Ankyloglossia or tongue-tie causes the membrane on the bottom of the tongue, the lingual frenulum, to be shorter and thicker than average, resulting in the tongue tip having less mobility and freedom of movement. Doctors usually diagnose the condition shortly after birth, when new mothers or physicians notice a newborn struggle with breastfeeding. Children with this condition may be unable to stick out their tongue, and it can affect eating, speech, and swallowing.

Signs and Symptoms of Ankyloglossia

The signs and symptoms of ankyloglossia may include the following:

• Problems with moving the tongue side-to-side or with touching the top of the mouth.
• A heart-shaped or forked looking tongue.
• The inability to stick the tongue out.
• Various problems with breastfeeding.
• Speech problems with sounds like ‘t’, ‘n’, or ‘d’.

Diagnosising Ankyloglossia

A doctor or dentist will carry out a physical examination, look into the medical history of the baby and mother, and investigate breastfeeding problems. An examination of the child’s mouth will include measuring the length of the lingual frenulum and the tongue. The baby is likely to cry if the doctor lifts his tongue. For older children, doctors assess issues with speech and certain sounds.

Non-Surgical Treatment of Ankyloglossia

Non-surgical treatment for ankyloglossia involves helping the mouth and tongue compensate for the latter’s lack of movement. Children can learn alternative ways of making certain sounds with the help of a speech therapist. Non-surgical treatment of ankyloglossia may also consist of exercises prescribed by orofacial myology professionals to help strengthen the muscles in the mouth, tongue, and face.

Surgical Treatment of Ankyloglossia

Ankyloglossia is usually treated surgically with a simple and non-invasive procedure. In most cases, the doctor cuts the frenulum with scissors or a laser in a tongue division or frenotomy operation, which is generally painless and results in minimal or no bleeding. For older children, the surgeon may use general anaesthetic. The only risk with this surgery is the possibility of an infection post-procedure.

Prognosis of Ankyloglossia

Frenotomies usually take a few days to a week to heal. A white patch may form, but this disappears within a week or two. Tongue-tie is unlikely to return, as the tissue does not normally grow back. Instructing children to regularly extend their tongues can further prevent future issues.

Ankyloglossia and Breastfeeding

Most infants with ankyloglossia will have some problems breastfeeding. Bottle feeding is generally not an issue. New mothers can experience nipple pain when trying to feed a baby with ankyloglossia, and the babies will struggle to latch onto the breast. Babies also may seem hungry, not gain weight adequately, or vomit after they have fed. In addition, they might make clicking sounds or grind their gums when they nurse.

Ankyloglossia and Speech

Older children with ankyloglossia can have problems with their speech, including the production of certain sounds or phonemes such as the ‘r’, ‘l’, and ‘w.’ Also, children may have difficulty enunciating words, and some children say pronounce words properly requires a lot of effort.

Other Effects of Ankyloglossia

Other actions affected by untreated ankyloglossia include kissing, eating ice cream, licking one’s lips. Such issues can create social problems such as embarrassment, and lead to teasing. Children may be unable to explain the difficulties they have.

Prevalence of Ankyloglossia

Ankyloglossia is relatively common and is more likely to happen in boys than girls. It can affect anyone but appears to run in families. Depending on the diagnostic criteria, studies report the condition occurs in 4 to 10% of the overall population, although the incidence has been reported to be up to 16%.

Other Conditions Associated with Ankyloglossia

Some rare symptoms are linked to ankyloglossia, including those that cause a cleft palate, such as Kindler or van der Woude syndrome.