Tongue Tie (Ankyloglossia) and Its Treatment
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 upper lip tie which is when the upper lip is stuck to the gumline as well as posterior tongue tie in which the tongue tie is hidden under the tongue lining.
- Trouble with breast-feeding
- Swallowing problems
- Speech difficulties with sounds requiring a mobile tongue tip (sibilants and lingual sounds)
- Unable to "French Kiss" (obviously at an older age)
With tongue tie, the tip of the tongue is unable to help the infant draw the nipple into the mouth. It also prevents the tongue from being normally positioned between the nipple and lower gumline leading the infant to chew on the nipple. Ouch!
Normal Breast Feeding
Tongue Tie Preventing Infant From Drawing Nipple Fully Into the Mouth
Treatment is recommended ONLY if the tongue tie is causing a problem. If no symptoms are exhibited, one does not need to pursue any treatment.
Treatment itself is fairly straightforward. If the child is less than 12 months of age, it may be possible to perform in the clinic under topical anesthesia only. If between the ages of 1-12, sedation in the operating room is generally performed as the child is usually uncooperative (needs to keep mouth open AND tongue still). >12 years of age, the procedure can be performed in the clinic as long as the patient is fully cooperative.
Steps to procedure:
The tongue tie is visualized and topical lidocaine is applied using a Q-tip. Depending on the age and how thick the tongue tie is, injection of numbing medicine may also be performed.
The tongue tie is clamped across for about 1 minute. 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.
The clamp is released and scissors 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.
After the procedure, tylenol or motrin alone (if even that) is enough for pain control if > 6 months. Infants < 6 months do not typically require anything, but Hyland's Teething Gel or Orajel Naturals (not regular Orajel) may be applied for pain control. No antibiotics are needed. There may be a drop or 2 of blood that appears in the area for a few hours. The patient may immediately resume a diet without restrictions.
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 1-2 weeks can also be performed to prevent reattachment, though not typically necessary. Mainly this entails lifting the tongue tip towards the roof of the mouth using the index finger and thumb from one hand and than firmly massaging the wound site with a finger from the opposite hand.
Posterior Tongue Tie
There is a relatively rare and under-diagnosed type of tongue tie known as submucous tongue tie (or more commonly known as "posterior tongue tie" among lactation consultants).
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, 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.
Click here for more information about posterior tongue tie and its treatment.
If your baby has a tongue tie, please contact our office for an appointment.
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