The Mobility-Scale Lippe (M-S-L)

The graphs use the “M-S-L” to describe the restricted mobility of the upper lip due to different shapes of the labial frenulum. Trying to correlate the anatomy, i.e. the appearance of the upper lip ligament, with the occurrence of breastfeeding problems is not helpful. This is because, in connection with breastfeeding or even bottle-feeding, only the function of the upper lip is of interest, i.e. the question of whether the infant can turn up the upper lip in such a way that it can grasp sufficient breast tissue, get into “deep sucking” and hold the vacuum.

If the upper lip cannot be turned up without stress, no vacuum can be held. The infant loses breast tissue, slips toward the nipple, retracts the upper and lower lip, and begins to drink compensatory with the chewing and facial muscles. As a result, the corners of the mouth open, milk runs out and air is swallowed.

Independently of this, subsequent problems can arise as a result of a deeply inserting shortened labial frenulum:

Indentation (notch) of the masticatory ridge due to the pull of the labial frenulum:
A black triangle when laughing “Poppy Seed Smile” can develop from the “notch”. A black triangle remains between the central permanent anterior teeth, which is not filled by the gum and looks as if a poppy seed is stuck in the space. In addition to the aesthetic problem, a dirt niche is also formed in which food debris often gets stuck, thus increasing the risk of caries. Diastema is the gap between the central upper permanent incisors which are not regular because the deep-inserting labial frenulum is in the way Narrow-lipped appearance, which translates to “pretending to be nice, being short-tempered, lying with antipathy politely and smiling” 4 Impairment of pronunciation of sounds that require rounding of the lips, such as sh, o, or u. Problems and pain when brushing teeth, resulting in increased risk of tooth decay and gingivitis. Increased risk of dental caries due to dirt niches with long food retention time. The permanent pull of the labial frenulum can cause the gums to retract, exposing the necks of the teeth and making them sensitive.

In practice, we rarely experience that the too short lip ligament can be identified as the sole cause of breastfeeding problems. Often the restricted tongue mobility of a too short frenulum is the main reason and in a small percentage of cases ( about 10%) the restricted lip mobility due to the too short frenulum is an additional factor. Isolated separation of the frenulum, which is too short, due to breastfeeding problems is very rare.

Study:

Pransky et al studied 618 infants and found 2% (14 infants) to have an exclusively too-short labial frenulum. After separation, 100% of mothers reported significantly improved breastfeeding. The other figures obtained in this study are also interesting. 290 (47%) had anterior ankyloglossia, 120 (19%) had posterior ankyloglossia, and only 14 (2%) had restrictive upper lip. Some patients had both anterior ankyloglossia and restrictive upper lip (6%) or posterior ankyloglossia and restrictive upper lip (5%). Among patients with anterior ankyloglossia, 78% reported improvement in breastfeeding after frenotomy. Among patients with posterior ankyloglossia, 91% reported improvement in breastfeeding after frenotomy.

Pransky SM, Lago D, Hong P. Breastfeeding difficulties and oral cavity anomalies: the influence of posterior ankyloglossia and upper-lip ties. Int J Pediatr Otorhinolaryngol. 2015 Oct;79(10):1714-7. doi: 10.1016/j.ijporl.2015.07.033. Epub 2015 Jul 31. PMID: 26255605.

M-S-L

The Mobility-Scale Lip indicates the extent of movement restriction of the upper lip in degrees. Grade 0 means a freely movable upper lip and grade 3 a severely restricted upper lip mobility.

OberlippenbandM-S-L Grade 3

Manual and stress-free upturning of the upper lip is not possible. The upper lip cannot be pulled over the lower edge of the nostrils. It is an ankylolabia. When drinking at the breast, confirm the suspicion of retracted upper lip. The likelihood of a problem with sucking through the labial frenulum of the upper lip is high. Frenotomy of the upper lip ligament is likely to improve drinking. A presentation to the specialist is necessary. Note: The tongue tie must be evaluated separately!

OberlippenbandM-S-L Grade 2

Turning up the upper lip to below the center of the nostrils is possible. This causes stress, which becomes visible through the white discoloration (reduced blood flow) of the gums and/or upper lip. There is an increased likelihood of obstruction during sucking due to the labial frenulum of the upper lip. When drinking at the breast, check the function of the upper lip. If it is retracted, a frenotomy of the upper lip ligament can lead to an improvement in drinking behavior and must be assessed individually on the basis of an individual breastfeeding history. Note: The tongue tie must be evaluated separately!

LippenbandM-S-L Grade 1

Folding the upper lip up over the center of the nostrils is stress-free. The likelihood of obstruction to sucking by the labial frenulum of the upper lip is low. If the infant turns up the upper lip when drinking from the breast or bottle, or if it can be turned up manually, a frenotomy should not be performed. Even if this is not possible at first, a wait-and-see attitude is advised for 2 weeks. Note: The tongue tie must be evaluated separately!

Lip frenulumM-S-L Grade 0

Manual stress-free upturning of the upper lip is fully possible. The upper lip can be pulled completely over the entire nostrils without stress. The likelihood of obstruction during sucking due to the labial frenulum of the upper lip is eliminated. Frenotomy of the upper lip ligament to improve drinking is not medically indicated. Note: The tongue tie must be evaluated separately!