Tongue Tie

Tongue Tie

 

Assoc. Prof. Dr. Supakorn Rojananin, M.D.

Chairman, Department of Surgery

Faculty of Medicine Siriraj Hospital, Mahidol University

 

Tongue is an organ doing so much a routine or everyday job in the mouth that most of the people have overlooked of its importance. It is the biggest part in your mouth formed by several pairs of muscles fusing together in the midline and covered by epithelial lining, taste buds, sensory nerve, salivary glands and lymphoid follicles. If you open your mouth and look at the mirror, you can amazingly notice that your tongue can move in wider ranges of motion than any other muscles do. Its routine jobs include sucking, eating, drinking, chewing, moving or mixing food, swallowing, licking, sticking out, cleaning or sweeping food particle or debris between tooth, speech, kissing or doing funny things. It also can perceive taste, sensation, regulate temperature and absorption.

 

Before we born, tongue and mouth structure development was guided by a strong cord of tissue that was positioned in the center of the mouth called a lingual frenulum. After birth, the frenulum continued to guide the position of incoming teeth but it finally receded and became thin which was easily seen as a thin vertical fold of tissue at the midline of underside of the tongue. If there is a congenital anomaly characterized by an unusual short frenulum commonly known as tongue tie or Ankyloglossia, this condition will hamper free movement of the tongue and may cause difficulties with breastfeeding, and speech. In severe and untreated cases will subsequently prevent the tongue from contacting the anterior palate. This can result in an open bite deformity and mandibular prognathism causing loss of self esteem, personality and embarrassment.

However, many babies with tongue-tie do not have symptoms. The lingual frenulum stretches as the child grows or adapts to the tongue restriction.

However, some children with tongue-tie have difficulty latching on to the mother's breast and sucking because the tongue cannot move milk from the milk glands of the breast to the nipple. Bottle-fed babies usually do not have feeding problems because it is easier to get milk from the nipple of a bottle.

 After National campaign of breast feeding was launched for the benefit on health of the babies as well as a closer relationship to their mothers.  We found that some babies had difficulty in breast feeding due to tongue tie causing an early shift to bottle feeding. In the US studies, prevalence of tongue tie was ranged from 1.7% to 4.8% with an average of 3.3%.

According to Associate Professor Dr. Mongkol Laohapengsang, Chief of the Division of Pediatric Surgery, Faculty of Medicine Siriraj Hospital, among babies with difficulty of breastfeeding, tongue tie  accounted in 12.9%. In the past, most babies were observed conservatively hoping that the frenulum would be lengthening with time and the problem would resolve by itself. Only those growing up toddlers with persistent tongue tie will need surgical release by age three. This correction will help them to gain a normal language development. However, surgical release of tongue tie in a growing up toddler is a more complicated procedure. Patient should be put to sleep with general anesthesia, needs hospitalization, more cost, and takes more risk.

Today, the concept of treatment is changing; we can observe tongue tie in a very first week of babies when all of them have difficulty in breastfeeding. Frenulotomy or surgical division of the frenulum will be done on these babies with minimal risk. The procedure is very simple using a small sharp scissors to snip the frenulum under topical anesthesia with minimal to none bleeding. No suture is required and the mucosa will heal rapidly. Prompt breastfeeding is encouraged and there is an immediate improvement in breastfeeding in over half of the babies.

Dr. Mongkol discloses that, recently, Siriraj set up a care team to correct this problem to all babies with tongue tie from the first few days after their deliveries. All information of surgery and after care is available and recommended to all mothers before going home. After surgical correction, 95.6% show immediate improvement with an efficient breast feeding. During 2004-2006, there were 800-1,000 cases done each year.

In conclusion, problem of tongue tie is not rare as previously thought. A simple surgical correction with minimal risk is available in most of provincial hospitals. Early intervention not only can improve the efficiency of breast feeding but also prevent subsequent impairment of speech and tooth development.