What is Ankyloglossia (Tongue-Tie) (Tongue-Tie)?
Ankyloglossia, also known as tongue-tie, is a condition that affects different fields within medicine and dentistry. Despite this, no universal definition, classification system or diagnostic criteria exist for this condition. As such, there’s disagreement over when to treat it, leave it alone, or what the best approach is if treatment is necessary. This passaged discusses the underlying causes, frequency, and common symptoms of ankyloglossia. It also covers current ways of diagnosing and managing the condition, along with potential misdiagnoses, expected outcomes, and complications.
Regarding its definition, the word ‘ankyloglossia’ doesn’t have a standard definition. The International Affiliation of Tongue-Tie Professionals defines the lingual frenulum – a leftover piece of tissue between the tongue’s lower surface and the floor of the mouth – as the main concern. If this tissue restricts the movement of the tongue, it’s termed symptomatic ankyloglossia.
In 2020, a group of medical specialists dealing with tongue-tie issues came up with a shared definition, describing tongue-tie as a “condition of limited tongue movement caused by a restrictive lingual frenulum.” They also noted that the terms ‘anterior’ and ‘posterior’ ankyloglossia have recently gained traction. When the frenulum attaches near the tip of the tongue, thus limiting tongue movement, it’s referred to as classic or anterior ankyloglossia. Posterior ankyloglossia is when the frenulum attaches further back on the tongue, restricting its movement. However, this latter term is controversial. Some consider it a simple variation of normal anatomy, attributing breastfeeding challenges to different factors such as the mother’s milk production or nipple shape.
For grading the condition, different tools have been proposed. The Coryllos grading system is helpful to analyze the type of frenulum, but it doesn’t account for how the tongue functions or provide criteria to diagnose ankyloglossia. Another tool, called the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), evaluates both anatomy and function and assigns scores to help diagnose ankyloglossia. Regardless of the assessment tool used, it’s crucial to prove restricted tongue movement and confirm that the lingual frenulum is solely responsible for this restriction.
What Causes Ankyloglossia (Tongue-Tie) (Tongue-Tie)?
The exact cause of ankyloglossia, also known as tongue-tie, remains a mystery. Some scientists have linked it to a genetic syndrome called X-linked cleft palate. Tongue-tie has also been seen in rare syndromes, such as Kindler, Opitz, and Van Der Woude.
However, tongue-tie is mostly found in people who do not have any birth abnormalities or diseases. Studies show evidence that tongue-tie could be passed down in families. Interestingly, it seems that babies born to mothers who took cocaine during pregnancy may have a higher chance of having tongue-tie.
Risk Factors and Frequency for Ankyloglossia (Tongue-Tie) (Tongue-Tie)
Tongue-tie, or ankyloglossia, has a varied prevalence rate, ranging from 0.1% to 10.7%. This wide range is due to varying definitions and different methods used by researchers. In recent years, there’s been an increase in tongue-tie diagnoses, mainly due to different definitions being used by medical professionals. However, this has led to an overdiagnosis in babies and children and unnecessary surgeries.
Some mild cases of tongue-tie often get better on their own over time. This is why the condition seems more common in studies focused on newborns (1.72% to 10.7%) as compared to those examining older children, teenagers, and adults (0.1% to 2.08%). Outdoor studies indicate that tongue-tie appears to affect more males than females, however no particular racial group is more likely to get it.
- Tongue-tie has a prevalence rate of 0.1% to 10.7%.
- This varied range is due to differing definitions and research methods.
- There has been an increase in diagnosis, leading to overdiagnosis and unnecessary surgeries in some cases.
- Mild cases of tongue-tie often improve on their own over time.
- Studies focused on newborns report higher prevalence (1.72% to 10.7%) than those examining older people (0.1% to 2.08%).
- Tongue-tie appears to be more common in males.
- There doesn’t seem to be a prevalent racial group for the condition.
Signs and Symptoms of Ankyloglossia (Tongue-Tie) (Tongue-Tie)
Ankyloglossia, also known as tongue-tie, can cause several issues. One of the most noticeable symptoms is difficulty with breastfeeding. Babies may struggle to latch onto the breast correctly, lose their latch frequently, become irritable during feedings, and might not gain weight properly. Mothers may feel pain during breastfeeding, might not produce enough milk, or find that the baby isn’t sucking effectively enough to empty the breast. These challenges can cause a lot of stress and lead some mothers to stop breastfeeding early. Moms may also experience infections, bleeding, or ulcers on their nipples.
People with ankyloglossia have a lingual frenulum (the small bit of skin under the tongue) that can be attached in different places, be too short, or too thick. These differences limit the tongue’s mobility. Usually, people with this condition cannot extend their tongue past their lip’s edge. Their tongues might also look heart-shaped or dimpled.
This hindered tongue mobility can affect pronunciation, especially of certain consonants and sounds. However, it’s worth noting that having different pronunciation isn’t necessarily considered a speech disorder. Though we know that ankyloglossia and speech difficulties are common amongst newborns and children, the direct link between these issues is still unclear. More research and a standard rating system would provide more clarity on this matter.
Adults with ankyloglossia can also face some unique challenges. Everyday actions like licking lips, kissing, eating ice cream, or even doing tongue tricks might be difficult. Some people may feel discomfort under the tongue or get tongue cuts from their teeth.
Finally, ankyloglossia might contribute to malocclusion, a misalignment between the upper and lower teeth when the jaws are closed. This is especially true for a type of malocclusion known as Class III. The believe originates from the observation that the tongues of people with ankyloglossia tend to push forward and downward, which could affect jaw development. However, the evidence is limited, and the belief could be based only on speculation.
Testing for Ankyloglossia (Tongue-Tie) (Tongue-Tie)
Some factors such as tongue-tie could lead to issues with breastfeeding, but it doesn’t mean all babies who have tongue-tie will experience these problems. Research has shown that many infants having different degrees of tongue-tie could feed properly without any need for surgery.
Tongue-tie can be easily diagnosed during a physical exam and is often cited as a source of breastfeeding issues. However, when a baby has trouble breastfeeding, the medical evaluation should not just focus on the tongue. It’s crucial to explore other possible causes affecting the baby’s head and neck too.
The doctor should also get a breastfeeding history from the mom. It’s important to check if the baby has issues with the roof of their mouth, upper jaw, or lower jaw development, or even problems such as neurological or cardiovascular disorders. Blockages in the baby’s upper airways might make feeding more complicated.
Healthcare professionals should collect information about various factors related to breastfeeding. This includes the mom’s prior experience with breastfeeding, how often and how long she’s breastfeeding, and whether she’s using formula or breast pumps. They should also consider any issues affecting the mom herself, like discomfort during the early weeks of breastfeeding, improper breastfeeding position, nipple structure, milk supply, and the risk of breast infection.
Moreover, some healthcare providers like ear, nose, and throat specialists and dentists who diagnose tongue-tie, might not fully know about breastfeeding techniques. Many times, the main reason for breastfeeding difficulty is incorrect breast positioning. So, it might be helpful to see a breastfeeding specialist who can provide advice and support.
Treatment Options for Ankyloglossia (Tongue-Tie) (Tongue-Tie)
Even though certain studies suggest that breastfeeding difficulties in infants with a condition known as ankyloglossia can be improved through a procedure called frenotomy, it’s important to understand that not all infants show improvement after this operation. This is why parents need to be informed about this reality before choosing surgery for their infant. They should also be informed about other non-surgical options, such as observing the child’s condition, methods to enhance lactation, and consultations with speech pathologists.
Frenotomy is usually suggested for infants diagnosed with ankyloglossia who still face difficulties with breastfeeding even after trying non-surgical treatments. Performing this procedure early can reduce the chances that the mother will stop breastfeeding. However, it’s important to note that there isn’t much evidence to suggest that frenotomy can improve other issues unrelated to breastfeeding.
There are certain conditions in infants, such as neuromuscular disorder, hypotonia, and specific jaw alignment issues that may actually make frenotomy a risky choice. This is because frenotomy can, under certain conditions, worsen existing mouth or tongue positioning conditions, complicate swallowing, and even obstruct the airways.
It’s crucial to know the difference between ‘frenotomy,’ ‘frenuloplasty,’ and ‘frenectomy,’ even though these terms are often used interchangeably. Frenotomy, also called frenulotomy, is the operation typically performed on infants, which involves a small cut in the lingual frenulum (a membrane connecting the underside of the tongue to the floor of the mouth). Frenuloplasty refers to cutting and repositioning this tissue, while frenectomy is about removing it.
Frenotomy is a quick procedure in which the tongue is lifted up to tighten the frenulum, and then a small cut is made close to and parallel to the tongue. The baby is securely held during this procedure for safety. Interestingly, one study of 200 infants found that while 18% cried during the procedure, a larger 60% cried afterwards. Some doctors choose to administer a sweet solution (sucrose) before the procedure to ease any discomfort. Topical anesthetics don’t really help, and injecting local anesthetics is not recommended for babies.
Though it’s rare, there are some risks and complications of frenotomy. This includes complications like bleeding, blocking of the airways, injury to nearby structures, scarring, and developing an aversion to oral activities. Among these, bleeding is the most common, but can usually be managed by applying pressure. It’s very important to check if the family has a history of bleeding disorders before planning a frenotomy, especially in older patients.
What else can Ankyloglossia (Tongue-Tie) (Tongue-Tie) be?
Difficulties with breastfeeding can be due to many reasons, and tongue-tie is just one of them. It’s very important to check for other possible health issues in newborns having problems with breastfeeding, such as:
- Facial bone deformities such as a receding chin or a cleft palate
- Blockage in the nose due to narrowed nasal openings or because parts of the nose did not fully develop
- Blockage of the airways that can result from problems like paralyzed vocal cords or a softening of the voice box
- Acid reflux that can irritate the throat and voice box
If these conditions aren’t found and fixed early on, it might result in worse health problems for the baby. These issues should be addressed before deciding to perform a tongue-tie surgery.
What to expect with Ankyloglossia (Tongue-Tie) (Tongue-Tie)
The long-term effects of ankyloglossia, commonly known as tongue-tie, are still not fully understood. However, for babies who struggle with breastfeeding due to this condition, a low-risk surgical procedure called a frenotomy can be a helpful solution. This surgery is typically beneficial for these patients.
Possible Complications When Diagnosed with Ankyloglossia (Tongue-Tie) (Tongue-Tie)
As previously noted, infants with a condition called ankyloglossia primarily struggle with breastfeeding. This can include issues like not being able to latch on properly, becoming irritable during feeding, and not gaining weight as they should. For mothers, this condition can cause pain during breastfeeding, insufficient milk production, sores on the nipples, infections, and bleeding.
For older children and adults with ankyloglossia, their tongue movement may be limited, causing difficulties in certain activities. These can include struggling to eat ice cream, licking their lips, and performing tongue movements commonly referred to as “tricks”. There might also be complications pronouncing specific letters, but the relationship between ankyloglossia and speech disorders is not fully agreed upon. Additionally, it’s uncertain how tongue-tie might impact the development of the lower jaw, the alignment of teeth, and the wearing away of the gums.
Preventing Ankyloglossia (Tongue-Tie) (Tongue-Tie)
Ankyloglossia, or “tongue-tie,” is confirmed when the tongue has limited movement due to the small band of tissue under it. However, not every “tongue-tie” requires surgery. If a newborn is struggling to breastfeed, it doesn’t mean the problem lies just with a possible “tongue-tie.” Other causes should be considered too.
In fact, the most common reason a baby might have difficulties breastfeeding is an improper breastfeeding position, rather than a medical issue. First-time mothers or anyone who is facing challenges with breastfeeding should seek help from a breastfeeding specialist to get the right support and guidance.
Moreover, before deciding on a frenotomy—a small surgery that cuts the band of tissue to free up the tongue—it’s important that patients are well informed about potential risks and complications. It should be noted that even after the procedure, some babies may still have breastfeeding difficulties.
