Cutting the mast?

I regularly hear an analogy of a sailing vessel to explain why it is important to treat a tonguetie invasively. In this analogy the tonguetie is the sail. Only freeing the superficial tie (the sail) would be inefective because the stiff base of the tie (the mast) remains and hinders movement. Cutting through the mast is therefore important for a succesfull treatment.

Now I am not a Sailor, but I have sailed. And I know that on a sailing boat you do explicitly not want to cut your mast. No mast no sailing vessel, and without a mast sails are a useless pile of fabric. The analogy seems therefore to be essentially not fitting the desired message.

This can mean 2 things:

  1. The analogy is not functional. If the ‘mast’, the stiff base of the tonguetie, indeed needs to be released, then a sailing vessel is not the model to explain that.
  2. The sailing vessel is a usefull analogy and that implies we need to treat with care and more knowledge is needed.

We could look at the sailing vessel with the tongue as a sail, the boat as the base of the mouth and jaw. In which case the rigging (the ropes connecting the sail to the boat) is the tonguetie.

And then releasing the tonguetie makes sense. Because rigging* that is too tight hinders the mobility and maneuverability of the boat. Loosening a rigger improves the functionality of the vessel. Provided one leaves the mast standing. No mast no sailing vessel.

Tonguetie treatment is going deeper and deeper into the mouths of very young babies Treating a tonguetie is a very old procedure recorded even in the Bible. But as far as I know this was never before done so invasively. In the old literature there appears to be no mention of diamond shaped wounds and aftercare.

Althoug we see clear improvement in breastfeeding and oro facial mobility at short term we do not know what the long term effects are going to be. We can not know the effect after 5, 10 or even 50 years for the simple reason that the procedure in the current form has not been performed long enough. In other words: we do not know what the effect of cutting the mast will be in the long run.

Primum non nocere: do no harm. We either need a better analogy, or the sailing vessel analogy indicates that treatment needs to be done with great care. Tonguetie treatments is proven effective, but how invasive it needs to be done should remain high on the agenda of every provider.

* and even then not every bit of rigging!

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