Ankyloglossia. Dr. P.T.Kenny.

See Frenotomy in action….

Normal Tongue

Tongue Tied

Ankyloglossia = “tongue-tie”. Mandibular ankyloglossia results from underdevelopment of the lingual frenulum, with the frenulum attaching in the midline near the tip of the tongue, along the floor of the mouth to the gingiva. There are different degrees to which the frenulum attaches to the tongue. Severe ankyloglossia is also termed “frozen tongue” and Z-plasty is necessary. Most cases of tongue-tie resolve spontaneously by adulthood with little likelihood of feeding or speech-development problems. The parents, rather than the child, have the problem. Simple frenotomy (snipping) is a quick, easy and safe procedure with benefits e.g. cosmetic, to reduce family anxiety, ?improve sucking … It can be performed in an outpatient setting.

Tongue-tie occurs in approximately 4% of newborns Tongue-tie occurs in approximately 4% of newborns. Many babies with this condition can breastfeed without difficulty, but in some cases, a tight frenulum makes latching on difficult. In those cases, frenotomy may be indicated. The Hazelbaker Assessment Tool for Lingual Frenulum Function is one tool that may be used to grade the severity of the tongue-tie objectively. There are no prospective trials on the outcome of speech in those infants identified at birth, so this is not currently an evidence based reason to clip the frenulum in the nursery. The impact on breastfeeding, however, is well documented.

Frenotomy. (a.k.a. frenulotomy or frenulectomy) is the procedure in which the lingual frenulum is cut. This procedure dates back to the 18th century, when it was a rather common practice for midwives to divide the frenulum with a sharp fingernail. Medical authors of that time also began recommending it for infants with breastfeeding difficulties. There is still controversy regarding when frenotomy is indicated, but it seems reasonable that physicians caring for newborns all be skilled in performing this simple procedure. When indicated, frenotomy in the newborn period (I prefer to do it before the age of 3 months) can quickly improve a "poor latch" on the breast, and prolong the mother's ability and willingness to breastfeed.

Indications for frenotomy. Clinical evidence of the short lingual frenulum inhibiting: Tongue protrusion Feeding Swallowing Speech

Contra-indications for frenotomy: Lack of clinical evidence or suspicion that the ankyloglossia is problematic to the infant or child. Unstable medical conditions, e.g. bleeding disorders, ?D.M. Severe ankyloglossia which requires Z-plasty.

Equipment: Tongue spatula. Small straight scissors. Small mosquito forceps. Lignocaine 1% with adrenaline. Cotton-tipped swabs. (Topical benzocaine 20% = Hurricaine syrup, or Xylocaine spray)

Technique. 1. Parents may help position and hold small infants or children if willing. Note: Crying often improves exposure of the frenulum. 2. Identify the frenulum and the degree of surgical lysis that is necessary. A limited "snipping" of the lucent, membranous portion of the distal frenulum is usually all that is required. 3. Dip a cotton-tipped swab in Hurricaine syrup, or Xylocaine spray to provide excellent local anaesthesia. (Many clinicians clip the membranous distal frenulum without topical agents.) 4. Retract the tongue (a small spoon or wooden tongue blade with a slit fashioned in the end works well). 5. With the tip of the mosquito clamp, grab and crush the frenulum to a depth and at the position where the scissor snip is to be made. 6. Snip the crushed portion of the frenulum. 7. Use a dry cotton-tipped swab, or one soaked in 1% lignocaine with adrenaline, to control oozing.

Tongue-tie snipping technique Tongue-tie snipping technique. A, Crush the frenulum where the snip is to be made. B, Cut through the crushed area.

Post-procedure.. Complications: Advice: Bleeding, infection, injury to tongue or sublingual tissue. Advice: Resume normal feeding habits immediately. Parent should report any feeding difficulties. Parent should report bleeding or signs of infection. Follow-up in 2 weeks.