Child with ankyloglossia.

Ankyloglossia, commonly known as 'tongue tie', is a congenital oral anomaly which may decrease mobility of the tongue tip (Messner & Lalekea 2002) and is caused by a short, thick frenulum (Horton et al. 1969). Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth (Horton et al. 1969). Image File history File links Summary Child exhibiting ankyloglossia. ... Image File history File links Summary Child exhibiting ankyloglossia. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Frenulum A frenulum (or frenum) is a small fold of tissue that prevents an organ in the body from moving too far. ... The mucous membranes (or mucosae; singular: mucosa) are linings of ectodermic origin, covered in epithelium, and are involved in absorption and secretion. ... Tongue The tongue is the large bundle of muscles on the floor of the mouth that manipulates food for chewing and swallowing. ... Sagittal section of nose mouth, pharynx, and larynx. ...

Incidence

The incidence of ankyloglossia has been reported from .02 percent to 4.8 percent (Lalakea & Messner 2003b). According to Lalakea and Messner (2003b), the different reports of incidence may be due to the lack of objective grading systems and uniform definitions of ankyloglossia. It has been found to occur more frequently in males than in females, with a 2.6:1 ratio (Messner et al. 2000). The prevalence of ankyloglossia has been to shown to increase with maternal use of cocaine (Harris, Friend & Tolley 1992). Harris et al. (1992) examined 500 infants at a well-baby nursery and found that ankyloglossia occurred in 3.5 percent of non-drug users’ offspring and 10.4 percent of cocaine-users’ offspring. The study also found that ankyloglossia was not dependent on race. Limitations of this study include that examiners were not blinded to the purpose of the study and the effects of ankyloglossia in the infants were not assessed. In optics one considers angles of incidence. ... The word male has the following meanings: In biology, it refers to one half of a heterogamous reproduction system, where the female is the other half. ... Female is a sex that denotes an animal which produces egg cells in order to reproduce. ... In number and more generally in algebra, a ratio is the linear relationship between two quantities of the same unit. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the ratio of the number of cases of a disease present in a statistical population at a specified time and the number of individuals in the population at that specified time. ... This article is about the drug cocaine. ... A human infant The word Infant derives from the Latin in-fans, meaning unable to speak. ... Nursery can mean: A nursery is a place for the temporary care of children in the absence of their parents. ... In biology, offspring are the product of reproduction, a new organism produced by one or more parents. ... The examples and perspective in this article or section may not represent a worldwide view. ...

Diagnosis

According to Horton et al. (1969), diagnosis of ankyloglossia may be difficult; it is not always apparent by looking at the underside of the tongue but is often dependent on the range of movement permitted by the genioglossus muscles. For infants, passively elevating the tongue tip with a tongue depressor may reveal the problem. For older children, making the tongue move to its maximum range will demonstrate the tongue tip restriction. In addition, palpation of genioglossus on the underside of the tongue will aid in confirming the diagnosis. Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... The Genioglossus is a muscle of the human body. ...

Effects

Ankyloglossia can affect feeding, speech and oral hygiene (Travis 1971) as well as have mechanical/social effects (Lalakea & Messner 2003a). Ankyloglossia can also prevent the tongue from contacting the anterior palate. This can then promote an infantile swallow and hamper the progression to an adult-like swallow which can result in an open bite deformity (Horton et al. 1969). It can also result in mandibular prognathism; this happens when the tongue contacts the anterior portion of the mandible with exaggerated anterior thrusts (Horton et al. 1969). Feeding is the process by which organisms, typically animals, obtain food. ... Look up Speech in Wiktionary, the free dictionary. ... Oral hygiene is the practice of keeping the mouth clean. ... In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... The palate is the roof of the mouth in humans and vertebrate animals. ... Genera Many, see text. ... It has been suggested that this article or section be merged into Prognathism. ... It has been suggested that this article or section be merged with jaw. ...

Professional Opinion

Opinion varies, however, regarding how frequently ankyloglossia truly causes problems. Some professionals believe it is rarely symptomatic, whereas others believe it is associated with a variety of problems. The disagreement among professionals was documented in a study by Messner and Lalakea (2000). The authors sent a survey to a total of 1598 otolaryngologists, pediatricians, speech-language pathologists and lactation consultants with questions to ascertain their beliefs on ankyloglossia; 797 of the surveys were fully completed and used in the study. It was found that 69 percent of lacatation consultants but only a minority of pediatricians answered that ankyloglossia is frequently associated with feeding difficulties; 60 percent of otolaryngologists and 50 percent of speech pathologists answered that ankyloglossia is sometimes associated with speech difficulties compared to only 23 percent of pediatricians; 67 percent of otolaryngologists compared to 21 percent of pediatricians answered that ankyloglossia is sometimes associated with social and mechanical difficulties. Limitations of this study include a reduced sample size due to unreturned or incomplete surveys. It was not clear why otolaryngologists and pediatricians differed in their opinions. There are several uses of the word survey, relating to two primary meanings: land surveying; and statistical surveys of people or other items, such as animals, stars, or messages. ... Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders. ... Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. ... The power of a statistical test is the probability that the test will reject a false null hypothesis, or in other words that it will not make a Type II error. ...

Feeding

Messner et al. (2000) studied ankyloglossia and infant feeding. Thirty-six infants with ankyloglossia were compared to a control group without ankyloglossia. The two groups were followed for six months to assess possible breastfeeding difficulties, defined as nipple pain lasting more than six weeks, or infant difficulty latching onto or staying onto the mother’s breast. Twenty-five percent of mothers of infants with ankyloglossia reported breast feeding difficulty compared with only 3 percent of the mothers in the control group. The study concluded that ankyloglossia can adversely affect breastfeeding in certain infants. Infants with ankyologlossia do not, however, have difficulties when feeding from a bottle (Lalakea & Messner 2002). Limitations of this study include the small sample size and the fact that the quality of the mother’s breast feeding was not assessed. From Latin ex- + -periri (akin to periculum attempt). ... A breastfeeding infant Breastfeeding is the process of a woman feeding an infant or young child with milk from her breasts, usually directly from the nipples. ... The udder of a cow with nipples showing In its most general form, a nipple is an appurtenance from which a fluid emanates, in this instance breast milk, to nurture a mothers young. ... Reusable glass milk bottles A bottle is a small container with a neck that is narrower than the body and a mouth. ...

Wallace and Clark (2006) also studied breastfeeding difficulties in infants with ankyloglossia. They followed 10 infants with ankyloglossia who underwent surgical tongue tie division. Eight of the ten mothers experienced poor infant latching onto the breast, 6/10 experienced sore nipples and 5/10 experienced continual feeding cycles; 3/10 mothers were exclusively breastfeeding. Following a tongue tie division, 4/10 mothers noted immediate improvements in breastfeedings, 3/10 mothers did not notice any improvements and 6/10 mothers continued breastfeeding for at least four months after the surgery. The study concluded that tongue tie division may be a possible benefit for infants experiencing breastfeeding difficulties due to ankyloglossia and further investigation is warranted. The limitations of this study include that the sample size was small and that there was not a control group. In addition, the conclusions were based on subjective parent report as opposed to objective measures. Intraoperative X-Ray of a Humerus fixated by Kirschner wires Surgery (from the Greek meaning hand work) is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. ...

Speech

Messner and Lalakea (2002) studied speech in children with ankyloglossia. They noted that the phonemes likely to be affected due to ankyloglossia include sibilants and lingual sounds such as [t d z s θ ð n l]. In addition, the authors also state that it is uncertain as to which patients will have a speech disorder that can be linked to ankyloglossia and that there is no way to predict at a young age which patients will need treatment. The authors studied 30 children from one to 12 years of age with ankyloglossia, all of whom underwent frenuloplasty. Fifteen children underwent speech evaluation before and after surgery. Eleven patients were found to have abnormal articulation before surgery and nine of these patients were found to have improved articulation after surgery. Based on the findings, the authors concluded that it is possible for children with ankyloglossia to have normal speech in spite of decreased tongue mobility. However, according to their study, a large percent of children with ankyloglossia will have articulation deficits that can be linked to tongue tie and these deficits may be improved with surgery. The authors also note that ankyloglossia does not cause a delay in speech or language but, at the most, problems with articulation. Limitations of the study include a small sample size as well as a lack of blinding of the speech-language pathologists who evaluated the subjects’ speech. In spoken language, a phoneme is a basic, theoretical unit of sound that can distinguish words (i. ... A sibilant is a type of fricative, made by speeding up air through a narrow channel and directing it over the sharp edge of the teeth. ... Speech disorders, or speech impediments as they are also called, are a type of communication disorders where normal speech is disrupted. ... In circumstances where the frenulum of the penis is too short to allow for proper retraction of the foreskin during erection (a condition known as frenulum breve), a minor operation may be performed wherein the frenulum is surgically divided - often under local anaesthetic - permitting full retraction of the foreskin. ... Articulation may refer to several topics: In speech, linguistics, and communication: Topic-focus articulation Articulation score Place of articulation Manner of articulation In music: Musical articulations (staccato, legato, etc) In education: Articulation (education) In sociology: Articulation (sociology) This is a disambiguation page — a navigational aid which lists other pages that... In cryptography, blinding is a technique by which an agent can provide a service to (i. ...

Messner and Lalakea (2003a) also examined speech and ankyloglossia in another study. They studied 15 patients and speech was grossly normal in all of the subjects. However, half of the subjects reported that they thought that their speech was more effortful than other peoples’ speech.

Horton et al. (1969) discussed the relationship between ankyloglossia and speech. The authors believe that tongue tie contributes to difficulty in range and rate of articulation and that compensation is needed. Compensation at its worst, the article states, may involve a Cupid’s bow of the tongue.

Mechanical/Social

Ankyloglossia can result in mechanical and social effects (Lalakea & Messner 2003a). Lalakea and Messner (2003a) studied 15 people, aged 14 to 68 years. The subjects were given questionnaires in order to assess functional complaints associated with ankyloglossia. Eight subjects noted one or more mechanical limitations which included cuts or discomfort underneath the tongue and difficulties with kissing, licking one’s lips, eating an ice cream cone, keeping one’s tongue clean and performing tongue tricks. In addition, seven subjects noted social effects such as embarrassment and teasing. The authors concluded that this study confirmed anecdotal evidence of mechanical problems associated with ankyloglossia and that it suggests that the kinds of mechanical and social problems noted may be more prevalent than previously thought. Furthermore, the authors note that some patients may be unaware of the extent of the limitations they have due to ankyloglossia since they have never experienced normal tongue range. A limitation of this study is the small sample size that also represented a large age range. A questionnaire is a type of survey handed out in paper form usually to a specific demographic to gather information in order to provider better service or goods. ... The Kiss by Francesco Hayez A kiss is the touching of the lips to some other thing; usually another person. ... The mouth, also known as the buccal cavity or the oral cavity, is the opening through which an animal or human takes in food. ... An ice cream cone or cornet is a cone-shaped pastry, usually made of a wafer similar in texture to a waffle, in which ice cream is served, allowing it to be eaten without a bowl or spoon. ... The word trick has several meanings in English: Confidence trick Magic trick Trick or treat A trick in a card game A trick can be a feat requiring some dexterity or ingenuity performed to amuse or as part of a game, such as a Skateboarding trick. ... Teasing is the act of playfully disturbing another person, either with words or with actions. ...

Lalakea and Messner (2003b) note that mechanical and social effects may occur even without other problems related to ankyloglossia such as speech and feeding difficulties. Also, mechanical and social effects may not arise until later in childhood as younger children may be unable to recognize or report the effects. In addition, some problems may not come about until later in life, such as kissing.

Intervention

There are varying types of intervention for ankyloglossia. Horton et al. (1969) have a classical belief that people with ankyloglossia can compensate in their speech for limited tongue range of motion. For example, if the tip of the tongue is restricted for making sounds such as /n, t, d, l/, the tongue can compensate through dentalization; this is when the tongue tip moves forward and up. When producing /r/, elevation of the mandible can compensate for restriction of tongue movement. Also, compensations can be made for /s/ and /z/ by using the dorsum of the tongue for contact against the palatal rugae. Thus, Horton et al. (1969) proposed compensatory strategies as a way to counteract the adverse effects of ankyloglossia and did not promote surgery. See: Intervention (counseling) - an orchestrated attempt by family and friends to get a family member to get help for addiction or other similar problem. ... Dorsum (pl. ...

However, intervention for ankyloglossia sometimes includes surgery in the form of frenotomy or frenuloplasty (Lalakea & Messner 2002). However, authors such as Horton et al. (1969) are currently in opposition to it. According to Lalakea and Messner (2002), surgery can be considered for patients of any age with a tight frenulum as well as a history of speech, feeding or mechanical/social difficulties. Also it is possible for you to be able to get most of the frenulum lasered off. Though it will be a bit sore and painful.

A viable alternative to surgery is to take a wait-and-see approach (Lalakea & Messner 2003b). Ruffoli et al. (2005) report that the frenulum naturally recedes during the process of a child’s growth between six months and six years of age; thus, it is possible for the child to outgrow ankyloglossia (Lalakea & Messner 2003b; Harris & Friend & Tolley 1992).

Conclusion

In conclusion, ankyloglossia can have feeding, speech and mechanical/social effects as well as result in other problems such as an open bite and mandibular prognathism. There is professional disagreement regarding how often ankyloglossia is symptomatic. In addition, intervention is also controversial as researchers such as Horton et al. (1969) believe that people with ankyloglossia can compensate in their speech for limited tongue range of motion and do not require surgery.

References

Harris, Edward F., Friend, Gerald W., Tolley, Elizabeth A., (1992). Enhanced prevalence of ankyloglossia with maternal cocaine use. Cleft Palate-Craniofacial Journal. 29(1), 72-76.

Horton, Charles E., Crawford, Hugh H., Adamson, Jerome E., Ashbell, T. Shelly (1969). Tongue-Tie. Cleft Palate Journal. 6, 8-23.

Lalakea, M. Lauren, Messner, Anna H. (2003a). Ankyloglossia: The adolescent and adult perspective. Otolaryngology – Head and Neck Surgery. 128 (5), 746-752.

Lalakea, M. Lauren, Messner, Anna H. (2003b). Ankyloglossia: Does it matter? The Pediatric Clinics of North America. 50, 381-397.

Lalakea, M. Lauren, Messner, Anna H. (2002). Frenotomy and frenuloplasty: If, when and how. Operative Techniques in Otolaryngology – Head and Neck Surgery. 13 (1), 93-97.

Messner, Anna H., Lalakea, M. Lauren (2002). The effect of ankyloglossia on speech in children. Otolaryngology – Head and Neck Surgery. 127 (5), 539-545.

Messner, Anna H., Lalakea, M. Lauren (2000). Ankyloglossia: controversies in management. International Journal of Pediatric Otorhinolaryngology. 54, 123-131.

Messner, Anna H., Lalakea, M. Lauren, Aby, Janelle, Macmahon, James, Bair, Ellen (2000). Ankyloglossia: Incidence and associated feeding difficulties. Otolaryngology – Head and Neck Surgery. 126, 36-39.

Ruffoli, R., Giambelluca, M. A., Scavuzzo, M. C., Bonfigli, D., Cristofani, R., Gabriele, M., Giuca, M. R., Giannessi, F. (2005). Ankyloglossia: a morphofunctional investigation in children. Oral Diseases. 11, 170-174.

Travis, Lee Edward (1971). Handbook of speech language pathology and audiology. New York, New York: Appleton-Century-Crofts Education Division Meredith Corporation.

Wallace, Helen, Clarke, Susan (2006). Tongue tie division in infants with breast feeding difficulties. International Journal of Pediatric Otorhinolaryngology. 70, 1257-1261.

External links

• Ankyloglossia - Geneva Foundation for Medical Education and Research