The Medical Consumer's Advocate

Tongue tie (short frenulum)

 

Q: My son was born with a shortened frenulum. Our pediatrician doesn't think there is anything to worry about. She says it will stretch and break on its own. My son is 6 months old now and he drinks from a bottle and eats from a spoon fine. What is your opinion on this matter?

A: The frenulum is a thin band of tissue beneath the tongue. In most people, this band of tissue is barely perceptible and does not limit tongue motion. In some people, the frenulum is short and dense, limiting tongue motion. This condition is known as "tongue-tie," or ankyloglossia, and it is usually noticed in infancy. Tongue-tie, if extreme, can cause problems with feeding and speech development. Your son clearly is not having problems feeding, but it is too early to assess his speech development. Not all tongue-ties need to be clipped. Once your son begins talking, it may be obvious that this surgical procedure is necessary; if there is any doubt, you should have a speech therapist examine your son and offer her/his opinion.

Is there any way to tell now if the tongue-tie will cause problems? Indicators of a problematic tongue tie are: notching of the tongue tip; inability to protrude the tongue tip beyond the upper gums; inability to touch the tongue tip to the roof of the mouth, immediately behind the incisors; difficulty moving the tongue from side to side. If some or all of these problems are present, you can anticipate speech articulation problems in the future.

Some practitioners clip tongue-ties with the infant awake, with or without local anesthesia. The rationale behind this is avoidance of the risks of general anesthesia. I personally think this is barbaric and unsafe, and I only do these procedures under general anesthesia. This allows me to control bleeding and place sutures with great ease and with minimal trauma to the infant.

Aside from infants and toddlers, there is one other group of tongue-tied patients who demand treatment, even though they have no problems eating or speaking. Tongue-tied teenagers typically become very unhappy when they realize that their condition interferes with their love life. Unlike infants and toddlers, clipping is easily accomplished in teenagers under local anesthesia.

 

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