Ankyloglossia (tongue-tie) in infants and children
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments 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 here. Other congenital anomalies of the tongue are discussed separately. (See "Congenital anomalies of the jaw, mouth, oral cavity, and pharynx".)
The reported prevalence of ankyloglossia varies from <1 percent to 10 percent, depending upon the study population and criteria used to define ankyloglossia [1,4-13]. A uniform definition and objective grading system for tongue-tie are lacking, though standardized measurement techniques and norms have been proposed (figure 1 and figure 2) [14,15].
In most series, the frequency of tongue-tie is higher among 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 .
Ankyloglossia — Clinical features of ankyloglossia may include [1,14,17]:
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- CLINICAL FEATURES
- "Posterior" ankyloglossia
- Upper lip tie
- POTENTIAL SEQUELAE
- Breastfeeding problems
- Articulation problems
- Mechanical problems
- Breastfeeding issues
- Articulation issues
- Other problems
- Surgical procedures
- - General considerations
- - Frenotomy
- - Frenuloplasty
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS