What is tongue tie?
Tongue tie (ankyloglossia) is where the strip of skin connecting an individuals tongue to the bottom of their mouth is shorter than usual.
Tongue tie, often present at birth, restricts the tongue’s range of motion.
An individual with tongue tie often has an unusually short, thick or tight band of tissue (lingual frenulum) which tethers the bottom of the tongue’s tip to the floor of the mouth. In babies this may interfere with breast-feeding. Someone who has tongue-tie might have difficulty sticking out his or her tongue. Tongue tie can also affect the way an individual eats, speaks and swallows.
Sometimes, tongue tie does not cause any problems. However, other times, it requires a simple surgical procedure to correct.
What causes tongue tie?
Tongue tie is a congenital issue that may become apparent soon after birth and occurs when the tongue does not separate from the floor of the mouth during womb development. Note that an individual may be “tongue tied” to various degrees.
How common is tongue tie?
Tongue tie is estimated to affect 4-11% of newborns but may go unnoticed until other issues become evident – see signs and symptoms below.
Why do tongue ties matter in children?
Tongue ties limit tongue mobility which is important for speaking, chewing, drinking, breathing, swallowing and more. It is also extremely important for adequate craniofacial development. Without identification and intervention,a tongue tie in a child can have downstream affects as a child’s face and head develop.
Note that the timing of releasing a tongue tie is important. Too early before a child can participate in and understand the importance of pre and post-surgery myofunctional therapy may be counterproductive and the child may not succeed as tongue ties can grow back. Myofunctional therapy is an important aspect for treating tongue tie. Surgery alone may not guarantee success.
Why do tongue ties matter in adults?
Many adults experience symptoms such as swallowing, breathing, and/or sleeping issues and/or upper body tension for years, not knowing that this is a negative consequence of tongue tie. As individuals develop from children to adults, Orofacial Myofunctional Disorder symptoms emerge as the body will . These adaptations aren’t viewed as abnormal, because the person just doesn’t know any different.
Adults most often complain of poor sleep quality, digestive and swallowing problems, TMJ pain, posture issues, speech impediments, headaches, and upper body tension. Adults tend to find out about tongue-ties when a child is born with a tongue-tie, and the parents start to understand the familial relationship.
Tongue-tie correction is important for adults too. Even though the frenectomy is not done for breastfeeding issues (as it is done in an infant), or to prevent insufficient craniofacial growth and airway issues (as it is done in children), adults should proceed with a release if the lingual restriction is causing difficulty with correct oral rest posture, nasal breathing, swallowing, speech, or sleeping.
What is a posterior tongue tie?
When parents hear about “tongue tie” or search on the internet, they most commonly see where the tip of the tongue is tethered down to the floor of the mouth. With a posterior tongue tie (PTT) the anterior portion of the tongue is not “tied”. It is often not easily seen or identified by many practitioners not trained to assess it. One of the most common statements from medical professionals is that “posterior tongue tie isn’t a thing”. Some of this confusion is the result of a misunderstanding of the anatomy thinking the tie is in the posterior oral cavity near the tonsils.
A posterior tongue tie is the presence of abnormal collagen fibers in a submucosal location surrounded by abnormally tight mucous membranes under the front of the tongue. All anterior ties have a posterior element. Therefore, any tongue tie causing breastfeeding problems is truly a posterior tongue tie; a percentage of those ties also have an anterior component. Failure to release ALL of the abnormal collagen fibers result in a continued tongue restriction. When providers are only able to release part of the restriction (incomplete release) there can be very limited improvement in tongue mobility and function.I see this all the time.
Tongue Tie Symptoms in Adults and Older Children
Because of recent increases in the popularity of breastfeeding, tongue-ties are being identified in infants. However there are many children and adults who have tongue-ties but are unaware. These unidentified tongue-ties can cause problems not only in infancy but that continue through adolescence into adulthood. It is never too late for a person to have their tongue-tie released. The benefits for some people can be life changing and well worth the time and effort. Tongue-tie symptoms in adults and older children may include:
Tongue movement is critical to properly form sounds in speech. When the tongue is tethered to the floor of the mouth it may not be possible to form particular sounds. Some people can compensate for the reduced range of motion, but not everyone. In those situations, the only way to properly produce the sound is to release the tongue enabling it to move. I have had patients go through years of speech therapy with minimal improvements until their tongue-tie was released.
TMJ & Chronic Head and Neck Pain
A single part of the body can be isolated from the rest of the body. The tongue is no exception. The tongue is connected to so many muscles throughout the head and neck that if it is restricted it can throw all of the other muscles off the balance. In adult patients, the tongue-tie can show up as chronic TMJ pain , headaches/migranes, head and neck tightness, snoring and sleep apnea as well as chiropractic adjustment that doesn’t help long term . A tongue-tie release allows the body to relax into a posture that was not possible with a tongue tie, relieving years of pain and tension.
Food Texture Issues
Sometimes when infants and children with tongue-tie begin solid foods, a tongue-tie may begin to reveal problems. This may appear to be picky eating,as the child will gag on certain food or a child who doesn’t eat a food because of how the texture feels. When a child has difficulty chewing their food they may be loud messy eaters or push food into the cheeks. Problems chewing food properly can result in indigestion or the person avoiding that food. If any of these are problems for your child you may want to have a speech-language pathologist trained in orofacial myofunctional disorders.
Tongue-ties and crowded adult teeth are directly related to each other. When the tongue has proper mobility, it rests against the roof of the mouth. This causes the roof of the mouth to widen, which allows for proper space for all of the adult teeth when they come in. Some children have straight primary teeth, but when their adult teeth come in they become crooked. Primary teeth should have large gaps. Adult teeth are much larger than primary teeth take up significantly more space. Without those spaces the adult teeth will be crowded.
Tongue function and position also drives the development of the face forward. When the tongue is tethered down, kids and adults may present with an overbite where the lower jaw is recessed. When the mandible is recessed the tongue will also be farther back in the mouth and a narrowed airway space can impede optimal breathing.
Other Signs and symptoms of tongue tie
Signs and symptoms of tongue tie include:
- Difficulty lifting the tongue to the upper teeth or moving tongue from side to side
- Trouble sticking out the tongue
- Heart-shaped tongue
- Tongue that appears notched
- Trouble breast-feeding
- Problems with eating, speaking or reaching the back teeth
- Digestive issues
- Rapid eating behaviors
- Aerophagia which occurs from air swallowing.
- Food texture issues and pickiness
- Chronic ear infections
- Speech issues
- Crowded teeth
- Dental problems
- Jaw pain
- Chronic head and neck pain
Treatment for tongue tie
Your speech pathologist can help to identify the need for the procedures described below. Speech pathologist also provide valuable training around pre- and post procedure exercises that improve the results of these procedures.
Your doctor will opt for one of the following procedures:
Frenotomy or Frenectomy
Quick and simple procedure with special scissors or laser that does not require stitches.
When the frenulum is too thick for a quick snip, your doctor may choose to perform a frenuloplasty. This usually requires anesthetics and special tools and will require stitches that usually dissolve as the wound heals. Lasers are becoming more prevalent and do not require stitches.
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