Tongue Tie

What is tongue tie (ankyloglossia)?

Ankyloglossia, one of the structural problems of the tongue found in babies from birth, prevents the tongue from moving in the mouth. In order for the tongue to fulfill all its functions as it should, it must be able to move freely in the mouth. However, in babies with a tongue tie, the tongue cannot move freely.

The structure causing the tongue tie is the lingual frenulum. This flexible structure is a structure that exists under normal conditions and connects the tongue and the floor of the mouth. However, in some babies this structure is quite short or stretched. This structural difference causes the problem of language linkage.

The tongue tie may not cause problems in some babies. In some babies, it can cause problems with sucking. It can also cause the baby to have problems with eating or speaking later in life.

Information on the occurrence of tongue tie in the community is not conclusive. However, the frequency of detection of ankyloglossia varies between 0.1% and 10%. The reason for such a wide range of variability is that the diagnostic criteria for ankyloglossia are not well defined.

Although tongue tie is usually seen in male babies, genetic factors play an important role. However, in some cases, cleft palate syndrome triggers tongue tie.

Tongue tie in infants

The front part of ankyloglossia, which occurs when the tongue tie that should disappear during the development of babies in the mother's womb persists after birth, is in the form of a thin membrane, while the back part is in the form of a thick band.

Because the tongue tie restricts the normal movements of the tongue, the tongue cannot pass the gum line and the tongue cannot come out. It also seriously affects the nutrition of babies. This makes it particularly difficult to suck. It is also possible for the tongue tie to cause different problems in babies. Some of these problems also affect the mother.

The problems caused by tongue tie in babies are as follows.

• Sleeping on the breast
• Restlessness
• Salt accumulation in the body
• Inability to gain weight
• Weight loss
• Lack of good nutrition
• Feeding difficulties
• Slow slipping from the breast
• Clicking sound during suctioning
• Chewing the breast
• Heart-shaped tongue
• The baby cannot take the breast fully
• The baby cannot fully grasp the nipple
• Cannot extend their tongue beyond their front teeth

Tongue tie causes problems not only for the baby but also for the mother. These problems include the following.

• Early initiation of bottle feeding or supplementary food due to mothers' loss of self-confidence
• Mastitis
• Canal blockage
• Decreased milk
• Pain in the breast
• Cracks, pain or bleeding in the nipple
• Incomplete discharge of milk

Tongue tie in children

Due to the different severity of the tongue tie, some cases are not diagnosed in infancy. This continues into childhood. The presence of a tongue tie in children can cause speech problems. However, the speech disorder manifests itself in the inability to say some letters. For this reason, they have some problems with the pronunciation of words. Especially in children after the age of 3, there are difficulties in removing letters such as r, s, l, z and t. In addition, when children have a speech disorder, it is important not only to suspect a tongue tie, but also to assess other risks. Symptoms of tongue-tie in childhood also include not being able to play wind instruments or having problems eating foods they are supposed to lick, such as ice cream. Since these problems in children will also affect their psychology, lack of self-confidence and various psychological problems can be seen.

Tongue tie in adults

There are many different reasons why a patient may not receive a diagnosis of tongue tie until adulthood. This is because there are different types of language link according to its structure or position. Apart from this, it is understood that the tongue tie that adults have does not prevent sucking or have any other symptoms.

In addition, the fact that tongue tie classifications have only recently been made may also be a reason why tongue tie has not been diagnosed. Because until some time ago, the tongue tie, which extends in the form of a curtain at the tip of the tongue, was thought to be the classical tongue tie. For this reason, tongue ties that do not extend to the tip of the tongue are not diagnosed. In addition, type 3 speech impairment is often undiagnosed because it does not cause speech disorders. In these patients, it is also possible for the tongue tie to reach into adulthood.

Symptoms of tongue tie

The most characteristic symptom of a tongue tie is that babies have difficulty sucking. Under normal circumstances, babies extend their tongues to cover their lower teeth when sucking. This protects the nipple. In the case of a tongue tie, babies cannot suck and therefore cannot attach themselves to the breast. Therefore, they are not able to suck efficiently. The inability to fully breastfeed also leads to a decrease in breast milk. In addition, it causes the baby to have gas problems due to swallowing air and not getting enough nutrition.

Other symptoms of tongue tie in babies include the following.

• The baby constantly pretends to be hungry
• Restlessness before feeding
• Breastfeeding duration is longer than normal
• Problems with the baby reaching its ideal weight
• The baby makes chewing movements instead of sucking movements
• The baby's lips do not fully cover the nipple
• Problems in the breast due to incomplete breastfeeding
• The baby cannot move freely between the two corners of the mouth
• Failure to pass the tip of the tongue past the palate
• Inability of the tongue to reach the upper palate
• V-shape of the tip of the protruding tongue

How is tongue tie diagnosed?

In the case of suspected tongue-tie, a simple physical examination is sufficient. The patient's history should also be taken. How feeding takes place and problems with feeding are particularly important in the diagnosis of tongue tie.

In order to diagnose tongue tie in childhood patients, they are asked to say certain consonants and syllables. This allows the child's language function to be assessed.

In today's medicine, there is no standard definition of tongue tie. However, tongue length in newborn babies is expected to be at least 16 mm. If the tongue length is less than 11 mm, there is a moderate tongue tie and if it is less than 7 mm, there is a severe tongue tie.

If tongue tie is detected in babies, weight controls should be performed. Because malnutrition is one of the biggest problems that can be caused by tongue tie.

Tongue tie treatment methods

Tongue tie treatment methods are still one of the most debated topics in medicine. The general opinion is that babies diagnosed with tongue-tie should be observed before treatment. For this reason, babies who are diagnosed are observed for a while and then the necessary treatments are applied. During this observation, it is important to make sure that the baby is getting enough nutrition and gaining enough weight.

If the tongue tie causes problems, a procedure called frenotomy is used. After this extremely easy procedure, babies can start breastfeeding immediately.

Tongue tie surgery

The surgical procedure used to treat the tongue tie is called frenotomy. Since the tongue tie structure does not contain nerves and blood vessels, pain and bleeding are very rare. For this reason, anesthesia is not applied in most of these extremely easy operations and babies can start their normal feeding immediately.

It is also possible to perform tongue tie surgeries with the laser method. These procedures are called laser frenotomy. In these operations, a laser is used instead of a scalpel. This allows the incisions to be made thinner, resulting in less bleeding in the area and faster recovery of patients.

If the tongue tie causes a serious condition, then operations called frenuloplasty are performed. In this method, the frenulum is fixed to another tissue with sutures. Since the frenulum tissue is sutured, the procedure is performed under anesthesia. In addition, patients need to do various language exercises with speech therapy afterwards.

Harm of tongue tie surgery

Tongue tie surgeries are performed under anesthesia in some cases. For this reason, the first risk of tongue tie surgery is the patient's reaction to anesthesia. The risks that can be seen in patients undergoing anesthesia are as follows.

• Restlessness and drowsiness when patients wake up after anesthesia
• Sore throat caused by intubation in an operation performed under general anesthesia, which lasted approximately 10 days
• Local anesthesia can cause toxicity. Systemic toxicity following local anesthesia is usually seen in the cardiovascular and nervous systems.
• Respiratory depression, heart problems or apnea may occur after general anesthesia.

There are also risks associated with the operation. These risks include the following.

• Possibility of bleeding during surgery or in the next few weeks
• Infection of the wound site
• Feeling of fullness in the tongue
• Impaired taste buds
• Dry throat
• Difficulty swallowing
• Tongue tie may not be completely curable
• May recur after surgery
• Cutting the lingual nerve can cause movement problems or asymmetry of the tongue, which is usually temporary.
• Rarely, it can cause injuries to the salivary gland ducts. This can lead to impaired salivary function.
• Bleeding that occurs long after surgery
• Severe pain
• High fever
• Temporary impairment of reflexes

After tongue tie surgery

How long it takes to recover after tongue tie surgery depends on the type of tongue tie and the type of surgical procedure performed. Some procedures will also affect nutrition and therefore need to be chosen carefully. In addition, exercises should be performed regularly after the procedure, regardless of the type of surgical procedure performed. Although tongue exercises may be uncomfortable at first, they are important for the successful outcome of the procedure.

When should a doctor be consulted?

There are different types of language link. Some of these have no effect on the development of babies. However, in some cases, it is necessary to consult a specialist immediately. These situations are as follows.

• Problems with the baby's sucking
• Speech-language pathologist finding signs of tongue tie in a child's speech problem
• The child's speech does not reach the back teeth at a later age and nutritional disorders occur