Tongue Tie (Ankyloglossia) and Its Treatment

by , last modified on 3/8/14
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tongue tieTongue 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.

Symptoms include:

  • Trouble breast-feeding
  • Swallowing problems
  • Speech difficulties
  • "French Kissing" (obviously at an older age)


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.


videoWatch Video on Tongue Tie Release

Steps to procedure:

Step 1:

The tongue tie is visualized and topical 4% lidocaine is applied using a Q-tip. If >12 years of age, injection of numbing medicine is also performed.

anesthesia

Step 2:

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.

clamped

Step 3:

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 5 minutes.

cut

 

After the procedure, tylenol or motrin alone (if even that) is enough for pain control. No antibiotics are required. 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.

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.

Treatment is a bit more complicated than regular tongue tie in that the mucus lining has to be incised in order to expose the tongue tie prior to release as desribed above. Once the tongue tie is released, the incision is sutured closed.

Given the more complicated steps to address this condition, it may need to be performed under sedation.

If you have a tongue tie, please contact our office for an appointment.

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