Tongue-tie is a condition in which the lingual frenulum is either too short or anteriorly placed limiting the mobility of the tongue.
Early in fetal development, the tongue is attached to the floor of the mouth. With cell death and atrophy, the only attachment is the frenulum. Tongue-tie results when the frenulum is short and this may limit the movement of the tongue. When there is an attempt to stick the tongue out, there may be a V shaped notch at the tip.
The incidence is 0.5/1000
Physical exam will easily demonstrate the short or andteriorly placed lingual frenulum.
Years ago it was routine to clip the frenulum at the time of delivery. Midwives had a long sharp nail to cut the frenulum and obstetricians would inspect the mouth and cut the frenulum immedialtely after the delivery. It was felt that tongue-tie was associated with speech abnormalities especially lisping and inability to pronounce certain sounds.
Tongue-tie actually represents partial ankyloglossia and fusion represents complete ankyloglossia. There is no evidence in the literature that partial tongue-tie causes speech defects, difficulty breastfeeding, or dental problems. The tip of the tongue normally grows until 4 years of age, and initial restrictions of movement may improve as the child gets older. Therefore, frenulectomy should not be performed before 4 years of age.
Management
