She was different, like you said, in terms of healing, she healed very quickly. Whereas a lot of babies don't heal quickly. Like kind of like you mentioned, she [00:14:00] also, um, Produced a lot of saliva during the healing phase, more than most other babies and children that I've worked with. So she had a very interesting healing case.

Um, but she did have really good results. She did have some reattachment that we have not addressed yet, but we, um, we do plan to work on that down the line when it's needed right now, it's not needed in my opinion, but, um, That's kind of, that's kinda my background story and where I come from as a mom with tongue tie releases.

And it's in complete juxtaposition to who I am as a professional with releases. Um, because you can talk all day about like what optimal function looks like, what optimal outcome looks like. You can help to guide, um, other families and other children into getting those outcomes. But you're wearing a completely different hat when you're a mom.

So I like to separate those two things. Um, but also kind of pull in a little bit from each, from each side when. [00:15:00] When talking about it. Yeah.

Venita Litvack: I think it's so important that you have like that perspective, but it is interesting, like you were saying that even though you have that perspective, the way you treat it is completely different than like what you talk about.

So yeah. Let's talk about the controversy around

Kayla Fontenot: it. Absolutely. So I'm sure everybody's kind of heard. A little bit of what the controversy is. It's does it exist? Is it real? Why are we doing this? Is it really gonna help? Is there enough evidence base for this? Is there enough literature for it? Um, are we getting the outcomes that we wanna get?

And my answer to all of that is yes. I see it clinically, every. And I have for years, um, we have an entire clinic that focuses on oral function throughout the lifespan. So we are working with clients that choose to get tongue tie releases. We are working with [00:16:00] myofunctional therapy clients all day long every day, and we are seeing the results that people want in terms of, um, Having successful breastfeeding outcomes, having successful bottle feeding and feeding transition outcomes.

And then we haven't even touched on like older kids and adults yet. And what the signs and symptoms of those are. That's really, um, that's really my favorite population because they can voice why this is so impactful for them and how much this has helped them. Um, but if we wanna talk a little bit about like signs and symptoms and older, The older population.

We can do that too. I would love to do that. Yeah.

Venita Litvack: I wanna just point out something that you said, cuz I wrote it down before you even mentioned it. Cuz this has been coming up a lot lately in the podcast courses that I've done is just bringing people back to ASHA's like E EVP, triangle and not forgetting that circle.

I think it's at the top where it says the client outcomes mm-hmm and when you're evaluating [00:17:00] any. Protocol or any therapy technique that if there are not reports from clients that say this is effective, then you really need to consider why you're using it. If the research says that it's effective and I don't wanna name any.

Um, treatment programs out there, but hopefully people are like thinking about some in their head there's treatments, programs out there that people go to school for that have a degree in that are not deemed effective by the people that it's actually used with. Um, however, with Tonkey release you there's a group on Facebook.

Um, I don't remember that. Is it the oral? My functional study group. By Linda Oro. Yeah. Mm-hmm do Orino. There are so many people in that group, uh, professionals, adults who have had it done themselves and they report significant outcomes. Yes. And then there's also research to support it. But a big piece of that is the client, um, [00:18:00] feedback, their personal experience with it.

But yes, please.

Kayla Fontenot: Let's talk about this. Yeah. Well, I mean, talk, you were talking about the EBP triangle, which I love because it's literature, client outcomes and clinical experience. And we do have literature that supports it. And it's like, anytime you go to look for literature, you can find literature on both sides.

Right? So it's whichever you, you do have to look at all of, all of the literature when you're making those decisions, but then you look at client outcomes. I can tell you, we've had hundreds of tongue tie releases at our clinic or not at our clinic, but patients that have had them done that we work with.

And, um, in terms of anyone ever reporting a negative outcome, it's knock on what it's yet to happen. Nobody's ever come back from a release and said, I regret doing that. Or I didn't wanna do that. Um, we hear things all the time. Like, wow, I'm breathing so much better. I'm sleeping so much better. My baby's now able to feed really well.

Um, And then of course, um, our clinical experience with it just ties right into [00:19:00] that. So we have two really strong pillars of the evidence based triangle. And then we've got the literature side, which I think is pretty mixed. There are some really there's really great, um, literature and evidence around breastfeeding and infants with tongue tie release.

And then it gets a little bit more into the gray zone. When you talk about the older, um, older population, older kids and adults, Okay. Very

Venita Litvack: interesting. I'd be really curious to know. And I forgive me for not knowing enough about this topic, but I'd just be really curious to know like what the research says on waiting.

Like, do these structures S stretch themselves out at some point, um, Or do people just learn to compensate? I'm sure it depends on the severity of the tie as well, but, uh, yeah. Can you speak

Kayla Fontenot: on that a little bit? I think that's pretty, yeah, that's a really good point. Um, for a really long time, people used to say that you could stretch a tie and what we've learned through the literature is that, [00:20:00] um, thats, um, the tie is made of.

Collagen and you can't stretch collagen. You can get a, like the tiniest little bit of stretch. Like that's it like that doesn't, it's not stretchy like other, um, like other tissues might be what we're actually seeing clinically when you work on these soft tissues over time and you go, oh, look, we can move the tongue a little bit more because we've been working on it.

That's just because we've released fascia. That's not because we've released the tie. So, um, I think that's a good point to bring up. They don't stretch. Um, you can, you can work on them and you can get better range of motion by releasing fascia, but you cannot stretch a tie. So if it's tied and it's impacting function, you know, if it's impacting function, it's a tie period.

And, um, we like to keep it really simple. Okay.

Venita Litvack: That's so fascinating. Why do you think they're so common? They just, or is it like, I, it just seems to me that it's pretty common.

Kayla Fontenot: I think that's a good thing to discuss. Um, [00:21:00] are they common? Are they overdiagnosed? Are they underdiagnosed?

You know, I don't have the answer to that. Yeah. Um, but I think what's really happened is that social media has really picked up, um, In terms of information spread and the rate that information spreads. And so I feel that because we have this information and we put it out there and so many people are putting it out there and sharing it's really just spreading like wildfire.

And we just have access to so much information on our fingertips. Now it's almost in your face every day. Um, and I think people are starting to understand the signs and symptoms a little bit more because of that. I, I know that just even in regular, you can go online any regular Facebook group, if like a mom group, you know, and my mom says, oh my gosh, I can't get any sleep.

My baby's having trouble breastfeeding. You're gonna see every mom in the group go, oh, get 'em checked for a tie, get 'em checked for a tie. You know? So I feel like that has really brought the general public's [00:22:00] attention to the matter. Um, Massive manner. So I think that's really kind of the driving force behind it.

Another thing is that, um, Because of like, things like that too. We've also got access to more education surrounding it so that you're seeing a lot more coursework being put out there about it. You're seeing people have access to a lot more coursework, look at all of the continuing education that people were doing over COVID, you know, and we're just getting on the computer and taking CEUs and doing virtual conferences and things like that.

So the information is just spreading rapidly and I think that's kind of the big driving force behind a lot of it. Yeah,

Venita Litvack: no, that makes sense. Uh, I have so many questions and it's not just for myself because we've already gone down this road. I'm just curious for other people, like, is there a level of severity in the tongue tie where you make a referral or like, what are you looking

Kayla Fontenot: for?[00:23:00]

I'm looking for all kinds of things. Generally shy away from using severity. Um, we, we do classify the ties. There are different scales that you can classify a tie on. And they usually go like one through four or four through one, depending on what scale you're using. And for me, it's not about. What classification of tie it is.

And I you'll hear all the time. Oh my gosh. The tie was so severe or, Hey, we got from a level one to a level four after the release. And for me, it's not about that for me. It's about function for me. It's about is the tongue doing every single thing that it needs to do in the mouth. And do we need a tongue tie release in order to get it to perform more optimally?

And I hope what I'm saying is making sense. Yeah. So please jump in and ask questions if it's not, um, But I am looking for the ability to, if we're talking about kind of the older, older kiddos or adults, the ability to isolate muscles in the tongue, use them with graded movement, [00:24:00] meaning that we can move them through space smoothly.

Um, Protrusion and retraction lateralization. Are you able to lift the lateral borders of the tongue in an infant that might look like, okay, they're tied. So they're not able to lift the lateral borders. Do we need to work on feeding therapy skills to get that to lift? Or do we need a tie release in order to get more of that mid blade elevation?

So we can compress against the hard palette. It just looks like all different kinds of things for every mouth, you know, every anatomy's completely different, but those are kind of the basics of what we're looking for. Just optimal function. Okay.

Venita Litvack: That makes sense. And then last question, I would say related to these is, uh, who are you typically referring your clients to do the

Kayla Fontenot: tongue tie release?

Yeah. So we've got a, a really great network because we're so lucky we're in Dallas, the Dallas Fort worth area. So we have a lot of great skilled providers in our area. Um, we [00:25:00] do work a lot with. Dentists and we work a lot with ENTs. It really depends on the parent's preference. We kind of say, here are the options, you know, you need to choose based on your circumstances, what you think will be the best for you.

And, um, we can help guide you through that and talk through some of the pros and cons after you discuss that with the providers. Okay. Great point. So

Venita Litvack: can this type of therapy, oral myofunctional therapy be done in other SLP settings? Or do you feel like it's primarily geared for private practice like school settings or

Kayla Fontenot: I think it can be incorporated into school settings.

I think it's just gonna look a little bit different. You know, in school based settings, you're working towards, how does this improve their education? So I think if you've got a client like with, um, an articulation disorder, like S I think it would be paramount to use oral facial myofunctional [00:26:00] techniques with those clients in a school setting.

And it might look a little different than private practice. You know, we have pretty much free reign to discuss and talk about all things medical, but in a school setting. Um, Can be difficult to say, Hey, there might be a tongue tie at play and that might need medical intervention. Um, we do have a lot of school SLP that will refer out to us in private practice because it's just a, a zone that they can't speak to and they can say, Hey mom, I think you might need to look into this.

Um, here's where you can go for this kind of treatment or to have this looked up. They can't really talk about it much, but in terms of the actual therapy techniques to maybe elicit that correct, S they can do the techniques all day long, um, and they can still potentially even get a good S sound without a tongue tie release.

It really depends on the case. You have to look at all aspects of it. , that's a tough question to unpack. Yeah,

Venita Litvack: no, I think your answer was perfect for it.

Kayla Fontenot: So you've

Venita Litvack: built your private practice in your current [00:27:00] area. What if someone is interested in getting certified in this therapy technique and building their practice around it?

What tips do you have for them?

Kayla Fontenot: Before I was in SLP, I started out as an SLP assistant and I had an excellent supervisor that was, um, really well trained in Talk tools, therapies, and oral motor techniques. And, uh, that was something that I was taught in school to avoid. And so I remember I resisted it like as, as an assistant, I just, I had so much resistance because it had been like beat into your head, like, don't do this, don't do this, don't do this.

It doesn't work. And she had been a therapist for, for quite a long time. And she was an excellent teacher and she had excellent outcomes with her patients. And I saw this over time and I went, maybe she's onto something, but. I just don't know yet. And I remember, um, the following year I was out on my own or in a, in a private practice and I was going, wait a second.

I see a kid who I think that would be perfect for. I think they need [00:28:00] to, we, we, I think we need to figure this out and I kind of got the CEU bug at that point. And I just started taking all of the coursework that I possibly could around. Anatomy physiology. How do the muscles work? Why do they need to work a certain way for speech to sound the way we want it to sound?

Um, and then things around chewing and swallowing as well. So I really got my, my basis from Lori Overlands, um, feeding, um, course, and. Looking at the feeding side of things and seeing how do the muscles work for feeding, because that's where I was most comfortable with it. Right. Because I can do oral motor all day for feeding and that's that's okay.

But then if we, we talk about it in speech, we go, oh, it's not okay. Right. But, um, it took some undoing and some unlearning and some relearning to get me there. So I started down in the feeding route going, okay, how much can I learn about how oral motor impacts feeding? And then I go. So if they're feeding and they're [00:29:00] doing all of these things on the feeding hierarchies, and they're doing all these motor skills for feeding perfectly, their speech is starting to look really good too, as a result, you know, of just focusing on the feeding.

So then I started kind of developing my own patterns and how to treat kids, looking at, looking through the lens of both. And then, you know, we found oral facial biology and we go, oh, okay, well, this makes sense. Because that's exactly what they're doing and it has a name and we've been trying to reinvent the wheel all this time.

And like we found our home we're so happy. We found a group of professionals that see this, the way that we're seeing it, you know? And, um, it was really validating. So that's when we got, um, into oral facial biology and everything that, that entails. It really, it's just, it's been a long journey. It's been a long time getting to this point.

You know, I've had this business, um, in flower mound for about six years now. So October, 2015 is when I opened this, um, location and we're now [00:30:00] seven or eight SLPs, um, that are all working on oral function. It's amazing. So that's great. Congrats. Yeah. yeah, that's awesome. Thank you. Thank you. .

Venita Litvack: So when you're looking at the oral mechanism, I know you mentioned some of these factors that you look to consider.

What are those, I think you talked about allergies, like other areas that people should be looking at.

Kayla Fontenot: Yeah. So when we're treating a client, um, or if the client comes in and says, Hey, we want myotherapy, you know, and what are some of the things that we look at in our evaluation or talk about with our parents?

So, um, Actually, I can just kind of walk you through what an eval looks like. We look at. That'd be great. We look holistically at the, the patient. So we are looking at we're I'm first of all, taking a lot of pictures. Okay. So they'll come in and I'm taking a picture of what does their face look like at rest?

Um, I'm and when I'm looking at that picture of their face, I'm [00:31:00] looking, are their lips sealed? Where are their asymmetries do their eyes line up are, um, is their smile even, um, is there tension or is there tension in certain areas? Like if you look at their chin, is it bunched up? Is it dimpling? Um, So that's just what I'm looking at in pictures.

I'm also looking at, um, just their posture and just the way that, um, their head is positioned over their shoulders. Are they able to sit up nice and tall and straight? Or does that head kind of come forward from kind of hunching over like this all the time? So I'm just looking at everything, kind of taking a note of it.

We do look intraorally as well. So just looking at structures, we're looking at dentitian, we're looking at the way the teeth might be tipped one way. Are they kind of flaring out of the mouth? Are there spaces between the teeth? Do they tip in? Um, we are looking at function of the tongue. So the way that they manipulate the bolus to, or to form a [00:32:00] bolus, um, to swallow, I'm looking at the way the tongue lateralizes protrudes retracts.

If the board, the way the borders lift, can they do all those things again with grading? Is their jaw moving when their tongue is moving or are they able to stabilize their jaw and move their tongue independently? Um, I'm looking at is there is their nose clear that day? Do they have allergies? Can they breathe through their nose?

We do like a little test, um, to see if they can nasal breed. So we'll have 'em hold water in their mouth for two. And try to breathe through their nose because they'll say, oh yeah, my mouth's closed all the time and kind of might look like they are, but they're sucking air in secretly. Um, just not doing it in a way.

That's not so obvious. So we'll do like a little two minute test. Um, I think that's something that the breed Institute teaches to, or we'll have 'em hold like a, a sticky note or a Popsicle stick in their mouth, hold it together to keep their lips sealed, to make sure that they're not. Or to make sure they're able to nav nasal breathe.[00:33:00]

And I, I love the two minute, um, breathing test, especially because when you have them either take out the Popsicle stick or spit the water out, I always look for the first thing they do after they spit it out. And is it. Are they just gasping for air at that moment. And that's the sneaky part, because most of them they'll take it out and just go, okay.

Like they couldn't really breathe all that time. Like they were just doing what they could to, um, perform for this test, but they really weren't breathing well through the nose. So, um, When we do things like that, it usually the next step in that is usually a referral to an allergist or to an E N T to check out their nasal airway.

So we're looking again, it's, it's a holistic type of treatment. We're looking at all different kinds of things. So oftentimes there are multiple referrals involved and, um, Working with an allergist or working with an E N T to clear the, um, clear the sinuses, clear the nasal airways manage the allergies.

That's all really important because one of [00:34:00] our overall goals is to be nasal breathing 24 7, um, when you're, when you're awake and when you're sleeping. Um, the other things that we're looking at are we able to rest the tongue in the pallet? To stabilize, um, the rest of the face or keep the rest of the face in harmony.

So if we've got our tongue suctioned up in our palette, we release all of the tension through here, through our Massas. We release the tension through our chin, our mentalis muscle, and our tongue is just kind of holding the jots up in space should be like a, like maybe the teeth are either slightly touching or a millimeter or two a apart.

And everything's just resting gently when our tongue is not. Holding the jaw in place. What's, what's holding the jaw in place. We're clenching, or we're using these accessory muscles to hold the jaw up so that we're not open mouth breathing all day. So we're, we're just looking at all of those things and deciding, um, [00:35:00] you know, what's at the root cause of this and how do we get you from where you're at to lips closed tongue sealed in the pallet and breathing through your nose.

So those are our three big goals.

Venita Litvack: Okay. I will share a personal story. I was a mouth breather that I didn't know about. Like I didn't, I wasn't aware. I mean, I knew I was, but I didn't realize like how much it was impacting me. And last year I got nasal surgery and it was life changing, like literally. Wow.

And it's just amazing. I like how long I compensated. For not like I could like actually work out after that. And mm-hmm, be able, you know, not be like completely winded after just getting started. It's just, and, uh, I would have like so many sinus infections and I don't know like what came first, the chicken or the egg, but.

Since then knock on wood. It's like nothing, but it was constantly an issue. Always having sinus infections. [00:36:00] Um, yeah, I can smell things like I didn't realize I wasn't smelling things before that, which know now having a baby and changing diapers, maybe I could go back a little bit and not smelling. But, um, no, it's just, it's a whole new world, so I definitely see what an impact it makes from a client's perspective.

Kayla Fontenot: Mm-hmm it? Absolutely. You know, I was my first, um, myo patient after I learned about oral facial biology and I, I self-treated and had amazing results. Um, and I show my before and after pictures, I, if I can say this on my Instagram, um, of the way. Becoming a nasal breather actually changed my facial structure entirely.

I just remember being like, Gosh, like probably 11 years old and aware that I couldn't breathe through my nose. I remember sitting in class going, okay, I'm just gonna close my mouth and try to just do this. And I would just, I was bored in class and I remember practicing and going, okay, I can't do it, but how can everybody else can, how come everyone [00:37:00] else can do this?

You know? And I was a chronic mouth breather, chronic allergies, just like you just always had a sinus infection, um, was constantly just having to treat that and. As a result. Um, the way that my face grew was my, my midface didn't develop as much as it should have. It didn't grow as forward as it should have.

My jaw was very, um, retro. So if you looked at me from the side, it was just, the jaw was kind of tucked back in. And, um, after about a year of learning where my tongue was actually supposed to sit in my mouth, it was. Night and day difference. Um, when you take a picture of my profile, when you can see that the jaw just sits forward naturally, and it's released all of this tension in my chin and it released tension through here, I used to have, um, TM, J, D as well, and that's resolved, um, Migraine headaches, things like that as a result of clenching and grinding [00:38:00] at night resolved.

Um, and I actually did have a tongue tie release last October, um, which further changed the way that my structure looks. If you look from photographs. Um, but it also released so much tension through my neck and through my shoulders and through my back. Um, It was phenomenal. I wow. Like no regrets on having that done.

It was, it's like you, you see other people and you help other people with it all the time. And then you finally get to go through it yourself. And you're like, wow, this is life changing. You know, this is amazing. So. Yeah.

Venita Litvack: Thank you for sharing that. Yeah. I mean, you can definitely speak from personal experience about the effectiveness, so, wow.

That's incredible. I'll have to tech check out your Instagram. Is it far back

Kayla Fontenot: it's actually, yeah, let me see. I don't think it's that far back it's maybe like, yeah. It's about 15, 20 post back right now. So. Okay. [00:39:00] yeah, you can see, I did like a side by side, so I did a, a before and then I did after just myo.

And then I did after just myo and ectomy. So it's like a two year time lapse. Okay. Yeah. Very

Venita Litvack: interesting. Yeah. My last question, this is more of just like a recent actually I've had two of types, two of these cases in my short career, like seven years so far. Um, do you ever see clients that have no Al Frum, like at all is, or is it just like,

Kayla Fontenot: no.

Okay. um, it is, it is something that can happen. It is a, um, I know it's an extremely rare, um, thing to not have a lingual Frum. I mean, it, I, I think the last time I looked, I think it was like 1%, but don't quote me on that. It was a really, really small percentage. I think what happens sometimes is that the Frum can be sub mucosal and it can just be really hard to tease out.

Or, um, there are just [00:40:00] so much compensations with the floor of the mouth lifting that it's. We're not able to see it when they SU when they suction their tongue to palette. So it's while it's completely possible. Um, I haven't seen it. I've seen it in photos. Like other people have come across it, but I have not personally seen it.

Venita Litvack: Okay. Yeah. No. And it, it kind of goes back to what you were saying that you're, you're looking more at like the functionality, like mm-hmm, maybe they, they don't have one, or maybe it is sub mucosal, but how is it actually impacting like everything

Kayla Fontenot: else? Exactly. That's the most important thing.

Venita Litvack: Okay. Mm-hmm

Is there anything else that you wanna share about tongue ties? Um, about the type of therapy before we wrap up

Kayla Fontenot: today? Yeah. So let's just, um, we can just briefly go over signs or symptoms that for an adult that might have a tongue tie. Okay. Um, cuz I know I touched on this a little bit in my story, but um, Temporal ULAR joint dysfunction or some what people call [00:41:00] TMD or TM they'll sometimes they'll call it TMJ, but it's, um, it's TMD and just any kind of joint pain, clenching or grinding your teeth.

Um, sleep apnea, chronic reflux, um, again that heart shaped tongue or having a groove, um, neck pain and then picky eating and mouth breathing. So all, all could point to needing an evaluation for, for functionality of the tongue.

Venita Litvack: Okay. Thank you for sharing those.

Kayla Fontenot: Yeah. Very helpful.

Venita Litvack: Great. Well, you talked about your Instagram a little bit, but can you share where everybody can find and connect with you?

They're interested in learning

Kayla Fontenot: more. Absolutely. You can find me at, on Instagram at Kayla font. No underscore S.

Venita Litvack: Great. And just so anybody, uh, can look for it's F O N T E N O T for the last Kayla. Thank you so much. [00:42:00] This has been extremely informative.

Kayla Fontenot: Thank you so much for having me. That was a lot of fun.

Venita Litvack: Until next time.