Reattachment essentially is where the posterior section of a tongue tie heals back together following division.
How the wound heals affects how and when the reattachment presents.
The wound can heal in one of three ways:
- Primary intention healing
- Secondary intention healing
The ideal is that the wound area remains open and new skin grows over the wound (re-epithelialisation). This means that there is no tether present between the floor of the mouth and the undersurface of the tongue. What you will see is that the wound gradually gets smaller over one to two weeks and it remains right back at the base of the tongue. This type of healing is possible because a wound in the mouth remains moist and thus skin cells are able migrate over the wound surface.
If the wound heals by primary intention healing, i.e. the wound edges join straight back together, then there may be no improvement in feeding as the tie is healed back after only a couple of days.
If the wound heals by secondary intention healing then it heals gradually from the back edge of the diamond and the top and bottom halves become attached together again. This also typically takes from 1-2 weeks. The difference in appearance is that the diamond gradually comes forwards and closes the gap between the base of the tongue and the salivary glands.
How this then affects feeding can occur in one of the following three ways:
- The first is that as the wound heals forwards, the restriction comes back, and the symptoms gradually return.
- The second is that the wound reattaches but with better height to the 'band' so there is some improvement in feeding initially but as wound contraction occurs under the influence of myofibroblasts, typically 3 to 5 weeks after division, this brings back restriction and then the feeding problems recur.
- The third is that the wound heals as in the second example but there is sufficient in height, and thus tongue function, which is maintained and thus the feeding symptoms have resolved.
The purpose of the woundcare is to keep the upper and lower halves of the wound separate so that they cannot reattach to one another and this allows the ideal healing of re-epithelialisation to be achieved.