Tongue-tie (ankyloglossia)
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Tongue–tie, medically known as ankyloglossia, is a condition characterized by the tongue being attached to the floor of the mouth, which can restrict its range of motion. It occurs when there is an abnormally short, thick, or tight band of tissue called the lingual frenulum that connects the underside of the tongue to the floor of the mouth.
This condition can potentially interfere with breastfeeding and cause difficulties in sticking out the tongue. It can also impact eating, speaking, and swallowing abilities in children. While some cases of tongue–tie may not cause cause problem, others may require a simple surgical procedure for correction.
Symptoms
The symptoms of tongue–tie can vary in severity, ranging from mild to severe. One noticeable sign is that your child’s tongue may have a heart–shaped appearance or a notch in it. However, in many instances, ankyloglossia is mild and does not significantly impact daily activities.
Signs and symptoms of tongue–tie include:
- Elevating the tongue to touch the upper teeth or moving it laterally.
- Challenges in pronouncing sounds that necessitate tongue contact with the roof of the mouth or upper front teeth. In adults, this may result in unclear speech.
- Difficulty latching when breastfeeding.
- Difficulties in swallowing.
- Trouble licking ice cream.
- Challenges in playing a wind instrument.
- Inability to extend the tongue beyond the lower front teeth.
- An appearance of the tongue that seems abnormal or deviated.
Causes
Usually, the lingual frenulum separates prior to birth, giving the tongue complete freedom of movement. The lingual frenulum stays affixed to the tongue’s base when tongue–tied. Although some tongue–tie cases have been linked to specific genetic elements, the exact reason why this occurs is still unknown.
Risk factors
While tongue tie can affect anyone, it is more commonly observed in males than females. In some cases, there is a familial tendency for tongue tie to occur.
Diagnosis
Typically, tongue tie is identified through a physical examination. Doctors may utilize a screening tool to assess the appearance and mobility of the tongue in infants.
Treatment
The treatment for tongue–tie is a topic of debate. Some doctors and lactation consultants suggest correcting it right away, even before a newborn leaves the hospital. Others prefer to wait and see if the issue resolves on its own. Sometimes, the tight tissue under the tongue may loosen over time without causing any problems. In other cases, the tongue–tie persists but doesn’t cause significant issues. If breastfeeding difficulties arise, consulting a lactation consultant can be helpful, and speech therapy with a speech–language pathologist can improve speech sounds. Surgical treatment may be necessary for infants, children, or adults if tongue–tie is causing problems.
There are two common surgical procedures:
- Frenotomy: A frenotomy is a simple surgical procedure that can be performed with or without anesthesia in a hospital nursery or doctor’s office. During the procedure, the doctor examines the lingual frenulum and uses sterile scissors to snip it free. The process is quick and minimally uncomfortable as there are few nerve endings or blood vessels in the frenulum. In the rare event of bleeding, it is usually minimal. After the procedure, a baby can breast–feed immediately. Potential complications include bleeding, infection, damage to the tongue or salivary glands, scarring, or reattachment of the frenulum to the base of the tongue.
- Frenuloplasty: A frenuloplasty is a surgical procedure performed under general anesthesia to address issues with the lingual frenulum that cannot be resolved through a frenotomy. This procedure involves releasing the frenulum and closing the wound with absorbable sutures. Although complications such as bleeding, infection, damage to the tongue or salivary glands, scarring, or reactions to anesthesia are rare, they are possible. After the frenuloplasty, tongue exercises may be advised to improve tongue movement and minimize the risk of scarring.
