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A Guide to Ankyloglossia (Tongue-Tie)

Our tongues are one of our most often used voluntary muscles in our body. They assist us in eating and drinking, give us the wonderful sense of taste, and most importantly facilitate speech. Because of how much we can do with our tongues and how often we use it, it can be a bit difficult to imagine life with less than normal tongue function. And while there are many conditions that affect the tongue, one such condition that affects children in particular is called ankyloglossia, more commonly known as tongue-tie. What is tongue-tie, is it a bad thing, and what should I do if I or my child has it? We will be discussing all of that in this article.

What causes tongue-tie?

We know that the tongue is practically a flap of muscular tissue in the mouth, and has a very high range of movement as a result. However, the tongue is actually restricted from moving out to its furthest limits thanks to a flap of skin that anchors the tongue to the bottom of the mouth. This flap is called the lingual frenulum, and is one of a few other frenulums found in other parts of the body.

Under normal circumstances, the lingual frenulum develops at birth and grows longer along with the tongue of the child. However, a congenital defect causes the lingual frenulum to not grow normally, resulting in a shorter frenulum as the child grows. The frenulum then pulls on the tip of the tongue, causing it to point downward and restrict its range of movement.

Guide to Ankyloglossia

Is tongue-tie bad?

Not necessarily. Ankyloglossia is not dangerous in the sense that it is a symptom of some serious illness; however, its restriction of the tongue’s movement can cause a few problems throughout the child’s development. An infant with a tongue-tie might have some difficulty when breast feeding or bottle feeding. As the child grows and eventually starts to learn speech, he or she may also have issues making certain sounds that need the tongue to extend to the roof of the mouth, such as the sounds of the letters “T”, “L”, “Z”, and “S”.

In general, ankyloglossia is a rather common congenital anomaly and can be found in anywhere between 4 and 10 per cent of newborns. There are, however, variations in how the tongue-tie manifests in the child, which may have a greater or lesser impact on the range of movement of the tongue. On one end of the spectrum, the tongue-tie may be mild enough that it can be detected but have little to no effect on the child’s speech development. On the other hand, a variant called total ankyloglossia affects the growth of the lingual frenulum in such a way that it effectively anchors the tongue to the floor of the mouth. These cases are fortunately extremely rare, but will need immediate treatment in order to allow the child to develop normally.

How will I know if my child has a tongue-tie?

Being a congenital birth defect, ankyloglossia can be detected and diagnosed as early as just after childbirth and well into the toddler ages. One of the most obvious symptoms of tongue-tie is that the tip of the tongue takes on an unusual heart shape – this is caused by the short lingual frenulum pulling the tip of the tongue downward, preventing the child from being able to stick their tongue out, roll backward, or touch the roof of their mouth. Some of the other symptoms of ankyloglossia include impairments to the child’s speech development as mentioned earlier, which itself can cause other problems once the child is out and about, such as getting bullied or teased by other children because of the speech impediment.

Can ankyloglossia be treated?

Fortunately, ankyloglossia can be treated quite easily, although the most common method for doing so is through surgery. This procedure is called frenectomy, which essentially involves cutting and removing the lingual frenulum in order to free the tongue and allow it to move freely again. The exact procedure, however, varies depending on the age of the patient the frenectomy is performed on. If ankyloglossia is found in the child during infancy (and in some cases even shortly after birth), the frenectomy can actually be performed immediately, wherein the doctor will apply a topical anaesthetic on the mouth and make a small incision on the problem area, after which the normal range of movement of the tongue will be restored. The incision in this case will heal very quickly, so your infant will be able to begin or resume breastfeeding shortly after the procedure.

Although ankyloglossia is typically diagnosed and treated during infancy, the frenectomy can still be performed in later childhood and even on adults. In these cases, however, the lingual frenulum will have already grown in size and strength, which means additional preparations will be required. The key differences here are the use of local or general anaesthetic instead of the milder topical kind, and that the wound will take a few days to completely heal. A paediatric surgeon, such as ones that deal with tongue-tie in Perth, may also be referred to you for the procedure to ensure it goes smoothly without any complications.

Will there be any problems?

Except for particularly rare or unusual instances, the frenectomy procedure is well researched and understood, so there is a very low chance of issues or complications arising after the procedure. That being said, you should be aware that the frenectomy is still a surgical procedure and there can still be side effects that can come from the anaesthesia (such as numbness) and from the wound (such as improper clotting or infection).

If you are still unsure of some of the details behind ankyloglossia and the frenectomy procedure, or would like to have their child formally diagnosed, it would be a good idea to find or be referred to a paediatric surgeon for a consultation.

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