Tied Tongue, also known as Ankyloglossia, is a hereditary condition which affects approximately 3-4 children /1000 born. It can be simply understood to be a condition wherein the tongue’s mobility is reduced due to the change of the sublingual frenulum in either attachment position, length, consistency or a combination of any or all of these factors.
The consequences of this condition can vary significantly, but often are not in a direct relationship to the measurable restriction of mobility observed.
Infants born with Tongue-tie can have considerable difficulty attaching to their mother’s nipple to form an adequate seal when attempting to breast-feed. This can result in pain for the mother and often results in cracked nipples and even mastitis occasionally. Quite commonly feeding can be slow and results in less-than-desirable weight gain. Many infants also suffer from significant “wind” pain and discomfort as a result of swallowing air while attempting to feed.
Many mothers with good volumes of milk production report infants feeding well despite significantly restricted tongue mobility. Nevertheless, it is common for tongue-tied babies to experience less-than-optimal breastfeeding. As a result, tongue-tied babies often end up being bottle-fed quite early on if the condition remains untreated. If treatment is provided early & the mother is still lactating many babies are subsequently able to breast-feed normally.
Treatment for infants is usually simple and uncomplicated. The soft tissue attachment can be modified readily by a surgeon using scissors, or more recently laser has been employed successfully in treatment. It is often performed without any anaesthetic injections being necessary, often requiring topical (paint-on) anaesthetic gel only. This intervention is best carried out at the earliest available opportunity to increase the likelihood of allowing satisfactory breastfeeding to occur subsequently. This procedure is usually performed by either a dentist with experience in this area, an oral surgeon or paediatric surgeon. Historically, it was often done in the labour ward, immediately post-natal, using nothing more than a sharp finger nail across the membrane of the new-born if required.
Unfortunately this condition is often left untreated in infants due to a high level of confusion among medical personnel regarding best-practice or even simply because it is not diagnosed at all. In these cases it can often impact negatively on speech development of the maturing child. It is possible as well as helpful to release the restricted tongue for these children as early as possible to encourage full and normal development of speech sounds.
The surgical procedure is unchanged for an older child, but may involve more emotional input from the child than when it is a naive newborn, thus causing some unpleasant memories which can best be avoided by earlier intervention. Allowing the condition to remain untreated can result in immeasurable changes to the psyche of the child from self-esteem issues related to the observed poor speech mentioned previously.
Additionally, this surgery can be quite painful post-operatively for several days due to the unavoidable invasion of the muscle tissue of the tongue, requiring analgesia during this time. Despite this discomfort it usually heals well over a period of 7-10 days. It is commonly more uncomfortable the older the patient is at the time of treatment. Again, new-borns heal much quicker than older patients and retain no memories of this experience to affect their relationship with health professionals in the future.
Reduced tongue mobility is best treated as early as possible. It is often responsible for feeding difficulties and speech development issues. Treatment is usually simple & uncomplicated and is carried out by dentists, oral surgeon specialists and paediatric surgeons.