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

Treatment of Ankyloglossia (Tongue-Tie)

Surgical intervention through frenotomy or frenectomy is the primary treatment for ankyloglossia, particularly when it causes functional limitations affecting breastfeeding, speech, or oral hygiene. 1, 2

Diagnosis and Assessment

• Diagnosis of ankyloglossia is based on clinical examination, evaluating tongue mobility, appearance, insertion, attachment, and shortness of the lingual frenulum 1
• The condition varies in severity, with different classifications proposed but not uniformly accepted 3
• Assessment should focus on functional limitations rather than just anatomical appearance 4

Treatment Approach Based on Age and Symptoms

Infants and Breastfeeding

• For infants with significant breastfeeding difficulties associated with ankyloglossia, frenotomy (surgical division of the lingual frenulum) may be beneficial 5
• Not all infants with ankyloglossia require surgical intervention, as many remain asymptomatic 5
• When frenotomy is indicated, it should be performed by a clinician experienced with the procedure using appropriate analgesia 5

Children and Adults

• Surgical intervention should be considered when ankyloglossia causes:
  • Speech articulation problems 2
  • Limited tongue mobility affecting daily functions 1
  • Mechanical difficulties with tasks such as licking lips or kissing 2
  • Oral hygiene challenges 1

Surgical Treatment Options

1. Frenotomy: Simple incision of the lingual frenulum

   • Less invasive option, often suitable for infants 5
   • Can be performed with minimal complications when done properly 3

2. Frenectomy: Complete removal of the lingual frenulum

   • More extensive procedure, often used for older children and adults 1
   • May be necessary for more severe cases 4

3. Frenuloplasty: Surgical revision of the frenulum with rearrangement of tissue

   • Used in more complex cases 3
   • May provide better functional outcomes in certain situations 4

Post-Surgical Management

• Speech therapy is recommended after surgical correction, especially in cases where speech has been affected 1
• Immediate rehabilitation exercises help maximize tongue mobility and function 1
• Follow-up evaluation is important to assess improvement in tongue movement and function 1

Important Considerations

• The decision for surgical intervention should be based on functional impairment rather than just anatomical appearance 3
• Parents should be educated about possible long-term effects of untreated ankyloglossia while their child is young (<1 year) to make informed choices regarding therapy 2
• The highest vascularization and mobility of the tongue should be considered when performing lingual frenectomy to minimize post-operative complications 1

Potential Pitfalls

• Lack of standardized diagnostic criteria can lead to over- or under-treatment 3
• Controversy exists regarding which cases truly require intervention versus observation 3
• There is no strong evidence supporting claims that ankyloglossia causes gingival recession 3
• Surgical complications, though rare, can include bleeding, infection, damage to surrounding structures, and scarring 3