Adult Tongue Tie (Ankyloglossia) and Its Treatment

by , last modified on 5/16/16
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tongue tie

Tongue tie (otherwise known as ankyloglossia) is when the tip of the tongue is anchored to the floor of the mouth. Tongue tie may extend all the way to the tip or it may extend partially to the tip resulting in a partial tongue tie. There is also a condition called posterior tongue tie in which the tongue tie is hidden under the tongue lining.

Although this condition is mainly discussed from the perspective of infants and breastfeeding, some teenagers and adults may choose to get this treated. Why?

It's mainly due to problems that stem from inadequate tongue mobility. Such problems may include:

  • Swallowing problems (tongue has trouble pushing the food towards the back of mouth)
  • Speech difficulties causing a lisp especially with sounds requiring a mobile tongue tip (sibilants and lingual sounds)
  • Unable to "French Kiss"
  • Serious wind instrument players where the tongue's relative immobility is limiting how well they are able to play
  • Lecturers where the tongue's relative immobility causes tongue pain after talking for prolonged periods of time


Regardless whether dealing with a newborn or an older child/teenager, the treatment is the same. Keep in mind that treatment is recommended ONLY if the tongue tie is causing a problem. If no symptoms are present, one does not need to pursue any treatment.

Treatment itself is fairly straightforward and can be performed in the clinic as long as the patient is fully cooperative.

Although we generally perform tongue tie releases using the scissor technique as shown below, we can also perform this procedure using a LASER as well. The laser we use in our clinic is a 1064nm diode laser. Generally speaking, the "thicker" and/or "deeper" the tongue tie (ie posterior tongue tie), the more bleeding that is encountered in which case using the LASER is the preferred technique as it minimizes bleeding as the cut is made. Read more about LASER vs scissor technique.


videoWatch Video [pending]

Steps to procedure (scissor technique shown):

Step 1:

The tongue tie is visualized and topical lidocaine is applied using a Q-tip or cetacaine sprayed to the area. Depending on the age and how thick the tongue tie is, injection of numbing medicine may also be performed.

anesthesia

Step 2:

The tongue tie is clamped across for about 10 seconds. Care is taken to clamp above the salivary duct openings (Wharton's duct), but below the body of the tongue.

This maneuver crushes the blood vessels closed so when the cut is performed, minimal bleeding occurs.

Alternatively, a LASER can be used to make this cut without any mucosal clamping. There are pros and cons for each technique, but in the end, outcomes are excellent regardless of which method used. Read more about LASER vs scissor technique.

clamped

Step 3:

The clamp is released and scissors (or LASER) are used to cut right along the tongue tie where the clamp was placed. Rarely a stitch is placed.

That's it! This whole procedure usually takes no more than a few minutes.

cut

 

After Care

After the procedure, tylenol or motrin alone (if even that) is enough for pain control. No antibiotics are needed. Active bleeding (if occurs) typically stops within 15 minutes. There may be a drop or 2 of blood that may sporadically appear in the area for the next few hours.

Avoid foods that require biting with the front teeth (apples, carrots, etc) which would cause the food to dig into the surgical site for about 1 week. Stick with soft foods. After that, a normal diet may be resumed.

It is not unusual for a white eschar to appear along the cut edge. Do not worry if this happens. It is just a scab that is wet (recall what a scab looks like on your hand if you get it wet... it turns white). It will disappear in about 1 week.

Stretching exercises 3x per day for the first 2 weeks can also be performed to prevent reattachment if a posterior tongue tie was present and a stitch was not placed. Otherwise, stretching exercises are not typically necessary. Stretching exercises, if performed, mainly entails pushing the tongue tip towards the roof of the mouth while pinching the wound closed.

Posterior Tongue Tie

There is a relatively uncommon and under-diagnosed type of tongue tie known as submucous tongue tie (more commonly known as "posterior tongue tie").

This condition is when the tongue tie is hidden UNDER the mucus lining of the tongue/mouth. You can't see this type of tongue tie that easily, but you can feel it if you run the finger underneath the tongue from side to side where the tongue tie would be. One would feel a tissue band (speed-bump sensation with finger sweep) where the tongue tie would be.

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