Introduction:
The arrest in the activity of a freely moveable organ is tremendous suffering. Tongue-tie is a similar condition where the tongue is attached by a tissue that does not allow its free movement. This is caused by congenital abnormality seen at the genetic level or could also occur due to dysfunctional cellular differentiation. One of the significant concerns of tongue-tie in newborns is lactation.
What Is a Tongue-Tie?
The tongue is attached to the floor of a mouth at its distal end. In cases of tongue-tie, a thin tissue called the lingual frenulum is attached to the tongue at its anterior side, making it difficult for the tongue to move freely. This is a congenital condition caused due to genetic dysfunction. The lingual frenulum separates itself from the tongue just before birth. But tongue-tie does not occur. Depending on the site of frenulum attachment, tongue ties are classified into four types:
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Class 1: In this stage, the tie is seen at the tip of the tongue.
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Class 2: In this stage, the tie is seen towards the midline of the tongue.
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Class 3: In this stage, the tie is seen at the base of the tongue.
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Class 4: During this stage, the tie is seen under the mucous membrane and is often mistaken as a small tongue.
What Are the Symptoms of Tongue-Tie?
Symptoms of tongue-tie include:
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The child finds it difficult to lift the tongue or move freely in the sideway direction.
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There is difficulty in protruding the tongue out.
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The tip of the tongue is marked with a division giving it a heart-shaped appearance.
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During breastfeeding, the tongue finds it difficult to suck the milk for too long.
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The child takes breaks in between sucking the milk.
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Due to improper feeding, the child does not gain much weight.
What Are the Complications of Tongue-Tie?
Tongue ties can affect a lot of regular activities in a newborn. Some of the complications seen are:
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The most common difficulty faced is during lactation. The baby finds it difficult to suck the nipples and instead chews them. This causes soreness of the breast and causes a lack of feeding. As a result, the child lacks proper nourishment.
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Due to tongue ties, the child's speech is also affected. For example, the child cannot pronounce certain syllables like ‘T,’ ‘D’, ‘Z,’ ‘L,’ ‘S,’ and ‘R.’
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Tongue ties also cause developmental difficulties in the mouth, especially while licking and sipping.
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It also causes poor oral hygiene due to restricted tongue movement. The tongue has a self-cleansing property where it licks off the excessive food particles stuck inside the mouth. Due to a lack of tongue movement, there is an increased tendency to develop tooth decay, gum infections, and gaps between the teeth.
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Prolonged feeding time can lead to insufficient milk supply and tire the mothers.
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Causes suckling sounds, gas pains, coughing, and gagging in babies.
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A tongue tie produces spacing between the teeth, especially in the lower anterior teeth. This can be treated using orthodontic appliances to correct the spacing.
How Can We Breastfeed Babies With Tongue Ties?
Tongue ties are misdiagnosed most of the time due to a lack of awareness. Nursing babies with tongue ties can be challenging. The proper posture of the tongue should be touching the roof of the mouth while sucking the mother's milk. The tip of the tongue should be resting behind the lower front teeth, and the middle and back of the tongue should touch the roof of the mouth. A proper tongue posture is very important in the development of the palate. It helps in the swallowing and speech process. It also stimulates the cranial nerves and releases growth hormones. During nursing, the tongue should be elevated, and an adequate latch should be found for breastfeeding. This is not achieved in tongue-tie babies; hence, it is advised to get medical help to release the tongue-tie as it affects the baby's developmental process.
What Is the Treatment Available for Tongue-Tie?
In certain cases, tongue-tie resolves on its own within four to five weeks of delivery. Tongue ties can be surgically removed to restore the oral cavity's normal anatomy and function. Such surgeries can be performed at any age. Various surgical procedures are available to correct such deformities, such as:
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Frenectomy: In this procedure, the doctor uses sterile scissors to cut the frenal attachment from the base of the tongue. The underneath side of the tongue is poor in blood supply and thus prevents excessive bleeding or hardly causes any pain.
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Frenuloplasty: This procedure is carried out in patients with thick frenulum attachment to their tongue. It is carried out under general anesthesia. The frenulum is cut, and sutures are placed. After a few days, the wound heals on its own.
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Laser: This procedure uses laser beams to remove the unwanted frenulum attachment. This benefits patients, especially kids who have unwarranted bleeding following a surgical procedure. Many available lasers, such as CO2 or Nd: YAG laser and Pfizer O-C surgical laser, are available in the market. The use of lasers over surgery is widely recommended due to its less invasive process and are done in a single visit with no local anesthesia required; it causes minimal damage to the tissues with very little scar formation, and there is no swelling noticed after the operation, it does not cause any pain after the procedure, and the wound heals within a short period of time.
There is no chances of getting an infection in that area due to microorganisms as they are exposed to laser radiation. The use of lasers eliminates the painful suturing process. The fastest healing lasers are erbium lasers, which have low thermal effects and good healing properties. The patient can lie comfortably throughout the operating procedure as it does not use any rotary instruments causing vibrations. However, lasers do have drawbacks. Deep exposure to lasers can damage or burn the surrounding tissue and bone. Tissues must be guarded against overheating by continuously applying air and water spray throughout the procedure.
Conclusion:
Tongue ties are a less complicated medical condition that cures independently and can be surgically corrected without further complications. The surgery is also a minimally invasive procedure done in a short period with a speedy healing time. Children with tongue ties use their jaw and lips to attain a latch. Unfortunately, this action fails to extract enough milk from the mother's breast, leaving the child underfed.
