The tongue is considered one of the most important organs in the body. Many essential daily activities rely heavily on the tongue, such as speaking and eating. Having a freely moving tongue helps with these vital activities. Tongue-tie is a condition that affects many individuals, and it is necessary to correct this problem to have a tongue that moves freely.

Tongue-tie, also known as ankyloglossia, is a defect that restricts tongue movement due to the presence of a thick band at the base of the tongue, connected to the floor of the mouth, which prevents full tongue movement and thereby causes obstacles in various daily activities such as eating, swallowing, and even speaking.

This thick band is a network of tissues called the lingual frenulum. Tongue-tie occurs due to a congenital defect in this frenulum, which may be shortened or have increased thickness, limiting tongue movement or tethering the tongue near the tip.

Normally, the frenulum separates before birth, allowing free tongue movement. However, in some cases, the frenulum fails to do so, and the tongue becomes attached to the floor of the mouth.

Tongue-tie may affect an infant's ability to effectively latch during breastfeeding. Also, it can cause symptoms for the mother during breastfeeding. In rare cases, tongue-tie may cause mechanical difficulties in the child's speech and oral health.

 

• Tongue-tie usually affects boys more than girls.

• Tongue-tie is not the sole cause of breastfeeding difficulties.

• Tongue-tie does not cause speech delay, but it can affect a child's speech articulation and ability to produce sounds and pronounce words.

• Difficulty moving the tongue from side to side.

• Difficulty extending the tongue beyond the front teeth.

• The tongue appears heart-shaped instead of its usual appearance upon extending it.

The exact causes of this problem are unknown, but they are often associated with genetic factors. Tongue-tie is a correctable problem in many cases with the help of minor corrective surgery.

 

Tongue-tie can affect a child's speech and expression because it restricts the movement and development of the tongue, leading to difficulties in feeding and speaking. Tongue-tie surgery can effectively remove the obstruction, improve the child's speech, and boost his self-confidence.

 

Tongue-tie may be suspected in infants or children who have difficulty with:

• Breastfeeding.

• Raising their tongue.

• Extending out the tongue (appears notched or heart-shaped when the child tries to do so).

• Moving the tongue from side to side.

• Licking their lips.

 

Partial attachment: The tongue is tethered only at the tip by about 2-4 mm and is attached to the mouth floor near the rear edge of the lower teeth. It is a mild and slight attachment.

Total attachment: The tongue is completely attached to the floor of the mouth.

The comprehensive evaluation considers the degree of tongue-tie and the extent of the child's tongue movement.

 

When a baby is born with a tongue-tie, immediate surgery can be performed to avoid further problems. It is important to visit a doctor promptly when observing the following issues:

Difficulty with breastfeeding: Free tongue movement is essential for the breastfeeding process. When a child breastfeeds, his tongue rests on the lower gum. If the child has a tongue-tie, the restricted movement may cause discomfort for the mother as the baby chews on the nipple, leading to lower milk consumption and insufficient nutrition.

Developmental speech problems over the years: When a child starts speaking, he will face pronunciation difficulties because the tongue plays a crucial role in clear speech. These problems may become more severe with age, and the child may struggle to pronounce certain sounds such as 's,' 'z,' 't,' 'd,' 'r,' and so on.

Difficulty performing daily activities involving the tongue: Older children or adults with tongue-ties may face oral hygiene problems due to difficulty cleaning the mouth. Food residues become harder to remove, leading to tooth decay or gingivitis. There may also be a gap in the lower front teeth. Licking ice cream or playing wind instruments can also be challenging for tongue-tied children.

 

The initial step in treatment is identifying the type of tongue-tie, considering the variation in frenulum thickness, as mentioned earlier. Therefore, the procedure varies as well. Dr. Wael Ghanem, a plastic surgery consultant, and congenital defect specialist, conducts a comprehensive examination to understand all the problems caused by the attached tongue. The main goal is to perform the surgery in a way that allows the tongue to move freely. The following are the two procedures for tongue-tie surgery:

1. Frenotomy: In cases of a thin frenulum, Dr. Wael Ghanem uses sterilized scissors to cut the lingual frenulum. Frenotomy is a very simple procedure that can be done without anesthesia. The procedure is completely painless, with only a drop or two of blood due to the very few nerve endings in the frenulum. In the case of infants, they can immediately begin breastfeeding naturally.

2. Frenuloplasty: In the case of a thick frenulum, frenotomy cannot be performed. Frenuloplasty is a relatively complex procedure compared to frenotomy. The procedure is done under local anesthesia. After the procedure, the wound is closed with absorbable sutures. Dr. Wael Ghanem may recommend tongue exercises after the procedure to regulate tongue movement.

 

Tongue-tie surgery is a simple surgical procedure. The child may experience discomfort but will not suffer severe pain due to the procedure.

 

Recovery after frenotomy is very simple since the frenulum skin is very thin and does not require any stitches.

In the case of frenuloplasty, absorbable sutures are used.

The doctor may prescribe specific exercises to regulate tongue movement and help the patient get accustomed to the new actions.

The tongue-tie cannot grow back after the surgery, but the child must perform the exercises prescribed by Dr. Wael Ghanem, the consultant in plastic surgery and correction of birth defects, every day to ensure that the tongue-tie does not reattach itself.

While the procedures are generally safe, some risks can occur with tongue-tie procedures, including bleeding, infection, injury to salivary ducts and glands, and respiratory deterioration. Dr. Wael Ghanem evaluates the child for potential contraindications for undergoing tongue-tie surgery. Dr. Wael Ghanem takes care to avoid the risks associated with tongue-tie procedures.