Definition

Tongue-tie, or ankyloglossia, is a congenital disorder where a child's tongue is abnormally attached to the bottom of their mouth. This disease arises due to a narrow tissue known as the lingual frenulum that attaches the tongue to the floor of the mouth and is shorter than the average length. A shortened frenulum can restrict the range of motion of the tongue. Tongue-tie might be asymptomatic; however, it frequently correlates with challenges in breastfeeding and speech articulation. In certain instances, a straightforward surgical intervention may be necessary to rectify the issue.

The precise incidence rate of tongue-tie is uncertain; however, research indicates that it ranges from 3 to 5 percent, with a potential range of 0.1 percent to 10 percent, depending on the parameters utilized to assess the frenulum. Several healthcare facilities have reported an approximate incidence rate of 25 percent.

Causes

Tongue-tie is a condition that can affect people of all ages. In some cases, it may have a genetic component, which means it can be passed down through families. This disorder is present in a maximum of 10 percent of children. Although it primarily affects infants and young individuals, older children and adults can also develop the condition."

Typically, during fetal development in the uterus, the tongue and floor of the mouth join together. During the development of the fetus, the tongue will detach from the lower surface of the mouth. Ultimately, a small strip of tissue known as the frenulum or lingual frenulum is all that remains, connecting the tongue's underside to the mouth's floor. As the infant matures, the lingual frenulum often undergoes a process of thinning and shrinking, facilitating unrestricted tongue mobility. Children with tongue-tie have a thick and non-receding frenulum that remains attached to the bottom of the tongue, which hinders the free movement of the tongue. The etiology of tongue-tie remains uncertain; however, in select instances, it has been associated with specific genetic variables.

Risk factor

Tongue-tie can occur in individuals of any age. Nevertheless, it is more prevalent in males than females. It can also be hereditary and inherited within generations. In most cases, tongue-tie is diagnosed in infants or young children.

Symptoms

The severity of symptoms associated with tongue tie can range from mild to life-threatening. Severe cases may result in the tongue becoming indistinct from the floor of the mouth. There are instances in which the symptoms of tongue tie are inconsequential to daily life. While it may be possible to detect tongue tie in infants by observing their mouths during yawning or crying, this condition is not always apparent.

Possible symptoms of tongue-tie in infants include the following:

• Difficulty achieving a proper latch during breastfeeding
• Experience rapid fatigue during breastfeeding
• Breastfeeding is a time-consuming process.
• Persistent appetite
• Weight gain challenge
• An audible "clicking" sound occurs during the child's breastfeeding process.

Tongue-tie symptoms in young children may manifest as:

• The sublingual area allows for observing either a thin or thick layer of skin.
• Unable to protrude the tongue beyond the lips while the mouth is open capable of elevating the tongue to the palate
• Experiencing challenges with lateral movement of the tongue

The severity of symptoms associated with tongue tie can range from mild to life-threatening. Severe cases may result in the tongue becoming indistinct from the floor of the mouth. There are instances in which the symptoms of tongue tie are inconsequential to daily life. While it may be possible to detect tongue tie in infants by observing their mouths during yawning or crying, this condition is not always apparent.

Possible symptoms of tongue-tie in infants include the following:

• Difficulty achieving a proper latch during breastfeeding
• Experience rapid fatigue during breastfeeding
• Breastfeeding is a time-consuming process.
• Persistent appetite
• Weight gain challenge
• An audible "clicking" sound occurs during the child's breastfeeding process.

Tongue-tie symptoms in young children may manifest as:

• The sublingual area allows for observing either a thin or thick layer of skin.
• Unable to protrude the tongue beyond the lips while the mouth is open capable of elevating the tongue to the palate
• Experiencing challenges with lateral movement of the tongue

Diagnosis

The initial step in the doctor's diagnosis of tongue-tie in your infant or child is to conduct an interview during which inquiries are made regarding the symptoms both the infant and the mother encounter while breastfeeding. Medical professionals may suspect that infants have tongue-ties if they continue to experience challenges with breastfeeding despite the mother employing proper lactation techniques. The physician will then physically examine the infant and the mother, paying particular attention to the breast region. The infant's nutritional status will be evaluated to detect any signs of weight gain. The physician will specifically inspect the infant's oral cavity to determine the location of the tongue's attachment to the floor of the mouth.

The findings of this tongue examination are adequate to validate the diagnosis of tongue-tie.

Management

Treatment of tongue-ties is a contentious issue. Medical professionals and lactation consultants advise prompt correction, even before the newborn's discharge. Certain medical professionals opt for a "wait and see" approach when it comes to disease progression and symptoms. Tie-tie symptoms may diminish as the child's lingual frenulum becomes more relaxed with the passage of time and maturation. There are specific circumstances in which tongue-tie may endure without engendering complications. Speech therapy with a speech therapist can enhance a child's speech ability, while consultation with a lactation consultant may assist the mother in breastfeeding in other instances.

Surgical intervention may be required for infants, children, or adults with tongue-ties that have resulted in complications. Frenotomy and frenuloplasty are cases of surgical procedures.

• Frenotomy

A simple surgical procedure known as a frenotomy can be conducted in a hospital or doctor's office with or without anesthesia. After examining the lingual frenulum, the physician will remove it with sterile scissors. The lingual frenulum contains few blood vessels and nerve endings, contributing to its brief duration and low associated irritation. Even if hemorrhaging does occur, only one or two drops may be lost.

Immediately after the procedure concludes, the infant can be breastfed. Although uncommon, complications associated with frenotomy may include infection, bleeding, injury to the tongue, or damage to the salivary glands. In addition, scar tissue formation and reattachment of the frenulum to the base of the tongue are both possibilities.

• Frenuloplasty

Frenuloplasty may be advised in cases where further intervention is required or when the lingual frenulum's thickness surpasses the frenotomy threshold. Frenuloplasty is performed with surgical instruments while under general anesthesia. Upon the release of the frenulum, self-absorbing sutures are typically used to close the wound while the tongue recovers.

Similar to frenotomy, uncommon complications associated with frenuloplasty include infection, bleeding, injury to the tongue, or injury to the salivary glands. Due to the procedure's more extensive scope, which also encompasses anesthetic reactions, scarring might ensue. Tongue movement exercises may be advised after frenuloplasty to enhance tongue mobility and mitigate the risk of fibrosis.

Complications

The following are examples of how tongue tie can impact the development of a baby's mouth and the way he or she speaks, consumes, and swallows:

• Breastfeeding complications. When sucking while breastfeeding, the infant must maintain his tongue above his lower jaws. If you cannot maintain proper tongue position or mobility, your infant might gnaw rather than suckle the nipple. This may result in considerable mammary discomfort and impede the infant's access to breast milk. Inadequate lactation can ultimately result in malnutrition and an inability to flourish.
• Impaired verbal communication. Tongue-tie can impede the articulation of specific phonemes, including "t", "d", "z", "s", "th", "r", and "l".
• Inadequate dental care. In older individuals, tongue ties can impede the effective removal of food particles from the teeth. This can lead to dental caries, gingivitis, and inflammation of the gums. Tongue ties can also result in diastema, which forms a gap or space between the two lower incisors.
• Additional conditions affect the mobility of the tongue. A tongue tie can impede activities such as licking ice cream or lips, kissing, or playing a wind instrument.

Prevention

Early identification and intervention are crucial for successful recovery in severe cases of tongue tie.

When to see a doctor?

If you are facing problems related to tongue tie, such as breastfeeding difficulties or difficulties in eating, speaking, or accessing the rear teeth due to impaired tongue movement, it is recommended that you consult a pediatrician or healthcare professional. Additionally, children with speech difficulties should undergo a medical evaluation to exclude the presence of ankyloglossia.