Ankyloglossia, commonly known as “tongue tie”, is a condition where the band called the lingual frenulum that connects the underside of the tongue to the floor of the mouth is shorter or tighter than normal, restricting tongue movement. This condition can manifest particularly as sucking difficulties in infants, speech problems in children, and swallowing or dental hygiene difficulties in adults.
The function of the lingual frenulum is to anchor the underside of the tongue to the floor of the mouth. However, when the band is shorter or thicker than necessary, the upward and forward movement of the tongue is limited. This can lead to both functional and aesthetic problems.
Signs and Symptoms
Tongue tie symptoms may vary by age:
- In newborns and infants:
- Difficulty sucking or inability to properly latch onto the breast
- Slow weight gain or frequent feeding needs
- In children:
- Difficulty producing certain sounds (e.g., “l”, “r”, “t”, “d”)
- Difficulty brushing teeth or maintaining oral hygiene
- Shyness during social interactions or speech, self-confidence issues
- In adults:
- Inability to extend the tongue forward
- Difficulty during dental cleaning or denture use
- Difficulty moving food around the mouth with the tongue
What Causes Ankyloglossia?
Ankyloglossia is a congenital condition. It occurs when the tissue between the tongue and the floor of the mouth does not fully separate during fetal development.
Although the exact cause is unknown:
- It is more common in male infants.
- Genetic predisposition has been observed in some families.
- In rare cases, it may be present alongside other congenital syndromes.
How Is Ankyloglossia Diagnosed?
Diagnosis is usually made through a simple oral examination by an ENT specialist or Pediatrician.
Tongue movements, frenulum length, speech, and sucking functions are evaluated.
If necessary, a joint assessment can be made with a speech therapist or lactation consultant.
Treatment Options
The treatment decision is made based on the degree of tongue movement restriction and the patient’s complaints.
Not everyone needs surgery.
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Non-Surgical Approaches
- Lactation counseling: In newborns, most of the problem can be resolved by correcting positioning and sucking techniques.
- Speech therapy: In children, pronunciation can be improved with exercises that strengthen tongue muscles.
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Surgical Treatment (Frenotomy or Frenuloplasty)
If the frenulum significantly restricts tongue movement and causes functional problems, surgical intervention may be necessary.
- Frenotomy: A brief, simple procedure; the tongue is released by cutting the frenulum.
- Frenuloplasty: For thicker or deeply positioned bands, tissue repair and reshaping is performed.
Procedure:
- In newborns, it can usually be performed in a clinical setting.
- In older children, it is performed under brief anesthesia.
- Aside from mild discomfort after the procedure, rapid healing is usually observed. Most patients achieve complete recovery within a few days.
Possible Risks and Considerations
As with any surgical procedure, rarely after frenotomy or frenuloplasty:
- Mild bleeding,
- Infection,
- Scar tissue,
- Complications such as salivary gland duct injury may occur.
Therefore, the surgeon’s experience and proper patient selection are very important.
When Is Surgery Necessary?
Frenotomy should be considered in the following situations:
- Severe sucking difficulty and failure to gain weight in infants
- Significant articulation (speech) disorder in children
- Functional or social difficulty in adults
However, not every patient diagnosed with tongue tie is automatically a surgery candidate. The surgical decision should be made based on the severity of complaints and functional impact.
Conclusion
Ankyloglossia (tongue tie) is a condition that can be easily treated if detected during infancy.
However, not every tongue tie requires surgery.
Accurate diagnosis, functional evaluation, and individualized approach are the most important steps.
Examination by an ENT specialist is the most accurate way to determine the necessity and timing of treatment.
