Form or Function? Which matters more?

tongue form or function

Should we consider form or function when diagnosing tongue, lip, and/or buccal ties? Is one more important than the other? Can we diagnose just based on a picture?

Form is the way it appears or the way it looks. When we talk about form we are thinking about what we see when we assess the orofacial structures. A few of those areas in particular include the tissue under the tongue, under the lip, and in the cheeks. What is its appearance? Is it thick, rigid, pliable, short, etc. Where is its origin and insertion point? 

When we assess function, we look at how the tongue and other muscles of the mouth are operating and if any actions are impeded or if we see any compensatory behaviors. 

Function should not be skipped! This is where we get into the nitty gritty and determine how a tie is impacting the patient. 

Are they able to nurse, manipulate a bolus and swallow efficiently, are there any concomitant symptoms such as headaches, jaw pain, pain for the mother if it is a nursing babe, etc?

We can have multiple patients who have the same ties from a form standpoint. However, how it impacts them from a functional standpoint can be totally different. Form is very important but function is where we determine what’s really going on. 

When someone asks, is this a tie? We must assess form but we must also be sure to assess function. 

This is why we cannot diagnose based on a picture or video! We must consider both form and function. If you see tissue under the tongue that appears tight but there is not a functional impact per your assessment and/or patient report, it is not a tie! 

This is why we need a functional assessment before referring to a release provider. This is also why a release provider should require a functional assessment before determining whether or not a release is a recommended next step. 

We all have frenula (or we should…) and so releasing tissue just because it is there is not helpful. It needs to be impacting function, too! 

So, form or function? Both are important but function (and the impact on function) drives decision making when it comes to intervening (or not)!