Is surgery necessary for tongue tie?
Dear Mirror Doctor, my baby is a month old and has tongue tie. Baby is feeding well with nothing to worry about.
Advertisement
My mother in-law however insists I get it released at all cost. Please is this necessary at all?
Worried mum
Dear Worried mum, Tongue tie is a problem that occurs in babies who have a tight piece of skin between the underside of their tongue and the floor of their mouth.
It is medically known as ankyloglossia, and the piece of skin joining the tongue to the base of the mouth is called the lingual frenulum.
It is a birth defect that affects up to 10 per cent of newborn babies. It is more common in boys than girls.
A lot of babies with tongue tie grow normally without any problems but in a few, the thick, short frenulum impairs their ability to protrude the tongue. These children tend to have problems with breastfeeding.
To successfully breastfeed, the baby needs to latch on to both breast tissue and nipple, and the baby's tongue needs to cover the lower gum so the nipple is protected from damage.
Babies with severe tongue tie are not able to open their mouths wide enough to latch on to their mother's breast properly. They tend to slide off the breast and bite on the nipple with their gums.
This is very painful and the mother's nipples can become sore, with ulcers and bleeding. In most cases, these feeding difficulties result in the baby’s failure to gain weight.
Poor oral hygiene
For an older child or adult, tongue tie can complicate oral hygiene — making it difficult to sweep food debris from the teeth. These debris stay in the teeth, become acted on by bacteria and contribute to tooth decay and inflammation of the gums, and in some cases, bad breath results.
Tongue tie can also lead to the formation of a gap or space between the two bottom front teeth (lower central incisors) with its aesthetic consequences in later life, particularly in females.
Tongue tie can also interfere with activities such as licking an ice cream cone, licking the lips, kissing or playing a wind instrument.
Answers to certain questions can determine whether tongue tie should be surgically treated or not. Is there trouble breastfeeding the baby? Is he having trouble making certain sounds or taking care of his or her teeth? Is a gap developing between his two bottom front teeth? Are there certain activities he is not able to do because of limited tongue movement?
These questions are necessary because treatment for tongue tie is controversial. Some doctors and lactation consultants recommend correcting it right away — even before a newborn is discharged from the hospital. Others prefer to adopt a wait-and-see approach.
Sometimes the lingual frenulum loosens over time and tongue tie resolves on its own. In other cases, tongue tie persists without causing problems.
For your child, however, because there is no interference with feeding now, I would have recommended a wait-and-see attitude.
However, it is preferable to let a paediatrician have a look to ascertain its severity and advise based on his /her assessment.
If tongue tie interferes with breast feeding, it can be treated with a simple surgical procedure called a frenotomy. This basically is snipping off the frenulum. This alters the way babies latch onto the breast and promotes successful breastfeeding.
Complications of frenotomy are rare — but could include bleeding, infection or damage to the tongue or salivary glands. It's also possible for the frenulum to reattach to the base of the tongue.
For older children or adults experiencing difficulties with tongue tie, a more extensive procedure known as a frenuloplasty might be recommended.
Frenuloplasty is done under general anaesthesia with surgical tools.
After the frenulum is released, the wound is usually closed with sutures that absorb on their own as the tongue heals. Its complications are similar to that of frenotomy.