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Tongue tie

Ankyloglossia

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Tongue tie is when the bottom of the tongue is attached to the floor of the mouth.

This may make it hard for the tip of the tongue to move freely.

Causes

The tongue is connected to the bottom of the mouth by a band of tissue called the lingual frenulum. In people with tongue tie, this band is overly short and thick. The exact cause of tongue tie is not known. Your genes may play a role. The problem tends to run in some families.

Symptoms

In a newborn or infant, the symptoms of tongue tie are similar to the symptoms in a child who is having problems with breastfeeding. Symptoms may include:

  • Acting irritable or fussy, even after feeding.
  • Difficulty creating or keeping suction on the nipple. The infant may become tired in 1 or 2 minutes, or fall asleep before eating enough.
  • Poor weight gain or weight loss.
  • Problems latching onto the nipple. The infant may just chew on the nipple instead.

The breastfeeding mother may have problems with breast pain, plugged milk ducts, or painful breasts, and may feel frustrated.

Exams and Tests

Most experts do not recommend that health care providers examine newborns for tongue tie unless there are breastfeeding problems.

Most providers only consider tongue tie when:

  • The mother and baby have had problems starting breastfeeding.
  • The mother has received at least 2 to 3 days of support from a breastfeeding (lactation) specialist.

Treatment

Most breastfeeding problems can be managed easily. A person who specializes in breastfeeding (lactation consultant) can help with breastfeeding issues.

Tongue tie surgery, called a frenulotomy, is rarely needed. The surgery involves cutting and releasing the tethered frenulum under the tongue. It is most often done in the provider's office. Infection or bleeding afterward is possible, but rare.

Surgery for more severe cases is done in a hospital operating room. A surgical procedure called a z-plasty closure may be needed to prevent scar tissue from forming.

Possible Complications

On rare occasions, tongue tie has been linked to problems with tooth development, swallowing, or speech.

References

Lawrence RA, Lawrence RM. Protocol 11: guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 8th ed. Philadelphia, PA: Elsevier; 2016:874-878.

Tinanoff N. Common lesions of the oral soft tissues. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 315.

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        Review Date: 8/1/2017

        Reviewed By: Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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