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Saturday, October 20, 2012

Tongue Tie–And Not the Kind Politicians Have

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by Dr. Richard Thrasher

Ankyloglossia, or tongue tie, is a very common congenital condition, meaning it’s something with which you’re born. This picture from Dr. Ghorayeb’s site shows a perfect example of a pretty dramatic one.

Ankyloglossia is when the lingual frenulum (the band of tissue under your tongue which tethers it to the floor of your mouth) is either too short or extends too far to the tip of the tongue. It can then prevent normal tongue movement.

While often not signficant, a severe tongue tie can impede breast feeding in newborns. Infants do not breastfeed by using suction, rather the tongue works as pump to mechanically pull milk into the mouth. If the tongue cannot extend past the alveolar ridge (gum line) it makes it difficult to breast feed. This is the one urgent reason for a fix of this condition. Later on, ankyloglossia can affect how far the tongue can protrude from the mouth making things like licking an ice cream cone more difficult.

Another effect of severe tongue tie is on articulation of speech. To see how this can effect someone’s ability to enunciate words, try putting the tip of the tongue against the top of the lower teeth and holding it there while saying the alphabet. Not so easy to do, but possible.

There are many methods for freeing the tongue. The simplest is to simply cut the frenulum in infancy. Snipping the frenulum with Castro-Viejo scissors is my preferred method. If done before a newborn is 6 weeks old, it can be done in the office without local anesthesia. Some parents are quite concerned about what their baby will experience, but as long as they are less than 6 weeks, the frenulum does not have any significant blood supply and no significant nerve supply so it’s not dissimilar to cutting finger nails. Babies don’t like it, but you know it’s not a painful experience. Typically babies will cry for about 10-30 seconds if at all and there’s usually 1-2 drops of blood. I prefer to take kids older than 6 weeks to the OR, unless they are much older in which case we can numb the frenulum in the clinic similar to what’s done for dental work. Some doctors do this for all patients. I find that the numbing shot hurts more than the actual release in the newborns, however.

Another method involves removing the entire frenulum. Sometimes lasers are used for either method. I don’t use lasers because it provides no better result than scissors, takes longer, and there is a slightly higher risk of complications. Sometimes, we use advanced plastic surgery techniques in older children or kids who have had a recurrence of the frenulum after a release. This more often requires a trip to the OR, but in coooperative patients can be done in the clinic under local anesthetic.

Two main complications are possible with this procedure. First, as mentioned above, is re-tethering of the tongue. A scar band can form and replace the frenulum causing the same symptoms. Often the scar band is thicker than the original frenulum and requires more advanced techniques to resolve. The other risk is to the salivary gland ducts that have their openings at the base of the frenulum. Many young kids become aware of these ducts because they are responsible for the ability to “gleek”. If you’re not familiar with this term, present long before fans of the show, Glee, were around, you can watch a video about how to do it, but I have to warn you that for some it may not be something they want to watch. If these ducts are damaged from the procedure, pain, swelling, and infection can occur in the salivary glands beneath your jaw bone (submandibular glands). This can become a significant problem even requiring removal of the gland(s). Fortunately, this is extremely rare and I’ve never seen a case of it caused by this procedure.

If you’re concerned about the possibility of ankyloglossia, have it evaluated. It’s a fairly straight forward problem which is easy to identify and quite easy to fix in most cases.

1 comment:

  1. Hi Very Nice Blog I Have Read Your Post It Is Very Informative And Useful Thanks For Posting And Sharing With Us And Your Writting Style Is Very Nice
    Castroviejo Scissors


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