Tongue-Tie (Ankyloglossia)

Tongue-tie or ankyloglossia is a birth defect in which the baby’s tongue is connected to the base of the mouth by a short and tight tissue that restricts the movement of tongue. Normally, this band of tissue, called lingual frenulum, is loosely attached to the base of mouth. 

The tight band affects the range of motion of tongue and breastfeeding. It may also affect eating, swallowing, and speaking. It is more commonly seen among boys than girls. Tongue-tie is diagnosed by physical examination. 

Clipping or frenulotomy treats ankyloglossia. In some cases the problem may resolve on its own or the child may adapt to the structure of tongue.

Tongue-tie is characterized by the following symptoms: 

• Difficulty in sticking tongue out
• Tip of the tongue fails to touch the roof of the mouth
• Difficulty in moving the tongue sideways
• Flat, or square-shaped tip of tongue
• Heart-shaped or notched tongue tip
• Difficulties in breastfeeding or bottle feeding
• Gap between teeth in the lower jaw

Tongue-tie is caused by the failure of separation of lingual frenulum from the tongue during development. As it separates, the tongue get backs its normal range of motion. 

The actual cause for the failure of separation is not known. Certain genetic factors are implied in the development of tongue-tie. In some rare cases, ankyloglossia is found to run in families. It is more common among boys than girls.

Tongue-tie (ankyloglossia) is diagnosed by physical examination. In older children, the range of motion of the tongue and shape of tongue indicate this defect.

Several treatment methods are used for tongue-tie (ankyloglossia).

Watchful waiting is recommended in some cases to see whether the condition resolves on its own as the child grows. If the baby has problems in feeding, the lingual frenulum is cut by a procedure called frenulotomy. 

Frenulotomy – in this procedure, the frenulum is snipped using sterile scissors. It is done quickly and does not cause any discomfort. This procedure helps the baby to breastfeed normally. Frenulotomy may lead to infection, bleeding, or salivary gland damage.  

Fenuloplasty – this procedure is recommended if the frenulum is too thick to be cut. It is also suggested if additional repair is needed for frenulum after frenulotomy. In this procedure, the frenulum is cut and the wound sutured. 

The sutures are absorbed after some time. Frenuloplasty may also lead to complications like infection, bleeding, and salivary gland damage. Tongue exercises improve the movement of tongue after frenuloplasty. It also prevents chances of tongue scarring. 

There are no known ways of preventing tongue-tie (ankyloglossia) as the actual cause of the condition is not known.

Watchful waiting is the alternative remedy suggested, if one does not want to opt for surgical methods.

To cope with tongue tie (ankyloglossia) and adapt your child's lifestyle, it's recommended to consult with a speech pathologist.

If the child has tongue-tie, an experienced speech pathologist can help to assess the speech patterns of the child.

If feeding and speech is not affected, surgery can be opted out. Even when everything else is alright, parents can consider surgical release of the frenulum for cosmetic reasons.

There are several risks and complications associated with tongue-tie (ankyloglossia).

Tongue-tie affects feeding and speech development. As the child has restricted movement of tongue, it inhibits sucking. This affects breastfeeding and may lead to malnutrition. 

Tongue-tie often affect the ability of the child to learn certain specific sounds. Cleaning the mouth by sweeping the debris is difficult with tongue-tie. Poor oral hygiene leads to gum inflammation and tooth decay.