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

Treatment of Ankyloglossia (Tongue-Tie)

Surgical intervention through frenotomy or frenectomy is the primary treatment for ankyloglossia, with the specific technique determined by the severity of the condition and the patient's age.

Diagnosis and Classification

Before determining treatment, proper diagnosis is essential:

• Clinical examination: Assess tongue mobility and appearance, including the insertion, attachment, and shortness of the lingual frenulum 1
• Kotlow's classification can be used to categorize severity 1, 2:
  • Class I: Mild ankyloglossia
  • Class II: Moderate ankyloglossia
  • Class III: Severe ankyloglossia
  • Class IV: Complete ankyloglossia

Treatment Options

1. Surgical Interventions

For Infants with Breastfeeding Difficulties

• Frenotomy (simple division of the lingual frenulum):
  • Indicated only when a clear association between significant tongue-tie and major breastfeeding problems is identified 3
  • Should be performed by a clinician experienced with the procedure
  • Appropriate analgesia must be used 3
  • Not recommended for all infants with ankyloglossia, as most are asymptomatic 3

For Children and Adults

• Frenectomy (complete excision of the frenulum):

  • Indicated for moderate to severe cases affecting speech, oral hygiene, or causing mechanical limitations 1, 4

• Frenuloplasty (surgical revision of the frenulum):

  • More advanced technique for complex cases 4

• Miofrenuloplasty:

  • Advanced technique for full functional tongue release in adolescents and adults
  • Addresses the three-dimensional structure of the lingual frenulum
  • Performed by experienced surgeons 5

• Laser Frenuloplasty:

  • Using diode laser for functional correction
  • Benefits include minimal bleeding, reduced infection risk, and less swelling
  • Particularly useful for Class III ankyloglossia 2

2. Post-Surgical Rehabilitation

• Orofacial Myofunctional Therapy:

  • Essential component of treatment, especially for older children and adults
  • Helps retrain tongue function and prevent relapse 2

• Speech Therapy:

  • Particularly important for patients who have developed speech problems
  • Should begin immediately after surgical intervention 1

Treatment Algorithm Based on Age and Severity

1. Neonates and Infants:

   • Observe for breastfeeding difficulties
   • If significant feeding problems exist, consider frenotomy
   • Ensure proper analgesia and experienced practitioner 3

2. Children:

   • Assess for speech disorders, oral hygiene issues, or mechanical limitations
   • For mild cases: Consider speech therapy first
   • For moderate to severe cases: Frenectomy or frenuloplasty followed by speech therapy 1, 4

3. Adolescents and Adults:

   • For moderate cases: Frenectomy with post-surgical rehabilitation
   • For severe cases: Consider miofrenuloplasty or laser frenuloplasty 5, 2
   • Always combine with orofacial myofunctional therapy

Important Considerations

• Regular follow-up is necessary to monitor healing and check for relapse, recommended every 3 months initially 2
• The lack of universally accepted diagnostic criteria makes standardized treatment recommendations challenging 4
• The individual's degree of discomfort and functional limitation should guide treatment decisions 4
• Surgical intervention should be considered when there are clear functional impairments rather than for minor or asymptomatic cases 3, 4

Potential Complications

• Bleeding, infection, and swelling are possible surgical complications
• Relapse can occur if proper post-surgical rehabilitation is not performed
• Inadequate release may result in persistent functional limitations 2