Tongue-Tie Snipping (Frenotomy) for Ankyloglossia

CHAPTER 82 Tongue-Tie Snipping (Frenotomy) for Ankyloglossia



Gary R. Newkirk, Mary Jane Newkirk


“Tongue-tie,” or ankyloglossia, results from underdevelopment of the lingual frenum (frenulum) and occurs in nearly 5% of infants. Infants differ substantially in the degree to which their frenum attaches to the tongue. Most cases of tongue-tie are thought to resolve spontaneously by adulthood with little likelihood of feeding or speech development problems. However, the condition is often not noticed until later in life and has been associated with such symptoms as a speech defect (e.g., a lisp), dental problems with the lower teeth, and accumulation of food in the floor of the mouth. If noticed in an infant or child, parents are usually the ones to bring this to the clinician’s attention (Fig. 82-1). The condition can easily be overlooked during the newborn examination because infants typically retract and roll the tongue downward when their mouth is open, which effectively hides the frenum from view. Furthermore, newborns rarely stick their tongues out for more than brief periods, so no one notices if the tongue cannot be protruded because of ankyloglossia.


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Figure 82-1 Ankyloglossia in a 2-week-old infant experiencing feeding difficulties.


Because tongue-tie is a fairly common and often unnoticed condition that lacks a precise definition, there are few formal outcome studies comparing infants having undergone frenotomy versus not. On one side of the debate, problems with sucking, breast-feeding, chewing, swallowing, dentofacial growth and development, gingival hygiene, and speech have been attributed to tongue-tie. On the other side, some researchers feel that the parents, not the child, have the problem. That is countered, again, by the fact that partial frenotomy, also referred to as tongue-tie snipping, remains a quick, easy, and safe procedure with benefits even if performed for cosmetic reasons or parental “dis-ease.” Clinicians are more likely to perform partial frenotomy if they believe that ankyloglossia contributes to poor infant sucking and other breast-feeding problems, such as insufficient infant weight gain or sore nipples or recurrent mastitis in the mother. Simple frenotomy for infants and small children who have partial ankyloglossia can be performed safely in the outpatient setting.


The best method and timing for frenotomy remain debatable. When ankyloglossia severely interferes with lingual function (e.g., “frozen tongue”), few would argue the need for reduction, but in this case formal Z-plasty is necessary. The patient should be referred to an experienced surgeon because this procedure requires general anesthesia and sometimes a complicated reconstruction.


Anatomically, the frenum of the tongue is a triangular fold of mucous membrane extending back from the lower midline gingival tissue along the floor of the mouth and then arching to the midline of the undersurface of the tongue. The extent to which the tongue portion of the frenum extends along the undersurface to the tip of the tongue is variable. Tongue-tie occurs when the frenum (or an abnormal portion of the frenum) continues distally toward the tip of the tongue so that the height/length of the frenum is so short that it prevents normal elevation or protrusion of the tongue.



Indications


Clinical evidence of short lingual frenum in an infant with resultant perceived speech problems or inhibited tongue protrusion, feeding, or swallowing.



Relative and Absolute Contraindications



• Lack of clinical evidence or suspicion that ankyloglossia is a problem for the infant or child.

• Unstable medical conditions, such as a bleeding disorder (in many cases, this can be reversed).

• Evidence of dental or oral infection. (The procedure should be postponed until the infection is adequately treated or resolves.)

• Severe ankyloglossia, which requires frenectomy under general anesthesia. (Usually this procedure involves Z-plasty or a similar plastic surgery procedure.)

• Orofacial abnormalities. It is recommended that infants or children with ankyloglossia combined with other orofacial abnormalities be referred.


Equipment



• Straight or curved mosquito hemostat

• Surgical scissors (some clinicians prefer iris or other straight scissors, others use curved Metzenbaum scissors)

• Tongue retractor (e.g., small spoon, wooden tongue blade)

• Ice, ice chips, popsicle, or teething ring (optional)

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Tongue-Tie Snipping (Frenotomy) for Ankyloglossia

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