Tongue-tie (ankyloglossia)

Overview

Tongue-tie (ankyloglossia) is a condition present at birth that restricts the tongue's range of motion.

With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue's tip to the floor of the mouth. Depending on how much the tissue restricts tongue movement, it may interfere with breastfeeding. Someone who has tongue-tie might have difficulty sticking out the tongue. Tongue-tie can also affect eating or speaking.

Sometimes tongue-tie may not cause problems. Some cases may require a simple surgical procedure for correction.

Symptoms

Signs and symptoms of tongue-tie include:

• Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side.
• Trouble sticking out the tongue past the lower front teeth.
• A tongue that appears notched or heart shaped when stuck out.

When to see a doctor

See a doctor if:

• Your baby has signs of tongue-tie that cause problems, such as having trouble breastfeeding.
• A speech-language pathologist thinks your child's speech is affected by tongue-tie.
• Your older child complains of tongue problems that interfere with eating, speaking or reaching the back teeth.
• You're bothered by your own symptoms of tongue-tie.

Causes

Typically, the lingual frenulum separates before birth, allowing the tongue free range of motion. With tongue-tie, the lingual frenulum remains attached to the bottom of the tongue. Why this happens is largely unknown, although some cases of tongue-tie have been associated with certain genetic factors.

Risk factors

Although tongue-tie can affect anyone, it's more common in boys than girls. Tongue-tie sometimes runs in families.

Complications

Tongue-tie may affect a baby's oral development, as well as the way the child eats, speaks and swallows.

For example, tongue-tie can sometimes lead to:

• Breastfeeding problems. Breastfeeding requires a baby to keep the tongue over the lower gum while sucking. If unable to move the tongue or keep it in the right position, the baby might chew instead of suck on the nipple. This can cause significant nipple pain and interfere with a baby's ability to get breast milk. Ultimately, poor breastfeeding can lead to inadequate nutrition and failure to thrive.
• Speech difficulties. Tongue-tie can interfere with the ability to make certain sounds — such as "t," "d," "z," "s," "th," "n" and "l."
• Poor oral hygiene. For an older child or adult, tongue-tie can make it difficult to sweep food debris from the teeth. This can contribute to tooth decay and inflammation of the gums (gingivitis).
• Challenges with other oral activities. Tongue-tie can interfere with activities such as licking an ice cream cone, licking the lips, kissing or playing a wind instrument.

Diagnosis

Tongue-tie is typically diagnosed during a physical exam. For infants, the doctor might use a screening tool to score various aspects of the tongue's appearance and ability to move.

Treatment

Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away — even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach.

The lingual frenulum may loosen over time, resolving tongue-tie. In other cases, tongue-tie persists without causing problems. In some cases, consultation with a lactation consultant can assist with breastfeeding, and speech therapy with a speech-language pathologist may help improve speech sounds.

Surgical treatment of tongue-tie may be needed for infants, children or adults if tongue-tie causes problems. Surgical procedures include frenotomy and frenuloplasty.

Frenotomy

A simple surgical procedure called a frenotomy can be done with or without anesthesia in the hospital nursery or doctor's office.

The doctor examines the lingual frenulum and then uses sterile scissors or cautery to snip the frenulum free. The procedure is quick and discomfort is minimal since there are few nerve endings or blood vessels in the lingual frenulum.

If any bleeding occurs, it's likely to be only a drop or two of blood. After the procedure, a baby can breastfeed immediately.

Complications of a frenotomy are rare — but could include bleeding or infection, or damage to the tongue or salivary glands. It's also possible to have scarring or for the lingual frenulum to reattach to the base of the tongue.

Frenuloplasty

A more extensive procedure known as a frenuloplasty might be recommended if additional repair is needed or the lingual frenulum is too thick for a frenotomy.

A frenuloplasty is usually done under general anesthesia with surgical tools. In an adult, the procedure may be done using a type of anesthesia that reduces pain and helps you relax. After the lingual frenulum is released, the wound is usually closed with sutures that absorb on their own as the tongue heals.

Possible complications of a frenuloplasty are like those of a frenotomy and are rare — bleeding or infection, or damage to the tongue or salivary glands. Scarring is possible due to the more extensive nature of the procedure, as are reactions to anesthesia.

After a frenuloplasty, tongue exercises might be recommended to enhance tongue movement and reduce the potential for scarring.

Preparing for an appointment

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Prepare a list of questions ahead of time, such as:

• How severe is the tongue-tie?
• Is treatment needed?
• What are the treatment options?
• Should I consider surgical correction?
• What's involved in surgical correction? What are the risks?
• Is anesthesia necessary?
• Will surgical correction improve my child's ability to get more milk during breastfeeding?
• Can the procedure be done in the office or hospital nursery?
• Do I need to consult an ear, nose and throat doctor or other specialist?

What to expect from your doctor

The doctor is likely to ask you a number of questions. For example:

• If your infant has tongue-tie, are you having trouble breastfeeding?
• If your older child has tongue-tie, is your child having trouble making certain sounds or taking care of their teeth?
• If you have tongue-tie, are you concerned about activities you're not able to do because of limited tongue movement?

Preparing and anticipating questions will help you make the most of your time with the doctor.