Ankyloglossia or congenital tongue-tie is controversial from just about all aspects. There is disagreement about the incidence, the significance and the need for surgical treatment. If surgical treatment is selected the age at which it should be done and the degree of complexity are also controversial. Even the terms used have different meanings to different disciplines.

Tongue-ties can be classified into four levels:
Type 1:
The frenulum is attached to the tip of the tongee and in front of the alveolar ridge.
Type 2:
The tongue attachment may be up to 4 mm behind the tip and on or just behind the alveolar ridge.
Type 3:
The attachment is to the mid tongue and middle of the floor of the mouth but is tight and non elastic.
Type 4:
The attachment is to the base of the tongue and is very thick and inelastic. This is more difficult to diagnos From lactation consultant’s perspective tongue-tie may interfere with breastfeeding. An effective latch on the breast requires the infant to extend the tongue past the gum line and to lift and compress the milk collecting sinuses behind the areola. Tongue-tie can prevent this from happening. If a proper latch on isn’t accomplished the infant doesn’t get enough milk, the mother’s milk supply is compromised over time and the mother’s nipples are injured. Therefore many, if not most lactation consultants are in favor of a surgical clipping of the fibrous membrane in the first days or weeks of the infant’s life if the infant has a functionally significant tongue-tie.

This procedure (frenotomy aka frenulotomy but NOT frenectomy) is done by a qualified physician and is quite simple. It involves lifting the tongue with fingers or a specially designed instrument called a grooved director and simply doing a tiny clip with blunt Metzenbaum scissors of a thin, non-vascular piece of tissue. There are seldom more than a few drops of blood easily staunched with direct pressure. The infant is typically put to the breast immediately afterwards. No stitches are typically needed. The only anesthesia required is local benzocaine gel to both sides of the frunulum 2 to 3 minutes prior to the release.

Breastfeeding is almost always improved as the tongue becomes mobile enough to do its job. In the case of a child over a few days of life breastfeeding may be complicated by learned patterns of restricted tongue movement that need to be re-trained to be effective for breastfeeding.

In the case of a child over 10 months of age a small amount of injected xylocaine with epinephrine may be used as a local anesthetic.

To clarify, ankyloglossia or tongue-tie is a condition in which the lingual frenum,* the bit of tissue connecting the bottom of the tongue to the lower jaw, is either too short or anteriorly placed, thus limiting the mobility of the tongue.

The operation to remedy this is most often called a frenotomy.

There is great difference in opinion as to how common this condition is, estimates ranging from .05% to 4.8%. This difference is largely because no one can agree on exactly what counts as ankyloglossia. There is no set length that a lingual frenum should be, making the diagnosis somewhat subjective. Regardless of the exact diagnostic criteria used, males are about twice as likely to be born with tongue-tie as are females.

Ankyloglossia is often believed to be a cause of articulation errors in children, although it appears that cutting the frenum may also in some cases reduce the child's control of the tongue, and thus also increase articulation difficulties. The effects of ankyloglossia decrease with age, and many cases 'disappear' by the age of four as the tongue-tip grows and lengthens.

Previous to the 1800s, it was routine to clip the frenum at birth. Given the time period, this was a dangerous practice, which could result in deadly infections. Tongue-tie was associated with speech problems, particularly lisping and inability to pronounce certain sounds. This practice was not limited to babies with tongue-tie.

Frenum is also spelled fraenum, fraenulum, and frenulum.

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