• Tongue-Tie

    (Ankyloglossia)

    Definition

    Tongue-tie is difficulty moving the tongue because of attachment of tissue too close to the tip of the tongue or tight tissue under the tongue. The limited movement can make it difficult to breast feed. The degree of limitation can vary from infant to infanton.
    Tongue-tie is present at birth.

    Causes

    A tissue called the frenulum helps the development of the mouth before and shortly after birth. This frenulum is attached to the underside of the tongue. After birth the frenulum should start to shrink and loosen its hold on the tongue.
    In some, the frenulum does not shrink as expected. The exact reason is not clear but it may be associated with genetics.

    Risk Factors

    Tongue-tie is more common in boys. It may also be more likely if other family members have had it.

    Symptoms

    Symptoms will depend on the degree of limitation. Most children with tongue-tie won’t have symptoms.
    In those that have symptoms, tongue-tie may cause problems with latching on to the nipple during breast feeding.
    Muscles and Nerves of the Tongue
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    Copyright © Nucleus Medical Media, Inc.

    Diagnosis

    Tongue-tie can be diagnosed with a routine physical exam. There are also ways to estimate how severe it is.

    Treatment

    Discuss your treatment preferences and options with your child’s doctor.
    If there are no severe functional issues, your child’s doctor may recommend watchful waiting. Over time, the frenulum will loosen on its own.
    The frenulum may be surgically corrected if there is very limited movement in the tongue associated difficulty breast feeding and gaining weight. Options include:
    • Frenulotomy—The frenulum is snipped to release the tongue for normal movement.
    • Frenuloplasty—Repair of a frenulum that is too thick and short.
    These surgeries can often be done in the doctor’s office.

    Prevention

    There are no current guidelines to prevent tongue-tie because the cause is unknown.

    RESOURCES

    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org/content/patient-health

    Healthy Children—American Academy of Pediatrics http://www.healthychildren.org

    CANADIAN RESOURCES

    Canadian Society of Otolaryngology—Head and Neck Surgery http://www.entcanada.org

    Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    References

    Ballard JL, Auer CE, et al. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110(5):e63.

    Hathaway A, McCauley R. Assessment and management of tongue-tie in children: A survey of related professionals. American Speech Language Hearing Association website. Available at: http://search.asha.org/default.aspx?q=tongue-tie. Accessed November 10, 2015.

    Kummer A. Ankyloglossia: To clip or not to clip? That’s the question. American Speech Language Hearing Association website. Available at: http://www.asha.org/Publications/leader/2005/051227/f051227a.htm. Published December 27, 2005. Accessed November 10, 2015.

    Lalakea ML, Messner AH. Ankyloglossia: Does it matter? Pediatr Clin North Amer. 2003;50(2):391-397.

    Neonatal ankyloglossia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114501/Neonatal-ankyloglossia. Updated April 17, 2017. Accessed April 24, 2017.

    Tongue-tie. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/?q=node/1413. Accessed November 10, 2015.

    4/24/2017 DynaMed Plus Systematic Literature Review http://www.dynamed.com/topics/dmp~AN~T114501/Neonatal-ankyloglossia: O'Shea JE, Foster JP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017 Mar 11;3:CD011065.

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