Ankyloglossia (Tongue-Tie)

 

Reviewed by Simon Rowley, Carl Kuschel, Lynley Nichols (Lactation Consultant NICU), and Stuart Ferguson (Paediatric Surgery)
December
2005
Clinical Guidelines Back Newborn Services Home Page
Definition Incidence Diagnosis of Clinically Significant Tongue-Tie
Assessment Management References

Definition

Incidence

Diagnosis of Clinically Significant Tongue-Tie

Anatomical
  • Type 1: Frenulum attaches to tip of tongue in front of alveolar ridge in low lip sulcus
  • Type 2: Attaches 2-4mm behind tongue tip and attaches on alveolar ridge
 
  • Type 3: Attaches to mid-tongue and middle of floor of the mouth, usually tighter and less elastic. The tip of the tongue may appear “heart-shaped”
 
  • Type 4: Attaches against base of tongue, is shiny, and is very inelastic
 
Functional disturbance
  • Feeding difficulties
  • Cannot initiate tongue grooving, cupping or depression
    • Interferes with front-to-back peristalsis as well as tongue palate synchronisation in breast feeding
    • May also adversely affect bottle feeding (rare)
  • Older children may have difficulties with feeding (for example, licking ice creams) or speech

Assessment

Physical examination
  • Rule out thrush, clefts, and other defects including neuromuscular conditions
  • Range of motion of tongue and degree of extension beyond lower dental ridge and lip
  • Elevation to palate with mouth wide open
  • Transverse movement of tongue without twisting of the tongue
Maternal assessment
  • Document degree of maternal nipple pain and nipple skin erosion
  • Painful breasts
  • Low milk supply
  • Plugged ducts
  • Mastitis
  • Untimely weaning
  • Candida
Infant assessment
  • Adequacy of latch and milk transfer
  • Efficiency of bolus handling
  • “Clicking” during feed due to loss of latch
  • Sliding off breast
  • Fatigue
  • Irritability during/after feeding
  • Poor weight gain (serial test weighs, supervised by a senior team member, may be helpful)

Management

References

1 Hall DMB, Renfrew MJ. Tongue tie. Arch Dis Child 2005;90;1211-5.
2 Messner AH. Lalakea ML. Aby J. Macmahon J. Bair E. Ankyloglossia: incidence and associated feeding difficulties. Archives of Otolaryngology -- Head & Neck Surgery 2000;126:36-9.
3 Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.  Pediatrics 2002;110:e63.
4 Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA.  Newborn tongue-tie: prevalence and effect on breast-feeding.  J Am Board of Family Practice 2005;18:1-7.
5 Hazelbaker AK. The assessment tool for lingual frenulum function (ATLFF): use in a lactation consultant private practice [thesis]. Pasadena (CA): Pacific Oaks College; 1993
6 Amir LH, James JP, Beatty J. Review of tongue-tie release at a tertiary maternity hospital.  J Paediatr Child Health 2005;41:243-5.
7 Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems.  J Paediatr Child Health 2005;41:246-50.
8 Maternity and Neonatal Services, Women's Health Division, Canterbury DHB.  Recognition, assessment and ankyloglossia release and its impact on breastfeeding outcome: a quality-team initiative.