What is Tongue Tie? How is Tongue Tie Surgery Performed?

Tongue tie, also called ankyloglossia, refers to the tissue connecting the floor of the mouth and the tongue being shorter than normal. This condition, which is present from birth, can bring with it many different problems over time. Although some children born with tongue tie do not show any symptoms, it generally results in obstruction of tongue movements.

What is Tongue Tie?

Tongue tie is a condition that describes the restriction of tongue movements due to the structure called lingual frenulum being shorter than normal. Lingual frenulum is the tissue that provides the connection between the floor of the mouth and the tongue. While this condition occurs with a thin tongue tie in moderate cases, in some severe cases, the tongue may be fixed in the floor of the mouth due to a thick tongue tie.

Tongue tie may cause problems in functions such as feeding, speaking and swallowing in children over time.

How to Understand Tongue Tie?

Tongue tie can be detected during routine examination immediately after birth, but it should be noted that this detection is not that easy and can sometimes be missed. Sublingual ties in babies that are overlooked during birth are usually detected during the first breastfeeding.

It is only possible for babies to suckle the breast if they completely cover the nipple. Meanwhile, the baby’s tongue rests on the lower gum and acts as a protective feature for the nipple. Babies with tongue tie may cause problems with sucking, which may negatively affect the baby’s nutrition. At the same time, symptoms such as drying and cracking may occur in the nipple. Some babies can suppress feeding problems to some extent by making their sucking action stronger. However, it should not be forgotten that mouth opening is small in these babies.

Apart from these symptoms, complaints that may occur due to tongue tie in babies and young children can be summarized as follows:

• Inability to fully grasp the breast during feeding or short sucking time
• Long-term breastfeeding at short intervals, the baby constantly appearing hungry
• Absent or very slow normal weight gain
• Hearing a “clicking” sound during feeding
• Biting or grinding teeth
• vomiting following feeding

It can be seen that babies with tongue tie cannot extend their tongue to any point other than the lower lip level. This complaint can be detected by seeing that the movement of the tongue to the sides and up and down is restricted. Restriction of tongue movements causes speech-related problems later in life. Difficulty in pronunciation and problems with expressing hard consonants are among the particularly prominent speech complaints. Restricted mobility may also result in difficulty with oral activities such as licking ice cream or playing a wind instrument later in life.

Poor oral hygiene is another problem seen in children with tongue tie. Tongue tie, which can make it difficult to clean the food residues under the teeth with the tongue, can pave the way for intraoral problems such as tooth decay, tooth loss and gingivitis over time.

In addition to this symptom related to the baby, women during breastfeeding may experience wounds and cracks on their nipples. At the same time, a decrease in the mother’s milk supply may occur due to lack of effective sucking. It should not be forgotten that breastfeeding-related problems can occur due to many different situations. It is recommended that women who have any complaints about this issue contact health institutions and get support from experts.

Does Tongue Tie in Babies Heal on Its Own?

In some children with tongue tie, some loosening of this structure may occur over time. In other children, tongue tie often persists, causing problems with feeding and speech. This condition, which is detected in approximately 4-11% of newborns, is more common in boys than girls.

The emergence of feeding problems is detected in approximately half of these children. The fact that tongue tie is located between the floor of the mouth and the tip of the tongue may cause the tip of the tongue to have a blunt, forked or heart-shaped appearance. However, tongue tie is not always a condition that can be easily detected, and the connection between the tongue and the floor of the mouth can occur at any point.

In general, the short tongue tie in the front is more easily detected than other areas. Tongue tie in the back occurs in the deeper parts of the mouth. Complaints arising from anterior tongue tie and posterior tongue tie are generally similar to each other. Detection of tongue tie can be easily made by examining the babies through physical examination in women who have complaints about this condition.

The approach called “Coryllos grading” is used to classify tongue tie cases. According to this classification, Type 1 ankyloglossia cases describe babies whose tongue tie is thin and elastic between the tip of the tongue and the protrusion of the lower teeth. In cases of type 2 frenulum, the tongue tie is thin and elastic. In this type of tongue tie cases, the attachment point is 2-4 millimeters higher than in type 1 tongue tie cases.

In babies with type 3 tongue tie, this structure is thick and solid. In this type of tongue tie cases, it is determined that the tongue tie fixes the tongue from the middle parts to the floor of the mouth. In cases of type 4 ankyloglossia, the tongue tie is at the back of the tongue and may not be visible from the outside. However, when physicians touch the back of the tongue with their fingertips during physical examination, a structure that is tense and stabilizes the tongue is felt there. In addition to this classification system based on the localization of the tongue tie, it is recommended that physicians grade ankyloglossia cases by taking into account the movement ability of the tongue.

How is Tongue Tie Treated in Babies?

Tongue tie treatment in babies may be considered if the complaints caused by this condition are severe. In non-symptomatic children, the child is generally followed up with regular check-ups without taking any action. In cases where treatment decision is taken, a procedure called frenectomy is used. The time to perform frenectomy is usually within the first 6-18 days of life. Children older than 6 months may need anesthesia for this procedure. Tongue tie surgery recovery time is approximately 10 days, and complaints such as restlessness may occur in babies during this period.

How is Tongue Tie Surgery Performed?

Frenectomy, which is a very simple surgical procedure, can be performed with or without anesthesia, depending on the child’s condition. Before the procedure, physicians first lift the tongue up to examine the structure of the lingual frenulum.

Thus, parallel incisions are made to the floor of the mouth using a sterile scissors or surgical instrument. This procedure, which can be performed quite quickly, does not cause any significant discomfort since there are very few nerve endings and blood vessels in the relevant area.

The bleeding that occurs is usually in the form of drips and can be controlled with light pressure applications. Babies can be breastfed easily after the procedure. In cases where the tongue tie is too thick for frenectomy, a procedure involving extra repair called frenuloplasty may also be used.

Cutting the tongue tie and thus freeing the tongue is a very safe and simple procedure, and it can be very important in resolving various complaints that may occur, especially breastfeeding-related problems. If you have problems during breastfeeding or detect symptoms that suggest your child has a tongue tie, it is recommended that you contact healthcare institutions and get support from specialist physicians.