Ankyloglossia (tongue-tie) in infants and children
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
Ankyloglossia, or tongue-tie, is a congenital anomaly in which a short, lingual frenulum or a highly-attached genioglossus muscle restricts tongue movement (ie, restrictive lingual frenulum) (picture 1A-B) . The definition of ankyloglossia is not standardized and there is wide variation of opinion regarding its clinical significance and optimal management [2,3].
Ankyloglossia will be discussed below. Other congenital anomalies of the tongue are discussed separately. (See "Congenital anomalies of the jaw, mouth, oral cavity, and pharynx".)
Published information about ankyloglossia largely consists of case series and observational studies [4,5]. Depending upon the study population and criteria used to define ankyloglossia, the reported prevalence varies from <1 percent to 10.7 percent [1,4,6-14]. The variation in reported incidence may be attributed in part to the lack of a uniform definition and objective grading system for tongue-tie . Several authors have tried to develop standardized measurement techniques and norms (figure 1 and figure 2) [15,16]. Most series identify an increased frequency in boys with a male to female ratio of 1.5:1 to 2.6:1 . While most cases of ankyloglossia are sporadic, mutations in the T box transcription factor TBX22 may lead to heritable (X-linked) ankyloglossia with or without cleft lip, cleft palate, or hypodontia .
Clinical features of ankyloglossia may include [1,15,18]:
●Abnormally short frenulum, inserting at or near the tip of the tongue (picture 1A-B)
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- CLINICAL FEATURES
- "Posterior" ankyloglossia
- POTENTIAL SEQUELAE
- Breastfeeding problems
- Articulation problems
- Mechanical problems
- Potential indications for surgery
- - Breastfeeding issues
- - Articulation issues
- - Other problems
- Surgical procedures
- - Frenotomy
- - Frenuloplasty
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS