It
presents at birth and can restrict the movement of tongue.
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. A
person who has tongue-tie might have difficulty sticking out his or her tongue.
Tongue-tie can also affect the way a child eats, speaks and swallows, as well
as interfere with breast-feeding.
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.
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.
Although
tongue-tie can affect anyone, it's more common in boys than girls. Tongue-tie
sometimes runs in families.
Complications
Tongue-tie
can affect a baby's oral development, as well as the way he or she eats, speaks
and swallows.
For
example, tongue-tie can lead to:
- Breast-feeding Problems. Breast-feeding
requires a baby to keep his or her 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 breast-feeding 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"
and "l." It can be especially challenging to roll an
"r."
- 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). Tongue-tie can also lead to the formation of a
gap or space between the two bottom front teeth.
- 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.
Tongue-tie
is typically diagnosed during a physical exam.
Treatments
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, surgical treatment
may be required.
Surgical
treatment of tongue-tie may be done for infants, children or adults if
tongue-tie causes problems. Surgical procedures are frenotomy or 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 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 breast-feed immediately.
Complications
of frenotomy are rare — but could include bleeding or infection, or damage to
the tongue or salivary glands. It's also possible for the 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 frenotomy.
Frenuloplasty
is done under general anesthesia with surgical tools. After the frenulum is
released, the wound is usually closed with sutures that absorb on their own as
the tongue heals.
Possible
complications of frenuloplasty are similar to frenotomy and 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
frenuloplasty, tongue exercises might be recommended to enhance tongue movement
and reduce the potential for scarring.
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