Ankyloglossia is a congenital condition commonly known of as "tongue-tie," where the thin band of tissue (lingual frenulum) attaching the middle part of the underside of the tongue to the floor of the mouth is unusually small and tight, hampering free movement of the tongue and restricting the mobility of the tongue tip. The condition may first be noted by parents within a few weeks of birth, particularly as it interferes with breastfeeding.
Tongue-tie is more likely to manifest with certain syndromes and congenital conditions which include:
X-linked cleft palate
Consequences of ankyloglossia
Some problems caused by tongue-tie in an infant include:
Impaired speech development
Deformity of the lower front teeth or the incisors
Deformity or recession of the gums
Malocclusion of teeth
Difficulty in breastfeeding due to incorrect latching of the baby's mouth onto the breast causing inadequate milk supply to the baby's mouth and pain in the mother's nipple
Inability to lick
Difficulty in eating in public
Inability to play a wind instrument
The oral cavity of the child is thoroughly examined before treatment is begun. The shape, size and length of the frenulum and the tongue's range of movement and function is usually examined on a first visit to the dentist.
On lifting the tongue from the floor of the mouth, the baby usually cries. The elasticity of the frenulum is examined. With a normal tongue, the attachment of the frenulum to the tongue should be approximately 1 cm behind the tongue's tip.
In older children, teeth positioning, speech and articulation also need to be examined. Normally alliterating sounds such as "t," "d," "l," "th," and "s" will be difficult for a person with tongue-tie.
Treatment involves a team of experts including a speech therapist, dentist, oral pathologist, paediatrician and surgeon or cosmetic surgeon.
In most cases, the frenulum is excised or cut to free the tongue. This is called a frenotomy. Early frenotomy can be carried out in an outpatient department with no need for general anesthesia. In older children, frenotomy needs to be performed under general anesthesia. The operation is usually attempted after the child is one year old.
Frenotomy is a simple, safe and effective surgical procedure. In most cases, the frenulum is cut with scissors after numbing the local area. There is minimal bleeding and pain. However, one complication is infection at the site of the operation.
Reviewed by Sally Robertson, BSc