Dr. Alok Banka

ENT Surgeon
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Tongue tie

Tongue-tie or ankyloglossia is a congenital condition characterized by short lingual frenulum, which results in tethering of the tongue. The prevalence of tongue-tie in newborns varies between 2.5% and 11%, depending on the population and the diagnostic criteria used.

Commonly employed diagnostic criteria relies on short thick frenulum that gives the tongue a heart shape on protrusion, or inability to protrude past the gum line. The tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short frenulum.

Ankyloglossia in babies is associated with a 25%–60% incidence of difficulties with breastfeeding, such as failure to thrive, maternal nipple damage, maternal breast pain, poor milk supply, breast engorgement, and refusing the breast. There is a 10% to 26% risk of cessation of breastfeeding during the initial 3 weeks of breastfeeding due to tongue tie.The indication for tongue tie division changes as the child gets older.Speech/ articulation problems Is 64% of which 19% patients specifies palatinal ‘R’ as the main indication. Other problems such as problems with deglutition and dentition, oral-motor dysfunction and various mechanical and social issues such as an inability to lick the lips, play a wind instrument, and ‘french kiss’ are sometimes related due to the limited function of the tongue.

In the past, ankyloglossia was thought to significantly impact breastfeeding and thus frenotomy (tongue tie release) procedures were commonly performed in infants. The increased availability and popularity of formula and bottle feeding reduced the focus on breastfeeding and thus the significance of ankyloglossia. However, with the recognition that breastfeeding confers many advantages to both infants and mothers, there is an increased expectation that mothers will breastfeed their newborn infants.

Division of tongue tie; also known as frenotomy is a simple procedure. In 2005, NICE released its guidelines for tongue tie division. It recommends early division if there is any breastfeeding problems or restriction in tongue mobility. In early infancy, division of the tongue-tie is easily performed without anaesthesia, although local anaesthetic is sometimes used. General anaesthesia is needed in older infant or child. The most common complication is recurrent ankyloglossia due to scarring. Frenuloplasty (horizontal-to-vertical frenuloplasty), as opposed to Frenotomy (frenulum is divided without sutures) , may decrease the risk of recurrence.

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