Ankyloglossia

Last updated
Ankyloglossia
Frenulum linguae.jpg
Adult with ankyloglossia
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg

Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease the mobility of the tongue tip [1] and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. [2] Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth. [2]

Contents

Presentation

Ankyloglossia can affect eating, especially breastfeeding, speech and oral hygiene [3] as well as have mechanical/social effects. [4] Ankyloglossia can also prevent the tongue from contacting the anterior palate. This can then promote an infantile swallow and hamper the progression to an adult-like swallow which can result in an open bite deformity. [2] It can also result in mandibular prognathism; this happens when the tongue contacts the anterior portion of the mandible with exaggerated anterior thrusts. [2]

Opinion varies regarding how frequently ankyloglossia truly causes problems. Some professionals believe it is rarely symptomatic, whereas others believe it is associated with a variety of problems. The disagreement among professionals was documented in a study by Messner and Lalakea (2000). [5]

Feeding

Messner et al. [6] studied ankyloglossia and infant feeding. Thirty-six infants with ankyloglossia were compared to a control group without ankyloglossia. The two groups were followed for six months to assess possible breastfeeding difficulties; defined as nipple pain lasting more than six weeks, or infant difficulty latching onto or staying onto the mother's breast. Twenty-five percent of mothers of infants with ankyloglossia reported breastfeeding difficulty compared with only 3% of the mothers in the control group. The study concluded that ankyloglossia can adversely affect breastfeeding in certain infants. Infants with ankyloglossia do not, however, have such big difficulties when feeding from a bottle. [7] Limitations of this study include the small sample size and the fact that the quality of the mother's breastfeeding was not assessed.[ citation needed ]

Wallace and Clark also studied breastfeeding difficulties in infants with ankyloglossia. [8] They followed 10 infants with ankyloglossia who underwent surgical tongue-tie division. Eight of the ten mothers experienced poor infant latching onto the breast, 6/10 experienced sore nipples and 5/10 experienced continual feeding cycles; 3/10 mothers were exclusively breastfeeding. Following a tongue-tie division, 4/10 mothers noted immediate improvements in breastfeeding, 3/10 mothers did not notice any improvements and 6/10 mothers continued breastfeeding for at least four months after the surgery. The study concluded that tongue-tie division may be a possible benefit for infants experiencing breastfeeding difficulties due to ankyloglossia and further investigation is warranted. The limitations of this study include the small sample size and the fact that there was not a control group. In addition, the conclusions were based on subjective parent report as opposed to objective measures.[ citation needed ]

Speech

Messner and Lalakea studied speech in children with ankyloglossia. They noted that the phonemes likely to be affected due to ankyloglossia include sibilants and lingual sounds such as 'r'. In addition, the authors also state that it is uncertain as to which patients will have a speech disorder that can be linked to ankyloglossia and that there is no way to predict at a young age which patients will need treatment. The authors studied 30 children from one to 12 years of age with ankyloglossia, all of whom underwent frenuloplasty. Fifteen children underwent speech evaluation before and after surgery. Eleven patients were found to have abnormal articulation before surgery and nine of these patients were found to have improved articulation after surgery. Based on the findings, the authors concluded that it is possible for children with ankyloglossia to have normal speech in spite of decreased tongue mobility. However, according to their study, a large percentage of children with ankyloglossia will have articulation deficits that can be linked to tongue-tie and these deficits may be improved with surgery. The authors also note that ankyloglossia does not cause a delay in speech or language, but at the most, problems with enunciation. Limitations of the study include a small sample size as well as a lack of blinding of the speech-language pathologists who evaluated the subjects' speech.

Several recent systematic reviews and randomized control trials have argued that ankyloglossia does not impact speech sound development and that there is no difference in speech sound development between children who received surgery to release tongue-tie and those who did not. [9] [10] [11]

Messner and Lalakea also examined speech and ankyloglossia in another study. They studied 15 patients and speech was grossly normal in all the subjects. However, half of the subjects reported that they thought that their speech was more effortful than other peoples' speech. [4]

Horton and colleagues discussed the relationship between ankyloglossia and speech. They believe that the tongue-tie contributes to difficulty in range and rate of articulation and that compensation is needed. Compensation at its worst may involve a Cupid's bow of the tongue. [2]

Although the tongue-tie exists, and even years following surgery, common speech abnormalities include mispronunciation of words, the most common of which is pronouncing Ls as Ws; for example, the word "lemonade" would come out as "wemonade".

Mechanical and social effects

Ankyloglossia can result in mechanical and social effects. [4] Lalakea and Messner [4] studied 15 people, aged 14 to 68 years old. The subjects were given questionnaires in order to assess functional complaints associated with ankyloglossia. Eight subjects noted one or more mechanical limitations which included cuts or discomfort underneath the tongue and difficulties with kissing, licking one's lips, eating an ice cream cone, keeping one's tongue clean and performing tongue tricks. In addition, seven subjects noted social effects such as embarrassment and teasing. The authors concluded that this study confirmed anecdotal evidence of mechanical problems associated with ankyloglossia and it suggests that the kinds of mechanical and social problems noted may be more prevalent than previously thought. Furthermore, the authors note that some patients may be unaware of the extent of the limitations they have due to ankyloglossia, since they have never experienced a normal tongue range of motion. A limitation of this study is the small sample size that also represented a large age range.[ citation needed ]

Lalakea and Messner [12] note that mechanical and social effects may occur even without other problems related to ankyloglossia, such as speech and feeding difficulties. Also, mechanical and social effects may not arise until later in childhood, as younger children may be unable to recognize or report the effects. In addition, some problems, such as kissing, may not come about until later in life.[ citation needed ]

Tongue posture and mouth breathing

Ankyloglossia most often prohibits the tongue from resting in its ideal posture, at the roof of the mouth. When the tongue rests at the roof of the mouth, it enables nasal breathing. A seemingly unrelated consequence of ankyloglossia is chronic mouth breathing. Mouth breathing is correlated with other health issues such as enlarged tonsils and adenoids, chronic ear infections, and sleep-disordered breathing. [13] [14]

Dental issues

Ankyloglossia is correlated to grinding teeth (bruxism) and temporomandibular joint (TMJ) pain. When the tongue normally rests at the roof of the mouth, it leads to the development of an ideal U-shaped palate. Ankyloglossia often causes a narrow, V-shaped palate to develop, which crowds teeth and increases the potential need for braces and possibly jaw surgery. [13] [14] [15]

Fascia and muscle compensation

The lingual frenulum under the tongue is part of the body's larger fascia network. [16] When the tongue is restricted by an overly tight frenulum, the tightness can travel to other nearby parts of the body such as the neck causing muscle tightness and poor posture. The tongue being restricted can force other muscles in the neck and jaw to compensate causing muscle soreness. [17] [18]

Diagnosis

Ankyloglossia Ankyloglossia 2.jpg
Ankyloglossia

According to Horton et al., [2] diagnosis of ankyloglossia may be difficult; it is not always apparent by looking at the underside of the tongue, but is often dependent on the range of movement permitted by the genioglossus muscles. For infants, passively elevating the tongue tip with a tongue depressor may reveal the problem. For older children, making the tongue move to its maximum range will demonstrate the tongue tip restriction. In addition, palpation of genioglossus on the underside of the tongue will aid in confirming the diagnosis.[ citation needed ]

Some signs of ankyloglossia can be difficulty speaking, difficulty eating, ongoing dental issues, jaw pain, or migraines. [19]

A severity scale for ankyloglossia, which grades the appearance and function of the tongue, is recommended for use in the Academy of Breastfeeding Medicine. [20] [21]

Treatment

There are varying types of intervention for ankyloglossia. Intervention for ankyloglossia does sometimes include surgery in the form of frenotomy (also called a frenectomy or frenulectomy) or frenuloplasty. This relatively common dental procedure may be done with soft-tissue lasers, such as the CO2 laser. [22]

A frenotomy can be performed as a standalone procedure or as part of another surgery. The procedure is typically quick and is performed under local anesthesia. First, the area under the tongue is numbed with an injection. Once the patient is numb, a small incision is made in the tissue and the tongue is freed from its tether. The incision is then closed with dissolvable sutures. Recovery from a frenotomy is typically quick and most patients experience little to no pain or discomfort. [19]

According to Lalakea and Messner, surgery can be considered for patients of any age with a tight frenulum, as well as a history of speech, feeding, or mechanical/social difficulties. Adults with ankyloglossia may elect the procedure. Some of those who have done so report post-operative pain.[ citation needed ]

Horton et al., [2] have a classical belief that people with ankyloglossia can compensate in their speech for a limited tongue range of motion. For example, if the tip of the tongue is restricted for making sounds such as /n,t,d,l/, the tongue can compensate through dentalization; this is when the tongue tip moves forward and up. When producing /r/, the elevation of the mandible can compensate for restriction of tongue movement. Also, compensations can be made for /s/ and /z/ by using the dorsum of the tongue for contact against the palate rugae. Thus, Horton et al. [2] proposed compensatory strategies as a way to counteract the adverse effects of ankyloglossia and did not promote surgery. Non-surgical treatments for ankyloglossia are typically performed by Orofacial Myology specialists, and involve using exercises to strengthen and improve the function of the facial muscles and thus promote the proper function of the face, mouth, and tongue. [23]

An alternative to surgery for children with ankyloglossia is to take a wait-and-see approach, which is more common if there are no impacts on feeding. [12] Ruffoli et al. report that the frenulum naturally recedes during the process of a child's growth between six months and six years of age. [24] [25]

Related Research Articles

<span class="mw-page-title-main">Tongue</span> Muscular organ in the mouth of most vertebrates

The tongue is a muscular organ in the mouth of a typical tetrapod. It manipulates food for chewing and swallowing as part of the digestive process, and is the primary organ of taste. The tongue's upper surface (dorsum) is covered by taste buds housed in numerous lingual papillae. It is sensitive and kept moist by saliva and is richly supplied with nerves and blood vessels. The tongue also serves as a natural means of cleaning the teeth. A major function of the tongue is the enabling of speech in humans and vocalization in other animals.

<span class="mw-page-title-main">Cleft lip and cleft palate</span> Medical condition

A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate contains an opening into the nose. The term orofacial cleft refers to either condition or to both occurring together. These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders.

<span class="mw-page-title-main">Palatine tonsil</span> Lymphoid organs at the back of the throat on both sides

Palatine tonsils, commonly called the tonsils and occasionally called the faucial tonsils, are tonsils located on the left and right sides at the back of the throat, which can often be seen as flesh-colored, pinkish lumps. Tonsils only present as "white lumps" if they are inflamed or infected with symptoms of exudates and severe swelling.

<span class="mw-page-title-main">Lingual frenectomy</span>

A lingual frenectomy is the removal of a band of tissue connecting the underside of the tongue with the floor of the mouth. A lingual frenectomy is performed to correct ankyloglossia (tongue-tie).

<span class="mw-page-title-main">Laryngectomy</span> Surgical procedure

Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. In a total laryngectomy, the entire larynx is removed. In a partial laryngectomy, only a portion of the larynx is removed. Following the procedure, the person breathes through an opening in the neck known as a stoma. This procedure is usually performed by an ENT surgeon in cases of laryngeal cancer. Many cases of laryngeal cancer are treated with more conservative methods. A laryngectomy is performed when these treatments fail to conserve the larynx or when the cancer has progressed such that normal functioning would be prevented. Laryngectomies are also performed on individuals with other types of head and neck cancer. Less invasive partial laryngectomies, including tracheal shaves and feminization laryngoplasty may also be performed on transgender women and other female or non-binary identified individuals to feminize the larynx and/or voice. Post-laryngectomy rehabilitation includes voice restoration, oral feeding and more recently, smell and taste rehabilitation. An individual's quality of life can be affected post-surgery.

<span class="mw-page-title-main">Macroglossia</span> Medical condition

Macroglossia is the medical term for an unusually large tongue. Severe enlargement of the tongue can cause cosmetic and functional difficulties in speaking, eating, swallowing and sleeping. Macroglossia is uncommon, and usually occurs in children. There are many causes. Treatment depends upon the exact cause.

<span class="mw-page-title-main">Frenulum of the tongue</span> Small fold of mucous membrane

The frenulumof the tongue, tongue web, lingual frenulum, frenulum linguae, or fraenulum is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the human tongue.

<span class="mw-page-title-main">Speech</span> Human vocal communication using spoken language

Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words, and using those words in their semantic character as words in the lexicon of a language according to the syntactic constraints that govern lexical words' function in a sentence. In speaking, speakers perform many different intentional speech acts, e.g., informing, declaring, asking, persuading, directing, and can use enunciation, intonation, degrees of loudness, tempo, and other non-representational or paralinguistic aspects of vocalization to convey meaning. In their speech, speakers also unintentionally communicate many aspects of their social position such as sex, age, place of origin, physical states, psychological states, physico-psychological states, education or experience, and the like.

A frenuloplasty of tongue is a frenuloplasty of the frenulum of tongue.

<span class="mw-page-title-main">Submandibular duct</span> Duct in the salivary gland

The submandibular duct is one of the salivary excretory ducts. It is about 5 cm long, and its wall is much thinner than that of the parotid duct. It drains saliva from each bilateral submandibular gland and sublingual gland to the sublingual caruncle in the floor of the mouth.

<span class="mw-page-title-main">Pierre Robin sequence</span> Medical condition

Pierre Robin sequence is a congenital defect observed in humans which is characterized by facial abnormalities. The three main features are micrognathia, which causes glossoptosis, which in turn causes breathing problems due to obstruction of the upper airway. A wide, U-shaped cleft palate is commonly also present. PRS is not merely a syndrome, but rather it is a sequence—a series of specific developmental malformations which can be attributed to a single cause.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Frenectomy</span> Surgical removal of a frenulum

A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of the upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure that is performed on infants, children, and adults. A similar procedure frenulotomy is where a tight frenulum may be relieved by making an incision in the tight tissue.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

Orofacial Myofunctional Disorders (OMD) are muscle disorders of the face, mouth, lips, or jaw due to chronic mouth breathing.

A lisp is a speech impairment in which a person misarticulates sibilants. These misarticulations often result in unclear speech.

TransOral Robotic Surgery (TORS) is a modern surgical technique used to treat tumors of the mouth and throat via direct access through the mouth. TransOral Robotic Sleep Apnea (TORSA) surgery utilizes the same approach to open the upper airway of patients with obstructive sleep apnea. In TORS and TORSA procedures, the surgeon uses a surgical robot to view and access structures in the oral cavity (mouth) and pharynx (back of the throat) without any incisions through the neck, chin or lip (these incisions are necessary in traditional, non-robotic approaches). Current TORS techniques include radical tonsillectomy, resection of palate and base of skull tumors, hemiglossectomy and resection of tumors above and involving the larynx. The TORSA technique is used for uvulopalatopharyngoplasty, hemiglossectomy, and other airway procedures.

Tongue training is a technique used to encourage proper tongue motion. Tongue training is used to treat individuals suffering from Ankyloglossia and other tongue dysfunctions. It is important for individuals suffering from orofacial myological disorders. Tongue training is a method used to teach the correct accent of any language.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

References

  1. ↑ Messner AH, Lalakea ML (2002). "The effect of ankyloglossia on speech in children". Otolaryngology–Head and Neck Surgery . 127 (6): 539–45. doi:10.1067/mhn.2002.1298231. PMID   12501105.
  2. 1 2 3 4 5 6 7 8 Horton CE, Crawford HH, Adamson JE, Ashbell TS (1969). "Tongue-tie". The Cleft Palate Journal. 6: 8–23. PMID   5251442.
  3. ↑ Travis, Lee Edward (1971). Handbook of speech language pathology and audiology. New York, New York: Appleton-Century-Crofts Education Division Meredith Corporation.
  4. 1 2 3 4 Lalakea, M. Lauren; Messner, Anna H. (2003). "Ankyloglossia: The adolescent and adult perspective". Otolaryngology–Head and Neck Surgery . 128 (5): 746–52. doi:10.1016/s0194-5998(03)00258-4. PMID   12748571.
  5. ↑ Messner AH, Lalakea ML (2000). "Ankyloglossia: controversies in management". Int. J. Pediatr. Otorhinolaryngol. 54 (2–3): 123–31. doi:10.1016/S0165-5876(00)00359-1. PMID   10967382.
  6. ↑ Messner, Anna H.; Lalakea, M. Lauren; Aby, Janelle; Macmahon, James; Bair, Ellen (2000). "Ankyloglossia: Incidence and associated feeding difficulties". Archives of Otolaryngology–Head & Neck Surgery. 126 (1): 36–9. doi:10.1001/archotol.126.1.36. PMID   10628708.
  7. ↑ Lalakea, M. Lauren; Messner, Anna H. (2002). "Frenotomy and frenuloplasty: If, when, and how". Operative Techniques in Otolaryngology–Head and Neck Surgery. 13: 93–97. doi:10.1053/otot.2002.32157.
  8. ↑ Wallace, Helen; Clarke, Susan (2006). "Tongue tie division in infants with breast feeding difficulties". International Journal of Pediatric Otorhinolaryngology. 70 (7): 1257–61. doi:10.1016/j.ijporl.2006.01.004. PMID   16527363.
  9. ↑ Wang, J; Yang, X; Hao, S; Wang, Y (May 8, 2021). "The effect of ankyloglossia and tongue-tie division on speech articulation: A systematic review". Int J Paediatr Dent. 32 (2): 144–156. doi:10.1111/ipd.12802. PMID   33964037. S2CID   233997867.
  10. ↑ Salt, H; Claessen, M; Johnston, T; Smart, S (July 2020). "Speech production in young children with tongue-tie". Int J Pediatr Otorhinolaryngol. 134:110035: 110035. doi:10.1016/j.ijporl.2020.110035. PMID   32298924. S2CID   215801978.
  11. ↑ Chinnadurai, Sivakumar; Francis, David O.; Epstein, Richard A.; Morad, Anna; Kohanim, Sahar; McPheeters, Melissa (June 2015). "Treatment of Ankyloglossia for Reasons Other Than Breastfeeding: A Systematic Review". Pediatrics. 135 (6): e1467–74. doi:10.1542/peds.2015-0660. PMC   9923517 . PMID   25941312. S2CID   10614311.
  12. 1 2 Lalakea ML, Messner AH (2003). "Ankyloglossia: does it matter?". Pediatr. Clin. North Am. 50 (2): 381–97. doi:10.1016/S0031-3955(03)00029-4. PMID   12809329.
  13. 1 2 Baxter, Richard (13 July 2018). Tongue-tied : how a tiny string under the tongue impacts nursing, feeding, speech, and more. Musso, Megan,, Hughes, Lauren,, Lahey, Lisa,, Fabbie, Paula,, Lovvorn, Marty,, Emanuel, Michelle. Pelham, AL. ISBN   978-1732508200. OCLC   1046077014.{{cite book}}: CS1 maint: location missing publisher (link)
  14. 1 2 Hang, William M.; Gelb, Michael (March 2017). "Airway Centric® TMJ philosophy/Airway Centric® orthodontics ushers in the post-retraction world of orthodontics". Cranio: The Journal of Craniomandibular Practice. 35 (2): 68–78. doi: 10.1080/08869634.2016.1192315 . ISSN   2151-0903. PMID   27356671.
  15. ↑ Yoon, Audrey; Zaghi, Soroush; Weitzman, Rachel; Ha, Sandy; Law, Clarice S.; Guilleminault, Christian; Liu, Stanley Y. C. (September 2017). "Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects". Sleep & Breathing = Schlaf & Atmung. 21 (3): 767–775. doi:10.1007/s11325-016-1452-7. ISSN   1522-1709. PMID   28097623. S2CID   37361766.
  16. ↑ Mills, Nikki; Pransky, Seth M.; Geddes, Donna T.; Mirjalili, Seyed Ali (2019). "What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum". Clinical Anatomy. 32 (6): 749–761. doi:10.1002/ca.23343. ISSN   1098-2353. PMC   6850428 . PMID   30701608.
  17. ↑ Lin, Steven (2017-08-15). "Adult Tongue-Tie Surgery Changed My Life". Dr Steven Lin. Retrieved 2019-10-29.
  18. ↑ Gutkowski, Shirley; Lind, Timbrey (2016). "Evaluation of a tongue-tie: The range of motion of the tongue should be assessed in all patients". www.rdhmag.com. RDH Magazine. Retrieved 2019-10-29.
  19. 1 2 "Symptoms and Best Treatments for Adults with Tongue Tie". Take Home Smile. 20 July 2022.
  20. ↑ Hazelbaker AK: The assessment tool for lingual frenulum function (ATLFF): Use in a lactation consultant private practice Masters thesis, Pacific Oaks College, 1993
  21. ↑ ABM Protocols: Protocol #11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad
  22. ↑ "Laser Surgery - Soft Tissue Dentistry". LightScalpel.
  23. ↑ "The Ins and Outs of Tongue-Tie". OM Health. Archived from the original on 2014-11-07. Retrieved 2014-06-23.
  24. ↑ Harris EF, Friend GW, Tolley EA (1992). "Enhanced prevalence of ankyloglossia with maternal cocaine use". Cleft Palate Craniofac. J. 29 (1): 72–6. doi:10.1597/1545-1569(1992)029<0072:EPOAWM>2.3.CO;2. PMID   1547252.
  25. ↑ Ruffoli R, Giambelluca MA, Scavuzzo MC, et al. (2005). "Ankyloglossia: a morphofunctional investigation in children". Oral Diseases. 11 (3): 170–4. doi:10.1111/j.1601-0825.2005.01108.x. PMID   15888108.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.