Tongue-Tie - Complications, Diagnosis, and Treatment

Introduction:

For the tongue to do all its functions, it should be able to reach every part of the mouth. This full range of motion helps you to speak by making different sounds. It also helps in swallowing and sweeping away the food particles sticking in the mouth and helps keep the mouth clean. In this condition, known as "tongue-tie," the tongue is tied to the floor of the mouth, restricting speech, eating, and other activities involving a range of motion. Tongue-tie is a common condition seen in around five percent of all newborns, three times more common among boys than girls.

What Is Tongue-Tie?

Tongue-tie refers to a condition in which the lower side of the tongue is attached to the floor of the mouth, restricting it from moving freely. This happens when the strip of tissue called the lingual frenulum that connects the tongue and the floor of the mouth is shorter than normal. It is otherwise known as ankyloglossia. This is a condition that has been present since birth.

How Is Tongue-Tie Developed?

When an embryo grows in the womb, the tongue and the floor of the mouth fuse, and eventually, the tongue separates from the floor of the mouth. Finally, only a thin cord of tissue connects the bottom of the tongue with the mouth's floor; as the child grows, the lingual frenulum thins and shrinks. In contrast, in children with tongue-tie, the lingual frenulum stays thick and does not recede, restricting tongue movement.

How To Know if the Baby Is Tongue-Tied?

Tongue-tie is associated with difficulties in breastfeeding. Tongue-tie is often noticed when the baby is finding it hard to breastfeed. The symptoms differ for each child; some children may not have any, whereas others may have noticeable symptoms.

The other symptoms that can be noticed in a baby with tongue-tie include the following:

• The baby tends to chew more than suck.

• Difficulty latching while breastfeeding.

• Baby does not gain weight as expected.

• Breastfeeding for a long time.

• The baby is fussy when trying to breastfeed.

• The baby makes a clicking sound while feeding.

• The baby seems hungry all the time.

• Trouble placing the tongue inside the mouth.

• The baby may be unable to move the tongue from side to side and cannot reach the tongue to the roof or upper gums of the teeth. They may also find it hard to put their tongue out of their mouth.

In young children, here are a few commonly noticed symptoms, which include:

• Impairment in speech.

• Difficulty swallowing.

• Not being able to lick ice cream.

• Problems sticking the tongue out.

• Difficulty kissing.

• Difficulty moving the tongue towards the roof of the mouth or sideways.

In addition to finding specific symptoms in the baby, the mother might also have a few symptoms, like:

• Pain while or after breastfeeding.

• Sore or cracked nipples.

• Inflammation or infection of the breast (mastitis).

• Reduced milk supply.

How Is Tongue-Tie Classified?

The Coryllos ankyloglossia grading scale is used to classify the tongue-tie types. The types include:

• Type I:

In type I, the lingual frenulum is thin and elastic and attaches the tip of the tongue to the ridge behind the lower teeth.

• Type II:

In type II, the frenulum is delicate and elastic, and the tongue is attached 2 to 4 millimeters from the tip to the floor of the mouth.

• Type III:

In type III, the frenulum is thick and stiffened and connects the tongue from the middle of the lower side of the tongue to the floor of the mouth.

• Type IV:

In type IV, the lingual frenulum is posterior or sometimes not visible. The tongue tie is only noticed when touched. To determine tongue function, the Hazelbaker assessment tool (HATLFF) is used in conjunction with the Coryllos grading scale.

How Does Tongue-Tie Affect Breastfeeding and Speech?

• Tongue-Tie and Breastfeeding: For breastfeeding, an adequate seal is required, for which the baby has to extend its tongue over the jawline. In the case of tongue-tied babies, this is not possible, and so they use their gums to keep the nipple in the mouth while breastfeeding.
• Tongue-Tie and Speech Impairment: The exact pathology behind how tongue-tie affects speech is still not clear. However, it is found that the tongue needs contact with the roof of the mouth to pronounce certain lingual sounds like "t," "d," "z," "n," "l," "s," and "th." In the case of tongue-tie, the baby cannot move the tongue to reach the roof of the mouth, so they have difficulty pronouncing.

How Is Tongue-Tie Diagnosed?

Tongue-tie is usually diagnosed during a physical examination when the symptoms are examined.

What Are the Available Treatment Options for Tongue-Tie?

There are cases where the child with a tongue tie does not have any noticeable symptoms, such as difficulty breastfeeding, swallowing, or speech impairment. In those cases, treatment is not required.

• Frenectomy: In cases when the child is having symptoms, a surgical procedure called frenectomy is performed. A frenectomy is a simple surgical procedure that is carried out under local anesthesia in which the lingual frenulum is cut. This procedure is also known as frenectomy, frenotomy, and tongue-tie division. Frenectomy is a painless procedure, but like any other surgical procedure, it carries certain risks like bleeding, scarring, infection, or injury to the salivary ducts present in the mouth.
• Frenuloplasty: Frenuloplasty is an extensive procedure that is carried out under general anesthesia. This surgical procedure is recommended when the lingual frenulum is too thick for a frenectomy.

What Are the Complications Associated With Tongue-Tie?

The long-term effects associated with tongue-tie are:

• Malnutrition:

Poor breastfeeding leads to inadequate nutrition and results in malnourishment.

• Impaired Speech:

Due to tongue-tie, the child may be unable to pronounce certain sounds, which can later affect their speech and overall school performance.

• Poor Oral Hygiene:

Because of the tongue tie, it may be difficult to sweep away food debris stuck to the teeth, contributing to tooth decay or plaque formation, which results in a condition known as gingivitis.

Conclusion:

There is no particular way to prevent tongue-tie, but early diagnosis and treatment are key to a child's recovery. Most babies recover completely without any treatment. However, in severe cases, when not treated, the child may not be able to breastfeed, which can lead to inadequate nutrition.