Diagnosing and Understanding the Maxillary Lip-tie (Superior Labial, the Maxillary Labial Frenum) as it Relates to Breastfeeding

Abstract

Successful breastfeeding is dependent upon an infant's ability to correctly latch onto a mother's breast. If an infant is born with oral soft tissue abnormalities such as tongue-tie or lip-tie, breastfeeding may become challenging or impossible. During the oral evaluation of an infant presenting with breastfeeding problems, one area that is often overlooked and undiagnosed and, thus, untreated is the attachment of the upper lip to the maxillary gingival tissue. Historically, this tissue has been described as the superior labial frenum, median labial frenum, or maxillary labial frenum. These terms all refer to a segment of the mucous membrane in the midline of the upper lip containing loose connective tissue that inserts into the maxillary arch's loose, unattached gingival or tight, attached gingival tissue. There is no muscle contained within this tissue. In severe instances, this tissue may extend into the area behind the upper central incisors and incisive papilla. The author has defined and identified the restrictions of mobility of this tissue as a lip-tie, which reflects the clinical attachment of the upper lip to the maxillary arch. This article discusses the diagnosis and classifications of the lip-tie, as it affects an infant's latch onto the mother's breast. As more and more women choose to breastfeed, lip-ties must be considered as an impediment to breastfeeding, recognizing that they can affect a successful, painless latch and milk transfer.

Breastfeeding difficulties and oral cavity anomalies: The influence of posterior ankyloglossia and upper-lip ties

“…Severe cases of upper lip-tie have been associated with maxillary diastema, or gap between upper two central teeth [18], but the relationship to breastfeeding problems has not been clearly documented. The proposed mechanism of functional problems caused by tight maxillary frenum involves the inability to normally move the upper-lip [15]. Yet, due to the limited amount of upper-lip movement required for breastfeeding and speech production, as well as the possibility of physical adaptation, significant functional problems may not occur.…”

“…Upper lip-ties are also now being recognized as a possible contributor to breastfeeding problems by some clinicians [15]. It is characterized by a tight maxillary or labial frenum, which may limit upper-lip movement.…”

“…Currently, there is only anecdotal evidence that upper-lip ties can cause breastfeeding problems. Restricted movement or the inability to flange the upper-lip has been purported to interfere with proper attachment during breastfeeding, which may lead to maternal nipple pain, poor latch and fussiness for the infant at the breast [15].…”

Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie)

“…The author is proposing studies to objectively look at the role of tethered oral tissue (lip and tongue ties) as a potential cause of reflux, as well as the need for a unifying classification system/validated tool for the description of lip and tongue restrictions [10]. Further studies are necessary to help establish this relationship.…”

“…Clinical exam of infants was performed by the author and maxillary lip and ankyloglossia was confirmed using the Hazelbaker assessment tool for lingual frenulum function with a score of < 8 indicating surgical intervention [7]. Kotlow classification system for maxillary labial frenulum was utilized to characterize anatomic position [8][9][10].…”