Tongue-Lip Adhesion (TLA) is a surgery done for infants with Pierre Robin sequence. TLA helps prevent the tongue from falling back into the baby’s throat. If the tongue falls back into the throat, it can block the airway and make it hard for the baby to breathe. The TLA surgery helps babies breathe safely and comfortably on their own.
Pierre Robin sequence is a condition that includes a small jaw (micrognathia), a tongue that falls back into the throat (glossoptosis) and breathing trouble. Most babies with Pierre Robin sequence also have a cleft palate. (Please refer to Helping Hand HH-I-449, Pierre Robin Sequence, for more information).
About the Surgery
Some babies with Pierre Robin sequence need surgery to help them breathe safely. Your airway team (plastic surgery and ENT) will help you make this decision.
A TLA is one of the airway surgeries for babies with Pierre Robin sequence. During this procedure, the surgeon temporarily attaches the tip of the tongue to the bottom lip. This prevents the tongue from falling backward into the throat and blocking the airway. After
the procedure, babies are better able to breathe on their own.
A plastic surgeon does this procedure in the operating room while your baby is asleep under general anesthesia. Along with the dissolvable stitches used to attach the tongue to the lip, two “buttons” are put in place to help anchor the tongue and prevent tension on the adhesion while the stitches dissolve. One button is placed at the back of the tongue, and the other button is placed just below the chin. These two buttons are connected to one another with a stitch that will later be removed, along with the buttons
After your baby’s TLA surgery: Your baby will return to the Neonatal Intensive Care Unit (NICU) after surgery. Your baby’s medical and surgical teams will work closely together to monitor the baby and to ensure they are as comfortable as possible. After 7 to 10 days, the plastic surgeon will remove the buttons at the bedside. Feeding therapists will work with you and your baby to make sure that oral feeding is successful before your baby goes home from the hospital. You will also have close feeding follow-up with the cleft/craniofacial team.
The procedure to release the TLA: When your baby is about 8 to 9 months of age, the tongue will be released from the bottom lip. This is done in the operating room with the baby under general anesthesia. After the surgery, your child will be admitted overnight for close monitoring of pain and oral intake.
What to Do And Watch For at Home
While you are at home, you do not need to do any specific cleaning or care for the site. Most people will not be able to tell your child has had a procedure.
- The TLA does not affect long-term feeding or speech development. Babies with a TLA are able to successfully drink liquids and begin eating solids with a spoon.
- A feeding therapist with the cleft/craniofacial team will see your baby regularly at clinic appointments. The therapist will monitor feeding after your baby’s discharge from the hospital. You will learn strategies to help you and your baby if you have any challenges with feeding.
- A TLA does not interfere with long-term development of the teeth.
- Speech therapists specially trained in the cleft/craniofacial clinic will monitor your child’s speech closely. The TLA should not change your child’s ability to communicate.
- If your baby shows any signs of trouble breathing, contact their surgeon right away.
After your baby’s discharge from the hospital, they will follow up with the Craniofacial/ Plastic Surgery Clinic. This appointment will be scheduled before your baby leaves the hospital. The team will continue to follow and monitor your child’s airway, feeding, development and other important parts of care.
If you have questions before the appointment, please contact the Craniofacial/Plastic Surgery clinic Monday through Friday from 8 AM to 5 PM at 614-722-6449. For any urgent concerns during evenings, weekends or holidays, please call (614) 722-2000 and ask to speak with the plastic surgeon on call.
Tongue-Lip Adhesion (PDF)
HH-I-460 12/19 | Copyright 2019, Nationwide Children’s Hospital