Ankyloglossia (Tongue Tie)

What is Ankyloglossia?

Known commonly as the tongue tie, Ankyloglossia is considered to be a congenital oral anomaly, which is caused owing to the thick and short lingual frenulum.

Lingual frenulum

Lingual frenulum is a membrane that connects the portion under the tongue to that of floor pertaining to the mouth.

Severity of Ankyloglossia

Ankyloglossia Pictures

Picture 1 – Ankyloglossia | Source – sweethaven02

The severity related to Ankyloglossia varies, as it could be a mild case to that of a complete one, where the tongue gets secured to that of the floor related to the mouth. As when the frenum tends to be normal, it embraces an elastic nature as it also doesn’t impact the movements related to the tongue while eating, sucking and when clearing the food off from the teeth, and when the frenum is short, tight, thick or broad it can produce adverse effects on feeding speech as well as on the oromuscular function.

Effects produced by Ankyloglossia

In case of Ankyloglossia, it can produce a telling impact on the speech, feeding and on the oral hygiene, where the tongue tie can also produce an impact on the social and mechanical effects. In the individual who gets affected by Ankyloglossia, the tongue gets prevented from making contact with that of the anterior palate. In effect, this leads to the infantile swallow, as it can also dampen the progress to embrace the adult-like swallow, which ultimately leads to an open bite deformity.

Ankyloglossia Symptoms

There are signs as well as symptoms that indicate the presence of Ankyloglossia, which include symptoms like the reduced mobility related to the tip of the tongue, impaired feeding ability, short frenulum, impaired oral hygiene and impaired speech. Breast feeding ankyloglossia babies is a major problem. The babies will not be able to open their mouth wide to suck the nipples.

What are mechanical and social effects of Ankyloglossia?

Ankyloglossia tends to lead to social and mechanical effects, where studies have been done to fathom the functional complaints that get entwined with that of Ankyloglossia.

It has been observed that mechanical limitations have been caused by the tongue tie, which comes through the form of cuts or that of discomfort experienced under the tongue, as well as the difficulties that arise with the case of kissing act.

Most importantly, the studies conducted to glean the mechanical difficulties caused by Ankyloglossia unearthed more information, where some patients are not even aware of the limitations caused by Ankyloglossia, and that the social and mechanical difficulties could arise without that of feeding and speech difficulties.

How Ankyloglossia affects speech?

Studies were conducted to know the impact of Ankyloglossia in children having this defect, where certain phones got affected owing to the tongue tie, which included the lingual sounds as that of ‘Y’ and sibilants. The experts who conducted the studies were also uncertain about the clear link that speech disorder has to that of Ankyloglossia, and they were also unsure as to predict a specific child ought to be treated at that age to thwart the problem of speech disorder that could arise later.

Other defects associated with Ankyloglossia

The study also threw light on various other defects that could arise in children who get affected due to Ankyloglossia, where the children who had Ankyloglossia might get affected by articulation deficits, and the deficits can also be improved through the means of surgery. Also, the Ankyloglossia could cause problems with that of enunciation, and when the speech patterns of the individuals with Ankyloglossia were studied, they were observed to put in more efforts during the speech as when compared to other peoples’ speech.

Classification of Ankyloglossia

Several methods get used to classify the tongue tie, where different assessments are arrived at through different professions. While classifying the tongue tie, some factors get considered.

The factors include the measurement related to the free tongue, and the height until which the tongue gets lifted, appearance related to the margin of tongue as well as the presence of indentation, ability and function to elevate or to protrude the tongue, breastfeeding as well as problems if any, and most importantly, the speech problems are some of the factors that are taken into consideration.

Assessment of Tongue Tie

The assessment related to tongue tie is carried out through different methods, where the Hazelbaker Assessment tool gets used by the lactation consultants for that of Lingual Frenulum Function, and the sucking problems and appearance are also put to use during the assessments. There is also the method related to the Kotlow Assessment, which has been brought to light by an American pediatric dentist, and which make use of 4 classes to classify the tongue ties, which gets done as per the length related to the free tongue.

One also can come across the quantitative evaluation getting performed on the lingual frenulum, which had been performed in a research, where digital caliper had got used to measure the tongues and frenulums pertaining to adults who had tongue ties. There is also a classification method, where tongue ties get divided into four types, which depends upon the point of attachment related to the frenulum to that of the tongue.

Are there genetic factors that bring about Ankyloglossia?

It has been observed that tongue tie run in many families, where some of the members inside a family may get affected by mild effects as they also do not possess any apparent symptoms, while some may get impacted severely on the function and structure. As familial bond exists in this case, parents tend to notice similarities in that of other relatives, specifically in that of the older children. The similarities that get spotted may come in the form of postures of tongue and lip, shapes related to the face and nose as well as that of the habits concerning speech. Ankyloglossia might at times get entwined with that of other congenital problems, which only affects the structure pertaining to the mouth, as in the case of palate or cleft lip. Tongue tie can also be present along with that of cerebral palsy or severe hearing loss.

Ankyloglossia Diagnosis

While the diagnosis of tongue tie gets performed, it gets impacted by two traditional criteria, which take into account the malnourishment as well as that of the misarticulating pertaining to tongue tip sounds as that of ‘n’, ‘t’ and ‘d’. There are other factors that bring about the limitations related to the lingual ability, which come alongside tongue tie, where these get used to know if tongue really exists in an individual.

Some of the factors that get considered include the appearance of the tongue as well as the movement of the tongue, maternal factors including nipple injury, pain and that of blocked ducts, and the infant factors that take into account vomiting, gagging and low weight. There other factors that include lack of lingual mobility that impacts the speed as well as the accuracy related to tongue movements, eating problems arising owing to poor coordination pertaining to tongue movements, dribbling that becomes prolonged, dental problems that are wide ranging and severe, and due to unclear speech caused by different aspects.

Ankyloglossia (Tongue Tie) Treatment

In case of Ankyloglossia, treatment gets recommended only in case of the tongue tie leading to a problem. If symptoms related to Ankyloglossia don’t get observed, then one need not go in for the treatment option. Also, the Ankyloglossia surgery treatment is a straightforward procedure, and in case of kids falling under the age of 12 months, the treatment can get meted out at the clinic, where only topical anesthesia gets used. In case of children falling under the age of 1-12, sedation gets performed in the operating room when the child becomes uncooperative, or else, the procedure gets done in a clinic as when the child is cooperative.

Ankyloglossia (Tongue Tie) Surgery Procedure

In the first step, the tongue tie gets visualized, which is followed by the application of topical 4% lidocaine by making use of a Q-tip. In case of children who are more than 12 years, numbing medicine gets injected as another option.

In the next step, the tongue tie gets clamped across, which gets done for about a minute. Extreme care is exercised to make sure to clamp the tongue tie above that of the salivary duct openings, and below that of the tongue’s body. The blood vessels closed get crushed by the maneuver, and by doing so, minimal bleeding gets experienced as when the cut gets performed.

In the final step, the release of the clamp takes place, where the tongue tie gets cut right along with the help of scissors at the portion where the clamp had been placed. In rare cases, a stitch gets placed. The procedure in its entirety consumes no more than five minutes.

Before and after frenuloplasty

Experts also made a study of children who had been affected by Ankyloglossia, and who fell in the age bracket of one to twelve years, who ultimately were taken through frenuloplasty, the ankyloglossia surgery. In this particular study, speech evaluation was performed in such children with Ankyloglossia, where it got performed before as well as after the children were taken through ankyloglossia surgery, frenuloplasty. Some of the children possessed abnormal articulation prior to the surgery getting performed, where some children went on to show improvements in the articulation as when the surgery got performed. Moreover, experts finally embraced the opinion that it becomes possible in case of children who get affected by Ankyloglossia to enjoy normal speech patterns, though they get affected by decreased tongue mobility.

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