Tongue-Tie (Ankyloglossia) – Symptoms, Surgery Procedure, in Adults vs Baby

Key Facts

• Tongue tie, also known as ankyloglossia, is a condition present at birth that restricts the tongue’s range of motion
• It is caused by an unusually short, thick, or tight band of tissue (lingual frenulum) tethering the bottom of the tongue’s tip to the floor of the mouth
• It can affect the way a child eats, speaks and swallows
• Frenectomy is the common surgical procedure to correct tongue tie
• Estimates suggest that tongue tie affects 4-11% of newborns

What is Tongue-Tie?

Tongue-tie (ankyloglossia) is a congenital condition where the lingual frenulum, the band of tissue that connects the underside of the tongue to the floor of the mouth, is shorter or tighter than usual. This restriction in the tongue’s movement can have various implications, including difficulty with breastfeeding in infants, speech difficulties, and issues with oral hygiene. The severity of tongue-tie can vary, with some individuals experiencing only mild restrictions, while others may have significant limitations in tongue mobility.

What’s the Difference Between Anterior Tongue-Tie and Posterior Tongue-Tie?

Tongue-tie can be classified into two main types based on the location and appearance of the lingual frenulum.

• Anterior Tongue-Tie: In this type, the lingual frenulum attaches to the tongue relatively close to the tip. This makes the tie easily visible and often forms a heart shape or a notch at the tip of the tongue. The restriction in tongue mobility is typically more noticeable with anterior tongue-tie.
• Posterior Tongue-Tie: This type involves a lingual frenulum that attaches further back on the tongue and is often less visible. The frenulum is usually thicker and more fibrous. Some individuals with posterior tongue-tie may not have overtly visible signs, but still experience functional limitations due to the restriction in the tongue’s movement.

Who Does Tongue-Tie Affect?

Tongue-tie primarily affects newborns and can have a significant impact on feeding. The limited movement of the tongue can create challenges in achieving a good latch during breastfeeding, and in some cases, bottle feeding. This can lead to inadequate nutrition and poor weight gain for the baby. As children grow, tongue-tie may affect speech development, the ability to chew food properly, and oral hygiene. In some cases, it may go unnoticed until later in life, where it can affect adults during activities such as speaking, eating, or even kissing.

What are the Symptoms of Tongue-Tie?

The symptoms of tongue-tie can vary depending on the age of the individual and the severity of the condition. Here are some common symptoms across different age groups:

In Infants:

• Difficulty latching onto the breast or a bottle
• Making a clicking sound during feeding
• Poor weight gain or failure to thrive
• Frustration or distress during feeding
• Prolonged feeding times

In Older Children:

• Difficulty with speech, particularly articulating certain sounds
• Challenges with licking ice cream, playing wind instruments, or sticking out the tongue
• A noticeable gap between the lower front teeth
• Issues with oral hygiene due to the difficulty in cleaning the teeth with the tongue

In Adults:

• Difficulty in moving the tongue freely, affecting speech or eating
• Discomfort or pain in the tongue, jaw, or neck
• Issues with oral health due to limitations in cleaning with the tongue
• Difficulty in certain social activities like kissing

What Causes Tongue-Tie?

Tongue-tie is a congenital condition, which means that it is present at birth. The specific cause of tongue-tie is not well understood. However, it is believed to result from an abnormal development of the lingual frenulum during fetal development. Some factors that may contribute to the development of tongue-tie include genetic predisposition, as it sometimes runs in families, and certain environmental factors during pregnancy.
It is important to identify and address tongue-tie early, especially if it affects feeding in infants or speech development in children. There are several treatment options available, and the choice of treatment may depend on the severity of the tongue-tie and the age of the patient.
In the next part of this article, we will focus on the treatment options for tongue-tie and the considerations involved in making the best choice for each individual case.

Diagnosis: How is Tongue-Tie Diagnosed?

Diagnosing tongue-tie typically involves a physical examination of the mouth and observation of the tongue’s movement. For infants, the healthcare provider or lactation consultant may observe the feeding process to see if the infant has difficulty latching or if there are other signs of tongue-tie affecting feeding.
In older children and adults, the assessment might involve asking the individual to move their tongue in various directions or to attempt certain sounds that require tongue mobility.
The healthcare provider may categorize tongue-tie based on the appearance and location of the frenulum, and its impact on the function of the tongue.

Is Tongue-Tie Surgery Necessary?

Whether or not surgery is necessary for tongue-tie depends on the severity of the condition and its impact on the person’s quality of life. For some individuals, especially those with mild tongue-tie, non-surgical interventions such as speech therapy or breastfeeding support may be sufficient.
For more severe cases, especially where feeding, speech, or quality of life is significantly impacted, surgical intervention may be recommended. The surgical procedure for correcting tongue-tie is called a frenectomy. It involves cutting or releasing the lingual frenulum to allow for greater tongue mobility. This procedure is relatively simple and can often be done with local anesthesia.
In making a decision regarding tongue-tie surgery, it’s important to weigh the potential benefits against the risks and to consider the individual’s symptoms and challenges. Consulting with a healthcare provider who is knowledgeable about tongue-tie is essential for making an informed decision.

What Happens if I Don’t Treat Tongue-Tie?

If tongue-tie is not treated, the implications can vary depending on the severity of the condition. In mild cases, individuals might not experience any significant issues.
However, in more severe cases, untreated tongue-tie can result in:

• Feeding Difficulties in Infants: This can lead to poor weight gain and malnourishment, and cause distress to both the infant and the mother.
• Speech Problems: The limited movement of the tongue can affect the clarity of speech. Individuals might have difficulty articulating certain sounds, which could affect communication skills.
• Oral Health Issues: Difficulty in cleaning food from teeth with the tongue can lead to an increased risk of dental problems.
• Social and Emotional Impact: Difficulty speaking clearly can affect a person’s confidence and social interactions.

Prevention: Can I Prevent Tongue-Tie?

Tongue-tie is a congenital condition, meaning it is present at birth. As of now, there are no known preventive measures for tongue-tie as it is often the result of genetic factors and the development of the tongue and mouth area during pregnancy.

Expectations: What Can I Expect If My Child Has Tongue-Tie?

If your child has tongue-tie, the approach and expectations will depend on how the condition is affecting them. If the tongue-tie is affecting your child’s ability to feed or speak, intervention might be necessary. This could range from speech therapy to a simple surgical procedure called a frenectomy.
Post-procedure, children often heal quickly and can experience improvements in feeding and speech. It’s important to follow any post-procedure care instructions and to maintain communication with healthcare providers regarding your child’s progress.

What Questions Should I Ask My Healthcare Provider?

If you suspect that you or your child has tongue-tie, or you have been diagnosed with the condition, here are some questions that you can ask your healthcare provider:

• What is the severity of the tongue-tie?
• How is the tongue-tie affecting my (or my child’s) oral function?
• What are the available treatment options for tongue-tie?
• What are the potential risks and benefits of a frenectomy?
• Are there any non-surgical interventions that could be beneficial?
• How can I support my child through the treatment process?
• What kind of improvements can be expected post-treatment?
• Are there any potential complications or issues to watch for after treatment?
• What steps can be taken at home to help alleviate symptoms or improve tongue mobility?
• Should we consult with a speech-language pathologist or other specialist?

Being informed and actively participating in the decision-making process is crucial when it comes to managing tongue-tie. Don’t hesitate to ask questions and seek the information needed to make the best choices for yourself or your child.

Does Tongue-Tie Affect Speech?

Tongue-tie can affect speech, especially when it significantly limits the movement of the tongue. The tongue plays a crucial role in the formation of certain sounds, and when its range of motion is restricted, it can be difficult to articulate sounds correctly. This may result in speech that is unclear or difficult to understand. Speech issues due to tongue-tie may include difficulty with sounds such as “l”, “r”, “t”, “d”, “z”, “s”, “th”, and “sh”.

How Does Tongue-Tie Affect Breastfeeding?

In infants, tongue-tie can make breastfeeding particularly challenging. The tongue is essential for latching onto the breast properly. Infants with tongue-tie may struggle to latch on correctly or maintain the latch for an adequate period. This can lead to inadequate milk intake and consequent poor weight gain. Additionally, the improper latch can cause pain and discomfort for the mother, and potentially lead to nipple damage or mastitis.

How Common is Tongue-Tie?

Tongue-tie is a relatively common condition, affecting approximately 4-11% of newborns. There is a higher prevalence in males than in females, with a ratio of about 2.6:1. It is important to note that the reported prevalence can vary due to different diagnostic criteria and methodologies.

Does Tongue-Tie Go Away?

Tongue-tie does not spontaneously resolve, as it is a structural condition involving the lingual frenulum. However, in some cases, the lingual frenulum may naturally loosen or stretch over time, reducing the limitations on tongue mobility. This doesn’t mean that the tongue-tie has gone away, but rather that its effects may be lessened. For more severe cases, or if the tongue-tie is causing significant difficulties, intervention may be necessary.

Bottom line

Concluding, tongue-tie is a condition that can have varying impacts on individuals. It’s important to identify and address the condition early if it’s causing problems with feeding in infants or speech development in children. There are various treatment options available, ranging from speech therapy to surgical intervention. Decisions regarding the management of tongue-tie should be made carefully and in consultation with a qualified healthcare provider.

This article is complete and was published on June 28, 2023, and last updated on August 25, 2023.