Ankyloglossia (Tongue Tie)
Ankyloglossia, or tongue-tie, exists when the inferior lingual frenulum (which attaches the bottom of the tongue to the floor of the mouth) is especially tight or fails to recede. Therefore, the tightness in the frenulum can impair the normal mobility of the tongue and interfere with speech or newborn feeding.
When is Treatment Indicated?
Newborns with a too-tight frenulum can have trouble sucking and may have poor weight gain. Nursing mothers who experience significant pain while nursing or whose newborn has trouble latching on should have their child evaluated for tongue tie. Tongue tie can be an underlying cause of feeding problems that not only affect the baby’s weight gain, but may also be the reason many mothers abandon breast feeding altogether.
In Toddlers and Young Children
The tongue is remarkably able to compensate and while many children will have no speech impediments due to tongue tie, others may. Around the age of three, speech problems, especially articulation of the sounds – l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a three-year old child’s speech is not understood outside of the family circle. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:
- V-shaped notch at the tip of the tongue
- Inability to stick out the tongue past the upper gums
- Inability to touch the roof of the mouth
- Difficulty moving the tongue from side to side
For older children with tongue-tie, appearance can be affected by persistent dental problems such as a gap between the bottom two front teeth.
Ankyloglossia surgery (referred to as frenotomy, frenectomy, frenulectomy, or frenoplasty) is a simple procedure and there are normally no complications. Although the procedure is relatively simple, it can yield big results. Parents of older children should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.
The child’s age and the thickness of the frenulum will determine the location and extent of the procedure. For very young infants, while the frenulum is still very thin (less than six-weeks-old), a frenotomy may be done in our office, with only a local anesthetic. The infant is able to eat normally immediately after the procedure is completed. On older children, the frenulum is thicker and general anesthesia on an out-patient basis may be recommended to perform a frenulectomy or frenoplasty.