Q: What is Tongue Tie?

A: The lingual frenulum (or frenum), is a remnant of tissue in the mid-line between the under-surface of the tongue and the floor of the mouth. When it interferes with normal tongue function it is called “symptomatic tongue-tie” or “symptomatic ankyloglossia”. Tongue-tie can thereby adversely affect breastfeeding. Research is urgently needed to elucidate possible implications that tongue-tie and other oral restrictions have on chewing, swallowing, regurgitation, digestion, speech and breathing disorders.

Q: How is tongue-tie identified?

A: Tongue-tie may not be obvious. If your baby has breastfeeding problems, or if your child has difficulties with speech articulation, and/or tooth misalignment or other dental problems, you should see a knowledgeable practitioner to receive an evaluation. Be sure the practitioner has experience evaluating tongue-tie.

Q: What kinds of problems are caused by tongue-tie?

A: In infants, tongue-tie can impair their sucking, especially at the breast. Babies can have minor to severe difficulty coordinating their sucking, swallowing, and breathing. Symptoms can run a wide gamut and may include latch difficulties, nipple pain or damage (although there may also be no pain whatsoever), poor milk transfer, compromised milk supply, inadequate weight gain and failure to thrive, among others. Children who are tongue-tied may present with speech articulation problems, other swallowing problems and an increased incidence of dental problems.

 

Q: Should tongue-tie always be treated?

A: The negative impact of tongue-tie varies from person to person. For some, the impact is very slight; for others the impact can be substantial. However, it is impossible to predict which babies will experience the worst problems as they grow up. Thus, treatment is recommended only in symptomatic individuals. Symptomatic tongue-tie can be treated at all ages if and when symptoms appear.

Q: How is tongue-tie treated?

A: Frenotomy consists of a simple incision into the connective tissue, called the lingual frenum/frenulum, to free the tongue from the floor of the mouth. Most practitioners perform this procedure in an office setting. Local analgesia for simple frenotomy is not recommended for newborn infants. For other age groups practitioners will make recommendations based upon the age and disposition of the child. The research demonstrates that the procedure carries little risk and is usually effective in improving function. After frenotomy infants should receive follow-up care by their IBCLC as well as appropriate supportive therapies such as manual therapy or bodywork.

Putting the baby to breast directly after treatment and frequently thereafter is an essential strategy in normalizing function. Healing by secondary intention is necessary to retain mobility, so your providers will explain their protocol for “stretching”, which is simply a way as to allow the wound to heal with minimal reattaching. Your IBCLC will discuss additional exercises to be performed.

 

Q: Can the condition worsen after treatment?

A: Research demonstrates that the procedure is safe and side effects are rare apart from a minimal bleeding that ceases spontaneously within minutes. Significant bleeding is rare in experienced hands and can usually be stopped through immediate breastfeeding or with local pressure to the surgical wound. Reappearance of significant bleeding later than 15-20 minutes after the procedure is extremely rare. The rate of improvement of breastfeeding difficulties varies but is generally high. Sometimes, the tongue becomes less mobile a few days to weeks after frenotomy due to the normal contracture associated with wound healing. Support from the IBCLC and/or manual therapist/bodyworker or myofunctional therapist (in older children or adults) may optimize function. More rarely, scar tissue formation may be present, which may resolve with proper wound care or may require additional intervention, which may include a second release.

 

Q: What is the difference between posterior and anterior (classic) tongue-tie?

A: Of the 4 types of tongue-tie , type 1 and 2 are called anterior or classic tongue tie, where one can see the frenulum attached to the base of the tongue near its tip. Types 3 and 4 are called posterior (more backward) tongue tie. Both types may adversely affect breastfeeding. For a point of view of Dr. Bobby Ghaheri about this question click here.