Pediatric: Frenulectomy (Ankyloglossia)

What is: Tongue-tie? (Ankyloglossia)

Tongue-tie is an abnormality present from birth in which the membrane linking the tongue to the floor of the mouth (lingual frenulum) is too short. This prevents the tongue from protruding past the lower gums. Tongue-tie can occur to varying degrees, from minor shortening to complete fusion of the tongue to the floor of mouth. Sometimes patients with tongue-tie may have other abnormalities of the mouth such as a high arched palate or recessed chin. Tongue-tie is usually an isolated finding in otherwise normal infants.  Up to 5% of all babies have some form of tongue-tie.

Symptoms and Types:

Tongue-tie is usually diagnosed during a routine baby exam either in the hospital or the pediatrician’s office. The most common symptom of tongue-tie in infants is difficulty with breast-feeding due to problems latching on to the nipple. As the child grows older, speech difficulties may develop.  Children with tongue-tie may have problems articulating of the sounds requiring elevation of the tongue, such as /l/ and /th/. A short frenulum may inhibit normal swallowing by preventing the tongue from coming into contact with the roof of the mouth. This may eventually lead to a protruding lower jaw due to repeated efforts to thrust the tongue forward while swallowing. These repetitive efforts may also cause the lower incisor teeth to move forward. Older children may experience social stigma due to a “forked-tongue” appearance. Certain social experiences, such as licking an ice cream cone or kissing may be difficult.

Diagnosis and Tests:

Tongue-tie is diagnosed by physical exam. The physician evaluates the patient’s ability to protrude the tongue beyond the lower dental ridge. During protrusion, the tip of the tongue may become grooved and heart-shaped as the short frenulum pulls against the midline.

Treatment and Care:

Two schools of thought exist regarding treating infants and children with tongue-tie. The first is a “wait and see” approach.  It is possible that compensatory behaviors may allow children to develop normal speech and swallowing over time without treatment, thus avoiding surgery.

Another approach is to perform surgery (frenulectomy) at the time of diagnosis. Surgery may avoid speech problems that may develop and become more difficult to correct as the child grows older. Surgery may also avoid the other social and cosmetic effects of tongue-tie may persist, even with normal speech. Frenulectomy is usually a simple procedure, lasting no more than a few minutes. In the newborn, this can be done in the office without sedation using local anesthetic. Older children will usually require a general anesthetic. Recovery is usually rapid, with resumption of breast-feeding or liquid diet immediately after surgery.

 

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