What is the treatment for a patient with a tongue tie (ankyloglossia)?

Management of Tongue Tie (Ankyloglossia)

Surgical frenotomy is the recommended treatment for tongue tie (ankyloglossia), particularly when it causes functional limitations in feeding, speech, or quality of life.

Diagnosis and Assessment

• Ankyloglossia (tongue tie) is characterized by an abnormally short, thick, fibrosed lingual frenulum that restricts tongue movement 1
• Prevalence: Occurs in approximately 4-11% of newborns 2
• Assessment should focus on:
  • Degree of restriction to tongue mobility
  • Impact on feeding (particularly breastfeeding in infants)
  • Speech difficulties
  • Discomfort or quality of life issues

Treatment Options

1. Surgical Management (Primary Treatment)

• Frenotomy: Simple cutting of the lingual frenulum

  • Most common procedure, especially for infants
  • Can be performed without anesthesia in neonates
  • Minimal bleeding and rapid healing 2

• Frenectomy: Complete excision of the lingual frenum

  • More extensive procedure than frenotomy
  • Often used for older children and adults 1

• Frenuloplasty: Surgical revision of the frenulum with rearrangement of tissue

  • Used for more complex cases 3

2. Post-Surgical Rehabilitation

• Tongue Training Exercises:

  • Essential for functional rehabilitation after surgical correction
  • Should begin shortly after healing begins 1

• Speech Therapy:

  • Recommended for patients with speech difficulties
  • Particularly important for children with established speech patterns 1, 4

Treatment Considerations by Age Group

Infants (0-12 months)

• Primary indication: Breastfeeding difficulties, including:
  • Poor latch
  • Maternal nipple pain
  • Inadequate weight gain
• Procedure of choice: Simple frenotomy
• Evidence: Frenotomy reduces maternal nipple pain in the short term 2
• Timing: Early intervention (within first few weeks) if feeding problems exist

Children and Adults

• Indications:
  • Speech difficulties
  • Eating difficulties
  • Restricted tongue mobility affecting quality of life
• Procedure of choice: Frenectomy or frenuloplasty
• Rehabilitation: Critical component including tongue exercises and speech therapy 1

Potential Complications

While generally considered safe, potential complications include:

• Bleeding
• Infection
• Formation of oral mucoceles
• Damage to sublingual ducts
• Scarring
• Recurrence of restricted movement 5

Follow-up Care

• Monitor healing process
• Ensure completion of tongue exercises
• Assess improvement in function (feeding, speech)
• Consider additional speech therapy if needed

Important Considerations

1. Controversy exists regarding diagnosis criteria and treatment necessity 3
2. Not all tongue ties require treatment - intervention should be based on functional impairment rather than anatomical appearance alone
3. Speech outcomes - limited evidence that untreated tongue tie significantly impacts speech development in all cases 4
4. Risk-benefit assessment - while complications are rare, they can be serious 5

Treatment Algorithm

1. Assess functional impact:

   • For infants: Evaluate feeding difficulties
   • For older children/adults: Assess speech, eating, and quality of life impact

2. If significant functional impairment exists:

   • Infants with feeding difficulties → Frenotomy
   • Children/adults with speech or other functional issues → Frenectomy/frenuloplasty

3. Post-surgical rehabilitation:

   • Implement tongue exercises
   • Refer for speech therapy if needed
   • Monitor for improvement in function

4. If minimal functional impact:

   • Consider observation rather than surgical intervention

The decision to treat should prioritize functional outcomes that impact quality of life rather than merely anatomical correction.