Ankyloglossia (tongue-tie)

Ankyloglossia is a developmental anomaly of the tongue characterized by a short, thick lingual frenum resulting in limitation of tongue movement. It has been reported to occur in 1.7% to 4.4% of neonates and is four times more common in boys than in girls. In adults, mild forms are not unusual, but severe ankyloglossia is a relatively uncommon condition that has been estimated to occur in about 2 to 3 of every 10,000 people.

Clinical Features
Ankyloglossia can range in severity from mild cases with little clinical significance to rare examples of complete ankyloglossia in which the tongue is actually fused to the floor of the mouth. Sometimes the frenum extends forward and attaches to the tip of the tongue, (Figure 1.1) and there may be slight clefting of the tip.



Figure 1-1 Ankiloglossia in 9 year old girl

Some investigators have speculated that ankyloglossia may contribute to the developmental of an anterior open bite because the inability to raise the tongue to the roof of the mouth prevents developmental of the normal adult swallowing pattern. However, others have questioned this theory. It also is possible that a high mucogingival attachment of the lingual frenum may lead to periodontal problems.
It has been suggested that tongue- tie may result in speech defects. Usually, however, the shortened frenum results in only minor difficulties because most people can compensate for the limitation in tongue movement. Yet there are rare examples of patients who have experienced an immediate noticeable improvement in speech after surgical correction of ankyloglossia. Recent reports from Japan have theorized that some ankyloglossia cases can be associated with an upward and forward displacement of the epiglottis and larynx, resulting in various degrees of dyspnea.


Treatment and Prognosis
Because most cases of ankyloglossia results in few or no clinical problems, treatment is often unnecessary. If there are functional or periodontal difficulties, a frenectomy may allow greater freedom of tongue movement. In young children it often is recommended that surgery be postponed until age 4 to 5. Because the tongue is always short at birth, it is difficult in the infant’s early life to assess the degree of tongue limitation caused by ankyloglossia. As the infant grows, the tongue becomes longer and thinner at the tip, often decreasing the severity of the tongue-tie. The condition probably is self-correcting in many cases because it is less common in adults.