Introduction
Breastfeeding is a vital aspect of a newborn's development, offering numerous health benefits to both the baby and the mother. However, various challenges can arise during this crucial period, one of which is ankyloglossia, commonly known as tongue tie. Ankyloglossia is a condition where the lingual frenulum, the tissue connecting the tongue to the bottom of the mouth, is unusually tight or short, limiting the tongue's range of motion. This condition can hinder effective breastfeeding, leading to discomfort and frustration for both the infant and the mother.
What Are the Complications of Ankyloglossia/Tongue Tie Associated With Breastfeeding?
Ankyloglossia, also known as tongue-tie, is a functional condition that can be a source of great distress to the breast feeding child and infant concerns multiple specialties within medicine as well as dentistry. Breastfeeding difficulties are often common in many other oral conditions in newborn or young infants, but the most common cause of this distress in the infant as per medical research remains the condition of ankyloglossia. Ankyloglossia is also reported in several young children or younger adults and can be a cause for functional or mechanical irritation.
Infants with ankyloglossia tend to not only experience breastfeeding difficulties from its mother such as poor latching, irritable behavior while trying to suck, failure to thrive, but the complications for the mother are even more such as nipple pain while breastfeeding, deficiency of the milk secretion (because of inability of the infant to suck milk properly), ulceration, infection or bleeding from the nipples. On the other hand, ankyloglossia in older children or young adults would be an altogether different functional issue. While some children experience mechanical limitation in tongue movements or in difficulty chewing or eating foods like ice cream for instance or in licking their lips, this can easily be a source of mental and emotional distress to the young child or adult. Restricted tongue mobility further would be the major reason why pronunciation of certain letters would be incorrectly spelled.
Though currently, the medical research linking ankyloglossia and speech disorders remains controversial, the role of ankyloglossia may be much more in hindering certain milestones in the child such as lower jaw or mandibular development, malocclusion (misalignment of teeth) or bite, gingival recession (exposure in the roots of the teeth caused by a loss of gum tissue). The current prevalence of tongue-tie across the globe in infants usually ranges from from 0.1 percent to 10.7 percent as per medical research statistics.
What Are the Differential Diagnosis for Ankyloglossia?
The neonatologist as well as the dentist should inspect the neonates mouth or oral cavity on why they may be experiencing problems with breastfeeding. Hence, it is important for the oral surgeon or dentist to firstly rule out as well as differentiate ankyloglossia or tongue tie from the following pathologies. These are :
-
Craniofacial diseases.
-
Genetic disorders affecting the jaw or palate such as retrognathia (unusual position of the mandible), cleft palate (when a baby is born with an opening or cleft in the roof of the mouth).
-
Syndromes associated with nasal obstruction. For instance, in piriform aperture stenosis or choanal atresia, there would be severe obstruction of the nasal passages leading to breast feeding difficulty.
-
Airway obstruction as in cases of bilateral vocal fold paralysis or in case of laryngomalacia (congenital softening of the tissues of the larynx above the vocal cords) in infants affected by laryngopharyngeal reflux.
It is therefore, crucial for the dentist or oral surgeon to establish the correct diagnosis in the infant as the morbidity and treatment outcomes may further worsen when such conditions are not identified correctly. Confirmative diagnosis is essential before the oral surgeon plans to perform a frenotomy surgery for ankyloglossia or tongue tie.
What Is the Procedure of Choice for Ankyloglossia?
After thorough inspection and diagnosis, a frenotomy would be considered an acceptable option for such infants because it is not only just a low-risk procedure, but it also eliminates distress in newborn infants for breast feeding and provides emotional well-being eventually to the breast feeding mother. Once the child shows an improvement in sucking or latching post surgery, conservative treatment options should always be the first option for breast feeding infants such as observation, lactation, speech pathology observation or therapy. However if the infant's distress is still unrelieved by conservative methods, then frenectomy can be considered. It is essential that the procedures of ‘frenotomy,’ 'frenuloplasty,' and 'frenectomy,' are distinguished clearly.
Frenotomy, also known as frenulotomy is the gold method or standard for treating ankyloglossia in breast feeding infants- which means it is only the incision of the lingual frenulum.
Frenuloplasty on the other hand involves cutting the lingual frenulum and tissue repositioning as well while frenectomy is the procedure where the lingual frenulum is completely eliminated. For young infants that are breastfeeding, oral surgeons do not recommend frenuloplasty or frenectomy.
What Is the Procedure for Frenotomy?
Frenotomy mainly involves holding the tongue up to tighten the lingual frenulum. The tissue is then cut through the fascia along a parallel line closer to the tongue. This cut is usually performed in a non traumatic way by the dentist or oral surgeon and should be done in a single motion in less than a few seconds. The infant should be restrained either by swaddling or in a papoose board, with the assistant or nurse usually supporting the child's head stably. It should be noted that local anesthesia is contraindicated for breastfeeding infants and applying a topical anesthetic is also deemed unnecessary
Prior to the procedure of frenotomy, it is essential that a family history of the child be obtained such as any bleeding disorders or history of bleeding in parents or grandparents or relatives.
The procedure of frenotomy has rare complications such as airway obstruction or damage to the surrounding oral structures, bleeding or oral scarring.
Medical research however indicates that this release of the lingual frenulum can also decrease the possibility that the mother need not abandon her breastfeeding and a positive or non traumatic contact can be experienced once again post surgery between the infant and the mother.
What Are the Contraindications of Frenotomy?
Contraindications of frenotomy or incision of lingual frenum in infants are in the following conditions :
-
Infants suffering from neuromuscular disorders.
-
Infants having hypotonia (decreased muscle tone), retrognathia (unusual position of the mandible) or micrognathia (lower jaw is smaller than normal).
-
In cases where a lingual frenectomy may aggravate the possibility of glossoptosis (displacement of the tongue). In the cases where an infant may have the possibility of glossoptosis, then frenotomy is not usually recommended because there would be possible obstruction of the airways post surgery as well and can complicate the swallowing method of the child.
Conclusion
Though the exact mechanism or natural pathology behind ankyloglossia remains unknown as per medical research, it remains one of the significant issues to be addressed for infants experiencing breastfeeding difficulties. Adapting conservative treatment measures or frenotomy for the distressed child can relieve both the infant related distress and ensure a smooth feeding experience post surgery.
