What is the treatment for ankyloglossia (tongue-tie)?

Treatment of Ankyloglossia (Tongue-Tie)

Surgical release of the lingual frenum (frenectomy or frenuloplasty) followed by speech therapy is the recommended treatment for ankyloglossia that causes functional limitations.

Diagnostic Assessment

Before proceeding with treatment, proper diagnosis is essential:

• Evaluate tongue mobility and appearance, focusing on:

  • Insertion, attachment, and shortness of the lingual frenulum
  • Limitations in tongue movement
  • Functional impairments (speech, feeding, swallowing)

• Classify severity using established criteria (such as Kotlow's classification)

  • Class I: Mild ankyloglossia
  • Class II: Moderate ankyloglossia
  • Class III: Severe ankyloglossia
  • Class IV: Complete ankyloglossia

Treatment Algorithm

Step 1: Determine Need for Intervention

Intervention is indicated when ankyloglossia causes:

• Breastfeeding difficulties in infants
• Speech articulation problems
• Limited tongue mobility affecting quality of life
• Swallowing difficulties
• Oral hygiene challenges

Step 2: Select Appropriate Surgical Approach

Three main surgical options exist 1, 2:

1. Frenotomy: Simple incision of the frenulum

   • Best for neonates and infants
   • Quick procedure with minimal bleeding
   • Often performed without anesthesia in very young infants

2. Frenectomy: Complete excision of the frenulum

   • More extensive than frenotomy
   • Requires local anesthesia
   • Appropriate for older children and adults

3. Frenuloplasty: Surgical revision with plastic repair

   • Most comprehensive approach
   • Includes rearrangement of tissue
   • Preferred for severe cases with thick, short frenulum

Step 3: Post-Surgical Rehabilitation

• Speech therapy: Essential component for complete rehabilitation 3, 4

  • Typically 1-2 sessions weekly for 4-8 weeks
  • Focuses on improving tongue mobility and function
  • Exercises to strengthen tongue muscles

• Tongue training exercises: Critical for optimal outcomes 4

  • Should begin as soon as healing permits
  • Include tongue stretching and strengthening exercises
  • Practice proper tongue positioning for speech sounds

Timing of Intervention

• Infants: Early intervention if breastfeeding difficulties exist
• Children: Before speech patterns become firmly established
• Adults: Can still benefit from treatment, though speech improvement may require more intensive therapy

Expected Outcomes

Following proper surgical management and rehabilitation:

• Marked improvement in tongue mobility 1, 4
• Enhanced speech articulation
• Improved swallowing function
• Better oral hygiene capability
• Resolution of mechanical limitations

Potential Complications

• Bleeding (rare but possible)
• Infection
• Scarring
• Recurrence if inadequately released
• Speech issues may persist without proper rehabilitation

Follow-up Care

• Evaluation at 1 week post-surgery
• Assessment of healing and initial tongue mobility
• Regular follow-up during speech therapy to monitor progress
• Final evaluation at 6 months to assess functional outcomes

Caveat

While surgical release is generally effective, it's important to note that the evidence base for ankyloglossia treatment has limitations 2. The lack of standardized classification systems and limited controlled prospective trials make it difficult to establish definitive treatment protocols. However, when functional limitations are present, the benefits of surgical intervention followed by appropriate rehabilitation typically outweigh the risks.