Thursday 26th July
The day started with a pre-conference introduction on Tongue Ties. Dr Rajeev Agarwal (Paediatrician, USA) introduced participants to the topic and set the foundation for the content of the rest of the conference. He included discussions about phenotypic presentation of ties but highlighted a concept that was the over-riding theme at the conference – treatment must be led by functional outcomes as the dominant consideration.
Following a brief break, the conference was opened by ICAP board chair, Dr Marjan Jones (Dentist, Australia). The concepts of the value of learning in a multi-disciplinary space were shared as well as the value of approaching learning with an open mind and with respect for all, including those with differing views. This opening address expressed the underlying ethos and vision of ICAP as being a space for unity in diversity.
The morning session was commenced by Ms Linda D’Onofrio (Speech and Language Therapist, USA) who spoke about “How Ankyloglossia is Implicated in Craniofacial Disorders”. Linda showed the progression of the embryo and the various connections of disorders to their point of origin in the pharyngeal arches. She was followed by Dr Bobby Ghaheri (ENT, USA) who presented a 2 part session on “The Impacts of Ankyloglossia on Tongue Mechanics.” Dr Ghaheri showed several ultrasounds highlighting the alteration in tongue motion and function during feeding following release of a restricted lingual frenum. Ms Carole Dobrich (IBCLC, Canada) provided information on the merits of a diagnostic tool and some context for the Frenectomy Decision Making Tool for the Breastfeeding Dyad (FDTBD). The FDTBD considers infant and maternal symptoms as well as the infant tongue and lip function. A Panel discussion ensued where surgery providers outlined their tool of choice and the reasons why. This session was a refreshing approach to expression of varying views among experienced surgeons from Australia, USA and Israel using cold blade or lasers (Erbium, Chromium YSGG, CO2, Erbium YAG and diode). Humour and collegiate interactions provided a fertile arena for exchange of frank yet respectful dialogue. The Panel was hosted and moderated by Dr Stacy Cole.
The speakers for this 1st day of the conference and members of the board - Ms Effath Yasmin (IBCLC, India), Dr Jimmy Chan (Dentist, Canada) , Ms Autumn Henning (Speech Therapist, USA) and Dr Marjan Jones – had an opportunity for some photos that are included in this post.
REMINDER FROM THE BOARD
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Comments/questions. Your voice matters and we hope to have universal participation in the elections.
The evening consisted of welcome drinks and canapes amidst lots of wonderful social and professional dialogue. It was an overwhelmingly positive and collegiate atmosphere and delegates were very happy.
Friday 27th July
First up, Ms Sandra Coulson (Speech Pathologist, USA) shared that “Toddlers CAN Do Orofacial Myology.” She highlighted various techniques where a toddler can become engaged and really change their oral habits with close guidance of a trained orofacial myologist and with great support from the family at home. She was followed by Dr Soroush Zaghi (ENT, USA) who showed some frenuloplasty cases where partial genioglossectomy was carried out to enable a functional release. Later that morning, Linda D’Onofrio spoke about the impact of restricted frenula on articulation – highlighting the sounds that are most frequently affected. Dr Weng Cheu Yue (Dentist, Singapore) guided the delegates through a path of the cranial nerves and showed the flow on effects of a poorly functioning tongue on neural responses in adults. In the main auditorium, the sessions in the afternoon were as follows - Dr Marjan Jones (Dentist, Australia) highlighted the signs and symptoms of oral restrictions in an adult who had not had a diagnosis earlier in life. Through the presentation, “The Tongue is for Life - Seeing the End in the Beginning” she presented that that when signs and symptoms are noted and investigated early, with intervention we can minimise or prevent emergence of more pronounced symptoms later in life. Ms Autumn Henning (Speech Therapist, USA) spoke about a “Kase Study” – a patient whose journey of diagnosis and treatment also took delegates on a learning journey to make the connections for auditory, sensory and oral manifestations. Dr Richard Baxter showed his practice’s protocols in “Best Practices for Minimizing Reattachment.” He highlighted the value of a team approach and the importance of evolution of our practice as our clinical observations and research guide us. Ms Jennifer Welch (IBCLC, Canada) presented a global approach to assessment while Dr Anjana Srinivasan (MDCM, CCFP, IBCLC, Canada) illustrated a hospital-based referral breastfeeding clinic’s experience with tongue ties and upper labial ties. Ms Jessica Altemara (IBCLC, USA) introduced the implementation of a three pillar approach in the dental office setting, and Dr Ellen Chetwynd (PhD, RN, IBCLC, USA) showed how to teach babies how to “think their way” into better nursing. Ms Effath Yasmin (IBCLC, India) illustrated a craniosacral biodynamic vantage point of timing your frenotomy treatment plan while also guiding her audience through some meditation and relaxation exercises. Ms Lisa Lahey (RN, IBCLC, OMT, USA) highlighted the IBCLC’s involvement with post frenectomy aftercare and oral rehabilitation.
Following a delicious dinner, participants were invited to watch the film by Ms Effath Yasmin (IBCLC, India) called Untying Breastfeeding. This film showed the journey of several breastfeeding dyads and the impact of oral restrictions, breastfeeding challenges and the decision to seek treatment on the family. It brought together dialogue from several countries and professions, and was a film that really touched so many delegates, many of whom were moved to tears at this heartfelt project. Ms Yasmin invited delegates to arrange the screening of the film in their regions to further the education of professionals and parents alike.
Finally, there were service awards. ICAP delegates had been asked to submit nominations for several categories ahead of the conference. After much deliberations, the award recipients were as follows:
Saturday 28th July
The day began with a session presented by Ms Michelle Emmanuel (OT, USA) who presented on the expanded TOTS team “From Triangles to Octagons.” She spoke about the various facets of care surrounding management of oral restrictions requiring different modalities at various stages in the progression toward optimum function. Dr Larry Kotlow (Pediatric Dentist, USA) presented a two part lecture – the first focused on identification, diagnosis, treatment and after care of infants with oral restrictions. The second part of his lecture expanded that working toward optimum tongue function for breastfeeding is just the start of a life-time of function. His many decades of experience was widely appreciated by delegates. Dr Audrey Yoon (Dentist, USA) lectured on her recently published work on ankyloglossia as a risk factor for maxillary hypoplasia. She drew on her clinical work for this research to explain an approach to restore orofacial structures toward treatment of obstructive sleep apnea.
In the breakout sessions in the afternoon, Michelle Emmanuel (OT, USA) enlightened the delegates about cranial nerve dysfunction and the many layers to diagnosis of an infant with oral-motor and functional challenges. Dr Scott Siegel (DDS, MD, USA) joined us via live telecast to deliver his presentation on Aerophagia-induced Reflux and shared the content of his research in this area from 2016. Ms Jacqueline Kincer (IBCLC, USA) discussed the topic of IBCLC and COMS Optimizing outcomes: Infant Oral Function Repatterning after Frenectomy. Ms Carole Dobrich (RN, IBCLC, Canada) emphasized the roles of all key team players involved with tongue tie and breast feeding. Ms Tine Greve (RM, IBCLC, Norway), Mr Roger Price (BSc Pharmacy, USA), Ms Lisa Paladino (RN, IBCLC, USA), Ms Carol Gray (LMT, CST, USA) and Ms Alys Brown (RM, IBCLC, New Zealand) also contributed to break out sessions with a variety of presentations on tongue tie, feeding, and international management of TOTS.
One of the novel experiences of the conference was trying to take a photo of 250+ people in the rain! Nevermind that people love to catch up and chat! Nevertheless we managed to get the majority of participants there and had a few laughs along the way.
Sunday 29th July
Sunday morning began with some committed ICAP members who attended the General Meeting where the board presented its report and where the Bylaws were passed. Members were invited to elect for the board. However, a motion was put forward to delay elections to allow members to become more familiar with nominees prior to voting. The final session of the conference was an opportunity from several professions in different fields about how they work as a team and the how they execute the notion of a team approach in their various practices.
The outgoing board sincerely thanked each speaker, each delegate and each vendor for their support and words of encouragement. It is our sincere hope that the spirit in which this organization was set up and executed continues. The outgoing board members and founders stand ready to assist in any way possible to accompany and support the newly elected board to maintain the vision and mission of ICAP.
ICAP Board of Directors