Tongue Tie (Ankyloglossia) - Parent's Guide

Tongue tie, ankyloglossia, tongue mobility restriction, short frenulum, - all of them are names given to the situation where the newborn or infant’s tongue does not have enough range of motion to attach to the breast, suckle and swallow efficiently. It is a congenital anomaly characterized by an abnormally short lingual frenum, which may restrict tongue tip mobility.

Tongue tie definitions range from vague descriptions of tongue that functions with a lesser-than-normal range of movement to a more specific variety of the frenum being short, thick, muscular, or fibrotic.

Classification of Ankyloglossia by Kotlow based on “Free Tongue” Length

• Clinically accepted, normal range of free tongue=>16 mm
• Class I: mild ankyloglossia=12-16 mm
• Class II: moderate ankyloglossia=8-11 mm
• Class III: severe ankyloglossia=3-7 mm
• Class IV: complete ankyloglossia=<3 mm

Causes

A lingual frenulum (connective membrane under the tongue) that is either too short or too thick causes Tongue-tie(ankyloglossia). This membrane retreats during normal embryo development stage, at around 13 weeks. In some babies, the tissue does not retreat enough to allow the tongue the natural range of movement the baby will need to be able to breastfeed adequately. Some babies with insufficient tongue mobility can take feed easily from a feeding bottle. For babies with very restricted movement, even bottle feeding can be troublesome. They may choke easily or leak milk from the sides of their mouths while feeding.

Effects

Ankyloglossia affects eating, speech, and oral hygiene as well as have mechanical/social implications. It can also prevent the tongue from contacting the front palate. It can then promote a childlike swallow and hamper the progression to an adult-like swallow which can result in an open bite deformity.It can also result in jaw distortions; this happens when the tongue contacts the front portion of the jaw with exaggerated frontal thrusts.

Diagnosis

The Hazelbaker tool is a measurement method of evaluation of lingual function and appearance that facilitates the identification of infants with significant ankyloglossia.  

Treatment

 In infants in whom the malformation is minor, the doctor may advise that the condition is left untreated. As long as it doesn't impact day to day functions such as feeding, eating, speech, etc.

When the frenulum malformation disrupts movement, growth, or development, restorative treatment is necessary to resolve the situation, usually by frenectomy.

The frenectomy procedure refers to the surgical removal of the obstructive frenum. It is the preferred procedure for candidates with a thickened and fibrous frenum where severe bleeding is a risk. Also, In some cases, rejoining of the frenum by scar tissue during healing may occur. The surgery is conducted under general anesthesia in young children. Older children or adults, however, may tolerate the procedure with the use of local anesthetic alone. The frenum is released in a similar method as in frenotomy although at times limited division of the tissue may be required for adequate release. The wound is sewn closed with a flap closure.

It is a minor surgical procedure and is performed in your dentist’s clinic. It can be done with either a surgical scalpel or laser beam may be used as an alternative cutting tool. The surgery takes less than 15 minutes. Using a laser beam causes minimal bleeding. As the laser cauterizes, the wound stitches are not required. A laser surgery also results in less post-operative discomfort and a significantly shorter healing time. The child can be breastfed the very same day. It is recommended that the child is exclusively breastfed during the healing period.

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If your child needs a frenectomy, do not worry and stress about it. The procedure is very successful and causes minimal discomfort. Milk transfer, infant weight gain, infant growth, maternal nipple pain, and breast condition all can improve significantly after the surgery.

Rockville dentist, Dr. Mark Hagigi says "If you have noticed that your infant cannot grip the nipple properly, is easily exhausted or stops feeding midway, have him examined by an expert. Not all malformations are detectable to the untrained eye".

Ankyloglossia, or tongue-tie, forms a significant proportion of the known hurdles to proper breastfeeding. The condition is exceedingly common in boys than in girls and seems to have a genetic origin. Researchers are of the opinion that hormones make the male gender more vulnerable than the female kind. Two main indications associated with ankyloglossia in the breastfeeding cycle are infirm infant latch and nipple pain in the breastfeeding mother, which may be alarming signs of severe breastfeeding complications. Early detection and surgical intervention can improve the feeding process for both mother and child. Thereby preventing, the onset of further complications.